Search

Complex unstable cervical spine injuries in polytraumatized patients are stabilized ventro-dorsally in a two-stage procedure. The ventral stabilization is a day-one surgery with the goal to get primary stability for intensive care, early spinal decompression and protection against secondary damage of the spinal cord. The additional dorsal stabilization allows early functional treatment or in case of spinal cord lesions early neurorehabilitation. The combination of severe brain injury and unstable cervical spine injury is especially demanding concerning diagnostic and therapeutic procedures.

We present an analysis of a retrospective study of 61 humeral shaft fractures, stabilized with a thin AO tibial nail. All fractures were analysed according to the AO-classification. Follow-up included 48/61 patients and averaged 82 months. Local complications were postoperative radial nerve palsy in 1/61, infection in 0/61 and non-union in 4/56. A good result in shoulder function was obtained in 41/48 cases.

Estimates of the incidence of injury to the cervical spine among patients suffering blunt trauma to the head vary widely. In an attempt to quantify the risk, the records of 593 consecutive patients with blunt craniocerebral injuries admitted to our trauma center in 1991 were reviewed. The overall incidence of cervical spine injuries was 5.8% and for the unstable cervical spine injuries 2.9%. In the management of head trauma with associated cervical spine injuries realignment and immobilisation of the spine and surgery of the head were carried out as first step, followed by decompression and stabilisation of the affected segment in the same session. In patients with altered consciousness a loss of cooperation is always present and an early spinal stabilisation for the optimal treatment in the intensive care unit and in the wake-up-phase is important.

The understanding of the conditions under which bone and soft tissue can be regenerated by distraction has opened a new era in the field of limb reconstruction. Success in lengthening for posttraumatic limb length discrepancy has led to different applications of the distraction techniques. We present an overview of the clinical new possibilities, the strategy, the techniques and the complications using the distraction technique in the trauma patient. The optimal biologic method (limb distraction after resection or callus distraction by a transport technique) and the optimal fixation devices depend on the indication (local aspect, polytrauma, patient, motivation).

Control of hemorrhage and prevention of septic complications are the predominant difficulties associated with severe pelvic crush injuries. According to our experience spontaneous tamponade, external compression (MAST/G-suits), and blind ligation of the hypogastric artery seem to be ineffective, whereas angiography followed by embolization, controlled ligation or vascular reconstruction, packing with scheduled 2nd look reexploration, and rigid fixation of the pelvic ring are recommended to control severe hemorrhage associated with these injuries. Moreover, early repair of bowel and urinary tract lesions, diverting colostomy with rectal wash-out, radical debridement, and open wound care of degloving avulsion injuries appear to be the most important procedures to prevent posttraumatic sepsis. Our pelvic crush trauma protocol is based on 84 consecutive cases treated between 1972 and 1990. In all cases the Injury Severity Score (ISS) was over 40 points, each patient required at least 10 units of whole blood or red cells, the overall mortality rate was 41 out of 84 patients.