Der Unfallchirurg
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Case Reports
[Calcaneonavicular coalition fracture. A rare differential diagnosis of post-traumatic ankle pain].
The causes of chronic posttraumatic ankle pain are manifold, ranging from ligament and tendon injuries and fractures to joint degeneration. Calcaneonavicular coalition, a bridge between the calcaneus and navicular bones, is a rare disease with an incidence below 1%. The morphology of this coalition is variable. ⋯ Symptoms usually occur in adolescence with chronic pain around the ankle, mainly lateral and anterior, following distortion trauma. Patients often claim to have a lateral ankle sprain. We report 2 cases of a fracture of the calcaneonavicular coalition as the cause of chronic posttraumatic ankle pain and demonstrate the characteristics of tarsal coalitions with a review of the literature.
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Ten patients aged 55-85 years with a tibial head fracture AO B3 or C3 were treated primarily by implantation of an endoprosthesis. There were one unilateral, three superficial, and six revision-type prostheses. ⋯ At last follow-up all eight patients were completely or almost pain free; the extension deficit was less than 10 degrees , and flexion was 100 degrees or more. Primary endoprosthetic replacement of the knee joint is a valuable procedure for the treatment of complex tibial head fractures in elderly patients.
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The combination of ipsilateral femoral neck and shaft fractures remains a treatment challenge in orthopedic surgery because both fracture types constitute separate entities and require specific treatment concepts. ⋯ Treatment of ipsilateral femoral neck and shaft fractures is still demanding, but diagnosis has improved with regular use of CT body scans in the management of multiply injured patients. Furthermore, possibilities for operative treatment have been advanced by the introduction of the long proximal femoral nail and the antegrade femoral nail, two implants supporting stabilization of these fracture entities.
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Case Reports
[Pseudoaneurysm - a rare complication after insertion of a distal locking bolt of an intramedullary femur nail].
A pseudoaneurysm is caused by an extravasal hematoma after vessel injury. Persistent blood supply via the afferent artery can lead to aneurysm growth with potential rupture of the lesion. ⋯ Successful treatment consisted of endovascular embolization (coiling) with injection of a platinum coil into the aneurysm's supplying vessel. Pseudoaneurysm after fracture or fracture fixation represents a rare complication, but the risk of acute bleeding by pseudoaneurysm rupture should not be neglected.