Der Unfallchirurg
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Case Reports Comparative Study
[Significance of the intervertebral disk in failed reduction of surgically stabilized fractures of the truncal spine].
In 112 patients with a traumatic fracture of the thoraco-lumbar spine operatively treated with different dorsal stabilization techniques from 1983 to 1988, the frontal and sagittal planes of the spine were analyzed over a follow-up period of 5 years. In 14 cases Harrington instrumentation was used, in 81 cases, transpedicular plates, and in 17 cases, a fixateur interne. With regard to the frontal plane the overall loss of correction was 2.3 degrees: with Harrington stabilization 0.7 degrees, with fixateur interne 2.6 degrees, and with plate fixation 3.7 degrees. ⋯ The cause of deterioration was destruction of the invertebral disc in 66% of cases, and angulation of the fractured vertebral body in only 33%. Only in the first 2 years after operation was loss of reposition in the vertebral body observed. In conclusion, stabilization should be complemented by removal of the damaged adjacent disc and intercorporeal autogenous bone grafting from the dorsal or ventral approach.
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Multicenter Study
[2 years results of conservative therapy of unstable fractures of the pelvic ring in children].
Unstable fractures of the pelvic ring in children are usually treated conservatively. The results of this therapy were evaluated retrospectively in 17 children who had been under 13 years old at the time of injury. All but 4 of the children had additional injuries. ⋯ Only fracture healing in a near-anatomical position can ensure good clinical results in pelvic fractures in children. Considering the results presented here, operative reduction has to be recommended when reduction cannot be achieved by conservative means. However, there is no proof that open reduction and internal fixation provide better results than conservative therapy in unstable pelvic ring fractures in children.
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Review Case Reports
[Fracture and dislocation fracture of the os capitatum. Review of the literature and case report].
Capitate fractures are serious and rare carpal injuries. A case of a closed, isolated capitate fracture is presented. The largest fragment of the capitate, which was fractured at its waist, was dislocated with the wrist twisted in an ulnodorsal orientation. ⋯ The excellent functional result (according to the modified evaluation scale of Pechlaner/Beck) obtained after 15 months is demonstrated. Diagnosis and subsequent therapy should be as aggressive as in the case of scaphoid fractures. Different modalities and possible complications of an operative treatment are discussed.
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Comparative Study
[Surgical outcome after severe craniocerebral trauma in childhood and adulthood. A comparative study].
During a period of 15 years 1123 patients were operated on for severe head injury in our Department of Neurosurgery. We evaluated 936 patients (83%) on the basis of the Glasgow coma scale and the Glasgow outcome scale and allocated them into four groups by diagnosis and also grouped them by age. The 170 patients in the groups of children and adolescents (15%) were compared with the adults, and the features characterizing the causes of the accidents and the prognosis were analysed. ⋯ The postoperative results after severe head injuries in children and adults were the same as in the group with an initial rating of 3-5 points and 9-15 points on the Glasgow coma scale. Only the group of children with 6-8 points on the Glasgow coma scale on admission had better results than the adults. The reason for this might be the greater plasticity of the brain in childhood.
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This is a retrospective study of 56 abdominal stab wounds analysed with reference to aetiology, pattern of injury, diagnostic and therapeutic procedures and indications for surgery. Indications for mandatory laparotomy were a manifest haemorrhagic shock (n = 20), evisceration (n = 13) and persisting presence of a weapon in the abdomen (n = 2). All patients who did not undergo immediate surgery were observed closely in repeated physical examination, in some cases complemented by ultrasound examination or peritoneal lavage. ⋯ As a result of this selective approach, 31 patients underwent surgery immediately, 21 patients within 4 h and 4 patients more than 4 h after the initial assessment. The unnecessary laparotomy rate was 10.8%. The mortality rate was 3.5%, but in no case did death result from the selective approach.