Der Unfallchirurg
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Compartment syndrome of the lower extremities has various etiologies. Patients suffer from toe deformity due to incorrect healing following compartment syndrome. They are restricted in their mobility as a result, even though the primary causes of the compartment syndrome in the lower extremities have long since healed. ⋯ Instead, they are a typical response to biomechanical changes in the foot. Following compartment syndrome, they are the result of a relative shortening of the tendons and a loss of function and contraction of the muscle; in patients with splay foot and flat foot, the toe deformity is caused by bone and connective tissue pathology. Identical surgical measures are used.
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Due to the unique anatomy and pathophysiology involved, a compartment syndrome (CS) of the lower leg and foot is prone to develop sequelae that demand operative reconstruction. Moreover, the two regions are closely related. Although research into various pathophysiological areas is revealing specific complexities, aspects of the foot's compartmental anatomy remain controversial, perhaps because of methodological reasons. This may result in particular practices for diagnosing and treating CS in this region, which are discussed in this article.
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Pelvic fractures may accompany other injuries and can be life-threatening. In addition, the rectus abdominis muscles might also be torn. During fracture reduction, these muscles are fixed to their insertions. ⋯ Two and a half years after the accident, the patient developed a diastasis and an abdominal wall hernia, which were repaired by refixation of the rectus abdominis muscles to the bones with Mersilene bands. Results nine months after the reconstructive surgical intervention show a firm abdominal wall without recurrence. This case shows that even 2.5 years after an accident, the rectus abdomini muscles can be fixed with Mersilene bands to the bone and anatomic reconstruction of the abdominal wall can be carried out.
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[Prehospital Trauma Life Support (PHTLS): An interdisciplinary training in preclinical trauma care].
There is clinical evidence that standardized management of trauma patients in the emergency department improves outcome. Standardized prehospital management has been established for stroke patients and those suffering acute coronary syndrome. Prehospital treatment of trauma patients differs quite significantly from one system to another. The data from the German Trauma Registry show that the average time from accident until arrival in the emergency department is 72 min. This needs improvement. ⋯ PHTLS teaches a standardized and established approach to the trauma patient in the emergency department. It has been established in 36 countries and the content is reviewed regularly to consider new scientific evidence. Healthcare personnel in Germany have the chance to participate in this international standard of care and to introduce their own experiences into the review process.
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Proximal tibial epiphyseal injury is a rare finding in adolescents. We report the case of a 13-year-old boy with simultaneous epiphyseal fractures of both proximal tibiae to illustrate appropriate diagnosis and treatment of this condition. The injury occurred while performing a long jump: a Salter-Harris type II fracture of the right proximal tibia was sustained at take-off and a Salter-Harris type III avulsion fracture of the left tibial tuberosity upon landing. Closed reduction and internal fixation using K-wires were performed on the right side, whereas open reduction and internal fixation were done on the left side, using a lag screw and additional McLaughlin wiring.