Der Unfallchirurg
-
The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation. ⋯ A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.
-
Review
[Posttraumatic stress disorder : Risk factors, phenomenology, early recognition and management].
Posttraumatic stress disorder is characterized by the symptom levels intrusion, avoidance and hyperarousal as a reaction to an exceptionally threatening event. It is a well-investigated and well-treatable mental condition; however, the frequently accompanying disturbances in sleep, cognition, affect and especially avoidance behavior represent substantial hurdles in the trauma surgery treatment as well in occupational reintegration. Basic knowledge about risk factors and the clinical phenomenology also enable early identification by the primary trauma surgeon or the accident insurance consultant (D-physician) and if necessary to initiate a qualified psychotraumatologically founded treatment.
-
The reconstruction of large osteochondral defects is still a challenge in musculoskeletal surgery. Fresh frozen allografts are a frequently used resource for the treatment of such tissue defects. Furthermore, 3D-printed models enable multiple options in the preoperative planning and intraoperative adaptation of the allografts, so that healing is optimal and the best functional outcome for the patient is achieved.
-
Priapism is a painful erection of the penis lasting for more than 4h and is independent of sexual stimulation. It represents a urological emergency and necessitates rapid treatment. Etiologically, approximately 20% are caused by drugs, 50% are a combination of hematological diseases (e.g. sickle cell anemia), leukemia, injections in the corpora cavernosa, paraneoplastic processes and neurological or infectious causes. ⋯ Priapism as a result of traumatic intracerebral hemorrhage has so far rarely been described. This article presents the case of a 48-year-old male patient who presented to the emergency department with a traumatic subarachnoid hemorrhage. During the hospital stay the patient suffered from low-flow priapism, which was initially punctured and ultimately operatively treated.
-
With the exception of the relatively frequent fractures of the scaphoid bone, isolated fractures of individual carpal bones are rare. Because these injuries are uncommon and because of the complex anatomy and function of the carpus, treatment of carpal bone fractures can be challenging. ⋯ Small posttraumatic alterations of the precisely aligned carpal structure can cause chronic pain and functional impairment. Therefore, if a wrist fracture is suspected a thorough clinical examination and appropriate differentiated imaging is always necessary, at the end of which a fracture can be excluded or an appropriate conservative or surgical treatment is initiated, with the aim of restoration of carpal anatomy and function.