Aktuelle Traumatologie
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Aktuelle Traumatologie · Feb 1993
Case Reports[Transcranial Doppler ultrasound in craniocerebral trauma: valuable method in traumatologic emergency cases?].
Introduction of the transcranial Doppler method 1982 (1) by Aaslid made it possible for the first time to monitor noninvasively the cerebral haemodynamics after severe head injury, or in polytraumatized patients in the emergency room. Mean flow velocities (FVmean) and systolic-diastolic frequency spectrum (PI) in basal cerebral arteries were considered. In that way, influences of different pathological intracerebral processes to cerebral haemodynamics are detectable earlier and triage planning of therapeutic steps is facilitated. ⋯ If this is not possible, interpretation of flow signals and measured flow velocities can be only made by comparing both sides. All measurements should be made at normal mean arterial blood pressure. This method enables rapid orientation of intracerebral haemodynamics after SHI and facilitates the decision of what should be done first of all.
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Aktuelle Traumatologie · Dec 1992
[Epidural "sulmycin implant" coverage for local prevention of infection in surgical management of open craniocerebral injuries].
In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. ⋯ Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".
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Aktuelle Traumatologie · Dec 1992
[Arthrodesis of the upper ankle joint. Indications, technique, results].
From 1984 to 1990 a total of 119 arthrodesis of the upper ankle joint were performed at the Hospital of Accident Surgery of the Trade Association in Frankfurt am Main. The results of 98 patients after an arthrodesis of the upper ankle joint are documented by an x-ray control series and patient files, including the expertise on the medical status of pensioners plus a follow-up examination of 34 patients. The indications and the results are discussed on the basis of the various procedures. The results confirm the method of a compressions arthrodesis with an extension screw in case of a posttraumatic arthrosis of the upper ankle joint, while a fixateur externe should be used in case of chronical osteomyelitis, osteoporotic bones, extensive tissue swellings and after a pilon or talus fragment fracture.
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Aktuelle Traumatologie · Oct 1992
[Extra-articular fractures near the knee and concomitant knee damage].
While the prognosis of intra-articular fractures of the knee joint is determined by the reconstruction of the articular surfaces, ligamentous damage and resulting joint instability is a main problem with extra-articular fractures neighbouring the knee. In a follow-up of 43 cases of A 1-3 fractures according to the AO/ASIF classification, 37.2% of the patients revealed concomitant ligamentous damage. ⋯ In cases of supracondylar femoral fractures after open reduction and internal fixation the recovery of knee joint motion is more important than joint stability. Therefore ligamentous repair has to be performed secondarily if necessary.
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Aktuelle Traumatologie · Aug 1992
[Management of femoral neck fractures with the spongiosa screw and the dynamic hip screw].
Between 1983 and 1987 419 patients with femoral neck fractures were operated on at the University Clinics of Graz. In 120 patients we could preserve the head of the femur doing an internal fixation with cancellous bone screws or DHS. 68 of them we personally could control with a mean follow up of 45.2 months. The most important complications were the necrosis of the head which were observed in 19.1% of our patients and the non union which occurred in 5.8% but not all these patients required reoperation.