Haselhuhn K.-D.,Klinik fur Unfallchirurgie
Trauma und Berufskrankheit | Year: 2015
Background: The incidence of stiffness after elbow injuries is high. The causes are multifactorial and the pathogenetic mechanism is not exactly known. The causes are classified as being extrinsic and intrinsic and combined causes. Treatment: In order to prevent stiffness, short immobilization times and intensive multimodal physiotherapy are preferred. In case of a functional effective limitation of motion—limits of extension > 30 °, flexion < 120 ° and pro/supination < 50 °—the indication for an operative intervention must be considered. In addition to corrective osteotomy, re-osteosynthesis, material removal the distraction arthroplasty, arthroscopic and open arthrolysis are the most used procedures. Joint replacement and arthrodesis are last resort salvage procedures of therapeutic spectrum. The type of procedure and approach must be decided individually. Accompanying pain treatment and physiotherapy are obligatory. © 2013, Springer-Verlag Berlin Heidelberg.
Richter M.,Klinik fur Unfallchirurgie
Unfallchirurg | Year: 2011
Fractures of the forefoot are common and comprise approximately two thirds of all foot fractures. Forefoot fractures are caused by direct impact or the effect of indirect force. The forces exerted can range from repetitive minor load (stress fractures) to massive destructive forces (complex trauma). The clinical course in forefoot fractures is typically more favourable than in fractures of the mid- and hindfoot. The incidence of complications like infection or pseudarthrosis is low. Exceptions are rare fractures of the proximal shaft of the fifth metatarsal and the sesamoids with higher pseudarthrosis rates. Malunited metatarsal fractures can cause painful conditions that should even be treated operatively. Differences in structure and function of the different forefoot areas and specific fracture types require an adapted management of these special injuries. © 2011 Springer-Verlag.
Richter M.,Klinik fur Unfallchirurgie
Fuss und Sprunggelenk | Year: 2010
Evidence Based Medicine (EBM) is used to improve quality of care by directing diagnosis and therapy. EBM is used in all fields of medicine. EBM includes guidelines for specific diseases or injuries. Guidelines have to be revised from time to time to include developments in medicine and new publications. For the field of foot and ankle different guidelines exist (Hallux valgus, Achilles tendon rupture, Acute rupture lateral ankle ligaments) that have been due for revision. This article introduces and discusses the modified guidelines. In addition, the base term and definitions as well as the definition of corresponding terms like directive, regulation or law are introduced and discussed. © 2010.
Gansslen A.,Klinik fur Unfallchirurgie
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca | Year: 2013
PURPOUSE OF THE STUDY: Pelvic ring fractures in the geriatric population are of increasing frequency. Often insufficiency fractures or occult fractures are described. With a classical injury mechanism the majority of these injuries are the result of a low energy trauma, typically a fall from standing or during walking.Clinically, many patients report immediate anterior groin pain but detailed clinical examination often shows significant posterior pelvic pain. CT evaluation often reveals posterior pelvic ring injury, in the majority of cases a sacral compression fracture. Despite adequate diagnostics, many of these patients suffer from persistent pain, which can be observed up to 8 weeks after injury. To asses the role of external fixator in pain relief and early mobilisation in this group of patients the study was performed. From the database of all patients with pelvic ring and acetabular injuries 25 patients > 65 years with type B injuries stabilized by a supraacetabular external fixator were analyzed. Prospectively demographic data including sex, patient age, cause of injury, frequency and type of concomitant injuries and diseases, injury severity,fracture type and complications were recorded. For evaluation of the pain course, the visual analog scale was used. Preoperative and postoperative mobility and the type of post-treatment were evaluated. Stabilizing the pelvic ring with a simple external fixation procedure (supraacetabular one pin external fixator) allows immediate relief of pain, which allows early and successful mobilization of these patients. Normally, adequate mobilization is possible immediate after application of the fixator. This simple operative procedure, therefore, can be used for pain control and sufficient mobilization to avoid secondary medical complications.
Lein T.,Klinik fur Unfallchirurgie
Trauma und Berufskrankheit | Year: 2016
The surgical procedure for injuries of the anterior cruciate ligament (ACL) with an open epiphyseal growth plate has fundamentally changed in recent years. Although the indications for surgical reconstruction of the ACL after intraligamental rupture were in the past very reserved, the indications for operative treatment of osseous avulsion of the eminences were more clearly defined. The anatomically correct fixation of the avulsed osseous fragment leads to good up to very good results. The management of intraligamental tears of the ACL in cases of an open growth plate is still under discussion but in the literature there is a general trend towards operative treatment. In this article it is shown that relevant injuries of the growth plate are rare when an exact approach is used and are often related to technical failures. © 2015, Springer-Verlag Berlin Heidelberg.