Der Unfallchirurg
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Spinal epidural hematoma are a rare but serious complication of thoracic stab wounds. Their incidence should always be taken into consideration when first examining the patient, and it is also necessary to be able to find proof in either MRI or CT-scan. In our case the patients diffuse neurologic symptoms connected with a rather unreliable appearing personality made the diagnosis even more difficult. Initially it was possible to show the defect only in MRI.
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Between March 1997 and October 1999 thirty-one patients with displaced proximal humeral fractures were treated with crossed screw osteosynthesis. Insertion of the screws was realized by using a deltoideo-pectoral approach placing the screws anteriorly and posteriorly in a crossed manner from the distal fragment into the humeral head. Additionally, in all two-part-fractures a tension band was applied. ⋯ However, in 3 patients results were only "poor" (1 two-part-, 2 three-part-fractures). The complication rate was 29% (premature hardware removal due to head perforation in 3 cases; humeral head necrosis necessitating prosthetic replacement in 2 patients; secondary displacement in 1 case). Crossed screw osteosynthesis represents an justified alternative in the surgical treatment of displaced proximal humeral fractures permitting early functional therapy.