Purpose The purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury. Methods Data acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0–5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included. Results The study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0–1 years (42.5%), 2–3 years (26.1%) and 4–5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0–1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2–3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4–5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0–1-year-old and 2–3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0–1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0–1 years), 1 out of 6 (2–3 years) and 1 out of 4 (4–5 years). Conclusion Although the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.
The wrists are affected in the long-term in 90% of people with rheumatism and are often (42%) the first manifestation of a destructive disease. The functionality of the wrist and the whole hand is of great importance because in many cases loss of function of the wrists leads to severe limitations. Local and operative treatment of the wrist in rheumatoid arthritis (RA) is one of the main duties in rheuma-orthopaedics. For operative treatment there is a finely tuned differential therapeutic spectrum available. The diagnostic indications take the local and total pattern of affection, the current systemic therapy as well as patient wishes and patient compliance into consideration. In the early stages according to LDE (Larsen, Dale, Eek), soft tissues operations such as articulo-tenosynovectomy (ATS) are most commonly carried out. In further advanced stages osseus stabilisation must often be performed. At this point a smooth transition from partial arthrodesis to complete fixation is possible. After initial euphoria, arthroplasty of the wrist is being increasingly less used for operative treatment due to the unconvincing long-term results and high complication rate. With reference to the good long-term results of all operative procedures, in particular early ATS with respect to pain, function and protection of tendons, after failure of medicinal treatment and persistence of inflammatory activity in the wrist, patients should be transferred to an experienced rheuma-orthopaedic surgeon.
Der weitere Verlauf der Geburt ist in kurzen Ziigen folgender: es besteht eine gute Wehent/itigkeit, zeitweise besitzen die Wehen krampfartigen Charakter, k6nnen aber dutch Belladonnagaben gemildert werden. Mit der Er6ffnung des Mutternmndes stellt sich eine ausgesloroehene Wehensehw~ehe ein, die sieh dureh Hypo-1 In Anlehnung an eine Demonstration in der Sitzung der Medizinisehen Gesellsehaft YJoehum yore 8.12.37.
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