Der Unfallchirurg
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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.
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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.
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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.