Der Unfallchirurg
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Intraoperative ultrasonography is recommended for operations on the thoracolumbar spine to complement the information provided by standard X-ray, intensifier screen or myelography. There are no unanimates opinions concerning the impaction or exeresis of these fragments. The aim of this study was to show the advantages of intraoperative ultrasonography for anatomic determination and control of the maneuvers used. ⋯ The tilting before the impaction and the state of the overlying intervertebral disk represent essential factors for failures. Ultrasonography is better than intraoperative myelography. Nevertheless, it still needs to be complemented by intraoperative profile X-rays and a very precise preoperative CT scan of the intervertebral disk lesions analysis of complicated cases (fragments with residual pedicular attachments--type A 3.1.2.; T-like fractures--type A 3.2.1.).
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When patients with gunshot injuries are medically treated, it is also important to examine the wound itself to achieve further information concerning the distance and direction from where the bullet was fired. Besides that, it must be remembered that the bullet does not necessarily penetrate the target in a linear direction, but there can be various curves and angles in the bullet channel and subsequently adjacent organs injured.
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The purpose of this paper is to outline the treatment protocol for the first time traumatic anterior shoulder dislocator, with options including conservative, arthroscopic and open surgical treatment. Regarding the subclassification of the first time traumatic anterior dislocater, it is imparitive to differentiate between the unidirectional dislocator with and without hyperlaxity. This subclassification takes into account the structural quality of the stabilizing ligamentous structures of the glenohumeral capsule. ⋯ Surgical stabilization of primary anterior traumatic dislocation is indicated if the following strict criteria are met: adequate trauma, no self reduction, unidirectional instability without hyperlaxity, Hill Sachs lesion, age below 26 years, high level of sport activity and the special situation of luxatio erecta. Post primary stabilization is indicated for persistent subluxation, subjective instability or demonstrated pathologic instability tests. Rotator cuff tears due to traumatic dislocation in the elderly population require surgical repair.
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In IIIB and IIIC type open tibial fractures (according to Gustilo) the primary decision that has to be made regarding therapy is wether or not the limb can be salvaged. To standardize the criteria for amputation different salvage scores have been established in recent years. In this study the Hannover Fracture Scale (HFS), the Predictive Salvage Index (PSI), the Mangled Extremity Severity Score (MESS) and the NISSSA score were evaluated regarding their clinical relevance. ⋯ All the scores mentioned here appear to be helpful in decision making. Salvaged limbs in IIIB and IIIC fractures presented a comparable good outcome, whereas salvaged IIIC injuries with a high score presented an outcome which was as bad as in secondary amputations. Secondary amputated patients required not only significant longer hospitalization but also resulted in poor outcome compared with the patients having received reconstruction or primary amputation.
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Numerous epidemiological studies about multiple trauma patients do not include an analysis of patients under the age of 18. To study this, the data of 682 patients with multiple traumata, treated between 1981 and 1991 at Hannover Medical School, Germany, were retrospectively analyzed. The patients were divided into four age-related groups: preschool age (< 6 years), school age (< 13 years), teenagers (< 18 years) and adults (> or = 18 years). ⋯ Spinal cord injuries, especially injuries to the neck, also showed a high risk of death. Children younger than 6 years had the most severe head injuries. Safety improvements for children in cars, helmet usage on bicycles and early training in traffic safety for children might decrease the lethality in this group of trauma patients.