DÄ internationalArchive42/2014Put the “Walker“ on
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At what point in time surgery is performed is certainly dependent on the condition of the soft tissue. That condition is always most favorable during the first 6 hours after trauma. We undertake definitive treatment of Weber type B fractures immediately, whenever possible. Significantly displaced fractures, especially dislocated fractures, are not only promptly reduced but treated as an emergency at any time, day or night; the earlier the treatment, the better the outcome, this also holds true for B fractures. The swelling in poorly reduced and retained fractures hardly ever subsides adequately. Where soft tissue conditions are unfavorable, we use an external fixator until the swelling has disappeared completely; however, the outcome is still not as one would like it to be.

“The prophylactic administration of antibiotics before surgery is standard procedure“, it reads in the article. Here, the authors cite the AWMF guideline no. 029–022 as reference. However, this is a S1 guideline published in January 2012, not on May 10, 2014, as stated under References. Perioperative antibiotic prophylaxis (PAP) is only a “can” recommendation, not a “should” recommendation. As any uncritical use of antibiotics, uncritical PAP facilitates the development of resistant pathogens.

We always place the one-third tubular plate in a dorsolateral position. This plate is not pre-bent; when screws are inserted starting at the cranial end and advancing successively towards the caudal end, it acts like a leaf spring due to the fibula’s concave profile in this area, resulting in compression and fixation of the fracture. This osteosynthesis is more stable than the outcome achieved with the neutralization plate.

Following surgical treatment, we fit a so-called “walker“ (VACO-ped), as it enables early weight-bearing, at least with type B fracture (with type A fractures, it does so anyway). We allow full weight-bearing after one week with the VACO-Ped. For physiotherapy and skin care sessions, the walker is taken off. Its costs are more than offset by savings resulting from the lowered risk of thrombosis, the prevention of atrophy, and the fact that patients can be mobilized, which is of special importance in older patients. The only point still discussed controversially in our department is weight-bearing with the fitted walker in patients with type C fracture.

DOI: 10.3238/arztebl.2014.0721a

Rainer Wolf

Grünstadt

rainer.wolf@krankenhausgruenstadt.de

1.
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C: Fractures of the ankle joint—investigation and treatment options VOLLTEXT
1.Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C: Fractures of the ankle joint—investigation and treatment options VOLLTEXT

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