Der Unfallchirurg
-
Is the measurement of continuous cardiac output useful for the management of polytrauma patients? ⋯ The unique opinion was that the CCO device had an impact on their decision making in the fluid and drug management of the study patients. Our first experience, however, suggests that this device may become an important improvement in the management of haemodynamics in the early trauma phases. Before a wide-spread application of this method on the ICU an evidence based prospective randomized trial should be performed.
-
Comparative Study
[Constant Score and Neer Score. A comparison of score results and subjective patient satisfaction].
The Constant- and the Neer-Score are widely used to assess shoulder function after trauma or shoulder diseases. The objective of this study was to compare the correlation of score result with the patient subjective assessment. We hypothesized that there is a clinically relevant difference between the score result and the patient assessment, especially for highly selective patient groups. ⋯ The hypothesis of a clinically relevant difference between the subjective and the score-based assessment of shoulder function can be confirmed. Our results suggest that for clinical practice, statements and therapy strategies recommended in the literature, that are just based on score results might not be valid for all patient-groups (e.g. elderly patients).
-
A case of congenital, bilateral, diaphragmatic hernia in a patient with multiple trauma after a motor accident is presented. No anamnestic information was available because of the need for intubation at the accident site. After the insertion of bilateral chest tubes because of left sided pneumothorax and right sided haematopneumothorax a mediastinal mass became apparent. ⋯ A mediastinal mass of unknown origin in multiple trauma patients suggests the presence of traumatic diaphragmatic hernia. Diagnostic signs suggesting congenital hernia as compared to acute traumatic hernia are: unilateral or bilateral localisation in the dorsal muscular part of the diaphragm and non-suspicious appearance of parenchymal abdominal organs in relation to the size of the hernia. Diaphragmatic hernias reduce the vital and functional residual capacity of the lungs, possibly leading to respiratory complications and infections.
-
Comparative Study
[Repositioning femoral neck fracture in younger patients. Valgus or anatomic reposition?].
In a retrospective study, 51 patients with femoral neck fractures received open reduction and internal fixation. They were divided into two groups. Group A included all patients treated with anatomical reduction. ⋯ According to the Hip-Score of Merle d'Aubigné, the patients treated with anatomical reduction had a better functional outcome after 10 years. With respect to the results we recommend in younger patients (< 60 years) anatomical reduction in Pauwels I and Garden-II-fractures. Valgusreduction should be performed as well in Pauwels II and III as Garden-III-and-IV-fractures.
-
The treatment of traumatic defects of the auricle concerning the exact reconstruction of details and aesthetic aspects is exacting for the surgeon. To face the expectations towards best trauma care, the different locations and extent of auricular injuries should be included in the different therapeutic strategies. ⋯ Depending on this, different techniques and methods of reconstruction are recommended. Advantages and disadvantages are pointed out and discussed with several examples and with the present literature.