Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Life-threatening complex pelvic fractures are commonly associated with vast peripelvine soft-tissue injuries and hemorrhage. Correct assessment and classification of the existing pelvic trauma and additional severe injuries present is required for accurate diagnosis and effective therapy. Treatment of the usually multiply injured patient is time-sensitive. ⋯ Emergency stabilization of an initially unstable pelvic ring should be done first, followed by an extraperitoneal tamponade, if needed to control bleeding. The positive results of these actions can be measured by hemodynamic parameters. Delayed definitive internal stabilization of the anterior and/or posterior pelvic ring is then performed according to the fracture classification.
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Perianal impalement injuries with or without involvement of the anorectum are rare. Apart from a high variety of injury patterns, there is a multiplicity of diagnostic and therapeutic options. Causes of perianal impalement injury are gunshot, accidents, and medical treatment. ⋯ We propose a new classification for primary extraperitoneal perianal impalement injuries in four stages in which the extension of sphincter and/or rectum injury is of crucial importance. Therapeutic aspects such as wound treatment, enterostomy, drains, and antibiotic treatment are discussed. The proposed classification encompasses recommendations for stage-adapted management and prognosis of these rare injuries.
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The integration of multislice CT (MSCT) in the imaging of emergency trauma has led to a paradigm shift in trauma management. In case of hemodynamically instable patients, initial imaging is limited to a small set of standardized radiographs. Computed tomography is the imaging modality of choice for further diagnostic work-up. ⋯ There is increasing support for primary use of MSCT in critically ill patients due to the comprehensive imaging it allows while maintaining a fast scan time. The potential and limitations of diagnostic imaging in pelvic ring fracture and associated injuries are explained. Indications for vascular interventions in arterial bleeding are discussed.