Der Unfallchirurg
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Open reduction followed by internal fixation is the method of choice after unstable pelvic ring fractures and gives better results than either conservative treatment or external fixation alone. Even after anatomic reconstruction of the pelvic ring, however, a high incidence of late sequelae is reported, especially after C-type fractures (translational instability). The purpose of the study reported in this paper was evaluation of a new scoring system for the rating of the long-term outcome after pelvic fractures. ⋯ Even after anatomical reconstruction of the pelvic ring in C-type fractures (3 points) 20% of the patients were clinically rated as "poor" (1 point). The study showed that anatomic reconstruction of the pelvic ring is an important factor in a good or excellent clinical result, but even when this goal is met, other parameters (sacral fractures, SI dislocations, primary neurological/urological injuries) can lead to an unsatisfactory result. The new rating system is comprehensive and easy to apply and allows a clear differentiation of typical late sequelae after pelvic injuries; it will therefore be used for further long-term studies.
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Between 1 January 1992 and 15 March 1994 25 patients with compartment syndromes of the lower limb were treated by the vacuum-sealing technique (VS). Ten out of 25 patients had multiple injuries. Eight compartment syndromes were located in the thigh, 14 in the lower leg and 3 in the foot. ⋯ The wounds were either closed by secondary suturing (n = 20) or by skin grafts after partial closure of the wounds by suturing (n = 5). One patient developed a superficial wound necrosis, which healed spontaneously without invasive surgical treatment. In 52 intraoperative swabs of the wound surface there was bacterial growth in five bacteriologic specimens, but there were no clinical signs of infection.
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Multicenter Study
[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group].
Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). ⋯ Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.
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Review Case Reports
[Acute isolated ventral dislocation of the head of the fibula].
We present the case of a 19-year-old soccer player who had sustained a valgus, external rotation trauma to the flexed knee with traumatic anterolateral dislocation of the proximal tibiofibular joint and concomitant partial peroneal nerve palsy, which went away within a few days. We discuss the clinical features and treatment by temporary screw fixation of the proximal tibiofibular joint, as well as the results in the literature where predominantly conservative treatment is reported.