Der Unfallchirurg
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Intestinal injury is increasing in frequency among persons sustaining blunt abdominal trauma, and the consequences of delayed recognition of intestinal injuries are serious. This critical retrospective analysis evaluates the role for CT in the diagnosis of blunt abdominal trauma, including hollow visceral injury. ⋯ Intestinal wall thickening with low-density fluid in the abdominal cavity strongly suggests rupture. Until further experience is gained with CT, free intraperitoneal fluid in the absence of solid organ injury should be regarded as an indication for exploratory laparotomy.
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The sacroiliac region is the link through which the weight of the trunk is transmitted to the legs and a region frequently indicated by patients as the site of back pain. Sacral fractures often remain undiagnosed and untreated and frequently result in neurologic symptoms and deficits. Since a systematic approach is used to analyse the pelvic ring fractures with CT scans, the surgical management of sacral fractures had become a focus of interest. ⋯ Our instrumentation allows decompression (fracture reposition, sacral laminectomy, sacral foraminotomy) of the neural structures and stable fixation without compression. Five multiply traumatized patients with sacral fractures as a component of vertical shear injury of the pelvis had the sacroiliac region stabilized with the internal fixator. The preliminary results are presented.
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When plating is performed for fixation of complex femoral fractures the need for medial buttress to give durable weight-bearing ability of the bone is mandatory. However the means of achieving this is controversial. Many authors are in favour of mechanical reconstruction of the medial buttress, if necessary with a bone graft. ⋯ Bone grafting was necessary in 8 cases. Only in 2 cases were the defects located in the medial area. In 37 of the 39 osteosyntheses an excellent medial buttress was achieved by bone healing.(ABSTRACT TRUNCATED AT 250 WORDS)