Der Unfallchirurg
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Case Reports
[Combined total endoprosthesis implantation in bilateral femoral neck fracture with osteogenesis imperfecta tarda].
Osteogenesis imperfecta tarda is a hereditary disease with an insufficiency of osteoblasts caused by a collagen disorder, insufficient formation of osteoid and an impediment of periosteal bone formation. This leads to increased fragility of the bones and, as a consequence, to the risk of fractures. We report a simultaneous, bilateral medial femoral neck fracture, caused by a cerebral cramp attack. ⋯ We implanted a cemented total endoprosthesis on each side in just one operation. There were no complications in the intra- and postoperative course. A walking aid gradually increased the patient's mobility so that he could be discharged on the 21st postoperative day.
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Bite wounds have a special position in traumatology because of their high complication rate compared to similar soft tissue wounds caused by other reasons. The authors report in a retrospective study about the results of 525 patients with bite wounds. In 98 (18.7%) cases the wounds were sutured primarily after surgical revision when there was no sign of infection. ⋯ The infection rate after primary suture was 10.2% (3.2% at the face, 18.8% at the upper extremity and 25% each in the hand and the lower extremity). The average time period from the trauma to the first medical treatment amounted to 11 h in the infected wounds and 2 h in the non-infected ones. Cat bites became infected in 37.5%, dog bites in 14.9%.
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With further improvements of the prehospital rescue systems, an increasing number of patients with extreme injuries such as traumatic hemipelvectomy are admitted to trauma centers alive. The accepted definition of traumatic hemipelvectomy is: unstable ligamentous or osseous hemipelvic injury with rupture of the pelvic neurovascular bundle (open or closed integuments). A review of the literature up to 1995 yielded on 48 surving cases with such an injury. ⋯ Limb-saving procedures endanger the patient's life. Early and frequent second-look operations minimize wound healing problems. Early psychological support for the patient and family is advantageous for personal well-being and social reintegration.
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Quality of life (QoL) was analyzed in 73 patients with severe multiple trauma (PTS > or = 40 patients) between 1 and 13 years after injury. QoL was assessed by the Aachen Longtime Outcome Score (ALOS), the Spitzer Index (SI) and individual self-assessment. The patients were asked about further social, financial, psychological and physical items. ⋯ The rate of patients who returned to work (69%) was similar to other multiple trauma series, including series with less severe injuries. The reasonable long-term outcome even after severe multiple trauma seems to justify the enormous staff and economic expense required to manage these patients. Further improvement in QoL may be achieved by professional psychological support and early fracture treatment.