Der Unfallchirurg
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Severe hemorrhage remains the leading cause of death among trauma patients. Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular alternative to the established emergency room thoracotomy with cross-clamping of the aorta in patients with severe abdominal or pelvic bleeding. ⋯ The REBOA procedure is a promising endovascular technique for temporary stabilization of the circulation in patients with hemorrhagic shock. Further clinical studies and registries have yet to prove its superiority over emergency room thoracotomy.
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Uncontrolled post-traumatic bleeding is still the leading cause of death among trauma patients. In situations of mass casualty incidents (MASCAL) and military conflicts the treatment of uncontrolled critical bleeding is a challenge and associated with a worse outcome due to the austere environment; however, even under optimal treatment circumstances in situations of individual medicine the severity of vascular trauma is underestimated. As a consequence, this leads to a poorer prognosis for patients with (vascular) injuries. From this perspective it was reasonable to intensify the training of physicians, paramedics (Advanced Trauma Life Support©) and first responders (Hartford consensus) for handling of critical bleeding in traumatized patients. Furthermore, the main emphasis of the revised S3 clinical guidelines on polytrauma/severely injured treatment from 2016 of the German Society for Trauma Surgery is on the preclinical treatment. Despite a renaissance and increasing use of tourniquets, the treatment of bleeding in the transition from the trunk to the extremities (junctional vascular injuries), which are inaccessible to placing a tourniquet, remains a problem. ⋯ It was the military that in addition to the development of special tourniquets, intensified research programs and the implementation of hemostatic devices and dressings in this anatomical region. This article deals with junctional vascular injuries at the transition between the trunk and the extremities. In addition to the anatomical situation, this article gives the reader an overview of the currently available hemostyptics and their mode of action.
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A case of a patient with a combined wrist injury is presented, where a scaphoid fracture was overlooked in the computed tomography scan. The case emphasizes the value of the x‑ray control in ulnar abduction for all wrist lesions which need to be operatively stabilized.
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These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options. ⋯ Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.