Der Unfallchirurg
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Fracture of the femoral neck is a common problem in elderly patients. In these patients with concomitant illness and medical complications the hip fracture is then often the reason for a long-term institutionalization with serious implications for the outcome. While the treatment of displaced femoral neck fractures Garden's stage III and IV is quite clear, the procedure for impacted or undisplaced fractures Garden's stage I or II is still the subject of controversy. ⋯ Between 1990 und 1992, 53 patients (42 female, 11 male) with femoral neck fracture in Garden's stage I (24 patients) or II (29 patients) were treated in our Department of Traumatology with 6.5 mm cancellous screws. In all case early mobilization and weight-bearing were allowed. In this prospective study the average follow-up was 14.3 +/- 2.1 months (range 8-20 months).(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Birth trauma as the cause of fracture of the distal epiphysis of the humerus. A case report].
The authors report on a case of fracture of the distal humeral epiphysis sustained at birth. This is extremely rare. The main problem in treatment of this kind of fracture is correct and timely diagnosis. ⋯ The treatment of the injury is conservative. Closed reduction and immobilization for 3 weeks in an above-the-elbow plaster cast is advised. The end-results have been very good in all published cases, as they were in the present case, in which the shape of the injured elbow corresponded absolutely to that on the healthy side, mobility was unrestricted and no growth disturbances were observed after 9 months.
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Between 1972 und 1993 a total of 68 patients were treated at the Department of Surgery of the University Clinic of Mannheim for peripheral vascular injury resulting from multiple trauma. The average age of these patients was 31.3 years, and most of them were male (88.2%; n = 60). The injured vessels were localized evenly in all the extremities: 31 patients (45.5%) presented with arterial damage of the upper extremity, and 37 (54.5%) showed lesions along the femoro-popliteal arteries. ⋯ The general amputation rate was 2.9% (n = 2). One patient died on the table of a torn off subclavian artery combined with multiple other injuries. Paresis of the plexus is a particular problem after vascular lesions of the upper extremity: in 22 patients (71%) paresis of the plexus persisted after successful vascular reconstruction (follow-up period between 3 months and 16 years, median time 3.45 years).(ABSTRACT TRUNCATED AT 250 WORDS)
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The objective of this study was to evaluate and compare the derangement of body homeostatis and the inflammatory response after different types of traumatological operations in patients with multiple injuries. These were determined in a total of 60 operations. The procedures comprised osteosynthesis of the femur (n = 28), the pelvic girdle (n = 11) the spine (n = 8), and facial and basal skull reconstructions (n = 13). ⋯ We conclude that a considerable inflammatory response and pronounced disturbance of body homeostasis follow traumatological operative procedures, varying in severity with the type of surgery. Several parameters allow quantitation of the surgical trauma and differentiation between different operations/regions. Further research should focus on the interrelationship between pre-existing preoperative inflammation and the additional trauma inflicted by surgery in patients with severe injuries.(ABSTRACT TRUNCATED AT 250 WORDS)
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The aim of this study was to investigate criteria in the preclinical and early clinical treatment which contribute to the development of posttraumatic multiple organ failure (MOV). In a retrospective study, 1112 primarily treated patients with multiple trauma and an injury severity > 20 on the Hanover Polytrauma Score (PTS) were investigated. The patients were classified according to Goris into groups with MOV (+MOV; 16.8%) and without MOV (-MOV). ⋯ In particular, more blood units and fresh frozen plasma were given in the first 24 h after trauma, possibly in association with the trunk injuries and the consequently increased hemorrhage. The mortality for all patients was 27.2%, in the +MOV group 60.4%. Posttraumatic MOV was the most frequent cause of death (37.5%), and the mean time of death after MOV was 16.7 days.