Der Unfallchirurg
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Comparative Study
[The value of subjective estimation of the severity of thoracic injuries by the emergency surgeon].
Thorax trauma (TT) is associated with a high rate of pulmonary failure and increased mortality. To prevent these complications, the German trauma system recommends intubation and chest tube insertion at the scene of the accident, even in cases without acute respiratory dysfunction. Due to the possible life threatening complications of the therapy, the emergency surgeon should be able to correctly identify a TT at the scene. Therefore, we retrospectively compared the evaluation of chest trauma by the emergency surgeon with objective injury severity according to the Abbreviated Injury Scale (AIS). ⋯ Due to the high rate of misclassification and possible severe complications caused by therapy, and without having any benefit in terms of outcome, intubation and chest tube insertion should not be carried out in vital, stable patients.
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Comparative Study
[Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room].
Physical examination and radiography of the pelvis is part of most routine protocols in the emergency room (ER) management of blunt trauma patients. The purpose of this study was to determine the usefulness of these diagnostic tests with respect to diagnostic accuracy, therapeutic consequences, and prognosis in severely injured patients. ⋯ The clinical diagnosis of pelvic instability should result in an immediate order for blood products, taking surgical intervention into account. Pelvic radiographs in the ER are required for early surgical management. In patients with negative pelvis examination results, a routine pelvic radiograph is recommended because clinical examination cannot reliably rule out surgically significant pelvic fractures (20%) in the severely injured and intubated blunt trauma patient.
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Comparative Study
[Treatment of metaphyseal bone defects after fractures of the distal radius. Medium-term results using a calcium-phosphate cement (BIOBON)].
Since 1998 the calcium-phosphate cement BIOBON has been an established tool for the operative treatment of metaphyseal bone defects. No data are currently available in the literature on the clinical results of employing BIOBON: ⋯ Calcium-phosphate cements represent a good alternative to autogenous bone transplantation, especially in elderly patients.
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A retrospective study was made of 100 Tile type B and 122 type C pelvic ring lesions. Type B1-open book lesions occurred in 52 patients while 48 had lateral compression lesions of type B2 or B3. Only 13.1% of the patients showed no associated lesions. ⋯ The inverse was true for radiologic results: 93% of the B1- but only 75% of the B2/B3-patients had an anatomical reduction. Open book lesions, lateral compression lesions and combined vertical stable lesions should be differentiated. We suggest that lateral compression lesions be characterized as B1 and open book lesions as B2 type injuries in the classification system of AO.
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Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. ⋯ In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.