The emission of radiation during this procedure depends on the fracture type and the experience of the surgical team. Operating theatre personnel should be aware of the higher emission rates during the treatment of type C fractures and in teaching hospitals with inexperienced team members.
The incidence of trochanteric fractures is increasing in Europe, and the economic impact and mortality is high. The aim of the study was to evaluate the PFNA® (proximal femoral nail antirotation) with respect to its clinical use and mechanical complications.All patients with a trochanteric fracture who had been treated with a PFNA® between 12/2004 and 12/2007 were identified and analysed regarding complications and radiological findings. The study included 195 patients; 61.2% of the patients were classified as Singh I und II. The mean duration of surgery was 57 min. In ten cases (5.1%) the blade migrated, four cases (2.1%) showed blade cut out and in one case the nail broke (0.5%). The mean TAD was 26.7 mm, in cases of cut out 41.3 mm and in blade migrations 38.6 mm. No failure could be documented when the TAD was less then 30 mm. There is a strong relationship between increasing TAD and mechanical failure (P<0.001); 84.6% of the patients have been followed up, and 30.2% died in the follow-up period.The PFNA® is an easy-to-use implant for the treatment of stable and instable proximal femur fractures. Mechanical failure depends on the TAD.
Beckenverletzungen treten hauptsächlich im Rahmen stumpfer Hochrasanztraumata bei Verkehrsunfällen und Sturzereignissen auf. Eine Verletzung der Beckenregion kommt bei Traumapatienten in bis zu 12 % der Fälle vor und muss in Betracht gezogen werden. Die traumatische Unterbrechung des knöchernen Beckenrings kann durch die Verletzung intrapelviner Gefäße, Leitungsstrukturen und Organe zum hämorrhagischen Schock führen und ist nach wie vor eine der führenden Todesursachen nach Trauma. Eine Beckenverletzung frühzeitig zu erkennen und zu behandeln sind wesentliche Bestandteile der präklinischen Maßnahmen, um einem hä-morrhagischen Schock vorzubeugen. Mittlerweile stellt die externe Kompression des Beckens durch Anlegen einer Kompressionsschlinge (z. B. PelvicBinder, Inc.; T-Pod ® ; SAM PelvicSling TM ) ein etabliertes Verfahren zur Blutungskontrolle durch Reduktion des Beckenvolumens dar und ist innerhalb von Sekunden anzulegen. Unter bedarfsadaptierter Analgesie und Volumentherapie sollte dann der zeitnahe Transport in eine Einrichtung mit Polytraumaversorgung erfolgen.Abstract ! Pelvic injuries result from blunt trauma-like traffic accidents or falls. Up to 12 % of all trauma patients suffer from pelvic injury; this has to be taken into consideration in patients after high-impact trauma. Fractures of the pelvic ring may cause injury to intrapelvic vessels, organs and soft tissue which rapidly leads to hemorrhagic shock and thus pelvic injury remains one of the most common causes of death after trauma. Early suspicion, identification and management of pelvic fractures may reduce the hemorrhagic shock after pelvic injury. The external compression provided by a splint (PelvicBinder Inc.; T-Pod ® ; SAM PelvicSling TM ) represents a well established method to reduce the intra-pelvic volume and bleeding. The application is done within a few seconds and does not cause any delay in the necessary early hospital transfer.
Keywords• " pelvic injury • " polytrauma • " hypovolemia • " hemorrhagic shock • " prehospital management
VNR 2760512012137993658Bibliografie DOI http://dx.
A large part of early surgery for chest injuries is justified because it averts immediate threats to life (level 1c evidence). No randomised and only a few controlled trials have examined the relative value of the different surgical options so far. Long-term data are lacking especially on the safety of endovascular stenting.
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