Der Unfallchirurg
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High-velocity trauma now often results in complex injuries to the upper extremity, and especially the elbow joint. These can lead to both an enormous reduction in the range of motion of the shoulder, elbow and wrist joints, in severe cases with complete loss of upper extremity function. A complex injury is defined as a fracture and/or dislocation of the elbow in association with (1) a serial injury of the upper extremity, (2) a severe soft tissue trauma, or (3) concomitant injury to vessels or nerves. ⋯ The most severe injury in combined trauma of the upper extremity is a serial fracture in the elbow region. Such fractures are often associated with vascular and nerve lesions. Even with primary fracture stabilization and early soft tissue management these often end with significant functional deficits.(ABSTRACT TRUNCATED)
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The authors report a case of foot trauma produced by a piece of the lawn mower blade, which was fired projectile-wise from the machine while it was in operation. At hit the calcaneous and remained trapped in the bone. The wound healed after removal of the foreign body, wound debridement and systemic and local antibiotic prophylaxis. In the professional literature available, no report has been found on a missile injury produced by a piece of rotating lawn mower knife.
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During the period from 1 May 1990 to 30 November 1994, a total of 62 humeral shaft fractures were treated in the Department of Traumatology of the University of Bonn. In 42 instances the fracture was internally stabilized primarily, while in 13 instances the humeral shaft fractures were treated according to a regimen including primary stabilization, usually in an external fixateur, soft tissue reconstruction and delayed open reduction and internal fixation using an AO plate. The delayed stabilization was carried out 9.1 days, on average, after the injury. ⋯ All these neurological deficits resolved by the 6th postoperative day. Bony union was achieved after 16.2 weeks. If the surgeon adheres to the proper indications for open reduction and internal fixation, the compression plating of the humeral shaft fracture is a viable alternative to other forms of stabilization.
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Hypothermia is a frequent event in trauma patients and appears to be related to posttraumatic organ dysfunction, although in elective surgery hypothermia is known to prevent ischemia reperfusion injury. Retrospectively, we analyzed data of 641 trauma patients treated in our institution between 1988 and 1993. At hospital admission the core temperature (cT) was > 34 degrees C in the majority (64%) of all patients, < 34 degrees C in 23.6% and < 32 degrees C in 12.4%. ⋯ It also appeared that hypothermia is not an independent prognostic factor for posttraumatic lethality. The different effects of hypothermia in trauma and elective surgery may be due to a lack of energy-storing phosphates such as adenosine triphosphate (ATP). Ongoing investigations will identify the role of ATP in trauma-related hypothermia.