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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.


Nowack K.,Klinik fur Unfallchirurgie | Schlickewei W.,Klinik fur Unfallchirurgie
Unfallchirurg | Year: 2013

Background. Pediatric pelvic fractures are rare injuries. Typically they are associated with high-energy trauma, which often leads to life-threatening injuries of other organs. Anatomical differences (e.g., greater elasticity, different stages of maturation, remodeling) account for the different fracture mechanisms, fracture management, and outcome in children. The AO Classification (International Association for Osteosynthesis) is useful and can be used as a basis for the treatment algorithm in pediatric pelvic fractures.Aim. This article provides a review on pediatric pelvic fractures and shows - based on the AO classification - principles of conservative und operative treatment. © Springer-Verlag Berlin Heidelberg 2013.


We describe the case of a 71-year-old woman who presented with persisting painful symptoms of the back and pelvis which had begun 4 weeks previously. A preceding trauma was plausibly excluded. Diagnostics showed a slightly dislocated bilateral sacral fracture with underlying osteoporosis also known as an insufficiency fracture. We performed a percutaneous and cement-augmented bilateral iliosacral joint revision using screws and 6 months after surgery, imaging showed a stable fracture with appropriate screw positions. © Springer-Verlag Berlin Heidelberg 2013.


Culemann U.,Klinik fur Unfallchirurgie
Trauma und Berufskrankheit | Year: 2016

Shaft fractures of the humerus are considered to be benign fractures and are still treated conservatively even today. Indications for operative procedures are open fractures, closed fracture types with severe soft tissue damage or complicated fractures which compromise muscles, blood vessels or nerves. Further indications for operative treatment are patients with multiple injuries including humeral shaft fractures. The standard techniques for stabilization of shaft fractures of the humerus are closed reduction with antegrade or retrograde nailing and open reduction and stabilization with locking or non-locking plates. The reasons for revision after operative treatment are radial nerve palsy and the development of pseudarthrosis. In 90 % of cases primary palsy of the radial nerve undergoes spontaneous remission without further operative treatment but secondary palsy of the radial nerve following surgery should be promptly treated. After conservative treatment pseudarthrosis occurs in 2–8 % and after operative treatment in 6–15 % of the cases. After open surgical resection of the pseudarthrosis and changing the type of osteosynthesis, stabilization should be completed with cancellous bone transplantation. Distal humeral fractures, often comminuted or complex fracture types, must be fixed by anatomical reconstruction and stabilization with 90° or 180° locking compression plates to stabilize the ulnar and radial axis of the elbow. The necessity of postoperative physiotherapy for the patient requires high stability of the osteosynthesis used. Even with the best radiological and anatomical results movement restrictions often remain after surgical treatment of the distal humerus; therefore, it should be borne in mind that a total elbow replacement is a primary option particularly for geriatric patients. © 2016, Springer-Verlag Berlin Heidelberg.


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.


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.


Kraus R.,Klinik fur Unfallchirurgie
Trauma und Berufskrankheit | Year: 2014

Fractures of the distal radius are the most common fractures in growing children. Injuries often occur during sports and playing. There is no actual peak of age. Most often metaphyseal fractures (including physeal separations) occur, while joint involving epiphyseal fractures are extremely rare. All typical versions of fractures of the growth period appear. The power of growth-associated spontaneous correction is enormous and even remains beyond the age of ten. The spectrum of treatment options includes purely conservative treatment, redression (plaster wedging), reduction and percutaneous k-wire stabilization. An open reduction of metaphyseal fractures is almost never necessary. There may be problems in stabilizing more proximal fractures of the metadiaphyseal transition. Inhibitional growth disturbances following a premature closure of the growth plate are rare, but, if they appear, they require a differentiated treatment concept. © 2014 Springer-Verlag Berlin Heidelberg.


Fractures of the pelvis are of increasing interest, especially in older patients due to the often concomitant osteoporosis. The low bone quality can be a problem in several fixation situations. In this review the present and relevant literature on biomechanical data of unstable pelvic ring injuries and all biomechanical data dealing with osteosynthesis for acetabular fractures are discussed.

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