Der Unfallchirurg
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In 2020 a total of 126 patients attended the practice with distortion trauma of the ankle. Based on a thorough clinical and ultrasound examination 25 ligamentous injuries of the anterior talofibular ligament (ATFL, 9.8%), 8 osseous ligament avulsions (6.3%), 7 injuries of the lateral calcaneocuboid ligament (CC ligament, 5.6%), 5 lesions of the calcaneofibular ligament (CFL) each combined with ATFL injuries (3.9%) and 1 syndesmosis injury (0.6%) were recorded. This didactic article presents a comprehensible ultrasound examination course in an instructive manner from the clinical practice. ⋯ The talofibular advance can be measured on the monitor. Instability of the anterior syndesmosis can be visually demonstrated on the monitor using the sonographic Frick test. A final ultrasound control on the monitor confirms the structural healing and the re-establishment of ligamentous stability.
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Non-union represents a severe complication and a major socioeconomic challenge in orthopedics and trauma surgery. Timely and reliable diagnostics are obligatory to be able to carry out the treatment of non-unions in a patient-specific and efficient manner. ⋯ It can display the microperfusion inside the non-union gap in real time and provide valuable information for exclusion of an infection or on the healing progress after revision surgery. An establishment of this diagnostic modality in routine orthopedic trauma surgery contributes to optimization of the treatment of non-unions.
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With rising numbers of revisions of total arthroplasty procedures of the lower extremities, the annual number of cases of implant-associated infection are also increasing. The conventional two-stage replacement strategy often leads to increased morbidity and mortality of patients; however, in the literature a one-stage exchange procedure shows equally good results if the indications are strictly defined. ⋯ Despite existing controversies in the literature, this treatment approach seems to demonstrate a reduced hospitalization, reduced costs and improved patient satisfaction with the same re-revision rate. This review article explains the strategic approach to chronic infections of endoprostheses of the lower extremities based on clinical examples and a review of the current literature.
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Intramedullary nailing is the treatment of choice for a large number of fractures requiring surgery. In cases of fracture-related infections (FRI) the treatment of nail infections requires special attention due to the closed situation of the osteosynthesis material in the intramedullary canal. This article gives an overview of the general principles and diagnostic criteria for FRI after nail fixation and discusses the treatment recommendations based on three case examples. ⋯ If a chronic infection with soft tissue and bone defects develops after intramedullary nailing, a two-stage procedure analogous to the treatment of osteomyelitis should be considered. In this case a multidisciplinary team approach with specialists in plastic surgery, microbiology and infectious diseases is necessary. The use of local antibiotics and antimicrobial-coated implants is deemed to be advantageous.
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Spondylodiscitis and postoperative wound infections are the most frequent infectious diseases of the thoracic and lumbar spine. Every spinal surgeon will come into contact with such patients during his or her career. Knowledge particularly of the diagnostics, conservative and surgical treatment as well as microbiological considerations of antibiotic treatment are therefore of particular importance and are explained in this article.