Der Unfallchirurg
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Spinal trauma is frequently found in multiply injured patients. To gain more insight into the epidemiology and the clinical course of this entity, we analyzed the relevant data held in the German Trauma Registry (German Trauma Society, DGU). The Registry provides prospective, standardized and anonymous documentation on severely injured patients at different predetermined time points from the site of the accident until they are discharged from hospital. ⋯ Almost 10% of all documented cases of patients with severe injuries in the German Trauma Registry had severe spinal injuries. These injuries were frequently not recognized or their extent underestimated in the preclinical setting. About 70% underwent spine stabilization within 72 h after being injured. These results support previous findings suggesting that early stabilization of vertebral fractures might be beneficial in multiply injured patients.
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Clear indications have been recognised for arthroscopic surgery of the elbow since the 1980s. Good indications are loose bodies, mild or moderate restriction of the range of movement and early stages of rheumatoid arthritis. Cartilage diseases such as Panner disease or focal radial chondropathy can be treated by arthroscopic debridement and microfracturing. ⋯ The technical demands of endoscopic arthrolysis procedures for joints with mild or moderate restriction of range of movement are extremely heavy; only experienced surgeons should operate on such patients. Arthroscopy of the elbow joint should be carried out only by operators who have already gained experience in other joints, because of the close relations of nerves and vessels in the elbow. A rigorous standard should be followed in planning the procedure and in creation of the portals and performance of the diagnostic round-up in the joint, to make it possible to work purposefully and quickly, and thus with minimum complications.
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The clinical picture in pyoderma gangrenosum varies but a typical medical history with resistance to antimicrobial treatment and worsening or first manifestation of disease because of surgical procedures are indications of this diagnosis. We describe the course of a woman patient who had a pyoderma gangrenosum for more than 1.5 years. After confirming the diagnosis an immunomodulating therapy was initiated until complete remission of the ulcers. Differential diagnosis and different clinicopathologic forms of pyoderma gangrenosum are discussed and an overview of the association with internal diseases is provided.