Der Unfallchirurg
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The complex nature of combined fractures and soft tissue injuries of the distal femur and proximal tibia needs special attention and specific management. Distal femoral and proximal tibial fractures in young patients are usually caused by high-energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. ⋯ In 81 isolated distal femoral fractures, only 4 had a deep infection, none needed amputation, and in only 1 case did a knee arthrodesis have to be performed. The average Neer Score in 90 followed-up complex knee injuries, types 1 and 2, was 76.5 +/- 13.5 compared with 82.8 +/- 10 (out of 54 isolated distal femoral fractures). Out of 37 cases with knee dislocation, 22 (60%) had an poor result according to the Lysholm Score (average Lysholm Score 60.7 +/- 28).
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Both prehospital and hospital management of patients with severe head injury has clearly improved in the last decades. There is a greater knowledge of how secondary brain injury is caused and how it can be prevented. Intracranial mechanisms (e.g. haematoma and elevated intracranial pressure and systemic mechanism (e.g. shock and hypoxaemia) are two of the major causes of secondary brain injury. ⋯ The neck of the patient should be positioned straight and the upper part of the body should be elevated to about 30 degrees. The prophylactic use of steroids, mannitol or high dose barbiturates is not indicated. Aggressive hyperventilation (pCO2 < 30 mmHg), especially during the first few days after severe brain injury, should be avoided.