Der Unfallchirurg
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Operative fixation has become treatment of choice for unstable sacral fractures. Osteosynthesis for these fractures results in loss of reduction in up to 15%. Vertical sacral fractures involving the S1 facet joint (Isler 2 and 3) may lead to multidirectional instability. ⋯ Preexisting Morell-Lavalée lesions increase the risk for infection. Prominent implants cause local irritation and pain. Hardware prominence and pain are markedly reduced with screw head recession into the PSIS.
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Case Reports
[Arthroscopically controlled screw placement for osteosynthesis of acetabular fractures.]
In the surgical treatment of acetabular fractures via a ventral approach the hip joint is not visible. Hip arthroscopy can be an alternative tool instead of 3-D fluoroscope-based navigation to exclude intra-articular perforation of the screws.
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Placement of a proximal humerus locking plate through a percutaneous transdeltoid approach bears the advantages of a minimally invasive approach but may compromise the anterior branches of the axillary nerve. This anatomic study aimed to develop a risk profile for 6 types of modern proximal humerus locking plates as to their interference with the axillary nerve. ⋯ Using the anterolateral percutaneous deltoid splitting approach the relative position of the axillary nerve to the holes of a specific implant is of relevance for avoidance of iatrogenic lesions to the nerve.
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Bilateral lumbopelvic instabilities are rare; for the affected patients, however, they mean a severe reduction in quality of life. Optimal results can only be achieved with a well-adapted therapy algorithm that balances surgery and non-surgical procedures. ⋯ Treatment of bilateral lumbopelvic instabilities requires an accurate examination, sophisticated therapy protocol, and a multidisciplinary approach. Surgery with a bilateral lumbopelvic fixation combined with neuronal decompression is an adequate treatment that creates early bony stability, thus, promising functional weight-bearing mobilization.