Der Unfallchirurg
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Primary intramedullary nailing of femoral fractures is well known to increase the risk of pulmonary complications, especially in multiple-trauma patients with severe thoracic injuries. Aim of this study was to investigate the influence of primary plate osteosynthesis of femur fractures on major complications after trauma. This retrospective study based on the records of 325 multiple trauma patients (Injury severity score ISS > 18, no lethal brain injury, age 16-65). ⋯ Primary plate-osteosynthesis of femur fractures did not increase lethality or incidence of pulmonary complications in patients with or without severe thoracic injuries. Also complication rate after primary plate-osteosynthesis was less compared to published results after intramedullary nailing. For this, primary plate-osteosynthesis is recommendable in case of multiple trauma with thoracic injuries.
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Intraoperative ultrasonography is recommended for operations on the thoracolumbar spine to complement the information provided by standard X-ray, intensifier screen or myelography. There are no unanimates opinions concerning the impaction or exeresis of these fragments. The aim of this study was to show the advantages of intraoperative ultrasonography for anatomic determination and control of the maneuvers used. ⋯ The tilting before the impaction and the state of the overlying intervertebral disk represent essential factors for failures. Ultrasonography is better than intraoperative myelography. Nevertheless, it still needs to be complemented by intraoperative profile X-rays and a very precise preoperative CT scan of the intervertebral disk lesions analysis of complicated cases (fragments with residual pedicular attachments--type A 3.1.2.; T-like fractures--type A 3.2.1.).
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When patients with gunshot injuries are medically treated, it is also important to examine the wound itself to achieve further information concerning the distance and direction from where the bullet was fired. Besides that, it must be remembered that the bullet does not necessarily penetrate the target in a linear direction, but there can be various curves and angles in the bullet channel and subsequently adjacent organs injured.
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The purpose of this paper is to outline the treatment protocol for the first time traumatic anterior shoulder dislocator, with options including conservative, arthroscopic and open surgical treatment. Regarding the subclassification of the first time traumatic anterior dislocater, it is imparitive to differentiate between the unidirectional dislocator with and without hyperlaxity. This subclassification takes into account the structural quality of the stabilizing ligamentous structures of the glenohumeral capsule. ⋯ Surgical stabilization of primary anterior traumatic dislocation is indicated if the following strict criteria are met: adequate trauma, no self reduction, unidirectional instability without hyperlaxity, Hill Sachs lesion, age below 26 years, high level of sport activity and the special situation of luxatio erecta. Post primary stabilization is indicated for persistent subluxation, subjective instability or demonstrated pathologic instability tests. Rotator cuff tears due to traumatic dislocation in the elderly population require surgical repair.