Der Unfallchirurg
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Patients with fractures of the pelvic ring and accompanying injuries special of the extremity make heavy demands on hospital resources and face difficulties in rehabilitation. From the patients point of view milestones in recovery are quality of live and return to productivity. We studied 64 patients with pelvic-ring-fractures in a period of 10 years. ⋯ PTS-score and AO-classification correlate directly to long-term disability, based on Rosser-Index, and "return to productivity" figures but not always to radiological and clinical outcome. This study emphasizes the need for new injury scoring systems that better predict the recovery and ability to return to work of trauma patients after surviving unstable pelvic fractures. Proper follow-up evaluations should analyse the patient's quality of live and working activity beside traditional item like radiological and clinical findings.
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Cervical spine changed by Bechterew's disease is severely endangered with any increased load. Even decent trauma is enough to produce a fracture with affection of spinal cord. Because of little knowledge in these special items, late diagnosis of overlooked injury is not rare, especially in two-level injuries. ⋯ There were four patients, that would not have suffered cervical spine fracture (minimal injury force) without Bechterew's changes. There is often pulmonary failure through limitation of thoracic movement and cerebral ischemia following rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) in our collective is less than literature's medium rates (35-57%).
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Tissue defects of the heel region are a challenging problem. Various reconstructive techniques were performed in 44 patients with 59 defects around the heel region, who were treated between 1994 and 1999 following a traffic accident in 27%, a burn injury in 25%, and other traumatic causes in 48%. ⋯ The overall complication rate was 18% with the highest rate after local flap procedures. A therapeutic strategy was developed, which is based mostly on the localization and extension of the defect area.
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C-arm navigation is a new tool in computer assisted surgery. The aim of this study is to evaluate the accuracy of Iso-C-arm based drill holes in the proximal femur. In nine artificial proximal femura, two holes with an angle of 135 degrees and 100 degrees in relation to the shaft axis were drilled in the direction of the femoral head. ⋯ The main plane of deviation in all of the 135 degrees holes was posteriorly, whereas in the 100 degrees holes posterior deviation occurred in four cases, cranial in three cases, and in one case each caudal and anterior deviation occurred. In our opinion, the accuracy of fluoroscopy based navigation applied in the region of the proximal femur is sufficient and reproducible. This technique can be used for implant placement at the proximal femur in the future.
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Traumatic luxation of the ulnar nerve is a very rare injury. In the worldwide literature from 1960 to 2001 we could only find 4 reports concerning this trauma. When we take an exact anamnesis for granted making the diagnosis is very easy and it is not necessary to do highly sophisticated technical examinations. An X-ray and ENG-EMG examination and a precise clinical exploration of course is enough.