Der Unfallchirurg
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The influence of intermittent prone positioning on pulmonary gas exchange and parenchymal densities was investigated in ten patients. Three patients fulfilled the criteria of "severe ARDS"; seven patients had moderate lung injury as documented by the "lung injury score" (LIS). Nine out of ten were trauma patients and had an average injury severity score of 32.3. ⋯ In moderate lung injury the LIS improved 0.5 (0.25-1.0) points. In lung computerized tomography, we observed the disappearance of posterobasal densities. Repeated prone positioning may therefore be used in ARDS patients as well as in patients with moderate lung injury.
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In an 8-year period, from 1985 to 1992, 89 children presenting with a supracondylar humeral fracture were treated at the Department for Traumatology, Philipps-University, Marburg. All dislocated fractures (n = 48) were treated surgically. The majority (n = 34) of dislocated fractures were reduced open by a radial and an ulnar approach and subsequently stabilized using crosswise introduced K-wires. ⋯ In these fractures, we perform closed fracture reduction and K-wire stabilization. Type C fractures are fractures with rotational deformity, fractures dislocated in a frontal plane and fractures dislocated in a saggital plane with loss of cortical bony contact between proximal and distal fragments. Type C fractures should be reduced open by both a radial and an ulnar approach and subsequently stabilized using K-wires, introduced crosswise.
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Snowboarding is increasing dramatically in popularity in Switzerland as well as other countries. Work aimed at improving the design of the boards and of the boots and bindings has also increased rapidly during recent years. Most injured snowboarders are fit young men and boys who describe themselves as beginners and have had a minimal amount of instruction at an officially approved training centre. ⋯ Falling forward on the slope was the major mechanism of injury (80%), and torsion the next most frequent (20%). Snowboarding injuries were sustained most often on ice and hardpacked snow, compared with soft powder snow for alpine skiing injuries. Appropriate preseason conditioning, snowboarding lessons from a certified instructor, appropriate selection of rigorously tested equipment and use of protective devices are the main steps that must be taken to prevent injuries.
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The rate of pediatric equestrian injuries is relatively low, but the severity of injuries is greater than in many other pediatric sport activities. In a 4-year period the charts of 109 patients up through the age of 15 years, who were admitted for equestrian-related injuries were reviewed. Falls from horses are the most frequent cause of injuries and responsible for their anatomic localization and type of injury. ⋯ Forty percent of all injuries were fractures, 72% of which were fractures of long bones. The circumstances surrounding the accident and mechanisms of these injuries were analyzed. Effective safety measures such as improved equestrian helmets and adequate training in dealing with horses could reduce the risk of injuries.
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The evaluation of 174 humeral shaft fractures treated operatively in our institution and a literature review are used to illustrate the indications for operative treatment. For some indications, the authors prefer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the advantages of this method, making it an alternative to plating and even to bracing. ⋯ Closed fractures without concomitant injuries can generally be managed conservatively. We have treated 84 of these fractures with Hackethal's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).