Der Unfallchirurg
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The treatment of gunshot wounds and wounds caused by explosive devices as used in terrorist attacks is not currently an issue for education in most medical faculties; however, because of the increasing number of terrorist attacks in Germany and Europe this is becoming more important. The aim of this study was to evaluate the knowledge of dealing with and treatment of patients as victims of terrorist attacks of 5th year medical students at the Mannheim Medical Faculty of Heidelberg University prior to and after a specific seminar. ⋯ With the seminar "Military Medicine", which was held as part of the Mannheim reformed curriculum of medicine (MaReCuM plus) in the 5th year, the interest of medical students could be significantly increased. This study could show for the first time that terrorist attacks and the resulting injuries have significant relevance for medical students. Consideration of this topic in all medical school curricula would be justified.
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Review Practice Guideline
[Diagnostics and treatment of thoracic and lumbar spine trauma in pediatric patients : Recommendations from the Pediatric Spinal Trauma Group].
Spinal injuries in pediatric patients are overall very rare. Current reference studies including large patient numbers that enable the formulation of evidence-based recommendations on diagnostics and treatment of these injuries do not exist. ⋯ Spinal injuries in childhood are rare and should be treated in specialized spine centers. Pediatric patients with a stable cardiopulmonary status should undergo magnetic resonance imaging (MRI) if a spinal trauma is suspected. The basic principles of the treatment of spinal trauma in children is the restoration of spinal stability and correct anatomical parameters as well as the protection of all neural structures. The potential for correction and regeneration of the individual spinal sections depending on the age of the patient must be considered for deciding between operative vs. conservative treatment. Whenever operative treatment is needed, it should be performed by minimally invasive techniques as a sole instrumentation without spondylodesis. An early removal of the screw-rod-system should be performed.
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Multicenter Study
[Pediatric spine trauma-Results of a German national multicenter study including 367 patients].
In general, pediatric spinal injuries are rare. No reliable data on the epidemiology of spinal injuries in pediatric patients in Germany are available. Especially in pediatric patients, for whom the medical history, clinical examination and the performance of imaging diagnostics are difficult to obtain, all available information on a spinal injury must be taken into account. ⋯ The results were different from the knowledge obtained from adult patients with spinal trauma and describe the special circumstances for pediatric patients with spinal trauma. Despite certain limitations these facts may help to enhance future decision-making for the diagnostics and treatment of these patients.
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Pediatric traumatic vertebral injuries usually present as stable A (AOspine classification) fractures, whereas B and C injuries are relatively uncommon. In contrast to adults the appropriate treatment strategy in children remains an issue of debate. The data from two pediatric patients admitted with B and C type spinal injuries in 2007 and 2008 were retrospectively analyzed. ⋯ In both cases thoracolumbar MRI scans revealed degenerative alterations of the ventral half of the L1/L2 disc with a regular disc signal in the dorsal segment at the first follow-up and a progressive disc degeneration in one patient at the second follow-up. Surgical treatment of pediatric B and C type injuries via open reduction and temporary monosegmental posterior screw and rod instrumentation results in satisfactory clinical and radiological outcomes. In the absence of vertebral burst fractures, the function and stability of discoligamentous injuries in children can be restored without any additional osseous fusion.
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Identification and treatment of intra-articular injuries, stabilization of the syndesmotic complex by open reduction and internal fixation (ORIF) of the posterior malleolus (PM). ⋯ It is known that relevant chondral injuries frequently occur in complex ankle fractures and that ORIF of the PM leads to stabilization of the distal tibiofibular joint. So far only few clinical results have been published regarding AORIF and ORIF of the PM; however, the majority of the studies available found significantly better results for AORIF and ORIF of the posterior malleolus compared to conventional treatment.