Der Unfallchirurg
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Between December 1986 and November 1995, 222 patients with 225 acetabular fractures were treated operatively by three surgeons in the Department of Traumatology and Emergency Surgery of the University Hospitals of the Catholic University of Leuven. Indications for surgery were unstable fracture, displaced fracture through the acetabular dome and fracture with intra-acetabular fracture fragments. There were 37.3% A-fractures, 49.7% B-fractures, and 13% C fractures according to the AO Classification. ⋯ During this 9-year period, changes have been made to the preoperative radiological examination carried out, the choice of operative approach and our policy on prevention of thrombosis prophylaxis and postoperative ossification. After thorough preoperative diagnosis and with a meticulous operative technique, it is possible to stabilise the vast majority of acetabular fractures through the three classical approaches. Because the fractures are relatively rare, their diagnosis complex and their surgical treatment difficult, specific training is essential for every acetabular surgeon.
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Damage to the respiratory system caused by inhalation of toxic products of combustion and the subsequent development of adult respiratory distress syndrome (ARDS) are the main lethal factors in burns patients. Treatment with exogenous surfactant is one of the therapeutic options. However, no clinical reports have yet been published about this therapy. ⋯ Intrabronchial application of surfactant by bronchoscopy during exhaustive conventional mechanical ventilation resulted in improved gas exchange with an increase in arterial O2 pressure (paO2); inspired O2 concentration (FiO2) was lowered and there was an improvement in lung compliance. Both patients survived this critical situation. We conclude that treatment with exogenous surfactant in postburn victims with ARDS is a promising therapeutic approach to improve the survival rate of these high-risk patients.