Der Unfallchirurg
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In a period of 30 months, we treated 44 pelvic ring fractures by early operative stabilization. The ratio of associated musculoskeletal and intrapelvic lesions was very high, with a mean ISS of 36.2. The perioperative mortality rate (3/44) was acceptable with 6.8%. ⋯ The anterior external fixator provides insufficient stability in many cases. It must be supplemented by posterior fixation or exchanged for anterior and posterior internal fixation. Even then, many patients with type-C lesions have functional disabilities and subjective complaints after treatment.
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Standard neurosurgical management demands prompt evacuation of all extradural hematomas to obtain a low incidence of mortality and morbidity. In selected cases some authors have suggested that moderate hematomas can be managed conservatively without risk to the patient and with a normal outcome. The goal of this study was to analyze the differences in preoperative clinical parameters between a group of acute and a group of chronic extradural hematomas (chronic extradural hematoma was defined as a delay of more than 72 h from the accident to diagnosis). ⋯ In the group of acute extradural hematomas, 62% of patients had a Glasgow Coma Score of less than 8 and 47% had pupillary dilation. In the group of chronic extradural hematomas, moderate clinical symptoms were found, with headache and discrete psychological changes most common. Eighty percent (80%) of the patients had a Glasgow Coma Score of greater than 13 and no patients had pupillary dilation.(ABSTRACT TRUNCATED AT 250 WORDS)