Der Unfallchirurg
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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.
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This paper describes experience acquired during the war against Croatia under improvised conditions at the Kutina War Hospital in the immediate vicinity of the first front lines. Over a period of almost 6 months a total of 701 soldiers and civilians, 546 of whom had been wounded by firearm missiles, were treated at the Kutina War Hospital, which has a capacity of 30-40 beds. As many as 87% of the injuries were due to mine, bomb or artillery shell shrapnel. ⋯ Amputations were performed in 10.4% of cases, including fingers and toes. Only 8 patients died during or immediately after surgery, corresponding to a very low mortality rate of 1.46%. The main prerequisites for successful treatment are a professional relationship to war surgery and its specific requirements, satisfactory technical equipment, and excellent organization of medical and non-medical services.
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Necrotizing soft tissue infections are a group of life- and limb-threatening infections. They are caused by aerobic and anaerobic bacteria occasionally in a synergistic polymicrobial combination. The literature describing necrotizing soft tissue infections is controversial and often contradictory. ⋯ Our results suggest that prompt recognition and treatment of necrotizing soft tissue infections are essential for the patient's survival. Often the full extent of the infections is underestimated initially, resulting in delayed surgical therapy. To control the rapidly spreading necrosis, early diagnosis and radical debridement of the affected tissue are essential and should be done without compromise, even if the affected limb must be amputated.
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Identification and extraction of penetrating cranial foreign bodies can cause problems in some cases. Small fragments localized deep in the orbit or cerebrum can be especially hard to detect. Severe bleeding and traumatized anatomy can make orientation difficult. ⋯ In a 21-year-old man 39 glass fragments were extracted from the left orbit. In a 36-year-old man a bone fragment was dislocated to the apex of the orbit directly under the optic nerve. Location and extraction were achieved without damage to the orbital structures with the help of the CAS system.
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To analyze the characteristics of hemodynamic parameters and cerebral dynamics, the courses of intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP) and PaCO2 were analyzed retrospectively in 29 patients with severe head injury, comparing periods before and after the ventilatory mode was changed from controlled mechanical ventilation to spontaneous breathing with continuous positive airway pressure. Measurements were done before and after changing of the ventilation. ⋯ While changes of MAP did not reach significant levels in either group, concomitant changes in CCP appeared in group II (67 +/- 2 mm Hg to 60 +/- 2 mm Hg). Based on the observation of relatively high incidence of ICP increases and deterioration of CPP during weaning from ventilator, it is recommended that continuous ICP monitoring should be continued.