Der Unfallchirurg
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Osteoporosis results in fragility fractures that are associated with a high morbidity and mortality as well as an increased risk for subsequent fragility fractures. Thus, the first fragility fracture should be the last. To achieve this goal patients need treatment of osteoporosis according to the prevailing clinical guidelines. ⋯ In Germany, FLS should be established nationwide and according to uniform standards. This would significantly improve the quality of clinical care of patients with manifest osteoporosis.
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Arthroplasty has become a very successful operation with excellent long-term results. A dedicated diagnostic set-up to exclude osteoporosis prior to a joint replacement and the use of drugs to improve the outcome of a joint replacement are currently not recommended. ⋯ The same is recommended for hip joint replacement, even if the cement-free acetabular component yields good results. Rapid loading and mobilization appear beneficial also with respect to the osteoporosis and its systemic treatment.
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After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted. ⋯ In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.
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Serial fractures of metatarsal bones are rare and usually caused by direct or indirect high-energy trauma; however, in cases of pre-existing diseases, such as diabetes mellitus, they also can occur spontaneously or as insidious fractures. Due to the substantial soft tissue swelling mostly associated with such injuries, minimally invasive osteosynthesis with intramedullary Kirschner-wires (K‑wires) is recommended. The antegrade technique for placement of the K‑wires is preferred as the technically simpler retrograde procedure has several significant disadvantages. The preferred operative approach is described in detail exemplified by two clinical cases.
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With an incidence of 3% of all biceps tendon injuries, rupture of the distal biceps tendon is a rare injury but can be associated with significant functional impairment of the elbow. In case of a complete rupture, the diagnosis can be made clinically with a pronounced power deficit, in particular for supination of the forearm. ⋯ Regarding the therapeutic approach, there is general consensus in the current literature that surgical treatment with anatomical reconstruction of the tendon footprint is superior to the conservative approach. Various surgical techniques with good biomechanical and clinical results are currently available but no clear superiority of a single technique has so far been demonstrated.