A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma.

UNLABELLED: This study was designed to compare the clinical efficacy of a single dose of ceftriaxone with cefoxitin given 3 times a day for 3 days. METHODS: Patients had to have a penetrating injury to only one part of the body, reach the hospital within 2 h and be operated on within 16 h after the trauma. Patients were excluded if it appeared likely that they would require mechanical ventilation for more than 24 h. The same applies to open or grade II/III craniocerebral trauma. The end point was the occurrence of infections within 10 days. The costs of antibiotic treatment were also calculated. RESULTS: 96% of the ceftriaxone patients (n = 97) and 95% of the cefoxitin group (n = 98) remained infection-free. In neither treatment group was deep infection, abscess, phlegmon or sepsis seen. No additional surgery or intensive care due to infection was required. At $41.83 vs. $172.16, the average total cost of delivering antibiotic treatment was significantly lower in the ceftriaxone group (p < 0.001). CONCLUSION: Prophylaxis in penetrating trauma with a single dose of ceftriaxone is safe and has considerable practical and economic advantages.

Autologous keratinocytes cultured on benzylester hyaluronic acid membranes in the treatment of chronic full-thickness ulcers.

Keratinocytes were obtained from three patients with chronic full-thickness ulcers of different aetiologies. The cells were isolated, cultured and then seeded on to a membrane composed of benzylester hyaluronic acid. Once the keratinocytes had become subconfluent, the keratinocyte-containing matrix sheets were then applied as autologous grafts to the patients' ulcers. Results indicate that autologous grafting of keratinocytes cultured on benzylester hyaluronic acid membranes provides improved graft handling, reduces total time required for tissue cultivation and enhances cellular vitality because of the possibility of grafting at a subconfluent non-differentiated stage.

[Joint surface replacement of the lateral tibial plateau using patella transplantation]. / Gelenkflächenersatz des lateralen Tibiakopfplateaus mittels Patellatransplantation.

A case of surgical reconstruction of the lateral tibial plateau after impression fracture (Type 41-B3.1) of an 47-year-old female is presented. Joint reconstruction was performed by using a free patellar graft. The 16-year follow-up shows a very good functional outcome without subjective complaints. This case underlines that performing patellar autografting for surgical reconstruction of severe injury of the tibial plateau seems to be a promising alternative especially considering young patients in spite of avoiding total knee replacement.

[Revision: guiding principles for successful or unsuccessful stabilization of subtrochanteric femoral neck fractures. A review]. / Die Reposition: Richtungweisende Grundlage für Erfolg oder Misserfolg der Stabilisierung des hüftkopfnahen Schenkelhalsbruches. Eine Ubersicht.

Over a long period of time the dislocated and unstable fracture of the femoral neck has been called "the unsolved fracture". Regardless of all technical improvement developed the head- and joint preserving treatment of this fracture seemed to remain an "unsolvable" problem. Fundamental reason for this discrediting judgement was the continuously high rate of complications like segmental collapse of the femoral head and pseudarthrosis of the femoral neck. The invention and speedy acceptance of hip joint replacement made many surgeons hope that the "unsolved" problems of treating femoral neck fractures could be guided to a definite conclusion. This revising discussion is done to bring home being familiar with the experience gained by practising the head- and joint preserving surgery of femoral fractures.

[Autologous keratinocyte culture on hyaluronic acid ester membranes: an alternative in complicated wound management?]. / Autologe Keratinozytenkulturen auf Hyaluronsäureestermembranen: Eine Alternative in der komplizierten Wundbehandlung?

Cultivation and transplantation of autologous keratinocytes has been used in the last 15 years to treat complicated wounds of different origin. In spite of excellent technical advancements and clinical experiences cultured keratinocyte grafting still is associated with practical limitations. Application of hyaluronic acid ester membranes as carrier substrate for the transfer of keratinocytes allows improved graft handling: reduces total time required for tissue cultivation and furthermore enhances vitality of the keratinocytes because of possible grafting at semiconfluence.

[Electr(on)ic data processes in trauma surgery--"an old hat that still doesn't fit"]. / Elektr(on)ische Datenverarbeitung in der Unfallchirurgie--"ein alter Hut, der noch immer nicht passt".

Despite the application of data processing in medicine beginning almost 40 years ago and then employing the Hollerith-method until now no consent has been achieved to solve the problems that arise from the demands of jurisdiction concerning methodical proceedings and procedures in data processing in hospitals. Concerning this the hospitals' administrations are overstrained as are the clinical departments. The paper presented recalls empirical knowledge that has already been gathered long ago.

[Electronic picture and data storage and processing with PC in trauma surgery--an anachronism?]. / Elektronische Bilddatenspeicherung und -verarbeitung mittels PC in der Unfallchirurgie--ein Anachronismus?

Acquisition, storage and processing of any images relevant in trauma surgery together or in combination with (alpha) numeric data nowadays are possible employing a personal computer. The computing speed that is achieved with 486 cpu's "inside" is sufficient to process images in motion as well as single images to be filtered. The display and process-resolutions required for processing of X-ray-images can be achieved with the PC's hardware as well as with the software available. That is why there is no need any longer for special configurations for X-ray-departments. Calculating the price of the process-environment proposed, about 25,000 DM should be enough including the video tape recorders and the CD-ROM-recorder that are required.

[Forearm fractures in children]. / Frakturen im Bereich des Unterarms bei Kindern.

A total of 285 children out of an 8 year period with fractures of the forearm were studied. Of these 175 (62.2%) had a fracture of the distal radius and 51 (18.2%) had a fracture of the distal forearm and there were 42 (14.7%) fractures in the middle or proximal third in this region. Three children with injuries of the distal radial epiphysis had to be treated by percutaneous wire fixation. Except for 2 cases who needed surgery all severe dislocated forearm fractures could be treated by closed reduction. In all cases the children were immobilized with a long upper arm cast for 3 to 4 weeks. Follow-up examinations up to 6 years after injury showed excellent results in distal forearm and distal radial fractures whereas results were only satisfactory in midshaft forearm fractures.

[CORSET, experience with a new method of graft saving tissue replacement in large soft tissue defects]. / CORSET, Erfahrungen mit einer neuen Methode zum transplantatsparenden Gewebeersatz bei grossen Weichteildefekten.

Following the proposal of Oedekoven we investigated the method of continuous and rapid skin enlargement by dynamic traction (which we named the CORSET-method) at the border of wounds, applied through elastic silicon rubber bands. Since March 1992 we operated more than 20 patients. By means of the "rubber bands" mentioned above soft tissues can be stimulated to grow, that is to say increase the area of skin that had to be treated with transplants priorily in order to close soft tissue defects following a compartment-syndrome or septic complications in the abdomic wall following operations in the abdomen. Applying the CORSET-method there is no risk of inflammation or soft tissue damage caused by the operation itself.