Der Unfallchirurg
-
The authors present a case report of a 38-year-old man who suffered combined gunshot injuries of the heart and lungs from a small caliber gun. The gunshot resulted in combined injuries of a penetrating wound of the left lung, the right heart chambers and the right lung which were successfully managed despite a delay in surgery of several hours by pledget sutures of the heart wounds, wedge resection of the lingula and right lower lung lobectomy performed via a clamshell thoracotomy.
-
We show a comparison between two patient groups of the inpatient population suffering from femoral neck fractures registered in the external quality assurance between 1993 and 1997 and between 2005 and 2009. ⋯ The technique of operative treatment changed and while during the 1990s many patients with femoral neck fractures were treated by implanting a total endoprosthesis, in the 2000s treatment was dominated by the hemi prosthesis. During the two periods of study use of the osteosynthesis technique decreased. In conclusion, the study showed an obvious compression of performance in trauma surgery but despite everything there was a clear improvement of treatment quality with respect to complication rates.
-
The most prevalent fractures managed by trauma surgeons are those involving the distal radius. The injury occurs in two peaks of prevalence: the first peak around the age of 10 years and the second peak around the age of 60 years. Distal radius fracture management requires sensitive diagnostics and classification. ⋯ An armament of surgical implants is available for instable fractures requiring fixation. Palmar locked plate osteosynthesis has been established in recent years as the gold standard for operative management of distal radius fractures. Complex Working Group on Osteosynthesis (AO) classification type 3 fractures require extensive preoperative diagnostics to identify and treat typical associated injuries around the wrist.
-
Gunshot wounds are rare in Germany and are mostly the result of suicide attempts or improper handling of weapons. The resulting injuries involve extensive tissue damage and complications which are thus unique and require a differentiated approach. As trauma centers may be confronted with gunshot wounds at any time, treatment principles must be understood and regularly reevaluated. ⋯ By means of an evaluation of microbiological findings in a subgroup of patients involved in a civil war (n=10), the problem of multidrug resistant pathogen contamination, colonization and infection is discussed. In addition to a description of initial and emergency treatment of gunshot wounds, measures required for further treatment and decontamination are presented. Finally, the results are discussed with reference to the literature in this field.
-
Clinical Trial
[Fusion criteria for cages as vertebral body replacement in thoracolumbar fractures.]
No commonly accepted criteria to evaluate bony incorporation of cages as vertebral body replacement in thoracolumbar fractures exist. The goal of this study was a thorough radiological evaluation of the fusion process in posterior-anterior stabilized fractures. ⋯ The advocated criteria allow accurate assessment of bony incorporation of cages. Bony incorporation can be detected in and around the cages over time; however, only 57% of patients showed signs of bony fusion after 1 year.