Der Unfallchirurg
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Between 1972 and 1994 21 children up to 14 years old sustained complex pelvic trauma treated at the Trauma Department of the Hannover Medical School. Sixteen of the 17 survivors were followed at an average of 8.9 years. In 8 patients operative treatment of the disrupted pelvic ring (external or internal fixation) was performed; in 8 patients the treatment was conservative. ⋯ Despite this finding the pelvic outcome was rated good and excellent in 10 patients (63%), moderate in 1 patient (hypoplasia of the hemipelvis, and poor in 5 patients (31%) with severe pain or urogenital disturbances. The maximum ratings in social reintegration was given to 9 patients, a medium rating to 7 patients. All patients were socially integrated.
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Owing to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has improved dramatically in recent decades. This applies both to improved survival and to increased limb salvage rates. ⋯ The use of soft tissue procedures such as flaps and the use of modular implant systems has reduced the complication rates of limb salvage procedures. In the future we hope to further improve prognosis and quality of life for such patients by the application of risk-adapted strategies for chemotherapy and surgery.
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Fractures of the elbow joint are quite rare compared with the total incidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late functional outcome. ⋯ An external joint transfixation resulted in a score of < 5 in 32% of patients that were treated primarily by transfixation. In cases initially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar low score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence of a nerve lesion and the method of primary treatment, which should facilitate early mobilization.
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Case Reports
[Right-sided diaphragmatic rupture with intrathoracic displacement of the entire right lobe of the liver].
A case of rupture of the right hemidiaphragm resulting from blunt trauma with complete intrathoracic dislocation of the right hepatic lobe in a multiple trauma patient is presented. After a primary chest X-ray study had been interpreted as showing right-sided hemothorax, the thoracic drainage tube was accidentally placed into the liver. ⋯ Problems of diagnosis and operative procedure in rare cases of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed. CT may be helpful in the differential diagnosis of pulmonary contusions, hemothorax and diaphragmatic disruptions with intrathoracic herniation of intra-abdominal organs.