Der Unfallchirurg
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Between December 1986 and November 1995, 222 patients with 225 acetabular fractures were treated operatively by three surgeons in the Department of Traumatology and Emergency Surgery of the University Hospitals of the Catholic University of Leuven. Indications for surgery were unstable fracture, displaced fracture through the acetabular dome and fracture with intra-acetabular fracture fragments. There were 37.3% A-fractures, 49.7% B-fractures, and 13% C fractures according to the AO Classification. ⋯ During this 9-year period, changes have been made to the preoperative radiological examination carried out, the choice of operative approach and our policy on prevention of thrombosis prophylaxis and postoperative ossification. After thorough preoperative diagnosis and with a meticulous operative technique, it is possible to stabilise the vast majority of acetabular fractures through the three classical approaches. Because the fractures are relatively rare, their diagnosis complex and their surgical treatment difficult, specific training is essential for every acetabular surgeon.
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Damage to the respiratory system caused by inhalation of toxic products of combustion and the subsequent development of adult respiratory distress syndrome (ARDS) are the main lethal factors in burns patients. Treatment with exogenous surfactant is one of the therapeutic options. However, no clinical reports have yet been published about this therapy. ⋯ Intrabronchial application of surfactant by bronchoscopy during exhaustive conventional mechanical ventilation resulted in improved gas exchange with an increase in arterial O2 pressure (paO2); inspired O2 concentration (FiO2) was lowered and there was an improvement in lung compliance. Both patients survived this critical situation. We conclude that treatment with exogenous surfactant in postburn victims with ARDS is a promising therapeutic approach to improve the survival rate of these high-risk patients.
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Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in sport and play activities, e.g., a fall from gymnastics apparatus or a bike, or from popular sports items, such as skateboards or in-line skates. The injuries can be divided into pure dislocations of the joint and fractures of the distal humerus, proximal radius and ulna, or combinations of both. ⋯ Corrective measures are performed only in selected cases and after the growth plates are closed. Our own treatment regime is demonstrated using exemplary clinical cases of the different injuries and the results of a long-term follow-up study on sports injuries of the elbow in children. Errors in diagnosis and therapy, as well as possible complications, are pointed out.
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Comparative Study
[Advantages of the unreamed tibial nail in comparison with external fixator in treatment of grade 3 B open tibial shaft fractures].
Between 1987 and 1993, 41 grade 3B open tibial shaft fractures were treated with the unreamed tibial nail (URTN n = 22) or an external fixator (FIX n = 19). The method of treatment was left to the choice of the operating surgeon. Three below the knee amputations were performed, three patients died, and three were lost to follow-up. ⋯ The URTN group showed significantly better results regarding time to full weight-bearing (URTN 11 +/- 4 weeks; FIX 20 +/- 11 weeks, P < 0.01 M-W) Mann-Whitney Test, number of reoperations (URTN 1.04; FIX 2.89; P < 0.01 M-W), isolated bone grafting (URTN 3/22; FIX 8/19; P < 0.05 chi-squared), and average Karlström and Olerud score (URTN 30 +/- 4; FIX 26 +/- 5; P < 0.05 M-W). In all, 15/17 URTN patients and only 6/15 FIX patients achieved unlimited walking distance (P < 0.01 M-W). Time to bony union, infection, and nonunion were not significantly different between groups.
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Between 1972 and 1994 21 children up to 14 years old sustained complex pelvic trauma treated at the Trauma Department of the Hannover Medical School. Sixteen of the 17 survivors were followed at an average of 8.9 years. In 8 patients operative treatment of the disrupted pelvic ring (external or internal fixation) was performed; in 8 patients the treatment was conservative. ⋯ Despite this finding the pelvic outcome was rated good and excellent in 10 patients (63%), moderate in 1 patient (hypoplasia of the hemipelvis, and poor in 5 patients (31%) with severe pain or urogenital disturbances. The maximum ratings in social reintegration was given to 9 patients, a medium rating to 7 patients. All patients were socially integrated.