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Hannover, Germany

Gansslen A.,Klinik fur Unfallchirurgie | Hildebrand F.,Unfallchirurgische Klinik | Pohlemann T.,Universitatskliniken des Saarlandes
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca

The hemodynamic status in patients with pelvic ring injuries is amajor prognostic factor of an immediate mortality risk. Especially, patients "in extremis" are of high risk to die. This patient group is characterized by absent vital signs or being in severe shock with initial systolic blood pressure <70 mm Hg and/or requiring mechanical resuscitation or catecholamines despite >12 blood transfusions within the first two hours after admission. The sources of pelvic bleeding is in approximately 80-90% of venous origin and relevant arterial bleeding accounts for 10-20%. Important parts of the initial treatment treatment concept include mechanical pelvic ring stabilization combined with hemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation or posterior pelvic C-clamp, depending on the local available resources. In patients "in extremis" the concept of direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistant hemodynamic instability occurs despite shock therapy and mechanical stabilization and pelvic packing, arterial injury is ruled out by angiography followed by selected embolization of pelvic vessels. © Česká společnost pro ortopedii a traumatologii 2006. Source

The probability that an inpatient will be harmed by a medical procedure is at least 3% of all patients. As a consequence, hospital risk management has become a central management task in the health care sector. The critical incident reporting system (CIRS) as a voluntary instrument for reporting (near) incidents plays a key role in the implementation of a risk management system. The goal of the CIRS is to register system errors without assigning guilt or meting out punishment and at the same time increasing the number of voluntary reports. © Springer-Verlag 2011. Source

Despite the fact that proximal humerus fractures represent one of the most frequent types of all fractures, the quality of evidence is poor although it has improved in recent years. It is widely agreed in the literature that nondisplaced fractures can be treated conservatively with good outcome. Two recent prospective randomized studies have shown that this also applies to displaced three- and four-part fractures. The results of fixed-angle plate osteosynthesis are also not superior to conservative management in complex displaced fractures in the elderly and in many aspects are even worse. Fixed-angle plate osteosynthesis has not fulfilled expectations. High rates of complications and revision surgeries as well as moderate functional results have been demonstrated in numerous studies. Conventional fracture prostheses or inverse prostheses are solutions fo complex not reducible and/or retainable. Also for the dislocated 4-part fracture of the patient above 60ears no general advantages of the joint replacement compared to conservative treatment could be shown in a recent scandinavian prospective randomized clinical trial. © 2011 Springer-Verlag. Source

We present a literature review about implant removal after intramedullary stabilization of femoral or tibial shaft fractures, upper extremity fractures, and pediatric fractures.A special focus is the difficult implant removal. Implant removal of nails gets difficult when implants are bent or broken. Other difficulties include broken interfaces between nail and removal instrument or when bone ingrowth hinders extraction.A special difficulty is posed by broken solid nails. Implant failure shows typical failure patterns regarding the location of the fatigue fracture.Based on well-documented clinical cases, we describe in detail surgical techniques as well as tips and tricks which help in the difficult circumstances of bent or broken implants in proximal, midshaft, or distal nail segments for a large variety of implants (solid, cannulated, slotted). We also describe an elegant technique for the safe removal of an infected cemented arthrodesis nail.The time required to perform a nail removal can easily exceed the planned amount. Nail removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the nail should be made with great care. Therefore, good communication with the patient and thorough information about risks and benefits are essential. © 2012 Springer-Verlag. Source

Gansslen A.,Klinik fur Unfallchirurgie | Hildebrand F.,Unfallchirurgische Klinik | Krettek C.,Unfallchirurgische Klinik
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca

PURPOUSE OF THE STUDY Associated transverse and posterior wall fractures account for approximately 20% of all acetabular fractures. To asses the risk of these concommitant bone injuries on early joint failure despite a high rate of postoperative congruency. MATERIAL The analysis of 104 surgically treated patients with associated transverse and posterior wall fractures showed that more than half of these patients had associated injuries. The mean age was 35 years, and > 75% of these patients were male. A high energy trauma was the trauma mechanism in 94.2%. The mean ISS was 26.3 points. The majority of patients showed a juxta- or transtectal fracture line. The mean articular fracture displacement was 13.5 mm. 87.5% of the patients showed a femoral head dislocation. An acetabular roof comminution was present in 16.3%. 20.2% of patients received a fracture related preoperative nerve injury to the sciatic nerve. METHODS Osteosynthesis was performed 9.9 days after trauma. The Kocher-Langenbeck approach was used in > 90% for stabilization with a combination of plate and screw fixation in 71.1%. The mean operative time was 190 minutes with a blood loss of 855 ml. Postoperatively the hip joint was congruent in 90.3% with anatomical or near-anatomical joint reconstruction in > 90%. latrogenic nerve injury occurred in 12 patients (8.9%). RESULTS 67 patients (67.7%) could be followed after a mean of 42.7 months. The average subjective Visual Analog Scale pain score was 42.7. Mild or no pain was seen in 58.2%. The mean Merle d'Aubigne score was 15.4 with 56.7% of patients having a functionally perfect or good result. 52.2% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 32.8% of the patients. Analyzing only patients with anatomically reconstructed hip joints, patients showed comparable results with 61.3% having no or mild pain and 59.2% a good or excellent functional result. Posttraumatic arthrotic changes occur in only 26.5% of these patients. A joint failure was present in 32.7%. In this group, a joint failure was significantly more likely to be present with an additional acetabular comminution zone. CONCLUSION Associated transverse and posterior wall fractures have a significant risk of early joint failure despite a high rate of postoperative congruency. Source

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