Der Unfallchirurg
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The treatment of complex injuries of the elbow joint by a hinged fixator is a new concept of external transfixation with guided movement in a defined monocentric axis. Biomechanical investigations using cadaver specimens showed that the monocentric guidance ensures additional stability in these unstable osteoligamentous injuries, allows early functional treatment, and can be used in primary but also in revision surgery. ⋯ In agreement with the literature, our results provide evidence that the use of a hinged monocentric external fixator in combination with early functional therapy results in an increase in the ROM and represents a beneficial device and concept in the treatment of complex injuries of the elbow joint.
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Gunshot injuries to the head and brain are rare in Germany and the rest of western Europe. With the relatively low number of these injuries here, there are no standard methods of diagnosis and management, and there is some controversy over both. Quite a high proportion of such injuries result from suicide attempts and accidents. ⋯ The operative management depends on the extent and prognosis of the injury; a ventricular drain is probably indicated in most cases. Debridement of the bullet's path and removal of the projectile are more controversial. Mortality is extremely high after such injuries; if the victim does survive the prognosis is comparable to that following closed cranial injuries.
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The quality of care in Germany for seriously injured patients varies greatly in individual hospitals due to geographic variations among States and differences in resource allocation and treatment concepts. To assure and enhance treatment quality it seems sensible to establish a structured, quality assured network of clinics, which participate in the management of seriously injured patients according to different specified assignments. The conditions necessary for this type of network on a regional scale and for the clinics charged with the care of the seriously injured were summarized in the White Paper entitled "Management of the Seriously Injured-Recommendations for the Structure and Organization of Facilities in Germany for the Treatment of Seriously Injured Persons." The goal of this action is to ensure that every seriously injured person in Germany receives the best possible round-the-clock care in adherence to standardized quality criteria. ⋯ As a logical consequence of long years of experience and scientific knowledge, the German Association of Trauma Surgery has developed a concept for establishing a regional trauma network of clinics, adapted to local conditions, for management of seriously injured patients. The participating facilities assume different responsibilities in the network depending on their equipment and structure. This article describes the individual steps toward establishing and organizing a network.
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Spontaneous spinal epidural haematoma (SSEH) is a rare and serious condition. Four cases of SSEH are presented in this paper, three of which were in the cervical segment while one involved the entire spine. ⋯ The prognosis of SSEH depends heavily on the time that elapses between the onset of symptoms and the surgical treatment. The diagnostic procedure of choice is MRI.