Der Unfallchirurg
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Craniocerebral missile injuries are a relatively rare type of head injury during peacetime. In the Department of Neurosurgery of the Landesnervenklinik Salzburg 72 patients were operated on for gunshot wounds of the brain in the period 1970-1990, and 31 survived. In the same period 6763 patients were treated for other head injuries. As shown by the clinical courses and the operative results, the velocity and thus the extent of the primary brain damage determine the prospects of success in the treatment of cerebral missile injuries.
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One hundred patients with multiple injuries (mean ISS 37 patients) were prospectively evaluated over a period of 14 days following trauma. Significant differences in the blood levels of PMN elastase, cathepsin B, lactate, neopterin, C-reactive protein (CRP) and antithrombin III (ATIII) were found in non-survivors and in survivors with and without organ failure. ⋯ The prognostic value of these factors was comparable to trauma scores regarding organ failure and better with respect to death. Biochemical parameters may be helpful in estimating the severity of the injury and prognosis and in monitoring the ICU course of such patients.
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Compared with proximal ruptures of the biceps sinew, distal ruptures of the biceps sinew are extremely rare and generally need operative treatment. However, the large number of different operation techniques described in literature clearly shows that a safe method of treatment has still not been found. In the "Bergmannsheil" Hospital in Gelsenkirchen-Buer, 11 distal ruptures of the biceps sinew in 10 patients were operatively treated during 1985 and 1989. ⋯ In the course of follow-up examinations we noted a considerable deficit of supination power remaining in the affected lower arm, although the clinical results were good otherwise; we have therefore developed our own method, taking particular account of the essentially more important function of the biceps brachii muscle as a supinator in addition to its flexion function. The method applied is described. At the follow-up examination distinctly better supination power was noted in the 4 patients operated on by this method; the flexibility of the cubital joint was not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
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The case presented of a rare injury of the left knee joint underlines the necessity for meticulous examination. We report on isolated dislocation of the head of the fibula in a 25-year-old football player; the diagnosis and therapy for this rare injury are presented.
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In the Department of Surgery in the University Hospital "Bergmannsheil" in Bochum, 67 patients with unstable injuries of the thoracic and lumbar spine were analyzed in a retrospective study. The sagittal correction loss was greatest about 6 months after dorsal stabilization--6 degrees on the average--after stabilization with a plate alone. The correction loss after stabilization with plates combined with the Universal Spine Instrumentation System (USIS), which was developed for ventral derotational spondylodesis or after implantation of an internal fixation device, however, amounted to 3 degrees on the average. ⋯ This occurred equally often with all types of implants. Efficient use of the three systems is discussed with regard to the different pathomechanical modes of injury. A causative scheme of treatment is presented.