Der Unfallchirurg
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In an overview the clinical and academic problems of this kind of fractures are described and their treatment is discussed. The most important problem is the pseudarthrosis that can happen in the framework of a conservative treatment of displaced fractures, rarely after operative treatment with K-wires. A rather academic problem is the obligatory growth disturbance of a partial stimulation of the lateral part of the growth plate. ⋯ Pseudarthrosis, varus and fishtail deformity are a result of increasing instability of primarily or secondarily displaced fractures. All three problems can be avoided by metaphyseal compression osteosynthesis with an AO small-fragment screw with an additional axial K wire in the trochlea. Our own long-term results are shown and compared with the results of other procedures in the literature.
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Review Case Reports
[Must the accident victim be protected from the emergency physician?].
Quality control in preclinical medical care has become a matter of concern in recent years. In order to evaluate the quality of treatment one has to set standards. Most of the current standards were defined by different preclinical care organisations and are also accepted in the unique emergency medical care protocol used in the Federal Republic of Germany. ⋯ Insufficient application of resuscitation volume (< 2500 ml on admission) was evident in 17% of all documented patients. According to our results, the initial evaluation of severity of injury is still a major problem and leads to wrong decisions for treatment. Although the qualification of ambulance physicians has been standardized for some years, there are still clear deficits in the preclinical management of trauma patients that need to be targeted.
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While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German speaking countries rather publish on blunt abdominal injury. The presented paper discusses the strategic principles of acute clinical management of abdominal trauma on the combined basis of own research results and a comprehensive review of the literature. Blunt abdominal injuries in most cases from a part in the pattern of multiple trauma. ⋯ Splenectomy is indicated in patients with severe concomitating injuries or shock whereas in the remainder of cases the total or partial preservation of the spleen should be pursued. Hepatic injuries offer a broad spectrum of operative interventions, ranging from superficial hemostatic measures over compression techniques like 'packing' and 'mesh-wrapping' to atypical and anatomical resections and to liver transplantation in exceptional cases. Lesions of tubular organs and the pancreas pose especially difficult diagnostical problems but regularly allow a rather easy operative treatment.
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Some 13% of fractures in children are in the foot. Of these fractures, 50% involve the metatarsals and the phalanges. These are treated conservatively and do not cause therapeutic problems in general. ⋯ The precise scientific assessment of foot fractures in children is confronted with the problem that so far too few cases have been evaluated. Rare problematic fractures (i.e. talus, calcaneus) require scientific work-up to establish a "gold standard" for operative and conservative treatment. This can only be accomplished in a multicenter study.