Der Unfallchirurg
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In children and adolescents, injuries of the ankle are seen frequently in routine practice. The fracture pattern is less dependent on the mechanism of injury than on the maturity of the growth plate. ⋯ In displaced articular fractures an anatomical reconstruction of the articular surface and stable osteosynthesis have to be achieved to minimize the risk of early osteoarthritis. Growth arrest is not always avoidable despite an ideal reconstruction and can occur in all fracture types; however, with optimal conservative or surgical treatment, iatrogenic damage of the epiphysis can be avoided thereby reducing the incidence of growth disorders as a complication of ankle fractures in children and growing adolescents.
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Injuries to the subaxial cervical spine are increasing and have a high risk for neurological injury in comparison to the thoracic and lumbar spine. The current treatment recommendations according to the recommendations of the section spine of the German Society for Orthopaedics and Trauma (DGOU) and the S1 guidelines of the German Society for Trauma Surgery are summarized in this article. ⋯ Injuries should be classified according to the AOSpine classification for subaxial injuries. Based on this classification, a decision on a conservative or operative treatment regimen as well as individual details of the treatment can be made.
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Periprosthetic fractures in patients with underlying rheumatic diseases can be a special challenge depending on the extent, bone quality and septic complications. ⋯ The treatment of periprosthetic fractures with underlying rheumatic diseases necessitates the specific consideration of the multiple accompanying conditions. In general, extra-articular manifestations, average younger age, increased susceptibility to infections, multiple joint involvement and the basic medication must be taken into consideration. The local poorer bone quality can require an adaptation of the surgical technique. These factors are summarized in a treatment algorithm for periprosthetic fractures in patients with rheumatism taking the stability of the prosthesis, the infection status, the etiology, the localization and extent of the fracture into consideration.