Der Unfallchirurg
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This collective study was conducted by the German section of AO International to work out the indications for fixation of the tibial shaft by means of dorsal plating. Primary dorsal plating was done in 70 cases. Most of the patients had second- or third-degree open fractures with severe ventral soft tissue injuries or closed fractures that could not be reduced and fixed conservatively. ⋯ Most of these patients had such severe damage following fractures that dorsal plating was the last chance of avoiding amputation. The high rate of complications (12 infections and 7 non-unions and breakages of implants after primary dorsal plating; 20 infections and 11 non-unions and breakages of implants after secondary dorsal plating) has to be considered in the light of the extraordinary indications for the dorsal plating of the tibial shaft in especially severe fractures or disastrous sequelae. In cases with extremely severe conditions before fixation, dorsal plating of the tibial shaft for secondary operative treatment yields adequate results.
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Chest sonography after blunt thoracic trauma allows the immediate institution of emergency treatment before X-ray examination. Especially in cases of hemothorax or/and hemopericardium, ultrasound is more specific and sensitive than conventional X-ray. A definite diagnosis of pneumothorax is possible when the typical sonographic findings are present: there is a strong line of reflexes along the chest wall, with complete extinction. ⋯ In 2 cases rupture of the diaphragm seemed possible on ultrasound but was excluded by later (ultrasound) controls, and in 2 cases with ultrasound findings suggestive of pneumothorax subsequent X-ray examination confirmed the diagnosis of mantle pneumothorax. At follow-up, 29 pathologic findings according to radiographic examination were recognized on ultrasonography as liquid or organized pleural effusions or pulmonary infiltrates. False-negative or false-positive findings (apart from two supposed diaphragmatic injuries) were not recorded with ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comminuted fractures of the olecranon are an absolute indication for operative treatment. Adequate therapy is only possible when open reduction and plating are performed. In the last 20 years, 31 of our patients, i.e. 0.0001% of all patients treated for injuries, had this type of olecranon fracture, and in 25 follow-up examination was possible. ⋯ Brief plaster fixation after the operation makes it possible to restrict the development of ankylosis in the elbow joint. The results were excellent in 10 patients, good in 5 patients, fair in 4 and poor in 6 patients. In 3 patients, i.e. 10% ankylosis was present in the elbow joint; this was considered to constitute an indication for arthroplasty, which gave a better postoperative range of motion.
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In our population of trauma patients abdomino-perineal impalement injuries are very rare. With reference to our own patients we demonstrate the problems that arise with impalement injuries: infection, hemorrhage, intraabdominal organ lesions and difficulty in recognizing these. ⋯ In our own patients we have always tried to achieve definitive therapy as a primary procedure. There have been no lethal complications.
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The presence of soft tissue defects in the hand indicates serious traumatic damage that may compromise the systems involved in movement, circulation or touch and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft tissue defects. ⋯ The characteristics required of flap tissue are described, such as surface characteristics, ability to restore sense of touch, cosmetic appearance, ability to close deep volume defects, and potential for revascularization of adjacent tissue. Finally, commonly used, selected flaps are presented with notes on their advantages, disadvantages, and modifications, the techniques required and the indications for each.