Zentralblatt für Chirurgie
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We report on the case of a 15-year-old female who developed a pneumomediastinum after heavy vomiting. A rupture of the esophagus (Boerhaave syndrome) was excluded. In the CT of the chest, air was detected in the mediastinum and in the epidural space (epidural pneumatosis). ⋯ Air in the epidural space, associated with spontaneous pneumomediastinum, is an extremely rare condition. The air in the spinal canal arrives by migration through the intervertebral foramina from the posterior mediastinum and neck, where the fascial barrier is missing. Therapy consists of symptomatic, conservative treatment.
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The treatment of paediatric polytrauma patients in the emergency room is not common. The knowledge of specific injuries in consideration of the age-specific characteristics is of particular importance for precise diagnostics and therapy. The goal of this study is the aquisition of the frequency, the localisation and the severity of paediatric polytrauma (age: 0-16 years) in comparison with adults. ⋯ Taking the results into account with consdieration of the literature data, the authors recommend that the emergency room management for adults and, especially, the radiolgical diagnostic chain with CT scans should also be applied to polytraumatised children. The main reasons for this are the extremely high incidence of intracranial injuries and the high sensitivity of CT scans also for abdominal trauma and pelvic injuries.
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Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. ⋯ However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.
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Chest wall instabilities after extensive injuries of its skeleton belong to the most serious chest trauma with a relatively high rate of complications and mortality, mainly due to its pathophysiological consequences for the respiratory system. ⋯ Our experience with metallic fixation of the unstable chest wall is mainly positive. Decisive for the success of this procedure is the correct indication respectively selection of patients that will have a benefit from the surgical stabilisation.
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Legal consent to medical treatment requires comprehensive clarification and the patient's capability to consent. Minors under 14 years are usually not capable of consent -- the right to decide rests with the parents. With persons over 14 years the doctor must test for capability to consent. ⋯ Since minors under 18 years are only limitedly contractually capable, the approval of the statutory guardian suffices. With contractually incapable adults the court-appointed guardian or in serious cases the Guardianship Court decides. The legal position is explained, using three sample cases.