Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Successful management of abdominal trauma is characterized by efficient emergency-room work-up aimed at immediate determination of the prognosis by rational use of diagnostic techniques. The purposes of any conservative and/or surgical procedures are the preservation of organ function and low mortality and morbidity in multiply injured patients. ⋯ The surgical treatment of hepatobiliary, splenic and large-vessel trauma is still challenging, as it involves the risk of life-threatening bleeding, while in the case of pancreatic and bowel injuries the challenge lies in the avoidance of septic complications. Interdisciplinary management of complex injuries with application of the "damage control" concept contributes to high-quality results in abdominal trauma.
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In the AO classification, the distal tibia is 43 and A type injuries are extra-articular, B type partial articular and C type involve the whole of the articular surface with complete separation of the joint from the diaphysis. The term pilon fracture should be confined to B(3) and C type fractures. The injury mechanism of pilon fractures will vary from a simple fall to a high energy road traffic accident, leading to increasing fracture comminution and greater soft tissue injury with more open fractures. ⋯ The goal is to span the zone of injury with the fixator, to align the limb, to reduce the articular surface through very limited approaches, and to minimize complications related to treatment to maintain length and provisionally align the fracture. When soft tissue swelling has subsided definitive stabilization is performed. Bone grafting of defects is rarely necessary.
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Comparative Study
[From clinical guidelines to clinical pathways: development of a management-oriented algorithm for the treatment of polytraumatized patients in the acute period].
The treatment of polytraumatized patients in the acute period is an exemplary model of multidisciplinary cooperation in a very critical timeframe. Implementing standards formulated in the clinical guidelines of the German Association of Traumatology requires a detailed description of "how to do it." ⋯ Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented elaboration towards a clinical pathway as the basis for a quantitative process and cost analysis.
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It is difficult to verify the treatment of stab and gunshot wounds with prospective randomized studies. That is why the results of observational studies are so important. ⋯ Abdominal gunshot wounds need immediate surgical treatment. Concerning stab wounds, obligatory as well as selective surgical methods are both acceptable. Because of valid diagnostic options, thoracic stab wounds allow several ways of treatment.