Der Unfallchirurg
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Comparative Study
[Retrospective analysis of healing problems after reamed and unreamed nailing of femoral shaft fractures].
168 fractures of the femoral shaft treated by intramedullary nailing were analyzed retrospectively. From 1986-1992 116 fractures had been treated with the reamed AO universal nail (RFN) and from 1993-1996 52 fractures with the AO unreamed femoral nail (UFN). In 24% of the RFN-group and in 2% of the UFN-group (p < 0.0001) open reduction of the fracture had been necessary. ⋯ We believe that there is mainly a mechanical reason for this phenomen, in addition to fracture type and fracture localization the (insufficient) length of the unreamed nails might have impaired stability further. The different factors should be investigated in larger series. As a consequence we now treat transverse and short oblique fractures of diaphyseal femoral fractures distal to the femoral isthmus with a RFN whereas in other types and localizations of diaphyseal femoral fractures we continue to use the UFN with special attention to maximal nail diameter and length.
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About 10% of all trauma patients sustain rib fractures. The average age is 58. Men are more often affected than women. ⋯ The primary chest X-ray was thought to be without pathology. Arterial bleeding without exact localization could be found with computed tomography. Thoracotomy revealed the correct diagnosis and the cause of bleeding.
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Case Reports
[Diagnosis and surgical therapy of diffuse pigmented villonodular synovitis of the hip joint].
Pigmented villonodular synovitis (PVNS) of the hip is a monoarticular proliferative process involving the synovial membrane. A chronic inflammation as well as a neoplastic process have been proposed in the literature. PVNS is usually found in adults aged 20-50 years, without sex predilection. ⋯ Magnetic resonance imaging showed a suspected malignant soft tissue mass involving the hip joint. The diagnosis of PVNS was confirmed by arthroscopy and biopsy, and the treatment of choice was an open synovectomy. One year after the operation the clinical examination was normal.
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The treatment of severely ill patients remains a medical and human challenge. The aim of the study was to determine the survival rate of patients with prolonged intensive care unit (ICU) treatment. Additionally, the somatic, psychological, and social sequelae of the survivors should be determined. ⋯ The mortality after prolonged ICU-treatment is substantially higher compared to average ICU patients. However, having survived the acute phase of the illness, successful rehabilitation in somatic, psychic as well as social terms could be performed to a considerable extent. This outcome is comparable to the one of other ICU populations. The results encourage to a consequent use of all medical options.