Der Unfallchirurg
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In orthopaedic surgery and emergency medicine, patients of the age groups with a HIV risk represent the largest part of the entire population. As necessary steps have to be taken immediately at the scene of an accident and in the emergency room, contact with HIV-positive blood is often unavoidable, so that there is an increased risk of transmission for doctors and personnel. Due to the immunological state, the HIV patient is exposed to considerable post-operative complications such as wound infection, pneumonia and even sepsis. With the case of a 35-year-old HIV-positive patient who was multiply injured in a traffic accident, we want to present an interesting example of the problems that occur in the treatment of this patient group.
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Spinal trauma is frequently found in multiply injured patients. To gain more insight into the epidemiology and the clinical course of this entity, we analyzed the relevant data held in the German Trauma Registry (German Trauma Society, DGU). The Registry provides prospective, standardized and anonymous documentation on severely injured patients at different predetermined time points from the site of the accident until they are discharged from hospital. ⋯ Almost 10% of all documented cases of patients with severe injuries in the German Trauma Registry had severe spinal injuries. These injuries were frequently not recognized or their extent underestimated in the preclinical setting. About 70% underwent spine stabilization within 72 h after being injured. These results support previous findings suggesting that early stabilization of vertebral fractures might be beneficial in multiply injured patients.
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Clear indications have been recognised for arthroscopic surgery of the elbow since the 1980s. Good indications are loose bodies, mild or moderate restriction of the range of movement and early stages of rheumatoid arthritis. Cartilage diseases such as Panner disease or focal radial chondropathy can be treated by arthroscopic debridement and microfracturing. ⋯ The technical demands of endoscopic arthrolysis procedures for joints with mild or moderate restriction of range of movement are extremely heavy; only experienced surgeons should operate on such patients. Arthroscopy of the elbow joint should be carried out only by operators who have already gained experience in other joints, because of the close relations of nerves and vessels in the elbow. A rigorous standard should be followed in planning the procedure and in creation of the portals and performance of the diagnostic round-up in the joint, to make it possible to work purposefully and quickly, and thus with minimum complications.
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The clinical picture in pyoderma gangrenosum varies but a typical medical history with resistance to antimicrobial treatment and worsening or first manifestation of disease because of surgical procedures are indications of this diagnosis. We describe the course of a woman patient who had a pyoderma gangrenosum for more than 1.5 years. After confirming the diagnosis an immunomodulating therapy was initiated until complete remission of the ulcers. Differential diagnosis and different clinicopathologic forms of pyoderma gangrenosum are discussed and an overview of the association with internal diseases is provided.
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Case Reports
[Cardiac arrest following blunt chest injury. Emergency thoracotomy without ifs or buts?].
In German-speaking countries, most serious thoracic injuries are attributable to the impact of blunt force; they are the second most frequent result of injury after head injury in polytrauma patients with multiple injuries. Almost one in every three polytraumatized patients with significant chest injury develops acute lung failure, and one in every four, acute circulatory failure. The acute circulatory arrest following serious chest injury involves a high mortality rate, and in most cases it reflects a tension pneumothorax, cardiac tamponade, or hemorrhagic shock resulting from injury to the heart or one of the large vessels close to it. ⋯ However the probability of survival described in the literature is very low for patients sustaining severe chest trauma with acute cardiac arrest. The case report presented here describes a female polytrauma patient who suffered an acute cardiac arrest following cardiac tamponade after admission in the emergency department and who survived without neurological deficits after an emergency thoracotomy. Selections from the topical literature can help the treating physician in the emergency department in making decisions on whether an emergency thoracotomy is indicated after a blunt chest injury and on the procedure itself.