Der Unfallchirurg
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While the number of fatal accidents decreases every year, there is still need for improvement and action to prevent these deaths. The basis for this purpose has to be an analysis about the factors influencing the car crash mortality. ⋯ Univariate assessments may be falsified by bias; this effect can be uncovered by multivariate models.
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Chopart amputation leaves a very efficient hindfoot stump allowing full plantigrade weightbearing, even without an artificial limb in place for short distances. It must be said that this presupposes that the sole is covered with skin originally taken from the sole of the foot and that the tread of the heel is correct. ⋯ Weightbearing was not possible, and constant ulcers entailed frequent periods of unfitness for work, so that he expressly requested below-knee amputation at first. Correction of the equinovarus deformity by tibiocalcaneal arthrodesis using intramedullary nailing led to lasting healing of the skin and the possibility of full weightbearing.
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Clinical Trial
[Closure of defects on the dorsum of the foot with free flaps. Functional and aesthetic aspects].
Large complex soft-tissue defects on the dorsum of the foot, with exposed tendons, joints, bones, nerves and vessels, have to be reconstructed by transplantation of free tissue grafts with good blood flow. ⋯ Free muscle flaps with skin grafts, particularly the free gracilis muscle flap, are superior to fasciocutaneous flaps and perforating flaps in aesthetic outcome and donor site morbidity.
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The number of implanted hip prostheses is increasing constantly. At the same time the patients are becoming older and older. Thus, also patients with periprosthetic infections are older and therefore sicker. Uniform guidelines for the treatment of infected arthroplasties are controversial. Empirical studies show that the explantation of the original prosthesis and implantation of a revision may be the option with the greatest chance of success. These very aggressive procedures may overburden the old, polymorbid patient. The aim of this study was to ascertain whether or not keeping the hip prosthesis in combination with local debridement, formation of a permanent fistula and long-term administration of antibiotics is a possible option for the treatment of infected hip prostheses in old and polymorbid patients. ⋯ Restricting the indication to old, polymorbid patients, preservation of the arthroplasty in combination with local surgical debridement, permanent fistula and long-term systemic administration of antibiotics seems to be an alternative to explantation of the prosthesis with consecutive revision arthroplasty or resection arthroplasty.