Der Unfallchirurg
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Review Case Reports
[Bilateral atraumatic epiphysiolysis of the head of the tibia].
We report above a 14-year old boy, who suffered from a bilateral epiphyseal fracture type Salter/Harris II of the proximal tibia within four weeks without having an adequate trauma. Accompanying injuries were not found. ⋯ On both sides we achieved a correct axis and length in a uncomplicated healing with free joint movement. On the base of the result of our treatment we show a literature review of this rare form of epiphysiolysis.
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Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. ⋯ The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.
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Some 30% of unstable vertebral fractures of the thoracic and lumbar spine involve a destruction of the ventral column and thus of the supporting structures of the spine. This requires extensive surgical reconstruction procedures, which are carried out using minimally invasive techniques. The disadvantages of the minimally invasive methods are the high cost, the technical equipment and the expenditure of time required in the initial phase for the performance of the surgical procedure. ⋯ Considering the case values to date, a contribution margin deficit of EUR 4628.45 has been calculated for our patients with fractures of the thoracic and lumbar spine without neurological defunctionalization symptoms. An economically efficient medical care is thus no longer possible. Consequently, an adjustment of the German relative weights must urgently be demanded in order to guarantee a high-quality medical care of patients.
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Case Reports
[Retrograde tibial intramedullary nailing with the Flex Nail--treatment of tibial fracture in an unusual case].
We report a case by a 75 year old female patient suffering a third-degree open fracture of the shinbone with a severe damage of the soft tissue. Primary operation was a temporary fixation with a fixateur externe and a radical debridement of the soft tissue with vacuum-sealing. Ten days later we did the definitive surgery. ⋯ The defect of the soft tissue was treated by a muscle flap and meshgraft transplantation. Healing of the soft tissue and beginning consolidation of the fracture comes after 4 months. In our opinion the retrograd inserted Flex-Nail is a good option for treatment of compound fractures of the lower leg in special cases.
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40 acute traumatic ruptures of the Achilles tendon were evaluated in a prospective study after open repair using an early functional rehabilitation protocol. The age of the patients averaged 43 (23-64) years. The operation consisted of a Kessler suture and microadaptation of the tendon. ⋯ There were no perioperative complications. One rerupture occurred 6 weeks postoperatively and was operated successfully. The combination of surgical repair and early functional after treatment resulted in normal function after 1 year, but requires cooperation of the patient.