Der Unfallchirurg
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This clinical report refers to a case of quadriplegia caused by a knife stab wound in the cervical spine. Open removal of the knife made it possible to avoid such complications as bleeding and infection. Nevertheless, the tetraplegic signs and symptoms were the result of complete severance of the cervical spinal cord and therefore persisted.
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Two patients with posttraumatic dissection of the internal carotid artery were referred to the neurosurgical department with secondary neurological deterioration following a minor head injury with concussion. Both developed aphasia and right hemiparesis during the first few hours after the accident; one patient also had right focal seizures. ⋯ Doppler sonography disclosed pathologic flow patterns, and carotid angiography demonstrated dissection of the internal carotid artery, in one patient on the left only and in the other bilaterally, with embolic occlusion of a branch of the left MCA in the latter case. Clinical features, pathogenesis, diagnostic workup and possible treatment (medical, as in our two cases, versus surgical) of this rare pathology are briefly reviewed.
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The diagnosis of an ulnar fracture is easily made in Monteggia lesions, but dislocation of the radial head can occasionally be overlooked. In the case presented luxation persisted and ulnar pseudarthrosis developed. In spite of functional disorders, however, the patient still managed to work for 36 years as a lorry driver. An unusual feature of this case is that 40 years after the primary event traumatic fracture of the pseudarthrotic ulna developed and was managed by bone grafting, with good functional results.