We report a case of decompression illness in which the patient developed paraparesis during scuba diving after rapid ascent. MRI of the spine revealed a focal intramedullary lesion consistent with the symptoms. The pathophysiological and radiological aspects of spinal decompression illness are discussed.
In a prospective randomized trial the early functional results after immobilisation in a cast were compared to those after using a vacuum stabilizing system. The vacuum stabilizing system Vacoped offers equivalent stability compared to a plaster cast. In contrast to the cast the Vacoped can be removed for body care and physical therapy. Additionally the range of motion for dorsal flexion/extention in the upper ankle joint can be adjusted. From 9/1996 to 7/1997 there were 40 patients included in the study with an operated ankle fracture as monotrauma. Six weeks postoperatively the patients with cast treatment showed significantly higher functional deficits for the upper ankle joint (20%), the lower ankle joint (40%) and muscle atrophy (2.1 cm side difference) than the group with the vacuum stabilizing system (upper ankle joint 15%, lower ankle joint 25%, 1.4 cm muscle atrophy). Five patients out of the group with the vacuum system were already at work three weeks postoperatively. Three months postoperatively the functional results for both groups were approximating. The vacuum stabilizing system Vacoped offers better early functional results than conventional cast treatment after osteosynthesis of ankle fractures. Because of the increased patient comfort and the early ability for physical therapy the vacuum stabilizing system is preferable to cast treatment.
Zusammenfassung Hintergrund: Fr?hrehabilitation ist der fr?hestm?gliche Einsatz der Rehabilitation im Akutverlauf. Sie schlie?t in der Versorgung des Polytraumas die Rehabilitationsl?cke zwischen unfallchirurgischer Versorgung und Rehabilitationsklinik. Material und Methoden: 50 Polytraumaf?lle mit anschlie?ender fach?bergreifender Fr?hrehabilitation auf einer eigenen Fr?hrehabilitations-Station wurden retrospektiv analysiert. Als prim?re Outcome-Parameter wurden die Mobilit?t (Charit? Mobility Index?) und die ADL-Kompetenz (Barthel-Index) bei ?bernahme auf die Fr?hrehabilitations-Station und Entlassung untersucht. Ergebnisse: Im Verlauf der fach?bergreifenden Fr?hrehabilitation verbesserten sich die Mobilit?t (p<0,001; Effektst?rke |d|=2,5) und die ADL-Kompetenz (p<0,001; Effektst?rke |d|=2,4) hoch signifikant. Diskussion: Daten zum Outcome der Fr?hrehabilitation nach Polytrauma sind bislang kaum vorhanden. In Vorbereitung einer prospektiven kontrollierten Studie werden erstmals grundlegende Daten zu Rehabilitationsergebnissen der Fr?hrehabilitation von Polytrauma-Patienten pr?sentiert. Schlussfolgerung: Es wurde gezeigt, dass die Fr?hrehabilitation nach Polytrauma g?nstige Effekte in Mobilit?t und ADL aufweist.
The treatment of severely injured patients is a challenge for preclinical and clinical treatment concepts, causing financial aspects of increasing importance for the German health care system. A total of 32,500 polytraumatized patients (PTS III and IV) are managed in trauma center levels I-IV in Germany. Trauma center levels I or II are by definition capable of supporting the full range of treatment for the severely injured. With the baseline calculation of 64,000 DM per patient and 104 polytrauma treated per year in the Berlin Virchow Clinic, 6.66 million DM primary costs must be spent for treatment. The total annual costs of this center are nearly 24 million DM for emergency cases and 7 million DM fixed costs per year, for a trauma center level I. In Europe the distribution of trauma center levels I or II is sufficient and can be specified with 1 center per 1 million inhabitants. Nevertheless, the european air medical service could support more intensive use of these central trauma institutions. This was shown by comparing the number of polytrauma patients and the number of trauma centers. Less then half of these patients are treated in levels I or II trauma centers. The financial pressure on the health system and the rising quality must lead to better utilization of trauma centers. To meet this goal a annual treatment rate of 300-400 polytrauma patients should be aimed at. The claim of the American College of Surgeons that a trauma surgeon should treat 50 severely injured patients per year would then be possible.
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