Der Unfallchirurg
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The expert assessment of injuries due to criminal offenses is of great importance for any later legal proceedings. The initial medical examination of severe lesions is very often performed by clinicians; however, and when it which must be surgically shows that immediate surgical treatment is indicated later forensic interpretation is only possible if precise records documenting the nature of the wounds have been kept by the first doctor involved. The most frequent patterns of these injuries and relevant forensic aspects are discussed.
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In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing. Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect. Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria. ⋯ This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue. Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique. When the correct technique was applied the infection cleared up.
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Between 1982 and 1990, twenty fractures of the base of the fifth metatarsal were treated operatively and followed up for a mean of 4.5 years (range: 1-9 years). All patients were evaluated clinically, roentgenographically and with kinetic gait analysis. A scoring system was used to record and evaluate the clinical and radiological data. ⋯ Its cause lies in the initial pain after the trauma and during the postoperative care and sometimes continues even after the cessation of pain. Kinetic gait analysis allows quantification of asymmetry of gait and clinically non-visible load disorder. Therefore, pain and established gait asymmetry are clinically relevant in such patients because they can be treated specifically.
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Over 2 years, 16 patients with a total of 23 lesions of the craniovertebral junction and the upper cervical spine were treated. Clinically important aspects of diagnosis and classification are outlined. ⋯ Surgery is frequently indicated, especially in elderly and polytraumatized patients. In addition, 2 cases of atlanto-occipital dislocation are described: 1 of these patients survived for 5 days after early atlanto-occipital fusion.
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The extent of neurological lesions following an injury of the pelvic ring is often not initially recognized, as interest is then focused on the treatment of the pelvic ring fracture. Once the fracture has healed, the patient suffers from the sequelae of the neurological injury. Our series of 323 pelvic ring injuries includes 161 sacral fractures and 12 complete disruptions of the sacroiliac joint. ⋯ In 6 patients the sphincter function was damaged. Recovery was dependent on the localization of the sacral fracture. If the fracture traversed the sacral canal, no neurological improvement was noted.