Der Unfallchirurg
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Biomechanical investigations in eight specimen elbow joints to test articulated external fixation showed correct extension-flexion joint position between 0 and 120 degrees. The central axis through the radial and ulnar condyles varies less than 3 degrees in total. ⋯ All patients began with physiotherapy on the 3rd day after operation, the range of joint motion was 0-30-95 degrees in all cases, after 6 weeks 0-30-110 degrees. Additional articulated external fixation at the elbow joint can be an alternative treatment to long-term transfixation of the elbow in cases of complex injury.
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Isolated severe head trauma (SHT) or SHT in combination with multiple injuries are important factors for the prognosis of morbidity and mortality in patients suffering from the consequences of accidents. The prognosis mainly depends on the presence of primary mechanic brain injury and the development of secondary brain damage. Causes for the development of secondary brain damage are the intracranial space demand after traumatic injury and edema formation which may result in iscemia, as well as inflammatory processes. ⋯ Our knowledge about the bidirectional inflammatory interaction between brain and whole organism is still limited. In this context, the effects of secondary surgical interventions which may additionally, stress a traumatized body have to be considered and are the subject for actual clinical discussions and experimental studies. This article tries to summarize some important aspects on this topic.
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122 cases of patients who died in sequel of an accident (recruitment period 1993/94, mean ISS 40 +/- 19) in reach of air rescue base Dresden, Germany, were examined. Data were assessed from autopsy protocol and the protocol of the physician who treated on scene. We analyzed the time course of the emergency, the scheduled emergency medical service and the quality of prehospital diagnosis and therapy by the emergency team. ⋯ Hemorrhagic shock related to these injuries was found in 44.2%, mean resuscitation volume applicated in these cases was 960 +/- 610 ml. Typical faults in diagnosis and treatment were underestimating of severe trunk trauma and non-consistent use of invasive treatment procedures. Primary transport of the severely injured patient to a level I trauma center by helicopter was performed only rarely.
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Review Case Reports
[Dorsal carpometacarpal dislocation of the fifth finger: discussion of diagnosis and therapy on two cases].
Dorsal dislocation of the fifth carpometacarpal joint after injury is rare. Only five cases are reported in the literature. We report on two cases of dorsal dislocation of the fifth carpometacarpal joint after injury and we give a review of related literature. ⋯ A reduction without following Kirschner wire fixation - even in those dislocations that were found to be stable after closed reduction - is not recommended because of the risk of persisting pain after heavy manual work. In our two cases an instability of the fifth carpometacarpal joint existed after closed reduction. After Kirschner wire fixation and cast immobilisation for 6 weeks both patients showed 3 months after operative therapy a full range of movement and a powerful grip without any pain in the fifth carpometacarpal joint.
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The case of a 25 year old male with a stab wound of common carotid artery and the internal jugular vein is reported. He was admitted in severe hemorrhagic shock and immediately treated successfully by arterial reconstruction by means of a venous patch. ⋯ A survey of the literature shows that the fast repair of the carotid artery is clearly to be given preference to ligature. First can be executed successfully in exceptional emergency cases also by non-carotid surgeons, if basic vascular-surgical techniques are controlled.