Unfallchirurgie最新文献

The case of a self-amputation of the left-sided forefinger is presented. It was an isolated smooth amputation near the basic ankle of the finger without any accompanying injury of other fingers. The victim (a physician) claimed financial compensation from his accident-insurance; his contract included special disability taxes for finger injuries. However, the insurance company did not pay but was able to demonstrate--by means of a medico-legal reconstructive expertise--that the amputation was voluntary and self-inflicted. The argumentation concerning self-mutilation is presented (including the so-called execution-position of the finger and ergonometric aspects). Concerning the surgical care, intervention and diagnostic procedures a detailed documentation of the case history and the morphology of the injury pattern are recommended (especially in isolated finger-amputations of the non-working hand.

The drawbacks of plating techniques for the treatment of distal femoral fractures are the need for a large exposure with the possible risk of soft tissue damage, devascularisation of bone fragments and loss of the possible positive effect of the fracture hematoma. Moreover, early weight bearing is not advisable with these implants. To find out whether the retrograde nailing of distal femoral fractures is beneficial we performed this study. Between March 1, 1993 and September 1, 1995, 25 patients with 26 distal femoral fractures were treated in our department with retrograde femoral nailing. According to the ASIF-classification we classified 20 fractures as supracondylar A fractures and 6 fractures as intercondylar C fractures. All fractures were closed and without important soft tissue damage. One patient dies of a not fracture-related cause before fracture healing was achieved. Twenty-five fractures healed. According to our relative Neer-score we counted 18/25 (72%) excellent results (> or = 85 points), 5/25 (20%) good results (> or = 70 points), 1 (4%) fair result (> or = 55 points and 1 (4%) bad result (< 55 points). The retrograde intramedullary nailing makes a biological osteosynthesis of distal femoral fractures possible. Also in our aged patients good functional results could be obtained. Poor hold of the distal interlocking screws and difficult interlocking are the 2 major technical problems encountered with this implant. Early weight bearing is not advisable.

In 163 patients--125 (76.7%) female, 38 (23.3%) male--172 cementfree isoelastic acetabular cups were implanted. The average patient age was 72.6 years (range: 16 to 96 years). Sixty-seven (41.1%) patients with 72 (41.9%) cups could be followed-up for an average of 6.0 years (range: 2.0 to 12.2 years) after the procedure. Using the Harris-hip-score we found 49 (68.1%) "very good" to "fair" results. In 23 (31.9%) hips scoring had to be classified as "bad". The rate of cup-loosenings in the collective was low at 3.5% (6/172), probably due to the reduced physical activity of our comparatively older patients. Because after the 8th year symptomatic loosening must be routinely expected, the procedure is not indicated for younger patients. In older patients with femoral neck fractures the cementfree isoelastic acetabular cup has proven itself effective in our experience.

The data from 767 patients after a suicide attempt or suicide were analyzed retrospectively. Skeletal damage was present in 52% of the patients. This was also the highest percentage in the breakdown of the injury patterns, followed by damage of the central nervous system (26.6%). Injuries to parenchymatous organs (20.1%) took third place. Extensive soft tissue injuries were diagnosed in 18.1% and relevant vascular lesions in 16% of suicide cases. At the same time, the high percentage of multiple trauma patients (22.9%) reflects the severity and the extent of injuries suffered in the application of "violent methods". Injuries of suicide cases involving violence often resemble those of serious road traffic accidents. In contrast to unselected patients, the injury pattern of suicide cases with multiple trauma is dominated by jumps from a great height and being run over by a train. However, when unusual suicide techniques are used, the surgeon's experience may soon become insufficient. To our knowledge, special traumatology wards provide the best available diagnosis and emergency care for these patients unless they have suffered purely trivial injuries.

This prospective study investigated the incidence of injuries in German Bundesliga football based on an evaluation of 2 American football teams in the season and pre-season 1995 to 1997. Certified team physicians and team physiotherapists were the initial medical professionals providing on-site diagnosis, injury documentation and first treatment of all injuries. An injury was defined as minor injury (group I) causing a missing of practice or game up to 1 week, as severe injury (group II) causing a missing of practice or game for more than 1 week or hospitalisation and as fatal injury (group III) if the incident lead to treatment in an intensive care unit or remaining neurological or orthopaedical disability or death. Data were collected so that it was possible to calculate the risk of injury per time of exposition per athlete. The function of the athlete, influences of the weather and the mechanisms of the injuries were registered. Overall 713 injuries were documented. The rate of injury was calculated as 15.7 per 1000 hours of practice and game per athlete. Severe injuries with a loss of practice participation of more than 1 week were found in 94 cases. Fatal injuries were not seen in the period of the study. The knee was found to be the most common site of injury, the ankle ranked second. Our study showed that the risk of injury in American football in German Bundesliga is comparable with soccer or handball.

Fractures of the neck or the pertrochanteric region are often treated with dynamic hip screw especially in elderly patients. We give a case report covering treatment and follow-up for a bilateral spontaneous pertrochanteric fracture in a 45-year-old man as a result of hepatogenetic osteopathy.

Between 1980 until 1996 we operated altogether 327 patients because of a discoligamentous or osseous injury of the lower cervical spine. In a retrospective examination we evaluated the type of the injuries, the mechanism of the accidents, the neurological status on admission and the postoperative result. With regard to the long-term results we re-investigated 170 patients who have been operated on in our Department of Neurosurgery. In none of the patients we could find a neurological deterioration after the operation. The prognosis for patients with an incomplete and complete transversal syndrome is worse concerning a regression of the neurological deficit. The ventral spondylodesis in the technique according to Cloward-Crock, Robinson and Smith and Bailey-Badgley with ventral plate fixation provided the best results and we recommend these techniques for injuries of the lower cervical spine.

Patients who suffer an accident after alcohol consumption can be differentiated into 2 groups: patients which drink alcohol occasionally and chronic alcoholics. We examined prospectively in-patients treated after suffering a trauma in an alcoholised state. The diagnosis acute alcohol intoxication was made by a breath-alcohol-analysis, the diagnosis chronic alcoholism by a shortened MAST-test. In the average chronic alcoholics were 12 years older than acute intoxicated. Family background of chronic alcoholics was more often disrupted and social status lower than in acute alcoholics. For the acute alcoholics a car crash, for the chronic alcoholics a fall was the main trauma cause. In over 50% both patient groups suffered a minor head injury. Chronic alcoholics had a twice as long hospital stay (16.1 +/- 3.2 vs. 8.5 +/- 1.1 days), needed more specialist consultations (84% vs. 60%) and developed more complications (40% vs 16%) than the acute alcohol intoxicated. The ISS (Injury Severity Score) was the same for both patient groups (6.7 +/- 0.7 vs. 7.1 +/- 0.8) and had no prognostic value for the group of the chronic alcoholics. On the basis of the present findings it is advisable to check the diagnosis alcohol intoxication and to look whether chronic alcoholism is present whenever a drunken patient is admitted.

Fractures of the odontoid are reported to contribute in 15% to cervical spine fractures. The clinical findings range between no symptoms at all and sudden death. Neurological deficits are seen in 6 to 25% of these patients. The overall mortality in this group is 3 to 8%. Fractures of the odontoid process combined with primary myelopathy has been reported seldom. We describe a traumatic fracture of the odontoid process with primary myelopathy, the chosen therapy and the follow-up.