Der Unfallchirurg
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Isolated severe head trauma (SHT) or SHT in combination with multiple injuries are important factors for the prognosis of morbidity and mortality in patients suffering from the consequences of accidents. The prognosis mainly depends on the presence of primary mechanic brain injury and the development of secondary brain damage. Causes for the development of secondary brain damage are the intracranial space demand after traumatic injury and edema formation which may result in iscemia, as well as inflammatory processes. ⋯ Our knowledge about the bidirectional inflammatory interaction between brain and whole organism is still limited. In this context, the effects of secondary surgical interventions which may additionally, stress a traumatized body have to be considered and are the subject for actual clinical discussions and experimental studies. This article tries to summarize some important aspects on this topic.
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122 cases of patients who died in sequel of an accident (recruitment period 1993/94, mean ISS 40 +/- 19) in reach of air rescue base Dresden, Germany, were examined. Data were assessed from autopsy protocol and the protocol of the physician who treated on scene. We analyzed the time course of the emergency, the scheduled emergency medical service and the quality of prehospital diagnosis and therapy by the emergency team. ⋯ Hemorrhagic shock related to these injuries was found in 44.2%, mean resuscitation volume applicated in these cases was 960 +/- 610 ml. Typical faults in diagnosis and treatment were underestimating of severe trunk trauma and non-consistent use of invasive treatment procedures. Primary transport of the severely injured patient to a level I trauma center by helicopter was performed only rarely.
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Case Reports
[Atlanto-axial instability presenting a rare complication in fibrous dysplasia - a case report].
Fibrous dysplasia, in either monostotic or poliostotic form rarely involves the cervical spine. Most of these lesions remain asymptomatic and are incidental radiographic findings. ⋯ In addition, atlanto-axial instability causing clinical symptoms was detected. A dorsal stabilisation was performed using the DCS System.
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Review Case Reports
[Dorsal carpometacarpal dislocation of the fifth finger: discussion of diagnosis and therapy on two cases].
Dorsal dislocation of the fifth carpometacarpal joint after injury is rare. Only five cases are reported in the literature. We report on two cases of dorsal dislocation of the fifth carpometacarpal joint after injury and we give a review of related literature. ⋯ A reduction without following Kirschner wire fixation - even in those dislocations that were found to be stable after closed reduction - is not recommended because of the risk of persisting pain after heavy manual work. In our two cases an instability of the fifth carpometacarpal joint existed after closed reduction. After Kirschner wire fixation and cast immobilisation for 6 weeks both patients showed 3 months after operative therapy a full range of movement and a powerful grip without any pain in the fifth carpometacarpal joint.
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Multicenter Study Comparative Study
[The Trauma Registry of the German Society of Trauma Surgery as a basis for interclinical quality management. A multicenter study of the German Society of Trauma Surgery].
Based on the "Trauma Registry" of the German Society of Trauma Surgery, an interclinical quality management (QM) system was implemented. The principles of the QM system as well as the differences in the quality of outcome and treatment are presented. The analysis uses the data on 2,069 severely injured (ISS = 22 +/- 14) patients from 20 hospitals collected prospectively and anonymously between 2/93 and 12/97. ⋯ The hospitals participating in the Trauma Registry receive an annual analysis of their preclinical and acute clinical performance. Thus, every hospital can analyze and improve the quality of treatment based on reliable data that show which parts of the process have to be optimized. Furthermore, the data allow a comparison of the average and optimal results of the whole series.