Defining reproducible criteria for lower extremity salvage following severe high-energy trauma continues to be one of the most challenging and controversially discussed fields in orthopaedic surgery. At present, however, the difficult performance, limited availability and number of valid reconstructive options for complex injury types, i. e. simultaneous osteoligamentous trauma with neurovascular lesions and severe soft tissue defects ("composite/compound multilayer defects") represent the decisive prognostic injury components triggering and determining the fate of the limb. Consequently, due to the complex injury pattern of the extremity and the overall situation of multiple injured patient the treatment and decision making has to be made in a priority-adapted algorithm. In this treatment algorithm interdisciplinary cooperation with vascular and plastic surgeons is of tremendous importance. Although the number of severely injured patients remains stable in the last decade, changes in the treatment algorithms result from increased survival rates of multiple injured patients and improved modern reconstructive options leading to continuously increasing rates of salvaged limbs. This paper aimed to systematically review the current literature for lower extremity injuries in order to unravel the different surgical treatment options and provide guidelines for decision making with corresponding treatment algorithms for limb salvage. Furthermore, the experiences in the management of mangled extremities in our centre are presented and illustrated/underscored with different cases.
- MeSH
- algoritmy MeSH
- lidé MeSH
- polytrauma * etiologie patofyziologie chirurgie MeSH
- poranění cév chirurgie MeSH
- poranění dolní končetiny * etiologie patofyziologie chirurgie MeSH
- poranění měkkých tkání chirurgie MeSH
- poranění periferního nervu chirurgie MeSH
- replantace * škodlivé účinky metody MeSH
- skóre závažnosti úrazu MeSH
- záchrana končetiny * škodlivé účinky metody MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The authors describe the injury of the lower extremity caused by putting the child's leg between the spokes of bicycle wheel during ride. The result is contusion of soft tissues of the leg and ankle or the fracture of the shin in a typical place. The injury requires a through treatment of soft tissues and sometimes also reduction of the fracture under total anaesthesia with subsequent fixation by plaster of Paris. On the basis of the group of 52 patients it has been proved that the mentioned injuries but for exceptional cases heal without sequelea. The authors emphasize the importance of the prevention of this injury by the installation of a plastic cover over the bicycle frame.
- MeSH
- cyklistika zranění MeSH
- dítě MeSH
- lidé MeSH
- poranění dolní končetiny etiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
