Der Unfallchirurg
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The severity of high pressure injection injuries to the hand is often underestimated in the initial clinical examination. Therefore, it is critical to obtain information about the course of the accident, the pressure involved and the injected substance. X-ray examination can reveal the injected substance or accompanying air in the tissues and therapy is usually surgical. ⋯ From 1998 to 2008, 36 patients were treated after high pressure injection injury to the hand, 19 patients were transferred to the replantation centre immediately and 17 secondarily. These 19 injuries resulted in finger amputations and/or pain syndromes in 12 patients (33%) including 2 out of the primary group (10%) and 10 out of the secondary group (59%). It can be concluded that high pressure injuries to the hand should be treated in replantation centres.
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The options for surgical treatment of injuries to the upper cervical spine have increased considerably in recent years. A distinction can be made between two forms of surgical stabilization. ⋯ A spondylodesis, that can be performed at the atlantoaxial or occipitoatlantoaxial joint, aims to stabilize the upper cervical spine by fusion techniques. This article describes the surgical procedures for both treatment principles with regard to the indications, techniques, and complications.
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Life-threatening situations after multiple trauma which require interruption of the diagnostic algorithm and immediate surgical treatment after admission are a challenge for the multidisciplinary trauma team. The purpose of this study was to evaluate the incidence, causes, implications and relevance of life-threatening situations for major trauma patients after admission to trauma centers. ⋯ Life-threatening situations after major trauma which require immediate surgical intervention in the resuscitation room rarely occur in Germany. Nevertheless, they are associated with a high mortality and prolonged and complex clinical course if primarily survived. Indications and decision-making processes of these challenging situations have to be practiced with standardized algorithms and should be considered for the future education of orthopedic surgeons in Germany.