Der Unfallchirurg
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[Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry].
The increasing average age in the industrialized nations is leading to an increasing number of elderly traumatized patients. Against this background, an analysis of the age-specific characteristics of geriatric traumatized patients is necessary. In this study, 14,869 patients > or = 18 years were analysed, who were prospectively documented in the registry of the German Trauma Society (DGU) between 1996 and 2005. ⋯ Older patients stayed for a significantly shorter time in hospital and on the ICU. With a comparable injury severity, the lethality after trauma increased with age (18-59 years 13.8%, 60-69 years 24.1%, 70-79 years 35.5%, > or = 80 years 43.6%). The multiply traumatized geriatric patient is different from the normal group in regard to type of injury, therapy and outcome and should therefore be treated taking this fact into consideration.
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Heterotopic ossifications (HO) are defined as the abnormal formation of bone in soft tissues. It can be classified into acquired and congenital forms. The acquired form, of which the pathogenesis is not fully understood, is often diagnosed in patients with traumatic brain injury, spinal cord injury, musculo-skeletal trauma or injuries associated with burns. ⋯ Imaging techniques, foremost bone szintigraphy, are mostly used for verification of the diagnosis. Local radiotherapy and nonsteroidal anti-inflammatory drugs are the classical therapeutic and prophylactic options. In advanced stages, surgical resection may be required.
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With regard to diagnosis and treatment, there is no general agreement about the management of mild head injury. The value of clinical discoveries and the indications for x-ray investigations are controversially discussed, as well as the risks of radiation exposure. Important criteria in the judgment of mild head injury are knowledge of its possible stages over time (primary and secondary unconsciousness and symptom free interval), the dynamics of secondary intracranial injury development (epidural or subdural hematoma, brain contusion, brain swelling, brain edema), and the priority given to neurologic findings, accompanying vegetative symptoms and computerized tomography and x-ray results. By means of these parameters, an algorithm for appropriately managing the diagnostics and processing of patients with mild head injury has been created.
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The purpose of this prospective clinical trial was to report about results of primary or early secondary arthroscopic stabilization after first traumatic anterior dislocation of the shoulder. ⋯ Arthroscopic stabilization after first traumatic anterior shoulder dislocation of the young patient is an appropriate approach and regardless of whether it is performed as a primary or early secondary operation it significantly lowers the redislocation rate. The method leads to quick reintegration into professional life and sports activities.