Der Unfallchirurg
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Booby traps and gun-like devices for vole control can lead to complex trauma requiring emergency medical care. We present a case series of patients who suffered severe hand and facial trauma through detonation of booby traps and paraphernalia (n = 9, Ø 60 years of age). All patients were admitted to the emergency department of Hannover Medical School for primary care. ⋯ Six of these patients also presented fractures or lesions of capsular or tendon structures. Therapies included debridement as well as skin grafts or flaps for tissue defect coverage. We informed the Department for Commercial Safety (Gewerbeaufsicht Hannover) in 2014 because we believe that these traps pose a serious safety hazard.
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Fractures of the distal radius are most commonly caused by hyperextension injuries of the wrist. Tensile forces and force vectors, strength of impact, bone strength and soft tissue tension create individually different fracture patterns. Metaphyseal comminution, loss of cortical support, ligament avulsion and shear fragments are defining parameters for fracture instability. ⋯ Unidirectional instability can be indirectly neutralized by palmar locking plate systems. A multidirectional instability can be addressed by multiple plating following the column theory. Distal shear and avulsion fractures may require a fragment-specific osteosynthesis approach.
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Clinical Trial
[Release of moveable segments after dorsal stabilization : Impact on affected discs.]
Bisegmental dorsal stabilization is a common treatment option for instable compression fractures of the thoracolumbar spine; however, it remains unknown to what extent bridging compromises intervertebral discs. ⋯ Bridging of an intervertebral disc with IR within 24 months does not cause immediate loss of disc function or reduction of disc height; however, temporary bridging in combination with an adjacent endplate fracture causes significant reduction of disc height and loss of extension. Additionally, no beneficial effects could be seen by reducing the time span between stabilization and IR to below 12 months.
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Femoral neck fractures in young patients are rare but of high clinical relevance due to the complexity of risk factors and complications. Early stabilization and accurate reduction are of high priority. Femoral head-preserving stabilization by dynamic hip screws or threefold screw osteosynthesis are the methods of choice. Postoperative results should be closely controlled in every case in order to be able to treat possible complications in time.