Der Unfallchirurg
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Practice Guideline
[Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients].
Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate < 6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2) < 90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS) < 9], trauma-associated hemodynamic instability [systolic blood pressure (SBP) < 90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate > 29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). ⋯ Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.
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Clinical Trial
[Treatment results after cemented hemiprosthesis for care of unstable pertrochanteric femoral fractures in the elderly].
The optimal treatment strategy for unstable trochanteric fractures in the elderly is still controversial because of the frequent failure of osteosynthesis. ⋯ Cemented hemiarthroplasty is a safe treatment strategy for unstable trochanteric fractures in the elderly, which allows early full weight bearing. Because of frequent general complications, more interdisciplinary units and centres of excellence are needed to handle this challenging cohort.
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Case Reports
[The simultaneous distally based sural flap. A therapeutic option for coverage of both heels].
Exposed bradytrophic tissue in regions with high mechanical loading is an indication for defect coverage with (myo-, adipo-) fasciocutaneous flaps. In this case, distally based sural flaps were used for bilateral coverage of defects in weight-bearing areas of feet after fourth-degree frostbite. ⋯ Among its advantages in comparison to free microvascular flaps, the locally based fasciocutaneous flap can be harvested with less donor site morbidity after elevation and does not require secondary debulking. It has been shown that the reduced stability at the border zone between flap and mesh graft has an adverse effect.
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Computer-assisted systems are used frequently in pelvis and spine surgery but are still rare in general trauma and hardly ever used in shoulder surgery. The major limitation is the use of rigid markers and the problem of obtaining navigable images in the complex shoulder region. The aim of this study was to evaluate the use of a new image-based guidance system in shoulder traumatology. ⋯ The number of trials to implant the guide wire was less in the image-guided group compared to the conventional group (1 vs 2, p=0.02). For the first time image-based guidance was used in shoulder traumatology. The system holds high potential to assist surgeons without disturbing the workflow in assuring guide wire positioning, reduce the number of dangerous mistrials and reduce the emission of radiation.
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Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. ⋯ In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.