Der Unfallchirurg
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Multicenter Study
[Causes, injuries, therapy and possibilities of prevention of equine-related accidents : Results of a 2-center-study.]
Horse riding is associated with a high rate of injuries. The possibilities of prevention are limited because of deficient knowledge about the causes and mechanisms of equine-related accidents. In the present study 198 equine-related accidents were analyzed and based on these data risk groups were identified and guidelines to improve safety in horse riding were formulated. ⋯ Equestrians wear helmets increasingly more when riding but the willingness to wear body protectors is disappointing. Protective headgear has been proven to reduce the risk of injuries but based on these data a positive effect of body protectors could not be shown. In this study safety vest users suffered from injuries of the upper body more often than those who did not wear a body protector. Children and adolescents often overestimate their skills; therefore, teaching and supervision of inexperienced young riders along with the use of protective equipment can prevent major injuries.
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Case Reports
[Benign subcutaneous emphysema after nail penetration : Case report and important differential diagnoses.]
Crepitus under the skin after penetrating injuries: harmless benign subcutaneous emphysema or life-threatening infection with gas-producing bacteria (gas gangrene because of Clostridium perfringens, crepitating cellulitis because of anaerobic Streptococcus or other coliforme bacteria)? We report a case of a 74-year-old male who developed massive crepitation of the left upper extremity and the lateral thoracic wall and mediastinal emphysema after sustaining a laceration of the left thumb and forefinger from a nail. Because there was the suspicion of gas gangrene we performed generous skin incisions of the ventral and dorsal part of the hand, the forearm and upper arm and open wound treatment. ⋯ Due to fast regression of the subcutaneous emphysema and the mediastinal emphysema, continuing lack of symptoms, negative smear test results from the beginning and low infection parameters in the blood all wounds could be closed 9 days after primary surgery. The suspicion of gas gangrene was not confirmed so the diagnosis of benign subcutaneous emphysema was made.
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Case Reports
[Dislocation of double-threaded screws after stabilization of the odontoid process with the Knöringer technique.]
A type III fracture of the odontoid process according to Anderson-D'Alonzo in a 92-year-old patient was stabilized anteriorly with two double-threaded screws using the technique of Knöringer. Postoperatively, cranial dislocation of the screws was evident and attempts to correct the screw position failed resulting in screw proximity to the brain stem. ⋯ In case of instability posterior stabilization techniques should be selected. Anterior osteosynthesis of the odontoid process with double-threaded screws in osteoporotic bone carries the risk of screw dislocation.