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At least 1,207 records · Page 67Linked to original sources
PubMed2003

[Our experiences with change of osteosynthesis from external fixator to internal fixation in fractures of the lower limb].

INTRODUCTION: In polytrauma patients and fractures with severe soft tissue damage of the lower limb the use of external fixator is indicated. To show the possibilities and limits of change of external fixation to internal osteosynthesis we performed a retrospective analysis. PATIENTS AND METHODS: Between 1.1.1993 to 30.6.1997 671 cases were primarily treated with external fixator. After a mean of 16.5 days a change of osteosynthesis was performed in 75 cases. RESULTS: 5 infections of the pin tracks, 3 infections of the wound, two thromboses, one case of thromboembolism and one osteomyelitis were seen in these 75 cases. One patient died due to severe brain damage after head injury. No further operations were necessary, all fractures showed primary healing. Taking the severe soft tissue damages and severe multiple trauma into account only few complications were observed. CONCLUSION: The main problems and risks of internal fixation occur in the early phase of treatment, whereas complications after external fixation are more likely to occur in later stages. By a change from external fixation to internal osteosynthesis the advantages of both methods can be combined.

Accidents, Traffic↗
PubMed1994

[Amputation injuries of large extremity segments. Clinical management].

Amputating injuries are often combined with multiple trauma. The management of these serious traumas has to consider survival more than restoration of function and extremity preservation. Out of 51 patients with 60 macroamputation injuries only one case was successful in replantation. The leading rule in the treatment of macroamputation still must be life before limb, as our series of the years 1988 up to 1991 clearly shows.

Adult↗
PubMed1997

Suggested guidelines for treatment of acute renal failure in earthquake victims.

The 1990 Iran earthquake affected two states with a combined population of 2,300,000. It resulted in at least 13,888 deaths, 43,390 injured, and 33,616 hospitalized. The overall mortality among hospitalized patients was 0.17%. Acute renal failure (ARF) requiring dialysis support was diagnosed in 156 patients nationwide, with a mortality rate of 14%. Three teaching hospitals of Tehran University of Medical Sciences (UMS) admitted 495 patients, with total mortality of 7.5%. Of these, 30 patients (6%) required dialysis, with a mortality of 40%, accounting for 12 of the deaths. On admission, patients with ARF were more severely injured and had significantly higher incidence of multiple trauma; peripheral nerve injury; elevated muscle enzymes, potassium, and phosphorus; and abnormal urinalysis. In one of these hospitals, patients were treated with a specific hydration protocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Based on these findings, guidelines are suggested that may be helpful in the treatment of ARF in earthquake victims.

Acute Kidney Injury↗
PubMed1994

Acute renal failure in earthquake victims in Iran: epidemiology and management.

The 1990 Iran earthquake affected two provinces with a population of 2.3 million, resulting in at least 13,888 deaths and 43,390 injured, and in 33,615 hospitalizations. Overall mortality among hospitalized patients was 0.17%. Acute renal failure (ARF) requiring dialysis support was diagnosed in 156 patients nationwide, with a mortality rate of 14%. Three teaching hospitals of the Tehran University of Medical Sciences admitted 495 patients, with overall mortality of 7.5%. Of these, 30 (6%) required dialysis support, with mortality of 40%, accounting for one-third of all deaths. On admission, patients with ARF were more severely injured, with significantly higher incidence of multiple trauma, peripheral nerve damage, elevated plasma concentrations of muscle enzymes, potassium and phosphate, and abnormal urinalysis. In one of the three hospitals, patients were treated with a standardized hydration protocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Our limited experience suggests that this standardized approach to prevention and treatment of ARF in earthquake victims may be helpful.

Acute Kidney Injury↗
PubMed1997

Nocardia otitidiscaviarum infection of a traumatic skin wound.

A case of primary Nocardia otitidiscaviarum infection of a skin wound over an open fracture in a previously healthy adult who suffered multiple trauma in a car accident is reported. The organism was identified in cultures of pus specimens from the infected wound. The case demonstrated the difficulties of testing susceptibility of nocardiae in vitro and the necessity of prolonged antibiotic treatment. The prevalence of nocardial infections is underestimated, highlighting the need for adequate documentation of such infections and compilation of the information by public health authorities.

Adult↗
PubMed1992

High calcitonin levels in unconscious polytrauma patients.

We measured levels of calcitonin and other markers of calcium and phosphorus metabolism in both unconscious and conscious patients after multiple trauma. We found dramatic increases in calcitonin levels in unconscious patients, and smaller increases in conscious patients. In two cases, very high levels, more than 100 x normal, appeared to be related to more rapid healing of bone. Calcitonin levels were highest immediately after admission and decreased over the ensuing two weeks. The possible relationship between unconsciousness and the increased rate of healing of fractures is discussed.

Adolescent↗
PubMed1991

[Severe multiple injuries. Strategy and results. Experience at the Hôpital de la Pitié in 1988 and 1989].

In our series of 97 patients with multiple in juries observed in 2 consecutive years (1988-1989), we have selected only the most severe injuries, of which the patients died within 48 hours, and those that required a long stay in the intensive care department. On admission, we recorded 49 cases of stage II or more severe coma, and 67% of patients under respiratory assistance with an instable hemodynamic state. Out of the 44 deaths recorded, 30 subjects were comatose from the beginning. The justifies the confrontation of 3 specialist teams in 2/3 of cases. The specific recruitment of the hospital and the selection of the most severe cases of these "people under a death sentence" for the study shows a heavy toll of mortality (45,4%), including 60% on the first day. The main cause of death is head injuries (81%). The multivisceral and infectious consequences of long-lasting, heavy intensive care and pulmonary or myocardial contusions account fort secondary deaths in 25% of the patients who had survived. Emergent neurosurgical operations are exceptional, but a neurosurgeon's opinion is always essential. Orthopedic surgical issues are not specific, but the frequency of spinal lesions must be emphasized (27,2%). In this series, 85% of the patients with multiple trauma presented with a lesion of the locomotive apparatus and underwent emergent surgery in every second case in satisfactory conditions. Severe thoracic and maxillofacial lesions requiring surgery are rare. Abdominal lesions are more frequent (17%) and must be dealt with in priority, but they rarely cause death. On the contrary, lesions to the major blood vessels and retroperitoneal compound lesions have a very poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed2006

[Tetanus vaccination in the accident and emergency department].

While tetanus is a rare disease in industrialized countries, this infectious disease is still responsible for up to 1,000,000 deaths per year in the developing world. In Germany, the introduction of a country-wide vaccination program (STIKO) has led to a decrease in the frequency of tetanus infection from 115 cases per year in the 1960s to fewer than 15 cases per year in the years from 1990 to 2000. In spite of all the treatment now available, tetanus infection still has a lethal outcome in up to 40% of cases. The Robert-Koch Institute recommends active or passive vaccination depending on the wound classification and the patient's current vaccination status. Since when patients have multiple trauma the emphasis while they are being treated for shock is on stabilisation and diagnosis, there is a real risk of underestimating the size and the level of contamination of existing wounds. Since it is not possible to ascertain the patient's vaccination status in most cases, we recommend simultaneous immunization of polytraumatized patients with skin lesions using Tetanol-Tetagam early in the course of the diagnostic procedures while the patients are still in the emergency room.

Algorithms↗
PubMed1990

Mortality prognostic factors in chest injury.

1,026 multiple trauma patients (P) were compared to P with chest injuries (PCT) (407). Severity indices were related to type of thoracic injury and mortality. The Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Trauma Score (TS), CHOP, and the Respiratory Index (RI) were used. The mortality rate of P was 27.1% but increased to 32.9% for PCT (p less than 0.05). We noted that mortality rate was highly dependent on major chest trauma: 68.6% for flail chest (FC), 56% for lung contusion (LC), 42.3% for hemothorax (HA), and 38.1% for pneumothorax (PN). ISS and RI scores for PCT survivors were greater than ISS + RI scores for P survivors (p less than 0.05 and p less than 0.01). ISS values for LC, HA, and PN PCT survivors were greater than the ISS of P survivors (p less than 0.01). Nonsurviving PCTs, especially those with lung contusion, showed a highly significant increase in ISS and RI scores.

Adolescent↗
PubMed1994

[Scores as decision aids].

Scoring systems are nowadays said to be helpful in decision-making in preclinical and early clinical treatment of multiple trauma patients. To evaluate the importance of these scores in daily routine, we analysed the scores routinely used in our department at the Hannover Medical School. We present three scoring systems: the Polytrauma Score, the Pelvis Score, and the Hannover Fracture Scale. All of these have certain qualities relevant to the aspects of decision-making and prognostic value. The evaluation demonstrates that these scoring systems are genuinely helpful, especially for the inexperienced.

Adult↗
PubMed2001

First experience with fiberoptically directed wire-guided endobronchial blockade in severe pulmonary bleeding in an emergency setting.

We report the first use of a new wire-guided endobronchial blocker in a critical respiratory situation caused by localized pulmonary bleeding. During emergency management, it became increasingly difficult to ventilate a multiple-trauma patient with a conventional single-lumen tube because of massive bleeding through the bronchus of the left lower lobe. Using the Arndt endobronchial blocker set (William Cook Europe A/S; Bjaeverskor, Denmark), we were able to prevent the spread of hemorrhaging and achieved effective ventilation and marked improvement in gas exchange. This new device allows the effective blockade of an isolated lobe under direct bronchoscopy to buy time for further intervention.

Bronchoscopy↗
PubMed1994

[A case of chronic traumatic dissecting aneurysm of the thoracic aorta].

A case of chronic traumatic dissecting aneurysm was reported. A 61-year-old man was admitted to our hospital for multiple trauma caused in traffic accident. MRI, performed for evaluation of the spinal injury, revealed dissection of the thoracic descending aorta by chance, seven months after injury. Retrospectively CT, just after admission, showed bleeding around the thoracic descending aorta. Replacement of thoracic aorta was performed after 33 months from the traffic accident, for enlargement of dissecting lumen accompanied with hoarseness. The postoperative course was uneventful and the patient returned to his daily life successfully.

Aortic Dissection↗
PubMed1992

[Estimation of energy expenditure in clinical practice: applicability to individual multiple injury cases].

In 37 multiple trauma patients the estimated and measured energy expenditures were compared. Predicted energy expenditure overestimated it in 89% of patients. The correction factor for the different pathologies was the principal source of error, since the measured/predicted basal energy expenditure ratio was 1.19 +/- 0.17. This ratio had a wide range of values (0.84-1.61) which renders the prediction of individual energy expenditure highly unreliable. Since the overestimation of energy requirements in the critically ill patients may convey important complications, the direct measurement of such requirements is recommended.

Adult↗
PubMed1988

Do multi-lumen catheters increase central venous catheter sepsis compared to single-lumen catheters?

Triple-lumen catheters (TLC) are now routinely used in critically ill and multiply injured patients who require multi-port central venous access. An apparent rise in catheter contamination and catheter-related sepsis (CRS) occurred in patients receiving total parenteral nutrition (TPN) through a TLC as opposed to a single-lumen catheter (SLC). A prospective study was performed to determine rates of catheter contamination and CRS in multiple trauma and general surgical-medical patients who received TPN through TLC's and SLC's. Three hundred seven TLC's and 68 SLC's were placed in 234 patients during a 12-month period. There was no statistically significant difference in the rate of contamination or CRS between the two groups although there was a trend toward increased CRS and contamination in the TLC group. TLC's may be used for short-term administration of TPN without significant increase in catheter contamination or CRS.

Bacterial Infections↗
PubMed1991

Continuous hemofiltration with a low molecular weight heparin, enoxaparine: report on two cases.

The heparinization of multiple trauma patients during hemofiltration involves a high risk of bleeding. We report here two continuous hemofiltration cases -15 and 60 days in duration-using a low molecular weight heparin, enoxaparine. No major bleeding or clotting was observed. However, continuous infusion of the heparin is needed and the rate of delivery of the hemofiltration pump must be taken into consideration since it influences the clearance of the drug through the hemofiltration membrane. Anti-Xa activity measurement is not sufficient to adjust the heparin dose.

Acute Kidney Injury↗
PubMedDate not supplied

Management of pediatric femoral shaft fractures.

Femoral shaft fractures are the most common major pediatric injuries managed by the orthopaedic surgeon. Management is influenced by associated injuries or multiple trauma, fracture personality, age, family issues, and cost. In addition, child abuse should be considered in a young child with a femoral fracture. Nonsurgical management, usually with early spica cast application, is preferred in younger children. Surgery is common for the school-age child and for patients with high-energy trauma. In the older child, traction followed by casting, external fixation, flexible intramedullary nails, and plate fixation have specific indications. The skeletally mature teenager is treated with rigid intramedullary fixation. Potential complications of treatment include shortening, angular and rotational deformity, delayed union, nonunion, compartment syndrome, overgrowth, infection, skin problems, and scarring. Risks of surgical management include refracture after external fixator or plate removal, osteonecrosis after rigid antegrade intramedullary nail fixation, and soft-tissue irritation caused by the ends of flexible nails.

Adolescent↗
PubMed1992

[Long-term follow-up of polytrauma].

While there are numerous scoring systems for assessment of the immediate period after multiple trauma, hardly any studies exist on the long-term sequels of these serious injuries. We interviewed and examined 104 patients who had sustained such an injury 1-6 years previously (median 4.3 years). Our study revealed that the long-term outcome cannot be correlated with the ratings in a typical polytrauma scoring system. Therefore, we suggest a new scoring system that allows assessment of long-term results by taking into account accident-related limitations in three essential areas of everyday life: school/profession; basic abilities; leisure time/hobby/sports.

Activities of Daily Living↗
PubMed1989

Prognostic value of serum phospholipase A in the multitraumatized patient.

Phospholipase A serum activity was prospectively studied in 39 patients with multiple trauma. There was no correlation of phospholipase A activity with type or severity of injury. With increasing phospholipase A levels, a rise in mortality was found. A prediction of fatal outcome on an individual basis was not possible. The sensitivity for complications was 90%, whereas the predictive value of the positive test (64%) and specificity (47%) were low. When the behavior of phospholipase A and elastase release were compared, no correlation between these two parameters could be detected. Therefore, PMN leukocytes do not seem to be a major source of phospholipase A in serum.

Acute Kidney Injury↗