Der Unfallchirurg
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In a limited number of surgically treated patients with blunt trauma to the internal carotid artery (ICA), intimal lesions were found at the intersection of the ICA with the hypoglossal nerve (CN XII). Therefore, these clinical findings were investigated in an anatomic study. In two-thirds of these cases, the congenital "anomalous" relationship of ICA and CN XII caused a strangulation phenomenon during extreme turning manoeuvres of the head and neck. On the basis of our clinical intraoperative findings, anatomic studies und reports in the literature, a further mechanism of vascular injury is suggested in this area.
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We report our experience with 12 patients whose chest wall injuries were treated with stable internal fixation by means of rib plates. Of all patients with chest wall injuries requiring inpatient treatment, only 5.19% were operated for this diagnosis; that is to say this operation is seldom indicated. In 5 patients stabilization was done "on the retreat" when thoracotomy had to be performed for intrathoracic injury anyway; in another 5 patients inadequate recovery from respiratory insufficiency following conservative treatment led to the operation, and in 2 patients extreme dislocation of chest wall fractures with restricted chest volume was the reason for surgical intervention. ⋯ Two aged patients died of non-trauma-related myocardial infarction and myocardial insufficiency, respectively, while in hospital. Complications attributable to the specific surgical intervention were superficial infection of the incision (2 cases) and postoperative haemorrhage from an intercostal artery (1 case). No late complications related to the specific operative procedure occurred.(ABSTRACT TRUNCATED AT 250 WORDS)
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Bronchoalveolar lavage (BAL) specimens taken from nine patients with lung contusion following multiple trauma were compared with specimens from different control groups. Early interstitial and intra-alveolar reactions are PMN degranulation, mediator release and high protein leakage. The alveolar reactions are similar in extent to the reaction found in post-traumatic ARDS.
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Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. ⋯ The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.
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The implantation of distal interlocking screws in interlocking nailing can be difficult and time-consuming. With the AO Universal Femoral Nail as the basis, an implant was designed with which distal interlocking is accomplished from the inside of the nail by means of a simple claw mechanism. Instrumentation and interlocking are possible from the proximal standard approach, so that an additional operation adjacent to the knee (which is necessary when interlocking bolts are used) is superfluous; neither for the insertion nor for the removal of the interlocking mechanism is an image intensifier necessary. ⋯ Full weight-bearing was allowed after a mean of 4.4 weeks (0.7-8.2 weeks). In 1 case we saw a deep venous thrombosis with pulmonary embolism obvious on clinical examination and scintigraphy. Two patients died of their multiple trauma, and of cachexia the patient with the CML metastasis died 6 weeks after stabilization.(ABSTRACT TRUNCATED AT 250 WORDS)