Der Unfallchirurg
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Case Reports Comparative Study
[Ventilation in prone position in a 5-year-old child after multiple trauma. Effective treatment of persistent atelectasis].
We report on the ventilation in prone position in a 5-year-old traumatized child with severe thoracic and abdominal injuries (lung contusion, rib fractures, rupture of liver and spleen). Under continuous analgesic sedation, the young patient was ventilated in prone position for 6 h, since acute lung injury and atelectasis persisted despite various therapeutic measures (artificial ventilation in the pressure controlled mode, fiberoptic bronchoscopy, reexpansion maneuver). After initiation of the prone position, we observed a rapid increase in arterial oxygenation, which persisted in the following period. ⋯ After cessation of analgesic sedation, the extubation was performed 2 days later. Furthermore, we found no side effects of the prone position on the injured abdomen, and the liver function improved rapidly. Although there is a lack of experience with ventilation in prone position in pediatric intensive care, our report might be a recommendation for the indication of this technique in children.
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Comparative Study
[Ultrasound characterization of burn scars in children].
So far, little is known about the acoustic phenomena of high-frequency sonography for the assessment of healing processes in thermal wounds. However, ex vivo investigations have shown clear age-dependent differences in the rate of sound propagation in thermal scars compared to healthy skin. In order to answer the question of whether measurable acoustic characteristics of burn or scald scars can be classified in a way which corresponds to the clinical severity of the injuries, age of scar or type of treatment, 92 thermal scars, with an average scar age of 3.1 years, in 55 children were investigated with regard to corium thickness and echogenicity. ⋯ The comparison of different therapeutic strategies showed no therapeutic effect either for compression or for the application of silicone gel sheets. In contrast, a decrease in scar thickness and a loosening of scar structure could be seen after early application of a sterile, silicone-covered polyamide net bandage. The 20-MHz-Sonography is a suitable non-invasive procedure for the characterisation of burn scars.
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Case Reports Comparative Study
[Press-fit bone dowel arthrodesis of the ankle or the subtalar joint using a diamond bone cutting system. Surgical technique and initial results in 10 patients].
Arthrodesis of the ankle (AA) or the subtalar joint (AST) is still a necessary treatment in case of painful posttraumatic arthrosis or paresis of the muscles after compartment syndrome. Today the alloplastic ankle joint replacement does not satisfy. Many treatments of arthrodesis with minimal or extended resection of the joint surface with or without bone transplantation are described in literature. ⋯ At this time the patients showed no symptoms and were fully mobilised with complete weight-bearing. The advantages of KDA: preservation of the outline of joint and hindfoot, preservation of length of the leg and outline of iliac crest, no risk for the soft tissue, quick consolidation of the arthrodesis, no need of external fixation. The technique is also suitable for other indications as presented.