Der Unfallchirurg
-
The optimal choice between operative and conservative therapy in the treatment of femur shaft fractures in school age children remains controversial. Between 1985 and 1991, 34 children aged 6-14 years were treated in our institution for fractures of the femoral shaft: 8 were treated conservatively with traction, while 10 underwent plate fixation and 15 external fixation. The 34 cases were analyzed retrospectively. ⋯ All had unlimited hip and knee motion. Two children in the conservative treatment group were seen on radiographical examination to have a varus angulation of more than 10 degrees. In the plate and fixator group no malalignment was present.(ABSTRACT TRUNCATED AT 250 WORDS)
-
This article summarizes the present knowledge on the diagnosis of and treatment rationales for ruptures of the anterior cruciate ligament (ACL) of the knee. There is an increasing incidence of this injury due to the high number of persons involved in dynamic sports. The most significant diagnostic criterion is a positive pivot shift associated with a pathological anterior translation of the tibia in slight flexion of the knee. ⋯ The rehabilitation program after implantation of a patellar tendon graft can be accelerated markedly without endangering joint stability. Crutches are necessary only for the first 2-3 weeks. The success rate in terms of objective stability with an autologous patellar tendon graft is high, although specific disadvantages such as chronic patellar pain and a risk for loss of motion must be considered.
-
We present a technique to measure pulmonary microvascular permeability for albumin in patients with multiple trauma by means of bronchoalveolar lavage (BAL). Routine laboratory tests for the analysis of BAL fluids are used. The results were clinically validated in 10 healthy volunteers and 12 patients with multiple trauma in a first prospective study. ⋯ Normal values (> 0.09 +/- 0.02), posttraumatic physiological ranges (< 0.35), and a "high risk" range (> 0.5) for pulmonary microvascular permeability for albumin were developed. There was a high correlation between the first posttraumatic values of pulmonary microvascular permeability and the required duration of intensive care treatment (r = 0.81), the duration of continuous mandatory ventilation (r = 0.78) and the mean lung injury score by Murray (r = 0.76). We conclude that the presented method is harmless and useful to describe the post-traumatic course of pulmonary microvascular permeability.
-
Comparative Study
[Trauma score systems as instruments in quality control. A prospective study on validation of 7 trauma score systems with 612 trauma patients].
Quality control in the treatment of trauma patients often consists in comparisons of survival rates. The trauma population under study is seldom defined with regard to severity of injury. Therefore crude survival rates are of little help when the quality of care is discussed. ⋯ All trauma score systems tested showed sensitivities and specificities greater than 83%. They all proved their ability to classify trauma patients according to severity of injury. The TRISS performed best of all, with sensitivity of 93.1% and specificity of 93.7% at a cut-off point of 0.85.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Clinical Trial Controlled Clinical Trial
[Effects of different intramedullary stabilizing procedures of the femur on lung function in polytrauma].
We investigated the effects of primary (< 24 h) intramedullary femoral nailing on lung function and pulmonary hemodynamics in multiple trauma patients. The standard procedure following reaming of the medullary canal (AFN) was compared with a new procedure using a small, solid nail without prior reaming (UFN). Pulmonary hemodynamics were determined using a pulmonary artery catheter. ⋯ Our measurements did not show an increase in central venous triglycerides in the AFN group, probably because bone marrow does not become immediately soluble. There was no significant difference between the increase of elactase levels in the two groups. The femoral nailing procedure with reaming in multiple trauma patients involves a potential risk to the lung.(ABSTRACT TRUNCATED AT 250 WORDS)