[Sudden blindness following operative care of a multiply traumatized patient: posterior ischemic optic neuropathy]. / Unerwartete Blindheit nach operativer Versorgung eines polytraumatisierten Patienten: Hintere ischämische N.-opticus-Schädigung.

A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. Between the day of the accident and day 8 after, the patient developed impaired vision and in the further course amaurosis associated with fixed pupils. No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations.

[Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm]. / Schockraummanagement polytraumatisierter Patienten. Ein Mehrzeilen-CT orientierter Versorgungsalgorithmus.

INTRODUCTION: In the treatment of the seriously injured patient, time is crucial. Clarke et al. showed that in the hypotensive patient with blunt abdominal trauma and bleeding a delay in the surgical treatment over 90 min increases mortality of 1 % every 3 minutes. So called trauma algorithms are used as systematic approach to the seriously injured patient that can be easily reviewed and practiced. One impact of this algorithm is to shorten time in the emergency room and may improve outcome of the patient. The patient outcome is directly related to the length of time between the injury and the beginning to proper definitive care. OBJECTIVE: Are improvements still necessary and possible in the care of the seriously injured patient? New technical developments like multislice-CT are able to shorten time until definitive care. The practicability of an multislice-CT orientated treatment algorithm was evaluated. METHODS: After integration of an multislice-CT into the emergency room the treatment of the seriously injured patient (ISS >16) was changed. Therefore an algorithm which puts the CT diagnostics in the first minutes of the clinical care was developed. RESULTS: 50 patients were treated following the new algorithm. The time in the emergency room decreased from 87 min to 36 min. CONCLUSION: This algorithm requires a differing from previous surgical standards, but it proved to be timesaving, effective and practicable. It makes the beginning of the definitive care possible within the first 40 min after patient arrival in the emergency room.

[Single segment internal fixator device in treatment of thoracolumbar vertebral fractures]. / Die monosegmentale Montage des Fixateur interne bei der Behandlung von thorakolumbalen Wirbelfrakturen.

Treatment of vertebral fractures by the fixed-angle system of the internal fixator allows fusion over a short area and is the form of treatment now in general use. A bisegmental construction is usual, which means that reduction and relief of the injured vertebral body is achieved indirectly by means of two intact vertebrae immediately adjacent on either side. As a result, both segments stiffen up or are permanently damaged in their function. We report on the possibility of single-segment fixation. The principle is the fusion of the injured segment itself only, i.e., the vertebra actually injured and the vertebra adjacent to the injured segment. Unnecessary fixation of a second healthy segment can thus be avoided. The characteristics of the fracture type in which single-segment stabilization is possible are explained. In a small study of the technique, we used the new AO classification of vertebral fractures of the thoracolumbar spine. The operation technique differs in some details from that applied with a multisegmental internal fixator. For example, the pedicle screws occasionally need to be inserted extremely close to the end-plates if the remaining part of the vertebral body has been destroyed and therefore cannot provide stability. Contraindications are broken pedicles and complete burst fractures of the body. With due consideration for these limitations fractures in all three main groups of the AO classification can, in principle, be stabilized in a single segment. In the years 1988-1990, 14 patients were operated on in this way (12 acute injuries, 2 secondary operations).(ABSTRACT TRUNCATED AT 250 WORDS)

[Technique of surgical correction of post-traumatic kyphosis]. / Technik der operativen Korrektur posttraumatischer Kyphosen.

The correction of posttraumatic kyphosis in the thoracolumbar region almost always requires a combined anterior and posterior approach because of the particular anatomic situation and the pathomorphologic changes. We suggest that the patient be placed in a right lateral decubitus position. This allows dual access to the spine by a posterior midline approach and a retroperitoneal thoracolumbar approach, so that simultaneous anterior and posterior manipulation, correction and stabilization of the spine are possible with no need to turn the patient intraoperatively. Thus, compared with two-or three-stage procedures, the duration of the operation and of stay in hospital can be reduced. This is a retrospective review of the first six patients (average age: 35 years) treated with this approach between 1987 and 1990. All patients suffered from incapacitating back pain that was unresponsive to nonoperative treatment. The surgical procedure was performed at an average of 29 months (range, 5 months to 7 years) after fracture. The average postoperative correction of kyphosis (18 degrees to 45 degrees) was 75%. In addition, two patients had posttraumatic scoliosis (10 degrees and 12 degrees), which was completely corrected. The only complication was partial fracture of a vertebral body in one case, which occurred during the reduction manoeuvre but had no consequences. Three of the patients had complete relief of pain. The remaining three reported persistent pain, although they had good objective clinical and radiological results. The failure to eliminate pain in these patients is thought to be a result of their long-standing (2-7 years) symptomatic posttraumatic deformities. Therefore, we feel that early correction of symptomatic kyphosis is mandatory.

[Fracture of the tibial shaft--still a traumatology problem?]. / Die Unterschenkelschaftfraktur--noch immer ein traumatologisches Problem?

Diaphyseal fractures of the lower leg have continued to hold a special position in terms of incidence, type, severity, and frequency of typical complications as well as healing disorders. Despite general consensus regarding fracture healing and major factors of influence, there still is discrepancy of opinions and recommendations, in the context of pathophysiology, mechanics, and therapy. All in all, 302 fresh fractures and 134 cases of delayed healing or pseudoarthrosis in the diaphyseal region were treated, between 1971 and 1985. It has been the authors' experience that conservative treatment, according to the classical school, should be applied whenever possible. The trend in surgery, primarily for open fractures, is towards adequately dimensioned fixateur externe. Accurately defined minimum instability and healing with callus formation are nowadays appreciated and preferred. The fibula-ligament-membrane-complex may assume great importance to instable or defective forms of tibial fractures. Experimental and clinical investigations are likely to suggest that, depending on the individual case, the fibula should be included in the overall therapeutic concept, when it comes to impaired or delayed healing and pseudoarthrosis.

[Results of the operative treatment of fractures of the shaft of the femur- collective study contributed by the German Democratic Republic to the International Orthopedic Association]. / Operationsergebnisse von Femurschaftfrakturen- Sammelstudie im Rahmen der Sektion DDR der AO-International.

The permanent increase of fractures of the shaft of the femur are due to the rising traffic density. Problems are especially arising by complicated fractures. The results of the operative treatment of these fractures in 15 clinics of the GDR are analysed. Medullary nailing is used in most cases of simple forms of fractures. Second degree and third degree open fractures should be treated by osteosynthesis or exterior fixation. (It has been proven that the early osteosynthesis performed in these patients immediately after the accident is better than the delayed one.