Der Unfallchirurg
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Case Reports
[Cardiac arrest following blunt chest injury. Emergency thoracotomy without ifs or buts?].
In German-speaking countries, most serious thoracic injuries are attributable to the impact of blunt force; they are the second most frequent result of injury after head injury in polytrauma patients with multiple injuries. Almost one in every three polytraumatized patients with significant chest injury develops acute lung failure, and one in every four, acute circulatory failure. The acute circulatory arrest following serious chest injury involves a high mortality rate, and in most cases it reflects a tension pneumothorax, cardiac tamponade, or hemorrhagic shock resulting from injury to the heart or one of the large vessels close to it. ⋯ However the probability of survival described in the literature is very low for patients sustaining severe chest trauma with acute cardiac arrest. The case report presented here describes a female polytrauma patient who suffered an acute cardiac arrest following cardiac tamponade after admission in the emergency department and who survived without neurological deficits after an emergency thoracotomy. Selections from the topical literature can help the treating physician in the emergency department in making decisions on whether an emergency thoracotomy is indicated after a blunt chest injury and on the procedure itself.
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Comparative Study
[Diagnosis of chronic osteitis of the bones in the extremities. Relative value of F-18 FDG-PET].
Noninvasive diagnosis continues to present a challenge in chronic bone infections. Positive intraoperative microbiological and/or histological results are regarded as the gold standard for confirmation of the diagnosis. The aim of the present study was to evaluate the value of F-18 FDG-PET in the diagnosis of chronic osteitis in the patients of a department devoted specifically to septic orthopaedic surgery. In particular, the study was intended to answer the question of whether the results of FDG-PET correlate with those found in intraoperatively removed biopsy specimens (microbiology, histology) and what value this method of investigation has relative to computed tomography (CT) and magnetic resonance imaging (MRI). ⋯ F-18 FDG-PET is a promising diagnostic imaging method with high sensitivity and accuracy in the investigation of chronic osteitis. If the result of FDG-PET is negative chronic osteitis can be virtually excluded. The results presented suggest that it is superior to CT and MRI in sensitivity and accuracy. A definitive diagnosis of chronic osteitis will continue to require an invasive method in the future, in the form of removal of biopsy specimens for microbiological and histological tests.
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Functional bracing of humeral diaphyseal fractures was conceived after initial experiences with a similar method was used in the management of diaphyseal tibial fractures. Over the years, tibial functional bracing underwent major evolutionary changes, and found its indications basically limited to a smaller group of fractures, consisting of closed, axially unstable fractures that experience at the time of the injury an acceptable degree of shortening, and to transverse fracture that are appropriately reduced and rendered stable. ⋯ In 97.5% of the patients, the average healing time was 11.5 weeks. 16 patients (2.5%) required operative intervention because of a nonunion and 4 patients (<1 degrees) of the patient had a refracture after brace removal. Nerve function did not return in only one of the 67 patient who had radial nerve palsy.
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Over the last years, many special instruments and implants were designed for operative treatment of fractures of the wrist and hand. Therefore, conservative treatment of these injuries became old-fashioned in the eyes of most patients and surgeons. ⋯ The key to success is thorough knowledge of the use of casts, splints, and functional therapy and good patient compliance to avoid complications. Opportunities for conservative treatment of fractures of the wrist and hand are herein described.
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In the treatment of fractures of the long bones in children and adolescents, surgical and conservative methods are not mutually exclusive alternatives; rather, each can complement the other in the overall treatment strategy. Many operative procedures, such as fixation of juxtaarticular, metaphyseal fractures, need to be supplemented by conservative procedures, such as immobilization by means of casts. ⋯ The indications for purely conservative treatment strategies are basically different for articular and nonarticular fractures. Whereas in the case of articular fractures only the nondisplaced fractures are treated by conservative methods, in the case of nonarticular (shaft) fractures those involving a degree of displacement, as long as it is not too pronounced to allow the integration of spontaneous corrections, can also be treated conservatively.