Der Unfallchirurg
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Traumatic nerve injuries are associated with a high morbidity and long rehabilitation times. The extent of a nerve lesion and the related regeneration potential can often only be estimated during the course, whereby the time window for successful surgical interventions is limited. ⋯ A strategic approach to conservative and surgical treatment of traumatic nerve injuries depending on the extent of injury and resulting regeneration potential is recommended. In conjunction with the clinical course, electrophysiology and imaging diagnostics, e.g. nerve sonography, can help to differentiate between neurapraxia, axonotmesis and neurotmesis.
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A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. ⋯ Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.
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Review Case Reports
[Improvement in breathing mechanics by plate osteosynthesis of the ribs after cardiac massage : Case report and review of the literature].
This article reports the case of a 69-year-old patient with multiple rib fractures and sternal fracture after repetitive cardiopulmonary resuscitation (CPR). Because of secondary respiratory failure due to an unstable thorax, rib fixation was performed 10 days after CPR. Subsequently, ventilation improved resulting in successful extubation 4 days after rib plating. ⋯ Although flail chest occurs in up to 15% of patients after CPR, there is little evidence of the effect of rib fixation. The benefit of this procedure after chest trauma is reduced pain, shortened intensive care unit stay, lower rates of ventilation-associated pneumonia and lower costs for the healthcare system. Further clinical research is needed and interdisciplinary treatment should be kept in mind when dealing with patients resuscitated with prolonged mechanical ventilation.
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Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. ⋯ Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.