Der Unfallchirurg
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The prognosis of multiple injured patients is mainly limited by initial severe hemorrhage causing hemorrhagic shock, subsequent sepsis and multiple organ failure (MOF). Although mechanisms of altered microcirculation, cytokine release etc. have been intensively investigated, little is known about the relevance of severe liver trauma as an independent predictive outcome factor in these patients. This study aimed to clarify the impact of severe liver trauma in one of the largest trauma databases. ⋯ Severe liver trauma is an independent predictor for severe hemorrhage with a substantial increased risk of sepsis, MOF and trauma-related death. While conservative treatment of patients with severe liver trauma but no hemorrhage is effective, patients with hemodynamic instability seem to form a subgroup where contemporary treatment modalities are not yet sufficient.
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A baby was brought into the accident and emergency department with X-ray pictures and with a plaster cast in place because of a pain reaction in the right arm. The pictures showed destruction of the epiphyseal region and double periosteal contours. ⋯ No traumatological/orthopedic treatment was given, and the plaster cast was removed. Following recognition of the signs described a complete cure was possible.