[The importance of CT angiography for screening supra-aortic vascular damage in severely injured patients]. / Bedeutung der CT-Angiographie zum Screening supraaortaler Gefässverletzungen beim Schwerverletzten.

PURPOSE: Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. METHODS: Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. RESULTS: During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. CONCLUSION: Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.

[Volar locking compression plating versus dorsal plating for fractures of the distal radius: a prospective, randomized study]. / Volare winkelstabile vs. dorsale Plattenosteosynthese bei der distalen Radiusextensionsfraktur: Eine prospektive, randomisierte Untersuchung.

INTRODUCTION: This study investigated the radiographic and functional outcomes of two different methods for treating fractures of the distal part of the radius. PATIENTS AND METHODS: In a prospective controlled study patients with forearm fractures were randomized by age, handedness, and fracture type. RESULTS: The study included 120 patients, with a mean age of 66 years. Forty-nine percent of the fractures were extraarticular, and 51% were intraarticular. In the group treated with volar locking compression plates, six patients needed operative decompression of the median nerve and one needed reconstruction of the extensor pollicis longus (EPL) tendon. The group with dorsal plating had three complications requiring operative treatment: one deep infection, one dislocation of the plate, and one reconstruction of the EPL tendon. The radiological results for the Stewart 1 score showed 68% excellent results in volar locking compression plating compared with 57% in dorsal plating. Regarding functional outcome, 48% with volar plating showed excellent results compared with 22% with dorsal plating, as measured by the Stewart 2 score. CONCLUSION: Despite significant advantages of the volar locked compression plating, subjective satisfaction did not differ between the two groups.

Emergency Transfusion Score (ETS): a useful instrument for prediction of blood transfusion requirement in severely injured patients.

BACKGROUND: Efficient blood transfusion management presents an ongoing challenge for many trauma centers. We present the Emergency Transfusion Score (ETS), a measure that may allow important time and cost savings in the treatment of severely injured patients in the Emergency Room (ER). METHODS: The ETS includes the parameters low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism. An ETS >or= 3 indicates a transfusion probability of 5% and was set as the cut-off to order blood products (10 packed red blood cells [PRBC]/10 fresh frozen plasma [FFP]). RESULTS: A total of 481 patients requiring trauma team activation (ISS 18 +/-18; 7/03-12/04) were prospectively included. The ETS was < 3 in 306 patients (64%) and >or= 3 in 175 subjects (36%). Some 40 patients (8.3%) received blood (8 +/- 8 PRBC) after 23 +/- 9 min during ER treatment, and 39 of these patients had an ETS of >or= 3 (5.4 +/- 1.5 points). Sensitivity of the ETS was 97.5%; specificity, 68%. Positive predictive value of the ETS was 0.222; negative predictive value, 0.998. CONCLUSIONS: (1) The ETS is a safe and highly sensitive tool with which to detect severely injured patients in need of blood products. (2) The ETS is highly predictive for patients not in need of PRBC (negative predictive value 0.998) and helps to avoid unnecessary cross-matching and transport. (3) After implementation of the ETS, a sum of about 109,296 USD was saved per year by reducing the costs for cross-matching, transportation, and wasted blood products.

[Penetrating gunshot injuries to the head and brain. Diagnosis, management and prognosis]. / Penetrierende Schädel-Hirn-Verletzungen durch Schusswaffen. Diagnostik, Behandlungsmanagement und Prognose.

Gunshot injuries to the head and brain are rare in Germany and the rest of western Europe. With the relatively low number of these injuries here, there are no standard methods of diagnosis and management, and there is some controversy over both. Quite a high proportion of such injuries result from suicide attempts and accidents. The main diagnostic procedure available is computed tomography of the head with contrast medium; in certain cases MRI is indicated. The operative management depends on the extent and prognosis of the injury; a ventricular drain is probably indicated in most cases. Debridement of the bullet's path and removal of the projectile are more controversial. Mortality is extremely high after such injuries; if the victim does survive the prognosis is comparable to that following closed cranial injuries.

[Injuries- and frequency of complaints in competitive tennis- and leisure sports]. / Verletzungs- und Beschwerdehäufigkeit im Tennisleistungs- und Breitensport.

Tennis is one of the most popular sporting activities in Germany and worldwide. According to this fact injuries and complaints associated with this sport are common in tennis players. Here a retrospective analysis was undertaken in 60 tennis players with and 50 tennis players without tournament experience. Injuries were seen in all players. The most common lesions were blisters, sunburn and abrasions (65.5 %) followed by cramps (51.8 %), strains (35.5 %) and sprains (25.5 %). More severe injuries like meniscal lesions or ruptures of the cruciate- and ankle-ligaments or the achilles tendon were found in 2 % to 4 %. Fractures were not seen in this study. The majority of tennis injuries occurred in the lower extremity (182 vs. 62) whereas chronic complaints domain in the upper extremity (38/91). Most of the injuries and complaints have been treated conservatively with good results. Only 3.3 % of all acute and 2.2 % of the chronic lesions were treated by surgical intervention.

[Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach]. / Postoperative Morbidität der operativ behandelten distalen Radiusextensionsfraktur. Eine Vergleichsstudie zwischen dorsaler und volarer Plattenlage.

The aim of this study was to investigate perioperative morbidity in operative interventions in distal radiusfractures, comparing the operative approach from volar and dorsal. Only problems, resulting from the operative approach towards the distal aspect of the radius, were examined. In a Case-Control-Study, we investigated patients with operative by plate-osteosynthesis treated distal radius-extensions-fractures. During 3 years we investigated 92 patients. 49 were operated with a volar approach, and after changing the operative management, consecutive 43 patients with a dorsal approach to the distal radius. Indications for operative treatment were not changed. The approach to the distal aspect of the radius corresponded to the recent guidelines. Further perioperative procedures were identical, including procedures in anesthesiology. Datas of patients have been investigated for epidemiology, kind of operations, point of time in treatment, duration of operation, X-Ray, immobilisation and time of inhospital stay as well as all documented complications. It has been shown, that in respect of all criterias, concerning length of operation (106 vs. 83 min), intraoperative X-Ray (3.0 vs. 1.65 min) as well as postoperative immobilisation (33 vs. 25 days), and documented incidences of complications like secondary wound-healing (19/49 vs. 0/43) or nerval irritations (13/49 vs. 1/43), the dorsal osteosynthesis is definitively to be favored.