Der Unfallchirurg
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During the war period 1991-1992 in Croatia, ten wounded children (16 years of age or younger) with war injuries to the brain were admitted to the Division of Neurosurgery, Osijek Clinical Hospital. Six of them had been wounded by shrapnel and four by pistol or rifle bullets. All but one were managed surgically (i.e. by craniotomy). ⋯ Five of the wounded (four injured by shrapnel and one by bullets) had associated injuries (fractures of the leg bones, eye lesion, amputation of the right leg) which influenced morbidity, and in one case mortality. Children wounded with shrapnel had brain edema on admission to hospital. Our experience indicates that the thermal effect from heated shrapnel, as well as velocity, mass, size and shape of the shrapnel, could be an additional factor for the development of severe brain edema.
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Fractures of the distal third of the clavicle tend to develop delayed union or nonunion when treated conservatively. Correct diagnosis of fracture instability and/or associated lesions of the ligamentous structures of the acromioclavicular joint is mandatory for adequate fracture treatment. When classical radiographs fail to demonstrate instability, stress roentgenographs of both shoulders are indicated. ⋯ For fractures of the distal clavicle, good results can be achieved when the instability is recognized and adequately treated. The association of a distal clavicular fracture and an acromioclavicular ligament disruption should be added as a separate subtype in the existing classification of distal clavicular fractures. PDS banding is a valuable alternative for fractures with small peripheral fragment or associated acromioclavicular disruption.
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These guidelines reveal a consence of the presidency of the "German Society for Trauma Surgery" (Deutsche Gesellschaft für Unfallchirurgie) concerning: structure of prehospital and hospital care for trauma patients, principles, structure, resources and organisation of prehospital trauma care, criteria qualifying a hospital for trauma care and reconstructive surgery, qualifications of trauma care personnel, structure and necessary for emergency rooms and intensive care units, documentation and quality evaluation in trauma patient care.
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Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skin-traction, flap surgery, bone shifting, etc.). ⋯ Previous limb shortening to close bone defects, with a lengthening later in a "healthy" region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.
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In this retrospective study we present the long-term results in 89 patients who underwent anterior interbody fusion of acute cervical spine injuries in our institution between 1972 and 1983. There were 23 dislocations, 50 fracture-dislocations and 16 burst fractures without significant posterior lesions. Only 20 patients showed no neurologic symptoms. ⋯ With regard to the early stage of the procedure of anterior interbody fusion for traumatic lesions this study shows promising data with high fusion rates and low morbidity, especially for the combination with plate fixation. Further improved within the last 12 years this method offers an excellent alternative for operative treatment of most acute lower cervical spine injuries. Using devices which are not angle stable, special attention should be given to precise bicortical screw fixation.