Der Unfallchirurg
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Standard neurosurgical management demands prompt evacuation of all extradural hematomas to obtain a low incidence of mortality and morbidity. In selected cases some authors have suggested that moderate hematomas can be managed conservatively without risk to the patient and with a normal outcome. The goal of this study was to analyze the differences in preoperative clinical parameters between a group of acute and a group of chronic extradural hematomas (chronic extradural hematoma was defined as a delay of more than 72 h from the accident to diagnosis). ⋯ In the group of acute extradural hematomas, 62% of patients had a Glasgow Coma Score of less than 8 and 47% had pupillary dilation. In the group of chronic extradural hematomas, moderate clinical symptoms were found, with headache and discrete psychological changes most common. Eighty percent (80%) of the patients had a Glasgow Coma Score of greater than 13 and no patients had pupillary dilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ultrasound examination has become an important diagnostic method in muscle and tendon injuries. In addition dynamic ultrasound examination allows evaluation of the course of healing from various aspects. ⋯ As complement to clinical examination, ultrasonography enables appropriate adaptation of the therapy concept to the course of healing. In the hands of experienced operators, ultrasound examination has reached a high level of sensitivity and specificity in these injuries and can justifiably be routinely performed.
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Fractures of the sternum often are not discernable on X-rays. The standard lateral X-ray of the sternum may allow the diagnosis. The aim of this study was to find out whether sternal fractures can be visualized by ultrasound. ⋯ We show that sternal fractures can easily be diagnosed by means of ultrasound, and because of an interruption of the cortical reflex, possibly better than on radiographs. We also wanted to show whether sonography, which is in widespread use for the diagnosis of blunt abdominal trauma, can also be used in an emergency situation of blunt thoracic injury (e.g. seat belt injury). In 16 cases of fractures of the sternum already diagnosed by X-ray, an examiner unacquainted with the X-ray results was able to locate and diagnose all fractures by ultrasound within 1 min.
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Based on the results of a retrospective study of 67 patients who had diagnostic and surgical arthroscopy of the elbow from 1977 until 1990, we present the technique, results, complications, and indications for elbow arthroscopy. The average age of the patients was 26 years (range: 11-59). At follow-up, the patients were examined both clinically and radiologically. The results were scored according to Figgie's score, which contains the criteria of pain, function, power, and range of motion. The overall score increased significantly from 61.6 preoperatively to 85.3 postoperatively. The age of the patient did not influence the results. However, patients who were laborers had a poorer outcome than the others. Patients with a preoperative pain of 4 months to 2 years had better results than patients with a preoperative course of more than 2 years. With respect to the criteria (pain, function, power, range of motion), the pain improved significantly, whereas the other parameters showed no significant improvement. Breaking the diagnosis down into three categories (specific diagnosis, degeneration, unclear diagnosis), only patients with a specific and clear preoperative diagnosis showed significant improvement. The high number of neurological complications was especially striking. ⋯ According to our results, patients with loose bodies, early rheumatoid arthritis, and joint infection seem to be good candidates for elbow arthroscopy. However, patients with severe degeneration or patients with unclear preoperative diagnosis will rarely benefit from this procedure. In general, the patients' pain can be treated effectively, but range of motion or power will not increase after elbow arthroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Based on the results of a prospective trial to establish the value of routine ultrasound examination in cases of polytrauma or blunt abdominal trauma, we report on our standard ultrasound examination and computer assisted documentation of the findings. Between May 1988 and December 1990 we examined 233 patients with polytrauma or blunt abdominal trauma. ⋯ We found a sensitivity of 100% and a specificity of 99.5% for the ultrasound findings and a sensitivity of 80% and a specificity of 100% for the abdominal lavage. We conclude that ultrasonography should be the first diagnostic procedure used in the emergency room in cases of polytrauma and blunt abdominal trauma.