Der Unfallchirurg
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Hemorrhage after trauma in the area of the upper abdominal organs and the kidneys can represent a life-threatening situation. The primary treatment options are conservative or surgical treatment. Only in exceptional cases can endovascular treatment with an angiographic depiction of the active bleeding and, if necessary, intervention by means of embolization be used as an alternative.
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Percutaneous treatment of secondary thoracic and abdominal retention formations after blunt or penetrating trauma now represents a standard interventional radiological procedure. Various supportive imaging procedures are available, whereby computed tomography is mostly the treatment of choice due to the high diagnostic sensitivity. ⋯ After the study of this article you should have got to know and understand the indications for a minimally invasive approach, the possible techniques and necessary materials as well as the indications and contraindications.
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Pelvic arterial bleeding constitutes a potentially life-threatening event, which can be difficult to control with surgical procedures alone, especially in the case of ligamentous ruptures and a subsequently increased pelvic volume. ⋯ An interdisciplinary approach should be used in the indications for AE; which can be used as definitive treatment as well as in combination with surgical procedures. To improve the clinical outcome any delay between establishing the indications and the start of the intervention must be avoided.
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Case Reports
[External fixation for treatment of peripartum pubic symphysis separation : Clinical case and discussion].
A complete peripartum pubic symphysis separation is a rare but severe complication of natural birth. Its incidence is estimated to be 0.03-3 ‰. Minor partial separations with a small width can be treated with a pelvic binder. ⋯ This article presents the case of a 30-year-old woman who suffered a complete rupture of the pubic symphysis during the birth of her second child. Radiographic dehiscence was 39 mm. The operative treatment was carried out using a supra-acetabular external fixator for 12 weeks with a good result.
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Open fractures are associated with a higher rate of infections and delayed fracture healing; therefore, in addition to fracture fixation, infection prevention and soft tissue management are also important. Administration of antibiotics should be carried out as early as possible and over 24-72 h depending on the injury. The initial debridement and assessment of the severity of injury determine the treatment strategy. ⋯ With substantial contamination, loss of bone or extensive soft tissue damage, temporary fixation and temporary wound closure are carried out. The definitive treatment with soft tissue coverage should be performed within 72 h in order to reduce the risk of fracture-related infections. For osseous segmental defects, different approaches are available to restore bone continuity, depending on the size and soft tissue situation.