[Gunshot and Blast Injuries from a Trauma Surgery Perspective].

The severity and extent of gunshot and blast injuries are often misjudged due to a lack of specialist knowledge. The aim of this article is to outline the characteristics of gunshot and blast injuries, including emergency diagnostics and initial surgical treatment.Due to multiple high-energy penetrating injuries, barotrauma, or blunt trauma, affected patients are usually polytraumatized, with multiple organ damage and an average Injury Severity Score (ISS) of > 36.

[Preclinical Treatment of Gunshot and Blast Injuries in Germany].

Gunshot and blast injuries are extremely rare in the emergency services. However, in the context of the increasing threat of terrorist attacks, the possibility of these traumas is also coming into focus. This article provides an overview of the various entities and the corresponding treatment principles for penetrating injuries.

Gunshot injuries in Central Europe - Epidemiology and outcome in Germany, Switzerland and Austria - an analysis based on the TraumaRegister DGU®.

Background: Firearms are of special interest in trauma research due to high lethality and criminal value. Strong correlation between guns per capita and fire-arm related deaths has been shown. Most of existing literature regarding gun-shot fatalities are from the U.

[Microbiological challenges in the treatment of war injuries].

The treatment of war injuries represents a continuing and recurrent challenge in modern reconstructive surgery. Previously, tumor resections and sepsis-related resections were mainly responsible for lengthy bone defects in Germany. In recent years another picture has increasingly emerged, particularly caused by the medical support of Ukraine.

[A retrospective identification of severely injured patients using ICD 10 diagnoses codes : Part of the project "Quality of life and ability to work after severe trauma" (LeAf Trauma)].

Background: Due to continuous improvements in treatment, more and more severely and seriously injured patients are surviving. The complexity of the injury patterns of these patients means that they are difficult to map in routine data.

Aim Of The Work: The aim of the data exploration was to identify ICD 10 diagnoses that show an association with an injury severity score (ISS) ≥ 16 and could therefore be used to operationalize severely injured patients in routine data.

New Recommendations for the Care of Severely Injured Patients: Revision of the S3 Guideline on Treatment of Polytrauma/Severe Injuries.

Die 3. Überarbeitung der S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung wurde unter der Federführung der Deutschen Gesellschaft für Unfallchirurgie (DGU) von insgesamt 26 Fachgesellschaften und Organisationen durchgeführt und stellt eine umfassende Aktualisierung der Handlungsempfehlungen zur Schwerverletzten-Versorgung auf Basis neuer wissenschaftlicher Erkenntnisse und Studien dar. Die Leitlinie enthält 332 Kernempfehlungen unterschiedlicher Empfehlungsgrade und dazugehörige Erläuterungen, die Expertenwissen und über 2400 zitierte Literaturstellen berücksichtigen und somit das höchste Niveau (S3) einer Leitlinie erfüllen.

EuroTrauma, delays in access to bleeding control. A comparison between a conventional and a hybrid trauma center, both European military trauma centers.

Purpose: Comparison of access times to CT and surgical/radiological bleeding control between two European military trauma centers.

Methods: Retrospective and observational study conducted in two military level 1 trauma centers in Toulon (France) and Koblenz (Germany) between 2013 and 2018. Inclusion of severe trauma patients with ISS > 15 with clinical and biological criteria of bleeding.

[Extracorporeal shockwave therapy as an alternative treatment in cases of posttraumatic delayed bone union].

Background: Impaired posttraumatic bone healing is a relevant complication of fractures. Usually, the standard treatment is surgical revision. For about 30 years extracorporeal shockwave therapy (ESWT) has emerged as an alternative treatment option with similar consolidation rates but less complications.

Traumatic diaphragmatic rupture: epidemiology, associated injuries, and outcome-an analysis based on the TraumaRegister DGU®.

Introduction: Traumatic diaphragmatic rupture is a rare injury in the severely injured patient and is most commonly caused by blunt mechanisms. However, penetrating mechanisms can also dominate depending on regional and local factors. Traumatic diaphragmatic rupture is difficult to diagnose and can be missed by primary diagnostic procedures in the resuscitation room.

Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma : A registry-based analysis from the TraumaRegister DGU®.

Introduction: Damage control surgery (DCS) is a standardized treatment concept in severe abdominal injury. Despite its evident advantages, DCS bears the risk of substantial morbidity and mortality, due to open abdomen therapy (OAT). Thus, identifying the suitable patients for that approach is of utmost importance.

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®.

Purpose: The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients.

Terrorist attacks: common injuries and initial surgical management.

Terrorism-related incidents and shootings that involve the use of war weapons and explosives are associated with gunshot and blast injuries. Despite the perceived threat of terrorism, these incidents and injuries are rare in Germany. For this reason, healthcare providers are unlikely to have a full understanding of the special aspects of managing these types of injuries.

Anterior management of C2 fractures using miniplate fixation: outcome, function and quality of life in a case series of 15 patients.

Purpose: The classification systems by Anderson and D'Alonzo, Effendi, Benzel and others have limitations when it comes to morphologically categorising fractures of the second cervical vertebral body (C2) that present with or without an additional fracture of the dens or with or without an extension of the fracture line into the vertebral arch and displacement. Currently, there are no definitive recommendations for the treatment of fractures at the junction of the dens with the vertebral body of C2 on the basis of outcome and stability data. Depending on patient anatomy, either anterior or posterior approaches can be used to fuse C1 and C2 and to achieve definitive surgical stabilisation.

Management of Soft-Tissue and Bone Defects in a Local Population: Plastic and Reconstructive Surgery in a Deployed Military Setting.

Objective: Gunshot injuries, blast injuries, and major contusions can cause extensive extremity defects. In countries with damaged or destroyed infrastructure, local national patients with these injuries pose a challenge. Deployed medical facilities of the German Armed Forces provide medical care to these patients as part of their humanitarian activities.

[Characteristics and Treatment Strategies for Penetrating Injuries on the Example of Gunshot and Blast Victims without Ballistic Body Armour in Afghanistan (2009 - 2013)].

Much like other countries, Germany has recently seen terrorist attacks being planned, executed or prevented at the last minute. This highlights the need for expertise in the treatment of penetrating torso traumas by bullets or explosions. Data on the treatment of firearm injuries and, even more so, blast injuries often stems from crises or war regions.

The First Aid and Hospital Treatment of Gunshot and Blast Injuries.

Background: When gunshot and blast injuries affect only a single person, first aid can always be delivered in conformity with the relevant guidelines. In contrast, when there is a dynamic casualty situation affecting many persons, such as after a terrorist attack, treatment may need to be focused on immediately life-threatening complications.

Methods: This review is based on pertinent publications retrieved by a selective search in Medline and on the authors' clinical experience.

Causes of Primary Total Hip Arthroplasty in Active Duty Soldiers-Are Recurrent Medical Assessments Associated With Reduced Rates of Secondary Osteoarthritis in This Population?

The purpose of this study was to analyze the different causes of symptomatic osteoarthritis (OA) of the hip joint in active duty soldiers requiring a total hip arthroplasty and the hypothesis that soldiers had a reduced prevalence of secondary OA as a result of a selection process that has taken place through multiple medical assessments during their military career. We analyzed patient records from 2006 to 2012 for male patients ≤60 years with OA of the hip and indication for total hip arthroplasty in a military hospital in which civilian patients are also treated. About 44 military patients (MP) and 69 civilian patients (CP) were included.

Masquelet technique for reconstruction of osseous defects in a gunshot fracture of the proximal thigh--a case study.

Treatment of osseous defects of the extremities is a constantly recurring challenge in modern reconstructive surgery. This applies, in particular, to military surgery, especially to the sequelae of gunshot and blast injuries. Severe soft-tissue damage and inevitable contamination lead to an increased rate of infection.

Postoperative PMBC-derived IL-6 and TNF-alpha-release is uninfluenced by IL-12-mediated restoration of IFN-gamma synthesis.

Objectives: Interferon gamma (IFN-gamma) synthesis in peripheral blood mononuclear cells (PBMCs) is suppressed after major surgical trauma. Interleukin-12 (IL-12) has been shown to stimulate IFN-gamma-synthesis. We hypothesised that exogenous IL-12 can increase perioperative pro-inflammatory cytokine release.

Exogenous IL-12 and its effect on TH1/TH2 cell activity after cardiac surgery.

There is controversy about the origin of the alterations in T helper 1 (TH1)/TH2 cell activity after major surgical procedures such as on-pump cardiac surgery. We hypothesized that a postoperative decrease in interferon (IFN) gamma-producing TH1 lymphocyte activity may be the sole cause of this TH1/TH2 shift and that the addition of recombinant IL-12 can reverse TH1 suppression. Peripheral blood mononuclear cell fractions from 20 low-risk elective cardiac surgery patients were analyzed preoperatively (d0) and on the first (d1), third (d3), and sixth (d6) postoperative days.

A comparison of monocyte counts and ex vivo and in vitro monocyte cytokine production after major surgical trauma.

Background: Impaired function of cluster of differentiation 14-positive (CD14+) monocytes (MOs) after major surgical trauma is believed to predispose to infectious complications. Postoperative decreases in human leukocyte antigen (HLA)-DR expression, tumor necrosis factor-alpha (TNF-alpha) production and interleukin (IL)-12 synthesis have been reported. There are no studies comparing absolute MO counts and MO cytokine synthesis in peripheral blood and stimulated cultures.

Fusion of the septic ankle: experience with 15 cases using hybrid external fixation.

Background: In cases of septic joint destruction, an unfavorable situation of soft tissues and chronic osteomyelitis are responsible for high failure rates of ankle fusions. We wanted to evaluate the control of infection and the fusion rate using hybrid external fixators for the fusion of the septic ankle in a prospective study.

Methods: From 1996 to 1998, 15 arthrodeses were performed using hybrid external fixators.