Der Unfallchirurg
-
Gunshot wounds of the lower extremities are always serious injuries, especially in cases in which bone is affected. Contamination and extensive tissue damage can be life-threatening for the patient and severely affect the function of the extremity. Contamination and local infections with multidrug resistant pathogens are regularly encountered particularly in casualties evacuated from crisis regions. Treatment of this special type of injury, which differs in the form and extent from conventional high-energy trauma of the lower extremities, usually requires lengthy and extensive therapy algorithms in order to preserve the affected extremity. ⋯ These results show that the treatment of gunshot wounds of the lower extremities is time-consuming and extensive and requires the complete spectrum of modern trauma surgery. Despite the high risk of complications during treatment it is possible and feasible to apply procedures that preserve the extremities.
-
Case Reports
[Conservative treatment of distal radius fracture : Consequences of an uncritical follow-up.]
A 74-year-old woman sustained a fracture of the distal radius with an additional fracture of the styloid process of the ulna due to a fall. After reduction under local anesthesia immobilization treatment in a forearm cast was initiated. Despite increasing secondary dislocation during radiological x-ray follow-up control, the bone was described as correctly aligned by the treating physician and non-operative treatment was continued. ⋯ In addition, secondary dislocation during radiological follow-up examination should have led to conversion of treatment in favor of surgery. The arbitration board furthermore concluded that iatrogenic malpractice led to a severe deformity of the right wrist which would result in a loss of grip strength and future arthritic deformation of the wrist. Legal aspects of the case are discussed.
-
The management of gunshot wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. Penetrating injuries occur with an incidence of 5% in Germany. They are caused by gunshots or more commonly by knives or other objects, for example during accidents. Since even the number of patients who are treated at level 1 trauma centres is limited by the low incidence, the objective of this study was to assess the epidemiology and outcome of gunshot and stab wounds in Germany. ⋯ In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicide. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required which can provide the basis for an evaluation of the long-term quality of the management of patients with stab or gunshot wounds.
-
The differential diagnosis of lumbar back pain includes a broad spectrum of vertebral and extravertebral pathologies. Even in cases of a traumatic event physicians should keep an extravertebral cause in mind. This is a case report on the coincidence of perforated sigma diverticulitis and traumatic spine compression fracture in an 85-year-old woman with acute back pain. The presence of free retroperitoneal gas in the computed tomography (CT) scan was of significant diagnostic importance.
-
Since May 2012 plastic surgery for trauma patients at the University Hospital Leipzig is provided by an autonomous department. ⋯ The implementation of a department for plastic surgery increased the revenues. Additional profits should be achieved by process enhancement and not by prolonged LoS.