Der Unfallchirurg
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Motorcyclists profit from improved safety measures and medical care only slightly compared with other road users. The aims of this study were to gain new insights into crash mechanisms and the resulting injuries of motorcyclists and to understand trends in road traffic accident statistics over the last 10 years. ⋯ Knowledge of crash mechanisms, injury patterns and profiles of high-risk drivers can help reduce the collision rates and injury severity of motorcyclists.
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Combined forearm fractures are identified according to their location as Galeazzi, Monteggia, or Essex-Lopresti injuries. The feature common to these three forms is the combination of a forearm fracture with instability of the distal or proximal radioulnar joint. Appropriate management of the injury at an early stage is indispensable to achieve good functional results. ⋯ Essex-Lopresti injuries are treated by surgical reconstruction of the radial head, and in cases of comminuted fractures by implanting a radial head prosthesis. Subsequent treatment entails at least 14 days immobilization in a supinated position using an upper arm cast. Early functional therapy should follow when all three forms of injuries have been treated.
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The rare condition of chronic instability of the proximal tibiofibular joint can be of traumatic or idiopathic origin and can lead to secondary arthritis. After conservative treatment for 6 months and persistent pain, operative treatment should be considered. We present a case of traumatic instability, ligament reconstruction with a part of the biceps femoris tendon, and postoperative return to full and painless sport activities.
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For many years, resection was the only therapy used for comminuted fractures of the radial head. When associated with an injury of the collateral ligament, the outcome was often unsatisfactory. Implantation of the modern radial head prosthesis promises a better outcome. ⋯ Arthroplasty with a modular metallic radial head combined with ligament reconstruction is an effective alternative to radial head resection. Compared with resection, the results using the EVOLVE prosthesis demonstrate definite advantages with regard to clinical outcome.
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Ultrasound examinations in trauma patients should be done in the emergency department using curved-array (3.5-7.5 MHz) probes. Blunt trauma of the abdomen and thorax must be regarded as a single organ injury. Sonography is the imaging technique of first choice and has completely replaced peritoneal lavage. ⋯ Clinical experiences prove that standardized sonography must be part of polytrauma management and should be integrated in advanced trauma life support courses. Technical improvements with better image quality and miniaturization of hardware will contribute to increase the use of this technique. However, ultrasound does not replace computed tomography for follow-up in answering more sophisticated questions in multiple injured patients.