Unfallchirurgie
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In the five eastern federal districts of Germany the condition for organizing treatment forms of the Social Insurance for Occupational Accidents were different. In 1990 qualification of traumatologic surgeons demonstrated intensive standards and similarly positions as western Germany. ⋯ After two years the development of statutory accident insurance is respectable. The present situation reflects very good co-operation between western and eastern institutions, to remove some insufficiencies and to establish a sure territorial system for medical treatment.
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Knee ligament injuries associated with femoral shaft fractures can severely influence the functional results of treatment. In a follow-up of 59 operatively treated femoral shaft fractures 18.6% of the patients revealed ligamentous damages. In all cases one or both of the cruciate ligaments were injured. ⋯ While only 61.6% of the ligament injuries were primarily diagnosed, the testing of knee joint stability after osteosynthesis of a femoral fracture is essential. Furthermore arthroscopy should be performed if there is any hint of ligamentous damage. The ruptures of the anterior cruciate ligament and the ligamentous avulsion fractures can be successfully treated on by operative means.
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Improved survival rates of cancer patients have led to an increase in the incidence of metastatic disease of the bone. Normal load and minimal trauma may result in pathological fractures. The malignant diseases most commonly diagnosed were breast cancer, bronchial carcinoma and hypernephroma. ⋯ Immediate postoperative mobilization and early functional treatment are an indispensable part of the management of pathologic fractures. If possible extensive bone destructions involving the risk of fracture should be stabilized prophylactically. Specific techniques of composite osteosyntheses of fractures in metastatic disease of the bone are presented.
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Comparative Study
[Multiple trauma: definition, shock, multiple organ failure].
Multiple organ failure (MOF) following major trauma occurs in response to perfusion deficits, a persistent inflammatory focus, or a persistent focus of dead and/or injured tissue. Several pathophysiologic aspects are considered relevant to current clinical practice. ⋯ With early, aggressive control or removal of risk factors for multiple organ failure, namely early surgical intervention for control of hemorrhage, control of potential septic sources, decompression, and early fracture stabilization reductions in the incidence and mortality of MOF have been observed. Metabolic support: Malnutrition appears to be an important cofactor in morbidity and mortality. (III) Metabolic support needs to be started early and prior to the phenomenon of nitrogen retention during the hypermetabolic state of multiple organ failure.