Der Unfallchirurg
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Pathological fractures are defined as fractures that occur in patients with weakened bone due to systemic and local diseases. If osteoporosis is excluded, the frequency amounts to 5% of all fractures treated. ⋯ For this, diagnostic and therapeutic algorithms are demonstrated, arranged according to osteopathies, constitution anomalies, myelogenous and inflammatory bone diseases, primary and secondary bone tumors and posttraumatic/postoperative disorders. These algorithms should help the trauma and orthopedic surgeon to select the proper conservative and operative therapy and to use all resection and reconstruction possibilities, such as osteosynthesis, alloarthroplasty and bone transplantation.
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The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest X-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information obtained influences subsequent decisions on therapy in the early management of severely injured patients. ⋯ TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualizing lung contusions and pneumo- and hemothorax. Early TCT influences therapeutic management in a considerable subset of patients. We therefore recommend TCT in the primary diagnostic work-up of multiple injured patients with suspected chest trauma, because early and accurate diagnosis of all thoracic injuries along with acceptance of the implications for therapy may reduce complications and improve the outcome in polytraumatized patients with blunt chest trauma.
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The use of pulse oximetry during pre-hospital cardiopulmonary resuscitation was prospectively investigated in 23 cases. The question was whether the measurement of oxygen saturation during pre-clinical resuscitation is useful and what conclusions are possible. ⋯ Our results show that pulse oximetry could be used as a means of quality control during resuscitation. It is a useful part of pre-hospital monitoring and should be used during resuscitation as early as possible.