Der Unfallchirurg
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Thoracic trauma is considered to be responsible for 25 % of fatalities in multiple trauma and is a frequent injury with an incidence of 50 %. In addition to organ injuries, severe injuries to the bony parts of the thorax also occur and these injuries are described very differently mostly based on single center data. ⋯ A total of 21,741 patients met the inclusion criteria including 10,474 (48.2 %) suffering from either RF or FC. The mean age was 49.8 ± 19.9 years in the RF group and 54.1 ± 18.2 years in the FC group. Approximately 25 % were female in both groups, 98.1 % were blunt force injuries and the median ISS was 28.0 ± 11.2 in RF and 35.1 ± 14.2 in FC. Shock, insertion of a chest tube, (multi) organ failure and fatality rates were significantly higher in the FC group as were concomitant thoracic injuries, such as pneumothorax and hemothorax. Sternal fractures without rib fractures were less common (3.8 %) than concomitant in the RF (10.1 %) and FC (14 %) groups, as were concomitant fractures of the clavicle and the scapula. Out of all patients 32.6 % showed fractures of the thoracolumbar spine, 26.5 % without rib fractures, 36.6-38.6 % with rib fractures or monolateral FC and 48.6 % concomitant to bilateral FC. Thoracotomy was carried out only in isolated cases in RF and in 10.2 % of the FC group. Operative stabilization of the thoracic cage was carried out in 3.9-9.1 % of patients in the RF group and in 17.9-23.9 % in the FC group.
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A 24-year-old man was bitten on his right forefinger by his black mamba while he was feeding the animal. The primary symptoms caused by a full injection of the snake's venom therefore presented a life-threating situation. Due to pre-hospital troubleshooting of the emergency medical service and the timely administration of the antivenom further potentially harmful effects caused by the snakes venom were avoided.
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Rupture of the proximal tendon enthesis of the hamstring muscle (ICM) accounts for approximately 10% of all injuries of the ICM. It occurs most commonly in athletes and active middle-aged individuals. The complete rupture of all three tendons in active patients is generally seen as an indication for surgical repair of the tendon enthesis; however, the correct diagnosis is often not reached in a timely manner. ⋯ Operative treatment consists of anchor repair of the tendons resulting in good clinical outcome in several case series. Good knowledge of the anatomy and operative approach are mandatory to avoid complications as well as compliance with a gradual rehabilitation scheme to allow tendon to bone healing. The main aim of this review is to highlight the typical history, clinical presentation and examination technique to reach an immediate clinical diagnosis which should be confirmed with a magnetic resonance imaging (MRI) scan.
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After examining the cause of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed upon between the parties involved. In addition, this person must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability. The sole risk of the evolution of the functional deficit arising from a proven or prognosticated post-traumatic osteoarthritis is excluded from this standard of proof which means that flat-rate risk supplements are not suited to this individualized approach and thus do not apply.