Der Unfallchirurg
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The change of treatment modality in osteosynthesis is based on two principles. On one hand, one can exchange the implant as part of a two step procedure to reduce side effects of stabilizing fractures. On the other hand, a reosteosynthesis may be required for treatment of complications. ⋯ External fixator devices have been used for stabilization of long bone fractures with severe soft tissue damage using the two step procedure in the past decades; nowadays unreamed nailing is commonly preferred. Reosteosynthesis may be appropriate for the treatment of failing of osteosynthesis; they can also be used due to delayed union or nonunion of fractures, osseous deficiency or infection. In the case of failing osteosynthesis, the reasons for failing have to be studied thoroughly and a variety of subsequent procedures has to be taken into consideration for successful treatment.
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For young athletic patients with a primary traumatic shoulder dislocation a surgical treatment is recommended. The operation of choice is the Bankart-Repair. ⋯ In the surgical treatment of a traumatic shoulder dislocation, the open Bankart-Repair remains the "gold standard". In reviewing the literature, arthroscopic Bankart-Repair has not been shown to be equal or superior to the open technique.
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The case of an 22-year-old man is presented, who sustained a dislocated fracture of the left acromion process and a not dislocated fracture of the left scapular body with a large subcutaneous décollement as well as a dammage of nervus axillaris occurring during a traffic accident. After resuming diagnostics by means of CT, a tension banding of the ventral part of the acromion and a plate osteosynthesis of the dorsal part was performed. 7 weeks after injury neurolysis of nervus axillaris has been done. 4 months after accident the patient shows a satisfying functional result in the Constant score. Diagnostic, treatment and functional results after operative treatment of dislocated fractures of the acromion are shown and discussed.