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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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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Injuries to the subaxial cervical spine are increasing and have an increased neurological risk compared to the thoracic and lumbar spines. The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. ⋯ Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability and reconstruction/preservation of the physiological alignment.
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Trauma team alert (TTA) to the emergency room (ER) takes place in the event of disturbed vital signs or serious injuries (A criteria) or after a dangerous accident (B criteria). Due to low specificity and limited personnel resources, TTA is questioned for B criteria. The consequences would be an increase in undertriage and thus endangering patients. ⋯ The emergency intervention rate for A , B and NULL criteria was 75%, 6% and 2.1%, respectively. Differentiation according to the TTA criteria results in patient collectives with different injury severity and emergency intervention rates. This result justifies considerations to adjust team composition based on TTA criteria, as long as it is ensured that critical conditions can be identified and remedied by adapted teams.