Der Unfallchirurg
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Bilateral carotid artery dissection is a rare and unusual complication of blunt cervicofacial trauma. The diagnosis of a carotid injury is rarely suspected in trauma patients with neurological deficits. ⋯ Angiography should be considered in trauma patients with hemiplegia and a normal mental status and in patients with blunt cervical trauma with an abnormal neurological examination. Initial heparinisation can prevent arterial thrombosis and neurological deterioration.
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The prehospitaly initiated endotracheal intubation and controlled ventilation, is especially in multi-system-trauma cases, recognized to be the "gold standard". Thus especially in view of the increasing demands being placed upon the quality of prehospital emergency treatment in general, the quality of such prehospital induced ventilation, is becoming of increasing importance. Thereby we must take into consideration the limited possabilities, which are afflicted with a high degree of uncertainess, which we have at our disposal to effectively evaluate the efficiency of emergency ventilation. The purpose of our study within a collective of severely traumatized patients, was to determine the quality of prehospitaly induced ventilation with regards to the adequacy of oxygenation and ventilation and as a result of our findings, to identify areas for procedural optimization. ⋯ In summary it is evident, that as a rule, even very severe traumatized patients can prehospitaly be adequately oxygenated and that such oxygenation can with the assistance of pulse oxymetric monitoring be effectively controlled. Remaining problem is the emergency physicians ability to evaluate and control ventilation. The prehospital determination of minute volume (MV) in accordance with the presently valid recommendation: MV = 100-150 ml/kg body weight, in the majority of trauma cases results in inadequate ventilation. The introduction of an objectifying monitoring method is therefore urgently required.
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The case of a closed elbow dislocation with complete rupture of the brachial artery and its veins is described. This combination of injuries is rather rare and only 25 cases were found in the literature. The sharp lesion of the vessels was remarkable, probably due to the edge of the distally ruptured capsule. Immediate revision with suture of the vessels and an immobilization for three weeks gave a good result.
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Operative repair in ruptures of the extensor mechanism of the knee joint mostly requires additional external or internal fixation by plaster, transfer of tendons or encircling wires. Reconstruction of initially undiagnosed ruptures has to solve the problems of fixed proximal or distal migration of the patella and tendenous shortening. ⋯ During this period as well as a post-operative protection this fixator enables patients to maintain motion of the knee joint and full weightbearing. This technique can avoid poor functional results caused by long periods of immobilisation and is helpful in patients with marked displacement of the patella and inability to manually reduce the patella distally when delayed repair is necessitated.