Der Unfallchirurg
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Non-unions in the proximity of the elbow are very rare and in most cases caused by mistakes in initial treatment. Reconstruction after pseudarthrosis of the elbow continues to pose a challenge for any surgeon. The aim of our study was to analyze the initial mistakes and to underline the most important aspects of reconstructive surgery. ⋯ In 24 out of 27 cases a re-osteosynthesis, in 12 an arthrolysis, in 7 a neurolysis and in 2 cases an arthroplasty was needed. The patient could return to work an average 18 weeks after the operation and 53 weeks after injury. The initial complaints were reduced in 24 of 27 cases, with a significant improvement in the ROM and functional outcome according to the Mayo Elbow Performance Index.
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Review Case Reports
[Must the accident victim be protected from the emergency physician?].
Quality control in preclinical medical care has become a matter of concern in recent years. In order to evaluate the quality of treatment one has to set standards. Most of the current standards were defined by different preclinical care organisations and are also accepted in the unique emergency medical care protocol used in the Federal Republic of Germany. ⋯ Insufficient application of resuscitation volume (< 2500 ml on admission) was evident in 17% of all documented patients. According to our results, the initial evaluation of severity of injury is still a major problem and leads to wrong decisions for treatment. Although the qualification of ambulance physicians has been standardized for some years, there are still clear deficits in the preclinical management of trauma patients that need to be targeted.
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Between 1982 and 1993, 65 amputation and amputation-like injuries in the upper arm (n = 18), proximal and middle forearm (n = 32) and distal forearm and wrist level (n = 15) were treated in our institution. The overall survival rate in our series was 92.3% (60/65). In 3 of 65 cases early secondary amputation because of vascular failure was necessary. ⋯ Taking grades I and II results together, a "functional extremity" could be reconstructed at the upper arm level in 25%, proximal forearm 30%, and the distal forearm in 58%. The main advantage of replantation/revascularization of the upper limb is the possibility of restoring some sensitivity to the hand in addition to partial motor recovery, which always provides twice as much individual motor function as is offered by any type of prosthesis currently available. The higher cost and number of operations needed, as well as the longer postoperative care and longer disability time after replantation/revascularization are nevertheless justified by the significant increase in quality of life.