Der Unfallchirurg
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Infectious diseases of the musculoskeletal system are in trauma surgery sometimes the symptoms that most severely impair patients and are a challenge to surgeons, hospitals and the economy of the public healthcare system. The systemic capillary leak syndrome (SCLS) is a rare idiopathic syndrome that can provoke a fulminant life-threatening progress even if the primary infection is trivial. In addition to a clearly arranged description of the SCLS we report on an affected patient who developed a necrotizing myositis of the right thigh due to an unstable scar.
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There is an accumulation of blast injuries on New Year's Eve due to fireworks. During an attempt to manufacture a firework the substances being mixed in a mortar exploded. ⋯ This case report shows the importance of expertise in hand surgery in the treatment of such severe injuries. A toe-to-hand transplantation represents an additional treatment option.
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The medical assessment of affections of the apophyses frequently presents the assessor with problems in causality testing and estimation of functional impairment. Apophyses are the insertion of tendons and are therefore at the center of an acting parallelogram of forces. They fuse via an apophyseal plate in the second decade of life. ⋯ Once the mineralization is complete, this type of fracture no longer occurs. Osgood-Schlatter disease, an insertion tendinosis of the patellar tendon, occurs in around 20% of all sport-active adolescents but it is questionable whether it can be associated with the acute avulsion fracture. Knowledge of the pathogenesis of affections and injuries of the apophysis can provide the assessor with good foundations for the estimation of a causal association.
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Spinopelvic instability is common in type IV fragility fractures of the pelvic ring (FFP) and type C traumatic pelvic fractures. This results in the indications for operative stabilization using a spinopelvic support. Due to the variety of surgical techniques for spinopelvic support it is unclear what importance a minimally invasive spinopelvic screw-rod osteosynthesis can have. ⋯ The triangular minimally invasive spinopelvic stabilization (TMSS) showed a stable and sufficient treatment of the type IV fragility fractures and in the slightly displaced type C traumatic pelvic fractures. Coarse fracture dislocations limit the procedure.
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Legal appraisals of possible treatment errors in childhood and adolescence are rare, often refer to the treatment of trauma of the upper limbs and are frequently recognized. From the activity of the first author as an expert witness 31 expert opinions (25%) referred to the upper limbs. Supracondylar humeral fractures, radius neck fractures, radial condyle fractures and distal radius fractures were predominant. ⋯ Insufficient recognition of instability (radial condyle), inadequate reduction and inadequate stabilization (radius neck, supracondylar) as well as untreated malalignments and secondary dislocations (wrist) were the main reproaches. Poor communication and deficient documentation often aggravate the situation. Working along clear algorithms can help to avoid legal proceedings and assignment of guilt.