Der Unfallchirurg
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The growing number of mass casualty events during the early 1990s led, in January 1996, to the foundation of an honorary group of specially trained emergency physicians for dealing primarily with the management of large-scale emergency events and mass casualties. The incidence and quantity of these casualties was analysed in order to be better prepared for such events in the future. ⋯ All calls prospectively registered by the Augsburg Rescue Co-ordination Centre (ARCC) in the 5 years from July 1997 to June 2002 were analysed, distinguishing between the different types of damage, number of patients involved, and time of occurrence (time of day/season). The area served by the ARCC includes the city of Augsburg with its surrounding counties. An estimated 850,000 inhabitants live in this area of 4,100 square kilometers (1,600 square miles). Since 1998, more than 145,000 calls a year have been dealt with of which 28,000 were covered by emergency physicians. In the 5 year period discussed here, 75 large-scale-calls were registered, giving an average incidence of 1.25 calls/month. Most of the calls were fire alarms, followed by car accidents. In total, we were able to serve more than 800 patients. The lowest number per event was two people during an emergency landing of a sport aircraft; the largest number was about 150 patients during a large open-air event in the city. While there was no difference in the time of day at which the event happened, most occurred in November and December. Taking these results into account, the authors, supported by the members of the emergency physician team of the German Trauma Society, developed an algorithm describing the optimal procedure for mass casualty events. This is presented here. In mass casualty or large-scale emergency events, an experienced emergency physician is necessary to co-ordinate the rescue brigades on site.
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Comparative Study
[Computer assisted pelvic and acetabular surgery. Clinical experiences and indications].
CT based navigation has been used in spine surgery since 1994. Several clinical studies could show an increase in precision compared to the conventional technique and thus nowadays the navigated pedicle screw placement is a routine procedure in many hospitals. Based upon the experience in spine surgery the CT based navigation module was used for percutaneous screw fixations in minimally displaced pelvic ring and acetabular fractures. ⋯ In one SI screw the postoperative CT could reveal a ventral cortex perforation of the sacrum without any clinical symptoms. Based upon this limited clinical experience we see the indication for CT based navigation in minimally displaced acetabular fractures or in SI screw fixations in case of sacral dysplasia. The C-arm based navigation with adequate image quality is our method of choice for SI screw fixation in traumatic or degenerative instabilities, especially if reduction maneuvers are necessary.
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Comparative Study
[Analysis and correction of leg deformities. 2. Correction].
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Case Reports
[Coracoid pseudarthrosis caused by anterior shoulder dislocation with concomitant coracoid fracture].
Fractures of the coracoid process are rare and represent only 2-5% of all fractures of the scapula. The most frequent cause of a coracoid fracture is direct trauma, but indirect trauma may also lead to a fracture of this kind. Avulsion injuries as part of an acromioclavicular dislocation are the most frequent forms of trauma. ⋯ One cause of the coracoid fracture could be direct impact of the dislocated head of the humerus on the coracoid process, another may be the occurrence of a sudden strong pull of the muscles inserting at the coracoid process during shoulder dislocation. In the majority of cases, conservative treatment with six weeks of immobilization is appropriate. If a pseudarthrosis occurs and there is persistent pain, we recommend the operative fixation of the distal coracoid fragment by insertion of cancellous bone graft taken from the iliac crest and stabilization with a cannulated AO titanium small fragment screw and PDS cord.