Der Unfallchirurg
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Facial perforation injuries are very rare. We describe a case of a 48-year-old man who sustained a perforation trauma from an 11 cm long wooden tree branch in the middle of the face in a skiing accident. ⋯ The patient was transported to a center for oral and maxillofacial surgery and underwent several operations. He could return to his normal social and professional life 8 months after the accident.
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Case Reports
[Embolization of life-threatening intercostal hemorrhaging in a severely injured patient: a rarity in trauma care].
Transarterial embolization of ruptured intercostal arteries due to massive bleeding represents an infrequent indication in severely injured patients. The current literature shows isolated case descriptions but no clinical trials exist. ⋯ The vital signs returned to normal immediately after the procedure and surgical intervention could be avoided. The course of the disease represented in the following shows the effectiveness of this type of treatment not only for bleeding due to pelvic fractures and abdominal injuries, but also for isolated arterial bleeding in other body regions.
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Accidental hypothermia is a common complication in severely injured patients. Risk factors include environmental exposure of the patient at the accident site or in the clinic, infusion of cold fluids, hemorrhagic shock and anesthetics which influence thermoregulation. In contrast to animal studies, human studies and clinical experiences have identified accidental hypothermia of the severely injured patient to be associated with increased complication and mortality rates. ⋯ However, the activity of important enzymes, such as those of the coagulation pathway, is simultaneously down regulated. Hypothermia-induced coagulopathy, which is refractory to substitution of coagulation factors, is a major complication of hypothermia in traumatized patients. Therefore, hypothermic trauma patients with hemodynamic instability require aggressive rewarming.
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The purpose of the study was to evaluate the clinical and radiological follow-up of patients suffering from fixed post-traumatic and postinflammatory kyphotic deformities of the thoracic and lumbar spine and treated by posterior transpedicular wedge resection osteotomy of the spine. ⋯ Transpedicular wedge resection osteotomy of the thoracic and lumbar spine offers a safe surgical technique for the treatment of fixed postinflammatory kyphotic deformities.
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Subtalar dislocations represent uncommon injuries of the foot. Leitner [7] described the relationship between medial and lateral dislocations as 6:1. The mechanism is a trauma in plantar flexion/supination of the forefoot with a fixed hindfoot. ⋯ Subsequently, x-rays and CT scans should be performed in two planes in order to rule out concomitant injuries at the processus posterior tali and the talar head, as bony fragments can necessitate an operative intervention in the case of an interposition of the articulation. In terms of aftercare an immobilization of 6 weeks with a lower leg cast is suggested in the literature. In the presented case an early functional therapy with 2 weeks cast and 4 weeks with a therapy boot could achieve good clinical results.