Der Unfallchirurg
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The rate of pediatric equestrian injuries is relatively low, but the severity of injuries is greater than in many other pediatric sport activities. In a 4-year period the charts of 109 patients up through the age of 15 years, who were admitted for equestrian-related injuries were reviewed. Falls from horses are the most frequent cause of injuries and responsible for their anatomic localization and type of injury. ⋯ Forty percent of all injuries were fractures, 72% of which were fractures of long bones. The circumstances surrounding the accident and mechanisms of these injuries were analyzed. Effective safety measures such as improved equestrian helmets and adequate training in dealing with horses could reduce the risk of injuries.
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The evaluation of 174 humeral shaft fractures treated operatively in our institution and a literature review are used to illustrate the indications for operative treatment. For some indications, the authors prefer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the advantages of this method, making it an alternative to plating and even to bracing. ⋯ Closed fractures without concomitant injuries can generally be managed conservatively. We have treated 84 of these fractures with Hackethal's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).
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Between 1982 and 1993 we performed internal fixation or resection in 95 adult patients for radial head fracture. It was possible to follow up 68 patients for an average of 2.1 years. In 53 cases the initial injury was an isolated radial head fracture, which was treated by internal fixation in 41 and resection in 12 cases. ⋯ A satisfactory outcome was associated with young age, little initial fragment dislocation, internal fixation with screw + K-wire, and early postoperative physiotherapy. Primary resection for crush fractures of the radial head did not have negative long-term effects. In a comparison group with complex elbow injuries (elbow luxation in 9 and a Monteggia-type injury in 6 cases) in addition, results were considerably poorer and did not depend on the above-mentioned factors.
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Nailing technique has changed in recent years in some important aspects which are not limited to the omitted reaming procedure. These changes concern patient positioning, reduction technique, the use of temporary stabilizers such as the 'Pinless', and determination of implant length and diameter. Approach and exposure techniques have been modified to new, less invasive procedures, in order to fulfill technical, functional and aesthetic requirements. ⋯ Mean time to union was 23.9 weeks (range 10-48 weeks, n = 73); in two cases non-union was observed. The overall result was judged with the Karlström-Olerud score, which was applicable in 66 of 75 cases; excellent, n = 2; good, n = 22; satisfactory, n = 24; fair, n = 9; poor, n = 9. In the remaining nine cases no scoring was attempted because of severe injuries around the knee or ankle.
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Various different interlocking intramedullary nail designs are now available for the tibia the designs resulting from a different approaches to achieving stability for fracture fixation. During recent years small-diameter unreamed interlocking nails have been developed. So far there are no data on stiffness of different nail designs that can justify the use of certain nail types. ⋯ Four-point bending was done up to a moment of 66 Nm. For each implant bending and torque stiffness of the nail were calculated and compared with the test results obtained in the cadaver study. A P-value less than 0.05 (least significance difference test, ANOVA) was considered significant.(ABSTRACT TRUNCATED AT 250 WORDS)