Der Unfallchirurg
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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.
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Comparative Study
[Results of primary unreamed tibial nailing of tibial fractures with severe open or closed soft tissue injuries].
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. ⋯ More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.
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We measured the ventilatory pattern and additional work of breathing (WOBadd) at three different levels of inspiratory pressure support [IPS 5, 10, 15 mbar above positive end-expiratory pressure (PEEP)] and in a new ventilatory mode, automatic tube compensation (ATC), in nine operative patients without lung injury nine patients ventilated for several following acute respiratory insufficiency (ARI). In ATC, endotracheal tube resistance is compensated automatically by means of closed-loop control of the calculated tracheal pressure. Pressure support in this mode, i.e. airway pressure above PEEP, is equal to the actual flow-dependent pressure drop across the endotracheal tube (ETT). ⋯ These two patients were not extubated because they were dependent on an FIO2 > 0.5. Our results strongly indicate that ventilatory dependence in ARI patients may be caused by the ETT rather than by mechanical dysfunction of the lung. ATC is a very helpful mode to use in distinguishing between ventilatory failure caused by ETT and real ventilatory dependence.