Injury
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3260 patients with pelvic and acetabular fractures were assessed using a standardized documentation form by collating the data on 1905 patients treated at the Department of Traumatology of the Hannover Medical School together with those patients treated between 1991 and 1993 in the German Multicentre Study Group (Pelvis) of the German Trauma Society and the German Section of the AO International. 2551 patients had pelvic ring injuries. 61.7% of the patients were multiply injured. 12.2% were suffering a complex pelvic trauma defined as a pelvic injury with concomitant soft tissue injury. The pelvic ring fracture was classified as stable in 54.8% (type A injury), as rotationally unstable in 24.7% (type B injury), and as unstable in translation in 20.5% (type C injury). There were concomitant acetabular fractures in 15.7%. ⋯ Type B injuries were stabilized in 28.9% and type C injuries in 46.7%. The overall mortality rate was 13.4%, depending significantly on the associated extrapelvic trauma. In complex pelvic injuries, the mortality rate was 31.1% whereas for pelvic fractures without concomitant soft tissue injury the rate was only 10.8%.
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Pelvic malunions or nonunions are the result of inappropriate treatment of rotationally or linearly unstable injuries of the pelvic ring. Long-term sequelae such as chronic pain in the posterior pelvic ring, gait abnormalities, leg length discrepancy, sitting discomfort, neurological problems or impingement on the visceral organs may be secondary to the disturbed integrity of the pelvic ring. The late correction of the deformity is technically much more demanding than the treatment of acute pelvic ring injuries. ⋯ Possible complications include nerve or vascular injuries, incomplete reduction of the deformity, failure to unite, incomplete pain relief, and infection. Prior to surgery, a careful clinical and radiological examination is mandatory to assess the relationship between the presenting anatomical deformity and the complaints of the patient. The final decision for surgery has to be made by the patient taking into account reasonable expectation and the potential complications associated with the corrective procedure.
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A series of 39 unstable fractures of the distal one-third of the clavicle is presented. As results after non-operative treatment of these fractures are poor, surgical therapy is indicated. ⋯ According to the classification of Neer and Jäger/Breitner, a clear therapeutic strategy for lateral clavicular fractures can be defined. Unstable clavicular fractures with associated acromioclavicular ligament disruption should however be considered as a separate subtype in the existing classifications.
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An unstable pelvic ring injury was stabilized with the AO C-clamp in thirty multiply injured patients. The average ISS was 29 (19-57). Transfusions totalled 24 units of blood/fresh frozen plasma/platelets (0-117) on average. ⋯ Definitive stabilization was accomplished after 4.5 days on average (0-15). Complications relating directly to the clamp did not occur. The application of the C-clamp has a clear place in the management of polytraumatized patients with linear unstable pelvic ring injuries.
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The internal fixation of pelvic ring fractures and dislocations has become more popular recently. Aggressive resuscitation of the injured patient includes pelvic stabilization and improves survival rates. ⋯ Recent radiographic techniques for pelvic imaging facilitate comprehensive preoperative planning and intraoperative decision-making for pelvic injuries. Improved outcomes are expected as treatment is individualized for each patient.