Der Unfallchirurg
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The success of modern burn therapy is based on an understanding of the pathophysiology and application of burn intensive care implying fluid resuscitation and management of pulmonary or other organ failure. With the development of early eschar excision and wound closure by immediate grafting, survival and cosmetic outcome were further improved. Especially in post-acute therapy, early physical rehabilitation, early reintegration, and early plastic surgical correction of the sequelae are indispensable for the outcome.
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Limitations to the range of motion of the knee reduce knee function and life quality. Flexion deficits inhibit using stairs and shoe closure, and may cause social deprivation. We present a pathophysiological concept of arthrolysis of the knee for flexion deficit. Our concept divides into intra- and extra-articular factors involving knee stiffness. Extra-articular problems can be located proximally in the quadriceps mechanism and distally in the patellar tendon. ⋯ A strict postoperative protocol is obligatory for pain control and physiotherapy. In 19 cases treated with this algorithm there was a mean flexion gain of 26 degrees. The AOSSM subjective outcome score was excellent in ten and good in seven cases after a mean follow-up of 8.2 months. This treatment protocol allows improvement in flexion, even in difficult revision cases.
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Case Reports
[Percutaneous reduction and stabilization of a dislocated acetabular fracture. Case report].
In the treatment of acetabular fractures, anatomic reconstruction of the joint is the primary aim. To achieve this, rather large approaches with approach-related morbidity are needed. Percutaneous stabilizations are still limited to nondisplaced or minimally displaced fractures. ⋯ Using the enhanced fluoroscopy technology with the ability to generate axial cuts and reconstructions comparable to CT clearly improves the reduction control also in acetabular surgery. Thus even displaced acetabular fractures can be reduced and stabilized percutaneously. Anatomic reconstruction of the joint remains the primary aim.
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The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. ⋯ The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.
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The treatment of unstable cervical spine injuries with the halo vest represents an established procedure. So far no data reflecting the quality of life of patients following a halo vest treatment are available. Elderly people make up a large part of the inpatients in our hospital. Therefore special attention is payed to this group of patients in this study. ⋯ The treatment of unstable fractures of the upper cervical spine with a halo vest results in a prolongated fracture healing for elderly people. Furthermore a halo vest therapy reduces the health related quality of life. Therefore, even for elderly patients an internal osteosynthetic stabilization of an unstable injury of the upper cervical spine should be considered if indicated.