[4-point internal fixator stabilization of a sacral insufficiency fracture]. / 4-Punkt-Stabilisierung einer Sakruminsuffizienzfraktur mittels Fixateur interne.

Sacral insufficiency fractures develop due to a discrepancy between physiological load and load-bearing capacity. Besides osteoporosis as the main predisposing factor, other diseases lead to a loss of the bony elastic resistivity and therefore are able to cause these characteristic bilateral sacral stress fractures. Most patients complain of low back pain and show difficulties in mobilization.The non-operative therapy is based on analgesics and pain-adapted mobilization. Due to the noticeable functional deficit and persistent discomfort, surgery is necessary in many cases. Various operative methods are available, without significant differences regarding stability. We present the case of a 56-year-old man, in whom the progression of B-cell chronic lymphocytic leukemia (B-CLL) led to the development of osteolysis in the posterior pelvic ring and caused a sacral insufficiency fracture. Due to the progressive deterioration of mobilization and the persistent severe pain, we decided to stabilize the posterior pelvic ring. After surgery the patient could be mobilized and the pain was significantly reduced.

Cifosis y fracturas vertebrales torácicas / Kyphosis. Toracic vertebral fractures

Las fracturas tóraco–lumbares son frecuentes y presentan un tratamiento discutido tanto por su indicación como por las técnicas empleadas. Establecemos las indicaciones ortésicas y quirúrgicas de este tipo de fracturas, estableciendo un protocolo de actuación y mostrando ejemplos de nuestras indicaciones

The majority of traumatic vertebral fractures occur in the thoracolumbar spine. Decision to operate or treat conservatively often is based on the amount of posttraumatic kyphotic deformity. Hence, the physician should perform the measurement of angulation of endplates of adjacent, not injured vertebrae – resembling the local kyphosis – which is known to be more reliable. We stablished the conservative and surgical indications for the thoracic indications and the treatment algorithm, with example of our cases

Two times unlucky: treatment of repeated adjacent vertebral fractures following posterolateral interbody fusion.

Posterolateral interbody fusion with cages and posterior fixation is a widespread, accepted method in the treatment of lumbar instability with and without spinal stenosis. Adjacent level instability was occasionally detected in the neighbouring discs. A fracture of the adjacent vertebral body including the upper disc was not reported in the literature. The authors describe a case of a female patient with two time fractures in the adjacent levels-nontraumatic and traumatic-after posterolateral fusion. Recommendations regarding the operative treatment were given.

[Employing a modified gamma nail for the treatment of proximal femoral fractures]. / Einsatz eines modifizierten Gammanagels bei der Versorgung proximaler Femurfrakturen. Neuer "long gamma nail" 10 mm vs."long gamma nail" 11 mm-eine prospektive Studie.

A modified custom-designed long gamma nail (LGN10) and the long gamma nail (LGN11) were evaluated in a prospective trial for operative treatment of proximal femoral fractures. Between May 1998 and January 2000, 50 patients (mean age 79 years) were alternately treated with LGN10 or LGN11. The femoral antecurvature varied from 6 degrees to 10 degrees, with a maximum of 14 degrees, as evidenced by lateral radiograms. The need for intramedullary reaming in LGN10 cases was significantly less ( p=0.046). Other significant differences between the two study groups were not observed. One cranial cut out of the lag screw in the LGN10 group was observed. Other complications were not recorded during hospital treatment. Follow-up results are not yet complete. Using LGN10 seems to reduce intramedullary damage to the femur and make insertion of the nail easier.

[Risks and injuries of go-karting]. / Risiken und Verletzungsfolgen beim Kartfahren.

The demands on leisuretime activities are getting more exacting. So trendy sports just like inline-skating, mountain-biking, paragliding, bungee-jumping or driving go karts become increasing popular. On the other side risks and injuries of this fun sports are not enough represented. We observed in a 16 months period 5 serious accidents with go karts. The injuries included bruise of lower leg, a contusion of the stomach with a pancreatic lesion, an instable fracture of the spinal column, a difficult fracture of the knee and upper tibia and a large sized burnwound. The mean hospitalization time was 32,5 days (17-54 days) and the average age of the patients 27,7 years (9-45 years). The lack of safety devices and the subjective inexperience make go kart driving a dangerous fun. The TUV worked out guidelines for security of indoor kart centres but they don't have any legal liability in case of injury. Therefore everyone carrying out fun sports like go kart driving should be aware of the dangers and should gather information whether the accident insurance will help out in case of injury.

[Drill wire osteosynthesis in subcapital humerus fractures: percutaneous or open procedure?]. / Die Bohrdrahtosteosynthese bei subkapitalen Humerusfrakturen: Perkutanes oder offenes Vorgehen?

Between 1978 and mid-1990, 135 patients suffering from dislocated, non-luxated fracture of the humerus at the anatomical neck (fractura colli anatomici) were treated by means of open or closed percutaneous drill wire osteosynthesis. Follow-up examination after an average of 9 months did not show any significant differences between the two surgical approaches in 117 patients, independent of the shape of the fracture. However, in about 30% of the cases it was impossible to employ the percutaneous approach due to the presence of an obstacle to reduction, so that open reduction and fixation was the only choice. A great majority of the functional results must be considered as good, fractures of the tubercles having the most unfavourable prognosis independent of the surgical technique. It is, therefore, recommended to first try closed reduction with percutaneous drill wire osteosynthesis. If there are any obstacles to reduction, open reduction should be restored to during the surgery session.

Delayed cutaneous hypersensitivity after multiple injury and severe burn.

LetHality and overall prognosis after multiple injury and severe burn are determined to a major degree by the incidence and severity of infectious complications. Immunological reactions are influenced by the extent of trauma. Multitest Mérieux is an appropriate and an easily applicable means to delayed hypersensitivity testing (DHT). This study investigates to what extent Multitest Mérieux can help to predict the prognosis of multiply injured and severely burnt patients and whether new therapeutic measures can be recommended. This study encloses 52 patients during 1985: 16 severe burns, 20 multiple injuries with craniocerebral trauma and 16 without. Beginning with the day of injury standard laboratory and cardiopulmonary parameters were recorded every 48 hours. Delayed hypersensitivity testing was performed using Multitest Mérieux. The extent of trauma was determined by help of the ISS. All quantitative laboratory and cardiopulmonary parameters showed no significant changes in correlation to the clinical course during the period under investigation. However, a significant correlation between Multitest reaction at days six and eight and its overall results and the rate of infectious complications was found. Moreover, the extent of trauma measured by ISS shows a positive correlation with the rate of anergic reactions in Multitest. Thus Multitest Mérieux is an easily applicable and reliable means to the assessment of the prognosis after multiple injury and severe burn. Therapeutical recommendations beyond today's intensive care concepts cannot be given.

[The value of thoracic computed tomography in the intensive care diagnosis of blunt thoracic trauma]. / Die Wertigkeit der Thorax-Computertomographie in der Intensivdiagnostik des stumpfen Thoraxtraumas.

92% of all patients with a thorax-trauma suffer from a blunt chest trauma. In the early diagnosis by plane chest X-ray only a quarter of all pathological findings in comparison to the CT of the thorax are found. In addition to that the special deviations and imaging of the thoracic organs in the plane chest X-ray have to be noted. With the demonstration of same examples the special value of the thorax-CT in early diagnosis and patient control was demonstrated. Specially in showing the grade of lung contusion, the volume of bilaterally hemato-serothoraces, ventral pneumothoraces and additional injuries CT was more sensitive. The main disadvantage is the possibly long way of transportation and a contraindication is a severe trauma of the upper extremities and an instable fracture of the spine column.

[Therapy of humerus fractures of the collum chirurgicum]. / Zur Therapie der Humerusfrakturen des Collum chirurgicum.

From 1978 to 1989 178 patients were treated for humerus fractures of the surgical neck. An examination after an average of 9 months showed in 119 cases of dislocation of the humerus of less than one shaft width no significant differences between conservative and operative treatment. In case of major dislocation of more than one shaft width (n = 59) operative treatment resulted in significantly better functional results in all age groups. A wider indication for operation after 1986 lead to better results even in the elder patients. Younger patients profited by an operative treatment even in case of minor dislocation, especially as regards maximum mobility of the shoulder joint. In most cases percutaneous or open drill-wire osteosynthesis was preferred. It is concluded that in elder patients only humerus fractures of the surgical neck with major dislocations should be operated upon. With younger patients an indication for operative treatment can also be seen in cases with minor dislocation. Nevertheless, the fractures of the proximal humerus, even in case of an increased operative treatment, remain a field of conservative therapy.

[Learning from mistakes. Thoughts on preclinical care of accident victims based on 10-year experience in a large city of West Germany]. / Aus Fehlern lernen. Uberlegungen zur präklinischen Versorgung Unfallverletzter anhand der 10-Jahre-Analyse einer westdeutschen Grossstadt.

On the occasion of the 25th anniversary of preclinical emergency medicine a review of the last decade of preclinical treatment of polytraumatized patients was performed. Initially preclinical emergency medical services were established for the immediate care of victims in road accidents. Therefore these services were first usually stationed in Centers for Surgery or Traumatology. Emergency physicians in these were inevitably well trained in the emergency treatment of trauma patients. The Achilles tendon then was their limited ability to cope with differentiated internal problems. Whereas the quality of preclinical treatment in non-traumatic emergencies gradually increased during the last 10 years due to compulsory postgraduate training courses and due to the fact, that the percentage of physicians and anesthetists among the emergency crews also gradually increased, the average emergency physician no longer possessed enough practical experience with the early treatment of trauma patients, a disadvantage, which could not be sufficiently compensated in compulsory postgraduate training courses. This could be demonstrated in our 10 year quality control. Only physicians of Search and Rescue helicopter teams and residents of surgical and trauma departments made significantly few mistakes in the early treatment of polytraumatized patients. Typical mistakes of less experienced physicians could be sorted into 5 groups: --volume treatment: incorrect estimation of the severity of polytrauma/incorrect estimation of the amount of blood loss/insufficient substitution of volume/logistical mistakes. --O2 treatment: incorrect estimation of the degree of blunt thoracic trauma/hesitant indication for early artificial respiration/hesitant indication for thoracic drainage. --local treatment: incorrect estimation of the severity of soft tissue trauma/incorrect treatment of amputated limbs. --logistics and transport: additional iatrogenic laceration of soft tissues due to insufficient reposition and retention/logistical mistakes in choosing in the best means of transport and the best suited hospital for the patient. --special types of trauma: incorrect estimation of the severity of burn trauma/lack of experience in triage in cases of major accidents. To get better results in the early treatment of polytraumatized patients, the installation of a specialized emergency medical service for trauma patients in the main trauma centers of major cities combined with the function of the surgeon in charge for major accidents and catastrophies is to be discussed.

Rib fracture healing after osteosynthesis with wire mesh titanium and screws: a histological study in sheep.

Twenty sheep were placed under general anesthesia and five ribs (6-10) were transected at their lateral angle using a pair of rib shears. The fractures were stabilized by titanium wire mesh plates. After 4, 6, 8, 10 and 12 weeks groups of 4 animals were sacrificed and rib samples were prepared for histological examinations. The study showed that the osteosynthesis stabilized the fractures and that the healing is similar to untreated rib fractures. This osteosynthesis method is a good contribution to severe injured chest treatment.