Der Unfallchirurg
-
With the exception of fracture dislocations following fractures of the ankle joint and talus, dislocations in the talus are very infrequent injuries. They pose a lot of management problems: soft-tissue damage in open and closed dislocations, imperfect reduction caused by osteochondral fragments, recurrent instability, and aseptic necrosis of the talus, which is greatly feared. ⋯ In accordance with the results in the literature in the last few years, reconstruction of ligament damage and joint debridement were carried out in four cases and the results described. One case of open total dislocation of the talus is presented, which was complicated by a fracture of the calcaneus without traumatic avascular necrosis.
-
The influence of trauma and hemorrhagic shock on the non-specific immune system has been pointed out in various experimental studies. Other investigations have also been able to find a relationship between these changes and a higher incidence of post-traumatic complications in the form of organ failure. Our aim was to demonstrate the potential changes in the cellular defense system in a clinical study on multiple trauma patients. ⋯ We were able to demonstrate a significant disturbance in immune function in multiple trauma patients with post-traumatic complications compared to patients with a normal clinical course after injury. Disturbances in the PMNL function (seen after 4 days) were found to appear after the RES disturbances. Systemic interaction between these two phagocytic systems cannot be excluded and further investigation is therefore required.
-
Case Reports
[Traumatic cerebral infarct in multistage dissection of the extracranial internal carotid artery].
A 26-year-old motorcyclist bounced against the side of a turning car with about the speed of 70 km/h. On admission to the clinic, he was awake with stable circulation. The main injuries were contusion of the chest with pneumothorax on the right side, blunt trauma of the abdomen without hematoperitoneum, and a fracture of the right femur. ⋯ The intracranial portion was closed by expanding thrombosis. These lesions are of indirect origin and are the result of vast overstretching of the arteries by the head turning over the edge of the top of the car. The victim was found at once after the crash with his body hanging the deeply dented side of the car and the head (with the helmet on) on the roof.
-
Using a case report as an example, we report on the special features involved in fracture of the odontoid process in childhood. Although fractures of the cervical spine are very rare in children, this is the most common form. ⋯ Conservative therapy is indicated if the diagnosis is correct. There is a detailed discussion on the embryonal and radiological peculiarities of this age group.
-
According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. ⋯ When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).