Der Unfallchirurg
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Case Reports
[Elbow dislocation with fracture of the coronoid process and comminuted fracture of the radius head].
In fractures of the elbow with an associated fracture of the coronoid process, the size of the coronoid fragment determines the stability of the joint. A diminution of the arch of the incisura semilunaris by about 30 degrees causes instability of the elbow. ⋯ A suitable fragment of the head of the radius is used to reconstruct the coronoid process. The stability achieved allows early functional postoperative treatment with a good range of movement at the elbow joint.
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Compartment syndrome in the thigh is an uncommon condition. Most of the patients have multiple injuries. The main etiological factors are ipsilateral fractures of the femur and isolated severe soft-tissue injuries following blunt trauma. ⋯ Dermatofasciotomy does not lead to severe complications. In the follow-up there is no functional loss or neurological deficit. The indications for decompressive fasciotomy should be broad.
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Only a small number of cases of compartment syndrome in the upper arm has been reported in the literature. The authors have reviewed 14 patients with 14 cases of compartment syndrome treated at their institution from 1980 to 1988. In the majority of cases in this series, compartment syndrome was caused by blunt, high-energy trauma. ⋯ In this series, 2 patients died of their injuries and three arms had to be amputated. At final follow-up after an average of 45 months (range 11-91 months) the functional result was dependent mainly on the severity of the associated injuries. Patients with isolated compartment syndrome had full recovery of upper limb function.
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Between 1973 and 1988 50 patients with injuries of the popliteal artery were treated at the Medical School of Hannover University. While 26 patients with dislocations of the knee joint had mild soft tissue injuries, most of the 24 patients with periarticular fractures of the tibia and/or femur showed excessive soft tissue damage. In both groups 11 patients who were admitted with prolonged ischemia had to undergo amputations. ⋯ Moreover, all patients with ischemia of more than 6 h duration required fasciotomy. It can be concluded that fasciotomy will probably be necessary in patients with injuries of the popliteal artery and (a) severe soft tissue damage of the thigh and/or lower leg with compartment pressure of more than 30 mmHg; (b) ischemia of more than 6 h duration; (c) combined injuries of the popliteal vein and artery; (d) reconstruction of severely injured extremities. In general, fasciotomy should always be considered after reconstruction of the popliteal artery.
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In a limited number of surgically treated patients with blunt trauma to the internal carotid artery (ICA), intimal lesions were found at the intersection of the ICA with the hypoglossal nerve (CN XII). Therefore, these clinical findings were investigated in an anatomic study. In two-thirds of these cases, the congenital "anomalous" relationship of ICA and CN XII caused a strangulation phenomenon during extreme turning manoeuvres of the head and neck. On the basis of our clinical intraoperative findings, anatomic studies und reports in the literature, a further mechanism of vascular injury is suggested in this area.