Der Unfallchirurg
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Case Reports
[Insidious rupture of the Achilles tendon after ciprofloxacin-induced tendopathy. A case report].
A 45 years old female runner developed a bilateral tendinopathy of the Achilles tendon after repeated antimicrobiotical treatment with ciprofloxacin. One month later the right Achilles tendon ruptured without any sudden pain. MRI revealed degenerative changes of the left Achilles tendon; on the right side the tendon was ruptured with a dehiscence of 4 cm between both ends of the tendon. ⋯ This finding differ from findings in non drug induced tendinopathies. After antimicrobiotical treatment with ciprofloxacin the side effect of a tendon disorder must be considered. The impairment of the tendon may be as strong that a tendon rupture may occur at daily living activities without any typical clinical symptoms.
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On 90 patients with 93 unstable fractures of the thoracic spine and the thoracolumbar junction we treated by a minimal invasive procedure between may 1996 and april 1998, in 46 patients an endoscopic splitting of the diaphragm was performed. The diaphragma was dissected at its attachment at the spine and the adjoining costal base. After partial corporectomy and discectomy, a tricortical bone graft has been inserted. ⋯ Controlling the postoperative results a complete closure of the incision was documented by X-ray and CT-scan. There was no conversion to the open procedure or postoperative infection. Splitting the diaphragma opens also the thoracolumbar junction to a minimal invasive treatment and stabilization of fractures.
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Intubation and Positive End Expiratory Pressure Ventilation (PEEP) is a well established therapeutic strategy for impaired lung function, particularly following blunt chest trauma. Complications of this regime are however also well known and pose the question why non-invasive forms of respiratory assistance such as Continuous Positive Airway Pressure (CPAP) have only gained minor popularity. In a prospective study, 30 patients who had suffered blunt chest trauma were treated with CPAP administered by mask. ⋯ In comparison with the former standard method of treatment the average ICU stay was dramatically reduced, principally due to not having to gradually wean patients from ventilation and sedation. Other positive benefits include normal communication and feeding with active early mobilisation leading to faster recovery, both physical and psychological. We conclude that non-invasive respiratory techniques should be used more frequently and recommend further studies are undertaken to define the indications.
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A 3-year-old child was trapped under the heavy load of a forklift truck and sustained an unstable pelvic ring fracture (Tile type C) with complete SI disruption, disruption of the public symphysis and external rotation injury of the contralateral SI joint. An immediate internal fixation was performed, exposing the SI joint and the public symphysis simultaneously. ⋯ The implants were removed after 4 months. Clinical and radiological follow-up after 12 months showed no signs of maldevelopment of the pelvic ring.