Der Unfallchirurg
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The sacroiliac region is the link through which the weight of the trunk is transmitted to the legs and a region frequently indicated by patients as the site of back pain. Sacral fractures often remain undiagnosed and untreated and frequently result in neurologic symptoms and deficits. Since a systematic approach is used to analyse the pelvic ring fractures with CT scans, the surgical management of sacral fractures had become a focus of interest. ⋯ Our instrumentation allows decompression (fracture reposition, sacral laminectomy, sacral foraminotomy) of the neural structures and stable fixation without compression. Five multiply traumatized patients with sacral fractures as a component of vertical shear injury of the pelvis had the sacroiliac region stabilized with the internal fixator. The preliminary results are presented.
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Intestinal injury is increasing in frequency among persons sustaining blunt abdominal trauma, and the consequences of delayed recognition of intestinal injuries are serious. This critical retrospective analysis evaluates the role for CT in the diagnosis of blunt abdominal trauma, including hollow visceral injury. ⋯ Intestinal wall thickening with low-density fluid in the abdominal cavity strongly suggests rupture. Until further experience is gained with CT, free intraperitoneal fluid in the absence of solid organ injury should be regarded as an indication for exploratory laparotomy.
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When plating is performed for fixation of complex femoral fractures the need for medial buttress to give durable weight-bearing ability of the bone is mandatory. However the means of achieving this is controversial. Many authors are in favour of mechanical reconstruction of the medial buttress, if necessary with a bone graft. ⋯ Bone grafting was necessary in 8 cases. Only in 2 cases were the defects located in the medial area. In 37 of the 39 osteosyntheses an excellent medial buttress was achieved by bone healing.(ABSTRACT TRUNCATED AT 250 WORDS)
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Posttraumatic adult respiratory distress syndrome (ARDS) still involves significant mortality, despite progress in management concepts. Current therapeutic strategies are briefly described, including kinetic therapy, high-frequency jet ventilation and extracorporeal membrane oxygenation. ⋯ This young man with severe posttraumatic ARDS developed a potentially lethal bilateral pulmonary hemorrhage under treatment with ECMO, and on the basis of this bilateral pulmonary transplantation was considered to be indicated. The patient is alive and well 2 years after the procedure.
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Review
[Management of the patient with craniocerebral injuries at the accident site and clinic admission].
Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. ⋯ Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.