Unfallchirurgie
-
Comparative Study
[Multiple trauma: preclinical needs, transportation, time sequences].
Compared to the magnitude of the trauma problem few precise data exist on prehospital care of trauma patients. The aim of the study was the collection and careful evaluation of prehospital data on trauma patients concerning time sequences, patients' status and prehospital interventions. From 1. 1. 1987 to 31. 12. 1990 all 49,045 prehospital emergencies in Cologne were prospectively registered. 8792 trauma patients were treated by an emergency physician in the field. 9.5% were severely injured, defined by a trauma score less than or equal to 12. 9.9% of the trauma patients were intubated, 54.9% received an i.v. line, and 20.6% were triaged to a trauma center. Our data form a valid base for analysis of the effectiveness of prehospital trauma care.
-
Two cases of bullet injuries inflicted in suicidal intention are represented. In the first instant the barrel of a rifle in the second the barrel of a revolver was inserted to the oral cavity before the shot was fired.
-
Comparative Study
[Comparative study of various dorsal stabilization procedures in recent fractures of the thoracic spine].
After giving a brief summary describing the development of different methods for stabilisation of traumatic spine fractures the authors discuss their own results on 125 patients, who were treated between January 1st 1983 and September 15th 1988. The different surgical procedures (Harrington-instrumentation, transpedicular osteosynthetic stabilisation, fixateur interne) are compared. In the neurological physical examination 25% of the patients improved at least one degree in the Frankel-scale. ⋯ In overall-comparison of surgical procedures the fixateur interne showed best results (repositional loss of kyphosis angle 6.8 degrees, no fracture instability). Worse results were found for Harrington-stabilisation (repositional loss 9.1 degrees, fracture instability in three cases) and for transpedicular osteosynthetic stabilisation (repositional loss 12.4 degrees, fracture instability in two cases). In conclusion the authors describe the possible different complications for the three methods of judging from the clinical aspect and propose the following standard way of procedure: Fusion of the vertebral bodies with a stable implant and the possibility for intraoperative repositioning, postero-lateral spongiosa-grafting, fusion of the vertebral arc joints, transpedicular spongiosal filling of the traumatized vertebral body, resection of traumatized tissue from intervertebral discs and intercorporal blocking.
-
The fracture of the clavicle is a very frequent injury to children and young adults. Using a figure-of-eight bandage for treatment leads to good functional result and acceptable cosmetical appearance. ⋯ Distorsions and subluxations of the joints of the clavicle are to be managed conservatively, too. Only in cases of complete ruptures of the acromioclavicular, coracoclavicular or sternoclavicular ligaments, it is necessary to perform an open reduction and repair of the ligaments.
-
From 1970 to 1985 in the Orthopedic University Clinic (Oskar-Helene-Heim Berlin) 116 children with fractures of the proximal end of the radius received medical treatment. The frequency of the remaining complications like restriction of movement, differences in elbow axis angle (carrying angle), disturbances of growth or nerve lesions are described. The cause of those complications and the facilities for treatment are discussed in regard to controversy recommendations for therapy in literature. Special reference is made to problems of dislocation ad latus and late operative treatment.