Unfallchirurgie
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In all of our reported cases a seat belt injury was the reason for the sternal fracture. Only 4 of 27 patients of this prospective study suffered from a heart contusion. ⋯ Referring to our patients a screening of a heart contusion with CKMB/CK activity and ECG seems to be sufficient when the trauma is not older than 12 hours. The longer persisting plasma concentrations of cardiac troponin T (cTnT) enables a diagnosis of a heart contusion even after a few days.
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Between 1970 and 1993 29 fractures of the intercondylar eminence were seen in children with almost the same number of cases showing no or minor displacement as those requiring open reduction for major dislocation. Combined knee injury must be suspected the higher the patient's age and the more pronounced the displacement of the fragment. Magnetic resonance imaging (MRI) has gained diagnostic predominance. ⋯ Traction screws should be used only in older children with large fragments. Our series show good late results because occasional function impairment with knee instability tends to normalize with growth. Corrective orthopedic procedures--if at all--are required only for juveniles or adults.
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Fractures of the radius in premenopausal women caused by a slow speed trauma are often associated with osteoporosis. Out of 156 patients we were able to screen 26 for osteoporosis. Bone mineral density (BMD) of the lumbar spine and the femoral neck was compared with the age related control group. ⋯ There was no correlation between the number of risk factors and bone mineral decrease. All evaluated laboratory tests were within normal range. As a result of our investigation we suggest looking for osteoporosis in premenopausal women with fractures following slow speed trauma as a routine procedure to offer adequate therapy.
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The study presented investigates prospectively the clinical value of the PMN-elastase as a sequel parameter in 954 patients of a surgical intensive care unit. The elastase-values measured discriminate highly significant between patients with and without complications (p < 0.001) as well as between survivors and non-survivors (p < 0.001). Furthermore in patients underlying shock-phases in the course of treatment significantly higher elastase values are measured as in the patients remaining (p < 0.001). The highest prognostic evidence is determined by the elastase at the 9th day of course of disease concerning the prediction of a patient's death (sensitivity 78%, specificity 75%, positive predictive value 63%, respectively negative predictive value 87%).