Der Unfallchirurg
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A 30-year-old non-German speaking patient suffered an ankle sprain while playing beach volleyball. Conventional radiography did not reveal any fractures. The patient was treated with a Geisha cast for immobilization and relief and was also informed about pain-dependent weight bearing using an illustrated information sheet. ⋯ All courts up to the Federal Court of Germany dismissed the case as no expert witnesses could find any errors in treatment. The court held that the medical information of the non-German speaking patient was sufficient against the defendant’s arguments. It is, however, noteworthy that the burden of proof for sufficient medical information of a patient is always placed on the treating physician.
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The basis for the classification of acetabular fractures depends on accurate radiological diagnostics. The use of conventional X-rays alone implicates a low intrapersonal reproducibility and interpersonal reliability. By applying computed tomography (CT) at an early stage in the emergency room, the typical diagonal X-rays of ala and obturator, on which the classification is based, are no longer recommended. The aim of this study was to develop a new reliable classification system based on standardized CT slices according to the system of Judet and Letournel without using diagonal X-rays. ⋯ The CT-based classification developed represents an adaption to the current standard of diagnostics of acetabular fractures and represents a step towards simplification of the classification. It is suitable to estimate the correct surgical approach and the behavior of the fracture. For an accurate classification and the association to one of the fracture types in the system of Judet and Letournel more slices and 3D reconstructions (MPR) are necessary.
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Spinal and pelvic surgery (as in neuromuscular scoliosis or unilateral highly unstable vertical sacral fractures or unstable H- or U-shaped sacral fractures) relies on lumbopelvic fixation. This technique belongs to the standard procedures for lumbosacral injuries in orthopedic surgery. Preoperatively, a CT scan with 1 mm slices is essential to detect anatomical variants and cortical narrow nesses. ⋯ The safest screw path was determined as the bony canal between the posterior superior iliac spine (PSIS) and the anterior inferior iliac spine (AIIS). Intraoperatively, standard fluoroscopic views allow safe placement of the screws. The aim of the following manuscript is to illustrate anatomical and morphological aspects of the spine and pelvis as well as to describe important bony landmarks and optimal intraoperative C-arm views for optimal screw insertion.