Der Unfallchirurg
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Presentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding. ⋯ Interventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in patients with pelvic fractures. If an experienced radiologist on 24-h stand-by is assured and the infrastructure is efficient, this can be performed shortly after hospital admission and therefore should be integrated into the early clinical treatment protocol.
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Pelvic fractures may accompany other injuries and can be life-threatening. In addition, the rectus abdominis muscles might also be torn. During fracture reduction, these muscles are fixed to their insertions. ⋯ Two and a half years after the accident, the patient developed a diastasis and an abdominal wall hernia, which were repaired by refixation of the rectus abdominis muscles to the bones with Mersilene bands. Results nine months after the reconstructive surgical intervention show a firm abdominal wall without recurrence. This case shows that even 2.5 years after an accident, the rectus abdomini muscles can be fixed with Mersilene bands to the bone and anatomic reconstruction of the abdominal wall can be carried out.
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Case Reports Clinical Trial
[Surgical management of talipes equinovarus as sequelae of a compartment and/or postischemic syndrome of the deep flexor compartment of the lower leg].
Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. ⋯ By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable. The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.
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Clinical Trial
[Reconstructive surgery of sequelae of compartment syndrome of the lower leg and/or foot. Presentation of a new classification].
The sequelae of an undiagnosed insufficiently treated or unpreventable (by crush injury) compartment or postischemic syndrome, most often after lower leg fracture or popliteal artery injury, are caused by necrosis and contracture of the extrinsic foot muscles. Therefore claw toes, pes equinus or other forms, such as a severe pes equino varus related to the compartment involved will decide the kind of foot deformity. In cases of a combined compartment syndrome of the lower leg and foot, not only the extrinsic but also the intrinsic muscles especially the short flexors are involved, leading to extensive claw toeing of the hallux and the lesser toes as well. ⋯ Patients with contract hammer toes after calcaneal fractures were seen most often (n=26). Another large group of 24 patients suffered from the sequelae of a compartment and/or postischemic syndrome of the extrinsic muscles of the superficial and deeper compartment of the flexor tendons, producing a severe pes equino varus. Less common (n=16) were the deformities caused by an isolated compartment syndrome, such as necrosis of the anterior tibialis, long extensor muscles, peroneal muscles or a combined compartment syndrome of the lower leg and foot.
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Case Reports
[Rare complication of a dislocated rib fracture. Unusual clinical course following a motorcycle spill].
Dislocated rib fractures as a result of traffic accidents can be associated with various injuries of thoracic and abdominal organs. Especial attention should be paid to rare and difficult to determine lesions of a hollow abdominal viscus, which can, if not diagnosed early enough, lead to septic shock with a considerably diminished probability of survival. The following case is of a 51-year-old man who suffered a blunt chest injury with dislocated rib fracture, which caused a gastric perforation that had not been primarily detected. The diagnostic approach with its challenges for treating physicians and alternatives to the standard procedure in the case of dislocated fractures of lower ribs is analyzed here.