Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Oct 2007
Diagnosis, Timing and Treatment of Cervical Spine Injuries in Polytraumatized Patients.
Treatment of polytrauma patients has been discussed extensively during the past decades. Management in the prehospital phase, on admission, and in the early postoperative/ICU-period has to refer to injury severity, priority of injuries, and likelihood of development of multi organ failure. Cervical spine injuries are reported in 4-34% of polytrauma cases. ⋯ There was a better outcome concerning length of hospitalization in the "day-onesurgery" group. We consider MSCT as standard approach towards diagnosis of cervical spine injury in polytrauma patients. MRI and flexion/extension fluoroscopy can give additional information in selected cases.
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Eur J Trauma Emerg S · Oct 2007
Combined Abdominal and Spine Injuries after High Energy Flexion-Distraction Trauma.
Combined abdominal (AT) and spine (ST) trauma in the multiply traumatized patient (MT) requires optimal clinical management. At the Traumacenter Murnau, Germany all multiply injured patients (injury severity score ≥ 16) are registered in a large prospective database (DGU-Tramaregister). From 1 January 2002 until 31 December 2004, 731 multiply injured patients (ISS ≥ 16) were admitted to the Trauma Center Murnau. ⋯ Mean age of these patients was 37 years in comparison to 47 years in the control group (MT without combined AT and ST). ISS of patients with combined AT and ST was 38 points compared to 26 points in the control group, and mortality was 7% in the combined group compared to 14% in the control group. The present study documents that damage control principles applied to patients sustaining the complex combination of AT and ST can result in low mortality rates despite the severity of this injury.
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Eur J Trauma Emerg S · Oct 2007
Distribution of Spinal and Associated Injuries in Multiple Trauma Patients.
Injury to the spinal column and cord are often part of life-threatening multiple trauma. Epidemiological data could help to establish an evidence-based assessment and therapy of these patients. We present a retrospective chart analysis of 590 multiple traumatized patients admitted within a 4-year-period. ⋯ Injuries to the spinal column are frequent in the multiple trauma patients population. Diagnosed injuries to distinct body regions should make the trauma team suspicious of injury to the nearby spinal column. Appropriate treatment includes thorough assessment of all injuries to clarify the damage and carry on special protection of these spinal regions preventing from deterioration.
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Eur J Trauma Emerg S · Oct 2007
Operative Timing and Management of Spinal Injuries in Multiply Injured Patients.
Spinal injuries occurring in polytrauma patients are caused by high impact trauma. Due to high velocity mechanism, trauma of the vertebral column may be accompanied by injuries of adjacent body cavities such as thorax, abdomen, and pelvis. Neurologic examination is mandatory and has to be documented preferably using the ASIA/IMSOP-classification. ⋯ On the day of injury ventral spondylodesis of unstable cervical spine fractures of C3-C7 and dorsal spondylodesis of unstable thoraco-lumbar fractures using internal fixator are the standard procedures. Polytrauma patients benefit from early stabilization of spinal fractures including reduction of ventilation and ICU treatment, pneumonia rate, general complications, as well as hospital stay. However, it is controversial if mortality rate and neurologic outcome are affected by the time point of operative stabilization.
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The acute compartment syndrome of the forearm is rare and may therefore be easily missed. Although many clinicians will not see such a patient during their entire career, profound knowledge of the symptoms is required to recognize the syndrome in time. Besides immediate identification of the compartment syndrome early surgical treatment is mandatory to avoid its devastating consequences. ⋯ This paper aims to attend the reader to this diagnostic pitfall. Two patients with a compartment syndrome of the forearm are described to illustrate both ends of this diagnostic challenge. Pathophysiological, anatomical and clinical aspects, classification and therapeutic modalities are reviewed.