Der Unfallchirurg
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This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. ⋯ Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.
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We herein report a case of a highly differentiated verrucous squamous cell carcinoma of the sole of the left forefoot ("epithelioma" or "carcinoma cuniculatum plantare") that had--as a specific feature--developed within a preexisting long-standing skin scar due to an earlier occupational crush injury. Because of expansive tumor growth extending to the metatarsal bones and penetrating the tissue between the tendons, an ultrashort amputation of the hindfoot was performed according to the method of Chopart. The pathogenetic mechanisms possibly underlying the formation of scar carcinomas are discussed. For judgement of legal liability insurance questions, the criteria indicating a causal relationship between traumatic scars and cancer development are presented.
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Priorities in the diagnosis and treatment of a multiple trauma with injuries to the thorax and pelvis are usually determined by the pattern and the severity of the injury sustained. In this case a haemodynamically unstable patient with severest pelvic trauma and a moderate thoracic trauma developed progressive haemodynamic instability during an intervention to the pelvis, resulting in a lethal outcome for the patient. ⋯ In haemodynamically unstable patients with a major pelvic trauma combined with a moderate thoracic trauma, early CTT should therefore be a main priority in the initial management of such patients in the resuscitation room. The time spent on such a diagnostic procedure seems to be worth the information gained, which can significantly influence the initial choices and priorities in treatment.
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Computer-assisted procedures have recently been introduced for navigated iliosacral screw placement. Currently there are only few data available reflecting results and outcome of the different navigated procedures which may be used for this indication. We therefore evaluated the features of a new 3D image intensifier used for navigated iliosacral screw placement compared to 2D fluoroscopic and CT navigation. ⋯ Our data show a clear benefit of using C-arm navigation for iliosacral screw placement compared with the CT-based procedure. While both fluoroscopy-based navigation procedures decrease intraoperative radiation exposure times, only 3D fluoroscopic navigation seems to improve the precision compared to non-navigated screw placement.