[Update on gunshot wounds to extremities]. / Update zu Schussverletzungen der Extremitäten.

Due to recent rampage and terror attacks in Europe, gunshot wounds have become a focus of attention even though they are still rare in Europe. Approximately 50% of gunshot wounds affect the extremities and to understand the sequelae, a basic knowledge of wound ballistics is indispensable. The energy transmitted from the bullet to the tissue is responsible for the severity of the injury and is dependent on the type of weapon and ammunition. A differentiation is made between low-energy injuries caused, e.g. by pistols and high-energy injuries mostly caused by rifles. The higher energy transfer to the tissue in high-energy injuries, results in a temporary wound cavity in addition to the permanent wound channel with extensive soft tissue damage. High-energy gunshot fractures are also more extensive compared to those of low energy injuries. Debridement seems to be necessary for almost all gunshot wounds. Fractures should be temporarily stabilized with an external fixator due to contamination.

[Do meniscus injuries affect postural stability?]. / Beeinträchtigen Meniskusverletzungen den stabilen Stand?

BACKGROUND: Meniscal lesions are known to cause a loss of proprioception, which plays an important role in the regulation of postural stability. It is unclear, however, whether meniscus injuries adversely affect not only the sense of joint position but also postural control. The objective of this study was to investigate the influence of meniscal lesions on postural stability. MATERIAL AND METHODS: In this prospective study, postural stability was assessed by posturography in 27 patients with unilateral meniscal lesions. Both the injured and uninjured legs were tested and compared for significant differences using a t-test. RESULTS: Despite the presence of an arthroscopically confirmed meniscal lesion, none of the stability indexes that we calculated revealed significant differences in postural stability between the injured and uninjured sides. CONCLUSIONS: It was surprising to note that the loss of proprioception in patients with meniscus injuries did not influence postural stability. Patients with functional knee instability must therefore be examined for the presence of further injuries because a meniscal lesion alone cannot explain instability symptoms.

[German military surgeons in deployment abroad: life and working conditions]. / Deutsche Militärchirurgen im Auslandseinsatz : Lebens- und Arbeitsbedingungen.

Since 1992 the German Bundeswehr has been deployed for securing peace and peacekeeping abroad. Since then 83 German soldiers have been killed and overall 129 wounded in action as of 07.12.2009. In Northern Afghanistan the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif providing a multidisciplinary capability profile. Furthermore, there are two role 2 medical treatment facilities for primary surgical trauma care located in Kunduz and Feyzabad. In these role 2 facilities life saving procedures and damage control operations are performed in order to enable rapid evacuation to a higher level of care. Thereby military surgeons are often confronted with various medical and logistic challenges. The German Navy also has two equivalent role 2 medical treatment facilities (Naval Rescue Centers) aboard its two combat support ships (CSS) "Berlin" and "Frankfurt am Main" to support maritime task groups operating worldwide. These floating field hospitals provide an indispensable asset in the medical emergency care of naval operations with difficult space-time factors. Due to the specific operating alliance between CSS and Naval Rescue Center, special operations as well as evacuation and humanitarian missions following disasters near the coastline can be effectively accomplished.

[Experimental principles of the V.A.C.-therapy -- pressure values in superficial soft tissue and the applied foam]. / Experimentelle Grundlagen -- Druckwerte unter Vakuumtherapie-Schwämmen -- eine In-vitro- und In-vivo-Untersuchung.

OBJECT OF THE STUDY: Measurement of the pressure during V.A.C.(R)-therapy in superficial parts of the affected soft tissue as well as at the soft tissue/foam-interface, measurement of pressure values along bigger distances in the foam and the comparison of pressure transfer between polyurethane and polyvinyl-alcohol foams. MATERIAL AND METHODS: A multi-channel electronic transducer-tipped catheter system based on the piezo-resistant principle was used. Measurement was performed on a plain table surface, at a bovine muscle as well as in human tibial anterior muscle of a patient after fasciotomy. Applied pressure values by V.A.C.(R)-therapy-units were 50 to 200 mm Hg (continuous suction modus). RESULTS: 100 % pressure transition through vacuum-therapy-foams to wound surface, almost 100 % pressure transition even along 60 cm in very large polyurethane-foams using only one trac-pad connector. Pressure values > 125 mm Hg using polyvinyl-alcohol-foams showed a reduction of up to 25 % in distances > 15 cm from trac-pad-connector. On the surface of the affected soft tissue there are negative and positive pressure values (25 % quartile: - 25 mm Hg; 75 % quartile: + 15 mm Hg). DISCUSSION: Pore walls of the foam can produce positive pressure conditions resulting in soft tissue compression and consecutively hypoperfusion or ischemia. V.A.C.(R)-therapy seems to produce an heterogeneity of pressure distribution at the wound ground leading to pressure gradients and facilitating drainage of interstitial fluid. This mechanism could explain the anti-edema effects of V.A.C.(R)-therapy resulting indirectly in an increased nutritive perfusion.

[Clinical results with A new retrograde femoral nail with a radiographical-free proximal locking device. A prospective study with 50 fractures]. / Ein neues retrogrades Femurmarknagelsystem mit durchleuchtungsfreier proximaler Verriegelung. Eine prospektive Studie an 50 Frakturen.

INTRODUCTION: Conventional retrograde nailing of the femur causes two important disadvantages: the proximal locking of the nail is difficult because of the anatomic conditions and a chondral defect was left into the knee. MATERIAL AND METHODS: After the retrograde implantation the new nail was lead through the greater trochanter. An additional proximal aiming device for proximal interlocking can be fixed. The entrance portal will be sealed by an osteochondral cylinder. 50 cases of femur fractures were selected for the prospective study. We recorded all intraoperative complications and technical difficulties. The cases were followed up for 52 weeks, both clinical and radiology examinations were performed. RESULTS: The mean follow up was 15.5+/-5 months. All fractures were healed. Knee movement was 125+/-14 degrees. The Leung Score was 84+/-12.6 points; HSS Score was 90+/-9 points. In two cases wound infections were developed. Mal-union was observed in three cases, in two cases nail brake down. CONCLUSIONS: The new retrograde interlocking nail could be used to manage femur fractures successfully. Two aiming devices enable a easy interlocking. Replacement of the osteochondral cylinder into the entry portal reduces cartilage damage.

[Results 13 years after ACL plasty using a carbon prosthesis]. / Ergebnisse mit Kohlefaserimplantaten 13 Jahre nach Kreuzbandersatzplastik.

AIM: The retrospective results of carbon prostheses for ACL plasty from 1985 to 1989 are reported. The aim of this study was to determine the number and kind of necessary revisions and the rate of arthrosis and instability of the operated joints. METHOD: 101 patients out of 136 patients with ACL plasty using a carbon prosthesis could be reviewed clinically in this retrospective study. All patients answered a questionnaire. Additionally, the tibial translation was examined with the KT1000 at maximum power. Conventional X-rays were taken of the knee joints. The results were evaluated using different scores. RESULTS: 70 % of the patients had pathological findings in the clinically tested tibial translation and had a positive Lachmann sign. 66 patients had a tibial translation of 2 mm or above when tested with the KT1000 at maximum power. Radiological studies had shown a gonarthrosis of grades III and IV in 93 patients. An average of 77 points was found using the Lysholm score. CONCLUSION: The results 13.5 years after ACL plasty using a carbon prosthesis are unsatisfactory concerning joint stability and development of secondary arthrosis. There is a discrepancy between the results of the clinical tests and the subjective complaints of the patients.

[Pressure conditions under VVS-foams - an experimental in-vitro- and in-vivo-analysis]. / Druckwerte unter VVS-Schwämmen - eine experimentelle In-vitro- und In-vivo-Untersuchung.

The aim of this study was to determine the pressure conditions in the tissue beneath and on the surface of wounds. This was done in vitro both on a plain surface and on a bovine muscle. In comparison we measured the pressure of the anterior tibial muscle of a patient with compartment syndrome. Besides, we applied negative pressure using just one drape connector and measured the pressure in different distances to look if the pressure is constant in large V.A.C.(R) dressings. Both polyurethane and polyvinyl alcohol foams were used.