Der Unfallchirurg
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Fractures of the knee region in childhood and adolescence are rare but are an important group of injuries due to the high incidence of secondary complications from growth disturbances. Meticulous primary diagnostics and fracture treatment with clear indications for surgical treatment are essential for avoiding posttraumatic deformities, although these can occur even despite correct primary treatment and are therefore inherent to specific fractures and therefore often unavoidable. In cases of growth disturbance where a deformity is imminent or has already taken place, watchful waiting until closure of the growth plate is only rarely indicated due to the progress made in directing growth via surgical means. Even surgeons who are primarily working in the field of fracture treatment must be aware of current strategies for correction of posttraumatic deformities in order to prevent or treat them in time or at least be able to prophylactically inform patients and parents during primary fracture treatment.
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The geriatric trauma working party, a subgroup of the German Society of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU), focuses on the challenges of geriatric fractures, which are steadily increasing due to demographic changes. Inherent comorbidities implicate perioperative complications leading to loss of mobility and endangered independence followed by an increased burden on the social services. An interdisciplinary approach is required. ⋯ By passing an independent audit process these centers can achieve certification as a geriatric trauma center DGU (AltersTraumaZentrum DGU). Certified centers can participate in a recently established geriatric fracture registry which includes an internationally consented data set. Audit and registry enable centers to acquire an international benchmark, ensure permanent improvement in quality and allow participation in health services research.
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Case Reports
[Hip arthroscopy after luxatio obturatoria : With contralateral unstable pelvic ring fracture].
Traumatic dislocation of the hip is a severe injury. Even in cases of an early uncomplicated repositioning there is a high risk of associated intra-articular injuries, such as lesions of the labrum, ruptures of the ligament of the head of the femur and loose bodies. The degree of damage caused by dislocation of the hip becomes apparent with a highly increased risk of developing postinjury osteoarthritis after dislocation of the hip. ⋯ This was done in consideration of the reduced possibility of distraction due to the osteosynthesis on the contralateral side. Attention was particularly paid to the risk of intra-abdominal fluid extravasation (IAFE). This syndrome is described as a severe complication during hip arthoscopy especially in cases of defects of the hip capsule as assumed after hip dislocation and magnetic resonance imaging.
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We report the case of a 51-year-old male patient who sustained a liver rupture following mechanical cardiopulmonary resuscitation (CPR) with the LUCAS® system. The patient was under anticoagulation and developed an abdominal compartment syndrome. ⋯ Using the example of the presented case, this article outlines and discusses these points based on the currently available literature. It should also be noted that mechanical CPR can act in a similar way to chest trauma and can necessitate an investigation with contrast enhanced computed tomography.