Der Unfallchirurg
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Deformities of the lower extremities can result in local complications, chronic pain and early arthritis. To correct these deformities, several techniques of osteotomies are available. ⋯ The exact diagnostics and precise planning of the operative correction is crucial to avoid iatrogenic complications. This summary describes basic principles and indications for different types of osteotomies.
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During childhood injuries are one of the most common reasons for a consultation, second only to infectious diseases. Not as rare as aspected these injuries are caused by maltreatment. The aim of this study is to show the frequency of non-accidental injuries (NAI) in the patient group from a pediatric hospital in East Germany. ⋯ The findings show the importance of a detailed and specific anamnesis and physical exploration of children with trauma. Recognition of maltreated children does not only apply to pediatricians, but also to physicians of several specializations.
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Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.
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Because of insufficient soft-tissue conditions and variability in the size and mechanical friction of the stump treatment of upper leg amputees with an ordinary prosthesis might be difficult or even impossible. Alternatively, for such patients an endo-exo femoral prosthesis (EEFP) is sometimes the best treatment option. The use of EEFPs will be demonstrated as exemplified by the clinical course in a patient with a primary EEFP implantation including all relevant side-effects and associated problems.
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Press-fit fixation of anterior cruciate ligament autografts is an interesting technique because no hardware is necessary. A total of 168 cadaveric human patellar, quadriceps and hamstring tendons (average age 49.2 +/- 18.5 years) were used and 15 different fixation methods were tested. Constructs were cyclically stretched and then loaded until failure. ⋯ All techniques exhibited greater elongation during initial cyclical loading. Some of the press-fit fixation techniques investigated exhibited comparable biomechanical properties and preconditioning of the constructs is critical. Press-fit fixation enhances tendon to bone contact at the entry of the bone tunnel to the joint.