The Benefit of Benzodiazepine Reduction: Improving Sedation in Surgical Intensive Care.

Aims: Sedation, as it is often required in critical care, is associated with immobilization, prolonged ventilation, and increased morbidity. Most sedation protocols are based on benzodiazepines. The presented study analyzes the benefit of benzodiazepine-free sedation.

TraumaNetzwerk DGU(®): optimizing patient flow and management.

Purpose: Caring for severely injured trauma patients is challenging for all medical professionals involved both in the preclinical and in the clinical course of treatment. While the overall quality of care in Germany is high there still are significant regional differences remaining. Reasons are geographical and infrastructural differences as well as variations in personnel and equipment of the hospitals.

Implementation of a nationwide trauma network for the care of severely injured patients.

Background: Regional differences in the care of severely injured patients remain problematic in industrial countries.

Methods: In 2006, the German Society for Trauma Surgery initiated the foundation of regional networks between trauma centers in a TraumaNetwork (TNW). The TNW consisted of five major elements as follows: (a) a whitebook on the treatment of severely injured patients; (b) evidence-based guidelines (S3); (c) local audits; (d) contracts of interhospital cooperation among all participating hospitals; and (e) TraumaRegister documentation.

Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur--a prospective study of 41 patients.

Background: A great variety of methods for the stabilisation of periprosthetic fractures around total hip (THA) or total knee arthroplasty (TKA) have been described. We present the data of our experience in combining a polyaxial, anatomical locking plate with a standardised less invasive technique in the treatment of periprosthetic and peri-implant (femoral nail) femur fractures in this prospective study.

Patients And Methods: A consecutive series of 41 patients (33 women; age 79.

The two-incision, minimally invasive approach in the treatment of acetabular fractures.

Objectives: To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures.

Design: Prospective consecutive case series.

Setting: Level I University Trauma Centre.

Regionalisation of trauma care in Germany: the "TraumaNetwork DGU(®)-Project".

Purpose: The care for severely injured patients is a demanding task for all medical professionals involved in both the pre-clinical and the clinical setting. While the overall quality of care in Germany is high, regional differences remain. These are due to geographical and infrastructural variations, as well as different personnel and equipment situations in the hospitals.

Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study.

Background: The surgical treatment for displaced humeral head fractures overlooks a broad variety of surgical techniques and implant systems. A standard operative procedure has not yet been established. In this article, we report our experience with a second-generation locking plate for the humeral head fracture that is applied in a standardized nine-step minimally invasive surgical technique (MIS).

Monoaxial versus polyaxial locking systems: a biomechanical analysis of different locking systems for the fixation of proximal humeral fractures.

Objective: The development of locking plate systems has led to polyaxial screws and new plate designs. This study compares monoaxial head locking screws (PHILOS© by Synthes) and a new generation of polyaxial locking screws (NCB-LE© by Zimmer) with respect to biomechanical stability.

Methods: On nine pairs of randomised formalin fixed humerus specimens, standardised osteotomies and osteosyntheses with nine monoaxial (group A) und nine polyaxial (group B) plate/screw systems were performed.

The emergency room transfusion score (ETS): prediction of blood transfusion requirement in initial resuscitation after severe trauma.

The presented study was initiated to develop a scoring system for the prediction of red blood cell transfusion requirement in the early care of trauma patients. All trauma patients admitted to our institution who needed trauma team activation were evaluated during a 4-year period. A set of nine parameters with possible predictive value for the need of blood transfusion was recorded.

Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe.

Background: Although early fracture fixation is expedient in patients with multiple injuries, early total care (ETC) may be associated with posttraumatic systemic complications. This study was conducted to prospectively evaluate the concept of damage control by immediate external fracture fixation (damage control orthopedics [DCO]) and consecutive conversion osteosynthesis with regard to time savings, effectiveness, and safety.

Methods: In a prospective controlled trial, a cohort of 1,070 patients with an Injury Severity Score (ISS) of 20.

Free abdominal fluid on ultrasound in unstable pelvic ring fracture: is laparotomy always necessary?

Background: In unstable pelvic ring fractures free abdominal fluid on ultrasound (US) may be caused by retroperitoneal hematoma that passes into the abdominal cavity or by an additional intraabdominal lesion. In this study a clinical pathway for the therapy of potentially combined lesions was analyzed.

Patients And Methods: All patients treated in the ED for severe trauma underwent basic sonographical and radiologic diagnostics within 15 minutes.

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers.

Objective: The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested.

Design And Setting: Prospective clinical study in two level 1 trauma centers.

Methods And Materials: MQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle.

Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the Trauma Registry of the German Trauma Society.

Objective: On the basis of the data of a multicenter study, the impact of prehospital intubation and ventilation in the therapy of severe thoracic trauma without manifest respiratory insufficiency was analyzed.

Methods: Data were collected prospectively in the Trauma Registry of the German Trauma Society. In a matched-pair analysis, patients with severe thoracic trauma (Abbreviated Injury Scale score of 4) with and without prehospital intubation were compared.

Improvement in the therapy of multiply injured patients by introduction of clinical management guidelines.

A trauma algorithm representing the guidelines for the management of emergency treatment of severe blunt trauma was implemented at our institution in 1994. By comparison of two prospectively recorded cohorts of multiply injured patients, the clinical efficacy of these guidelines was analysed. The algorithm cohort comprised 74 patients over the period January 1994 to June 1996, and the Control cohort 126 patients over the period April 1988 to December 1993.

Nonsurgical treatment of a severe tracheal rupture after endotracheal intubation.

We report the case of an 82-yr-old woman with a large complete longitudinal tracheal rupture, following endotracheal intubation. The patient was treated nonoperatively with excellent outcome. The diagnostic and therapeutic course as well as other therapeutic options are discussed.

Percutaneous computed tomographic-controlled ventriculostomy in severe traumatic brain injury.

Objective: Percutaneous computed tomographic (CT)-controlled ventriculostomy (PCV) was introduced for the monitoring of intracranial pressure in patients with severe traumatic brain injury who did not require simultaneous decompressive trepanation.

Methods: PCV (n = 14) was compared with conventional burr hole ventriculostomy (n = 13) based on prospectively collected data.

Results: PCV proved to be a successful technique in all cases and also when a burr hole ventriculostomy was impossible previously.

[Shock room management in severe craniocerebral trauma].

Early clinical management of severe head injury should take place in an emergency resuscitation room and be conducted according to the guidelines of the treatment of severely injured patients with attention given to time. The first phase (with a maximum duration of 30 min) comprises physical examination, stabilisation of vital functions and basic technical diagnostics. With pulmonary and circulatory functions stabilized, the second phase begins with a craniol computed tomography examination followed by adequate therapeutic measures, including, if necessary, the CT-controlled implantation of an intracranial pressure catheter.

[Long-term outcome of the donor site after free, microvascular pedicled iliac crest transplantation: experiences with 95 cases].

Using the anterior iliac crest as donor-site for free osseous, osseomuscular, and osseomyocutaneous flaps has proven itself an important reconstructive instrument both in maxillofacial and in orthopaedic surgery. We present a long-term retrospective evaluation of the donor-site situation after vascularized free anterior iliac crest transfer. The study is based in 95 cases from the years 1985 to 1993 including 11 cases from Switzerland (Kantonsspital Aarau).

[Cost analysis of clinical treatment of polytrauma patients].

In order to assess the costs arising from the treatment of polytraumatized patients we analysed the data of 100 prospectively studied multiple trauma patients (ISS 38) calculating all medical expenses during their clinical stay. The average cost per patient in the studied group (n = 100) amounted to 63989.- DM.

[Plastic surgery in soft tissue reconstruction in large extremity defects].

Soft-tissue defects in the extremities vary greatly, depending on the trauma mechanism, localization and a number of factors related to the patient's physical condition. We offer an overview of the plastic surgery methods in reconstruction of different soft-tissue defects in the extremities, beginning with the diagnostic, clinical and radiological measures that make classification of soft-tissue defects possible, and then giving a concentrated view of the appropriate reconstruction methods. Collaboration between traumatology and plastic surgery seems to be especially important in lesions in the extremities.