Der Unfallchirurg
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Megaprostheses are frequently used after segmental resection of bone sarcomas, bone metastases, and in large osseous defects in revision arthroplasty. ⋯ Complications with the use of megaprostheses can be successfully treated by revision surgery in most cases.
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In multimodal therapy concepts for bone sarcomas, tumor resection is a deciding factor. Modern imaging techniques have made preoperative resection planning much easier and precisely allow tumor boundaries to be defined. ⋯ The aim of the resection of a bone sarcoma should be a wide margin with the exception of chondrosarcoma (G1). Ultraradical resections which sacrifice vital structures in order to extend an already wide (R0) resection margin showed no significant benefits. In patients with osteosarcoma, adjuvant radiotherapy should be considered if resection or re-resection is not in sound tissue (R1). Patients with Ewing's sarcoma should not undergo resection if a contaminated margin is expected. In patients with chondrosarcoma, the available data as for example from pelvic tumors are contradictory and do not allow a clear recommendation.
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Malignant bone tumors should be treated within interdisciplinary treatment concepts. The prognosis of pathological fractures is on the whole relatively poor because the fracture is indicative of a large and highly aggressive tumor and the hematoma associated with the fracture could possibly result in spreading of the tumor into the surrounding soft tissues. ⋯ The therapeutic treatment should always be carried out within the framework of an interdisciplinary, oncological bone expert team, especially in cases of pathological fractures of malignant bone tumors.
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Acute compartment syndrome of the upper and lower limbs is observed following trauma, reperfusion or as an intraoperative complication caused by positioning. The pathophysiology of the disorder has been extensively described and is well known as a loss of perfusion due to rising compartmental pressures. It is a serious and potentially limb- and life-threatening complication. ⋯ Thus, in uncertain cases, pressure measurements are essential. Dermato-fasciotomy is the routine method to decompress the compartmental space. This review article examines the clinical findings, diagnostic techniques, and management options for the patient with musculoskeletal injuries.
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Comparative Study Clinical Trial
[Treatment of isolated fractures of the olecranon : Percutaneous double-screw fixation versus conventional tension band wiring.]
Isolated fractures of the olecranon account for 7-10% of all osseous injuries in adults. These fractures are usually treated surgically by conventional tension band wiring. The percutaneous double-screw fixation is an optional treatment in patients with two fragment olecranon fractures with some postoperative advantages. ⋯ The percutaneous double-screw fixation is a safe and viable treatment option in patients with isolated fractures of the olecranon (Schatzker-Schmelling type A). The functional results regarding DASH scores obtained using this technique were comparable with those observed in patients with conventional tension band wiring; however, range of elbow motion and cosmetic results were significantly better in the patient group with percutaneous double-screw fixation.