Der Unfallchirurg
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Basic research in traumatology supports the clinical outcome of patients in trauma care and tries to find science-based solutions for clinical problems. Furthermore, institutions for basic research in traumatology usually offer training in different skills, such as how to write a scientific paper, or practice in microsurgery or intubation. Two examples of clinically significant research topics are presented.
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It is undisputed that the stability of fracture fixation influences the fracture healing process; however, up until now the mechanical conditions which guide bone healing were unknown and it was therefore not possible to optimize the design of fracture fixation devices. This article presents how the stability of fracture fixation, interfragmentary movement and interfragmentary tissue strain depend on each other and how the mechanical environment influences the cellular processes in the healing tissue. ⋯ This tissue differentiation hypothesis allows the prediction of bone healing by intramembranous and endochondral bone formation as a function of the local mechanical environment in the fracture healing zone. This allows the possibility for selection of a fracture fixation stability to achieve high-quality bone healing.
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We report on a soldier with a gunshot wound to the midfoot. The diaphysis of MT 5 was pounded to pieces and there was a fracture in the diaphysis of MT 4. After debridement and fixation of MT 4 and MT 5 to MT 2 and 3 via two Kirschner wires we conducted a second look procedure with reconstruction of MT 5 via a piece of iliac crest. After eight weeks of unloading and removal of the last wire we started to put successively heavier weight on the foot.