Zentralblatt für Chirurgie
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Until the early eighties conservative treatment was common even for unstable pelvic fractures. The long-term results of 114 non-operatively treated patients who had suffered a pelvic fracture (68 type A, 20 type B, 26 type C according to the classification of the ASIF) have been examined after an average time of 7.1 years after injury. 60% of cases with a stable injury of the pelvis (type A) did not suffer of any complaint. The remaining patients stated moderate pain. ⋯ Patients with unstable pelvic fracture localized pain mainly in the lumbo- or iliosacral region. Radiological and CT findings suggest arthrosis, partial ancylosis and incomplete reduction of the fracture as possible reasons for unsatisfactory clinical results. As consequence of these results we nowadays proceed extended radiological examinations (a.-p.-, inlet-, outlet-views, CT) and operative reduction and internal stabilization (ORIF) of all unstable pelvic fractures.
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Review Case Reports
[Management of ipsilateral fractures of the femur shaft and proximal femur--therapy overview and current management].
Fractures of the femoral shaft are combined in 2-5% of all cases with an ipsilateral fracture of the proximal femur. These double fractures are mostly caused by high energy trauma. An analysis of 9 selected papers points to the problem. ⋯ In the literature nearly 30 different operative treatments are described and underline the demands on proper operative techniques and implants for ipsilateral femoral shaft and hip fractures. In this publication the new unreamed femoral nail system (UFN) with a special proximal interlocking option for double fractures will be presented. This system provides a good possibility to stabilize femoral double fractures in an easy and safe manner.
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Meta Analysis
[Can selective decontamination of the digestive tract as a routine procedure on intensive care units be recommended?].
After giving an overview on the epidemiological and microecological background, the applicable drugs, and the necessary microbiological surveillance for Selective Decontamination of the Digestive tract (SDD), the results of 2 new metaanalyses of 22 and 25 individual randomized studies are discussed. A 50%-reduction of the pneumonia incidence results in an only marginal reduction of the mortality rate in the subgroup of topically plus for the first few days systemically treated patients in mixed intensive care units. ⋯ The chance and the need to confirm a mortality benefit in multicentre trials enrolling large numbers of homogeneous surgical patients are explained. At the present time, SDD as a routine can not (yet) be recommended.