Chance fracture--a rare injury in pediatric patients?

We report on a 9-year-old girl who was involved in a car accident. She suffered severe polytrauma with torn abdominal muscles, rupture of the mesenteric arteries, bowel and bladder, hematoma at the right colonic flexure and disruption of the intervertebral ligaments L2/L3, including the intervertebral disc, typical of Chance fracture. The abdominal bleeding was stopped, the bowel resected and the fracture fixed by internal fixation. The patient developed a postoperative enterocutaneous fistula in the right flank and paraplegia. She underwent three laparotomies with ileostomy and closure of the fistula. Two years later, she has normal bowel movement, the wounds are closed, the internal fixation has been removed, she is able to walk with crutches and suffers from a mild bladder dysfunction. Chance fracture is a typical fracture in adults involved in motor vehicle accidents. In the last 10 years, there have only been four case reports describing this fracture in children under the age of 10. All of these individuals were involved in a car accident and had been fixed with a lap belt. With the increasing use of lap belts, this fracture has to be considered even in young children. Mild clinical symptoms can be associated with severe intra-abdominal injuries.

[Treatment results after primary management of severely dislocated ankle fractures with external fixation and subsequent internal osteosynthesis]. / Behandlungsergebnisse nach Primärversorgung erheblich dislozierter OSG-Luxationsfrakturen mit gelenkübergreifendem Fixateur externe und sekundärer interner Osteosynthese.

BACKGROUND: Between 1 January 2001 and 30 June 2003, 31 patients with dislocated ankle fractures were primarily treated with an external fixator in our clinic. The aim of the present study was to investigate whether such a concept would determine the overall outcome or influence single parameters such as mobility, dystrophy, pain, arthritis, and complications. METHODS: Of the 31 patients, 25 aged 18-84 years at the time of the accident were followed up for 6-23 months to assess range of motion, clinical scores, radiological findings, and complications. An isolated injury was present in 23 patients and 3 were open injuries of second to third degree. Between two and five operations were necessary 4-27 days after trauma. The duration of primary hospital care required ranged from 10 to 43 days. RESULTS: The Olerud and Molander score (9 criteria with 100 max points) was 80 points at the follow-up investigation (rated "good"). "Excellent" results (>90 points) were observed in four cases. In the range of motion there was only an average loss in plantar flexion of 12.4 degrees compared to the healthy side in the patients followed up. CONCLUSIONS: The treatment result in the study population was compared to the results of prospective studies investigating dislocated ankle joint fractures as well as with our own random sample (n=7) of patients with secondarily treated ankle joint fractures that were initially treated with a cast. Initial external fixation seems to be justified and leads to acceptable results. The main functional lesions are not correlated to the specific treatment selected.

[Epidemiology of the severely injured patient. A prospective assessment of preclinical and clinical management. AG Polytrauma of DGU]. / Epidemiologie des Schwerverletzten. Eine prospektive Erfassung der präklinischen und klinischen Versorgung. AG Polytrauma der DGU.

The severe multiple trauma is of extraordinary medical and social and economical importance. Nevertheless there exist only a few german data to describe these patients. The aim of the study was an epidemiological analysis of 2069 patients of the Trauma Registry of the German Society of Trauma Surgery, recorded from 1993-1997. A descriptive kind of analysis of the incidence of injuries and complications of this collective was done and the amount of therapeutic means examined. Most patients (56.7%) were traffic victims, almost all patients suffered from blunt trauma. The relation male to female was 2.6:1, the average Injury Severity Score 22.2 +/- 13.1 points, the average age was 38.5 +/- 18.7 years. Chest trauma was the most frequent significant injury (AIS > or = 3 points, 44.5%), followed by severe head injury (39.2%) which was the most important reason for early lethality (death < or = 24 h after trauma, 51.7% of all deceased) and the total hospital lethality (18.6%). 68.9% of the patients showed injuries of the extremities. Patients were admitted to hospital in 71.7% in times of stand-by service (between 4 p.m. and 8 a.m., weekends, holidays) and required (median) 4 days ventilation, 6 days ICU treatment and stayed in hospital 19 days. Complications recorded were organ failure (lung 22.0%, circulation 18.7%, liver 9.6%, kidney 3.1%) and sepsis (11.6%). The presented epidemiological analysis is a comprehensive description of a large collective of multiple traumatized patients. The current data of the Trauma Registry of the German Trauma Society can be used to answer scientific, clinical and economical questions and for quality management.

Chromosomal aberrations induced in mice bone marrow by treating with cisplatin and irradiation.

BACKGROUND: The aim of this study was to quantify the combined effect of cisplatin and radiation on chromosomal damage with emphasis on the time interval between cisplatin and radiation. METHODS AND MATERIALS: Bone marrow of female NMRI-nu(+) mice was taken as a model system for a highly proliferative tissue irradiated with cobalt-60 (1 to 4 Gy). Cisplatin was injected intraperitoneally (i.p.) at 1.1 to 36 mg/kg. Cisplatin was given at various time intervals before and after radiation. Bone marrow and metaphases were prepared according to standard procedures. RESULTS: The percentage of aberrant metaphases after radiation or cisplatin alone increased in a dose-dependent manner (sigmoidal dose-response curve). Combining both modalities led to additive values at all time points for the percentage of aberrant metaphases. Borderline significant (p < 0.05) supraadditive effects were found 2 hours before or 1 hour after irradiation. However, a supraadditive percentage of aberrant chromosomes was found only at 2 or 1.5 hours with cisplatin before irradiation indicating the dependence of supraadditivity on the chosen parameter. CONCLUSION: It is doubtful to expect a true supraadditive or "radiosensitizing" effect, e.g. in the clinical setting from combined treatment with cisplatin and radiation. Rather, cisplatin might act as an independent cytotoxic agent.

[Repeated routine determination of pulmonary microvascular permeability after polytrauma]. / Wiederholbare Routinebestimmung der pulmonal-mikrovaskulären Permeabilität nach Polytrauma.

We present a technique to measure pulmonary microvascular permeability for albumin in patients with multiple trauma by means of bronchoalveolar lavage (BAL). Routine laboratory tests for the analysis of BAL fluids are used. The results were clinically validated in 10 healthy volunteers and 12 patients with multiple trauma in a first prospective study. Additionally, another 11 severely traumatized and 24 less traumatized patients were evaluated in a second prospective study. Normal values (> 0.09 +/- 0.02), posttraumatic physiological ranges (< 0.35), and a "high risk" range (> 0.5) for pulmonary microvascular permeability for albumin were developed. There was a high correlation between the first posttraumatic values of pulmonary microvascular permeability and the required duration of intensive care treatment (r = 0.81), the duration of continuous mandatory ventilation (r = 0.78) and the mean lung injury score by Murray (r = 0.76). We conclude that the presented method is harmless and useful to describe the post-traumatic course of pulmonary microvascular permeability.

[Comparison of severe multiple injuries in childhood and adulthood]. / Vergleich schwerer Mehrfachverletzungen im Kindes- und Erwachsenenalter.

Multiple injuries in children are responsible for a great part of childhood mortality. Remaining handicaps after injuries have a social and economic significance. In this study, the characteristics of polytrauma in childhood are evaluated by comparison with severely injured adults. The two groups of multiple trauma patients (117 children between 3 and 15 years of age and 1159 adults between 16 and 59) were equal in the overall severity of all injuries. Children were mainly hurt as pedestrians, whereas adults had an accident more often as car passengers. The most frequently injured region were in both groups fractures of the extremities. The greatest injury severity represented head injuries in each group. Complications were seen more often in adult patients. Multiple organ failure and isolated liver failure were exclusively seen in the adult group, pneumonia and lung failure occurred significantly more often. The duration of artificial ventilation and the duration of hospital stay were prolonged in the adult group. In summary, children with multiple injuries have a lower mortality rate than adults. The main cause of death are cerebral injuries. Remaining handicaps in surviving children are most often caused by fractures of the lower extremities.