Der Unfallchirurg
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Comparative Study Clinical Trial
[Heparin-induced thrombocytopenia as a complication of postoperative prevention of thromboembolism with unfractionated heparin/low molecular weight heparin after hip and knee prosthesis implantation].
With this prospective study we analysed the occurrence of a heparin-induced thrombocytopenia type II (hit type II) using unfractioned heparin (UFH) or low-molecular-weight heparin (LMWH) as postoperative thrombosis prophylaxis after primary total hip or knee replacements. Furthermore the postoperative course of the platelet count with UFH and LMWH was investigated. ⋯ The incidence of a HIT type II after the use LMWH seems to be lesser than after the use of UFH. The postoperative platelet count shows a typical course after a total joint replacement. With deviations of that a HIT type II must be excluded.
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Comparative Study Clinical Trial
[Primary external fixation with consecutive procedural modification in polytrauma].
It is the purpose of the current investigation to determine whether immediate external fixation of fractures, which is a simple and fast procedure, followed by secondary planned conversion represents a safe and reliable procedure without additional trauma in multiply injured patients (ISS > 15). ⋯ Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.
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The results are presented for pterional orbital decompression in 12 patients with symptomatic traumatic retrobulbar hematoma after various traumatic mechanisms. Pre- and postoperative course, neuroradiological findings, additional brain or facial injuries as well as outcome of eye function are analyzed in detail. Mean time delay between trauma and decompression was 56 h (2.4 days), with a wide range from 2 h to 15 days. ⋯ No complications related to the operation were seen. The pterional orbital decompression described here represents an effective alternative approach for patients with sight-threatening retrobulbar hematoma, especially in cases where it is necessary to gain space for the orbit in addition to evacuating space-occupying blood or bone clots and treating neighbouring lesions. Immediate detection and adequate treatment of orbital hematomas is mandatory to achieve an acceptable outcome of eye function.
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Case Reports
[Complete brachial plexus paralysis caused by compartment syndrome in heroin intoxication].
We report the case of a young man with heroin intoxication. While deeply unconscious, he sustained a compartment syndrome of the arm and shoulder region leading to a lesion of the upper plexus. ⋯ The function of the arm was restored in such a way that the patient was able to intoxicate himself again. He needed intubation and ventilation but recovered uneventfully.
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With the case of a 25 year old patient we will report of a rare injury, the isolated body fracture of a triquetrum bone. This kind of injury often happens in dorsalflected and ulnarducted hand position because of the anatomical position of the triquetral bone. The therapy of choice is conservative treatment with a volar splint for three to six weeks. ⋯ Complications as an aseptic necrosis of a fragment is not reported. We found only one case of a pseudarthrosis [5]. Even in our case occurred a complete healing of the bone and a complete functional remission.