Der Unfallchirurg
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Between 1980 and 1996 we treated 23 patients for dislocated fractures of the talus. The injury was caused by a car accident in 61% and a high fall in 22%. Five patients had open wounds (22%), two developed compartment syndrome of the foot (9%) at an early stage, and 11 patients had multiple injuries. We used the classifications of Hawkins and Marti/Weber. All fractures were surgically treated by fixation with screw osteosynthesis, percutaneous wire transfixation, and/or external fixation. Fifteen patients with dislocated fractures of the talus underwent clinical and radiological follow-up examinations using the Kiel score. ⋯ Even immediate anatomical reduction and sufficient stabilization cannot always decrease the rate of talar necrosis and peritalar arthrosis.
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Measurement of intracranial pressure (ICP) has to be regarded as a standard procedure in today's treatment of severe head-injured patients. Intraventricular or intraparenchymal measurement should be used. ⋯ Computer-based analysis of the ICP-signal provides further options of an online monitoring of intracranial reserve capacity and the state of autoregulation. However, until now, there are no software solutions commercially available which would allow for such advanced signal analysis--the reason might be that the potential of advanced signal analysis has only been discovered within the recent years.
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Patients with spinal cord lesions suffer injury even by marginal trauma, especially in the area of the knee joint. Because of lost sensitivity and proprioception, the treatment of the fracture has to be minimally invasive but stable enough for physiotherapy. ⋯ We saw in this study that the GSH nail is an excellent method for stabilizing supracondylar fractures of the femur in paraplegic patients because the treatment is minimally invasive and the fracture is stable enough for physiotherapy. The retrograde nailing of proximal fractures of the tibia is a good alternative method for treatment of patients with spinal cord lesions.
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We present a case of two patients with a distal femur shaft fracture due to a high velocity trauma. Both were treated with a distal femur nail (DFN). After mobilisation a fracture of the neck of the femur was diagnosed which was not seen in the x-rays on admission. ⋯ Immediately after operative treatment of a femur shaft fracture specifically after high velocity trauma or in polytraumatized patients an x-ray of the hip in two plains should be made in the same narcosis. A possible fracture of the neck of the femur could be treated at same time. Post-operatively a further diagnostic should be done in case of suspicion, e.g. pain during mobilisation.
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From 1996 to 1999, 572 fractures of the clavicle were treated in our department, 26 of which were located at the lateral end of the clavicle. Two children were operated: in one a closed reduction of the fracture under general anesthesia was performed, and in the other the fracture required open reduction with internal fixation. All other fractures were treated conservatively with a figure-of-eight clavicle strap for 3 weeks. ⋯ Sixteen patients came to our outpatient department for clinical and radiological control, and three patients informed us by phone. All patients including the two treated under general anesthesia were fully recovered and had no problems doing their job and engaging in different sports. The radiological controls showed a good ossification without visible deformity of the clavicle.