Für die Prognose schwerverletzter Patienten sind eine schnelle Diagnostik und frühe Einleitung notwendiger therapeutischer Maßnahmen entscheidend.

The prognosis of severely injured patients depends on a rapid diagnosis and early initiation of therapeutic procedures.To that end a total of 6,927 prospectively documented severely injured patients with an Injury Severity Score (ISS) a parts per thousand yen16 from the Trauma Registry of the German Trauma Society (DGU, 2002-2007) were analyzed with respect to time intervals during emergency trauma treatment.In cases of indicated emergency surgery the average +/- time in the emergency department was 42 +/- 34 min, in cases of early surgery 75 +/- 41 min and in cases of transfer to the intensive care unit (ICU) 83 +/- 43 min, respectively. The time from the last diagnostic procedure until the end of emergency treatment was 12 min (emergency surgery), 26 min (early surgery) and 32 min (ICU), respectively. Level I (78 min) and level II (72 min) trauma centres showed similar mean times in the emergency department while level III trauma centres had a mean time of 86 min. According to this analysis no general correlation between shorter duration of emergency trauma care and reduced mortality could be observed.The duration of time intervals depends on injury severity, treatment after completion of emergency trauma care and the level of the trauma centre. Time management in emergency trauma care can potentially be optimized after completion of the last diagnostic procedure in the emergency room.

Conflicting reports exist regarding the quality of prehospital treatment of pediatric trauma patients. The purpose of this investigation was to determine whether prehospital treatment and emergency management in pediatric trauma patients were similar to that in adult patients. All patients who had been prospectively documented in the registry of the German Trauma Society (DGU) between 2002 and 2005 were selected for this study. A total of 312 matched pairs of adult and pediatric patients suffering from identical injuries were defined and compared with respect to cause of trauma, diagnostic and therapeutic interventions, and outcome. Within the study group, 63% were male, and the average age was 10.5+/-2.7 (SD) years in the pediatric group and 33.9+/-9.3 years in the adult group. There was no significant difference regarding prehospital intubation, reanimation, fluid management, chest drainage, ground and air transport to the hospital, time to arrival or interval in the emergency room. In contrast, significant differences (p<0.05) were observed in terms of the cause of trauma and pre-existing diseases. Pediatric trauma patients were not triaged or treated differently from adult trauma patients in respect to key issues of prehospital and early clinical trauma management.

Controversy exists in the literature regarding the most appropriate treatment for anterior cruciate ligament (ACL) ruptures in the skeletally immature patient. To study the histological and biomechanical stages following ACL reconstruction during growth, it is necessary to establish an equivalent model to replicate the situation of an immature skeleton. In the present study we evaluated a large animal model of ACL reconstruction during growth using skeletally immature sheep. In contrast to existing models we did not intend to provoke growth disturbances. Instead, we identified those criteria known to be essential to prevent growth disturbances in the human situation and transformed them into an animal model. Applying those criteria to skeletally immature sheep at an age of four months, we performed a fully transphyseal ACL reconstruction of their right knee. The contralateral knee served as a control. The sheep were then sacrificed 3, 6, 12 and 24 weeks after surgery. This animal model is described in detail in the present manuscript. Basic science data are presented in order to 1) make it easier for other research groups to study ACL reconstruction during growth using our model and 2) to improve this model by modifying the one or other detail of the proposed technique. Using this model, remaining open questions concerning ACL reconstruction during growth can be addressed in future studies.

Vorstellung eigener Erfahrungen und Ergebnisse eines frühklinischen Behandlungsalgorithmus unter Integration der Notfallembolisation (TAE) bei instabilen Beckenfrakturen mit arterieller Blutung.

Der Beitrag zeigt die Analyse von Ergebnissen und Vorstellung des Einsatzkonzepts einer Rettungshubschrauberstation in der präklinischen Akutversorgung von eingeklemmten Fahrzeuginsassen.

BACKGROUND:Analysis of the results and presentation of a treatment concept of a helicopter emergency medical service (HEMS) in prehospital acute care of entrapped motorists. METHODS:Consecutive patient data collection from primary rescue missions of a helicopter emergency medical service (HEMS) from the years 2000-2004. Evaluation based on data collected regarding emergency medical care, rescue techniques, and tactical rescue approach. RESULTS:A total of 359 cases of entrapped motorists were documented: 237 patients were male, 122 were female, and the average age was 37 (range: 2-82 years). The motor vehicle accidents (MVA) occurred in 21% of the cases on the highway, in 29% on a main road, in 43% on a rural road, and in 7% in city/urban areas. Concerning the vehicle types, 86% were automobiles, 5% vans, and 9% trucks. Drivers accounted for 86% of the patients, front seat passengers for 10.1%, and back seat passengers for 3.9%. The average length of motorist entrapment amounted to 17 min with an average on-scene time of 27 min for the HEMS. The total rescue time averaged 56 min. A Glasgow Coma Scale (GCS) score between 3 and 8 was recorded in 33.7% of the patients; in 24% of the cases the shock index was <1; a respiratory rate of <10/min or >20/min was documented in 25.2% of the patients. An NACA score between I and III was recorded in 34.2% of the cases, NACA IV in 18.9%, and NACA >/=V in 46.8%; 11.9% of the patients died before hospital admission. CONCLUSION:For both the emergency control center personnel and the emergency medical technicians (EMT), a case of motorist entrapment must be considered as a trigger mechanism of injury, activating a sophisticated and time-sensitive prehospital acute care and transportation service. In the German emergency medical service this involves primarily the HEMS. Even in cases of potentially critically injured entrapped motorists, the prehospital adherence to"the golden hour of shock" is made possible, despite the resulting higher personnel and equipment expenses.

Objective. Presentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding.Method. Consecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch (R)) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding.Results. Of a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45 (14-80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3-5) and a total severity of injury with the ISS of 37 points (21-66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2-12.4) and an average transfusion requirement of 6 red blood cell units (4-13). The time until the TAE was started was on average 62 min (25-115) with a duration period of the TAE of 25 min (15-67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%.Conclusion. Interventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in patients with pelvic fractures. If an experienced radiologist on 24-h stand-by is assured and the infrastructure is efficient, this can be performed shortly after hospital admission and therefore should be integrated into the early clinical treatment protocol.

Patienten mit Lungenkontusion in Folge eines stumpfen Thoraxtraumas sind besonders gefährdet, neben einem ARDS weitere Organdysfunktionen bis hin zu einem therapieresistenten Multiorganversagen zu entwickeln. Daher stellt eine adäquate Therapie der Kontusionsverletzung einen Eckpfeiler der frühen, intensivmedizinischen Behandlung dar. Um die Prognose und den weiteren Verlauf günstig zu beeinflussen, sollte frühzeitig ein standardisiertes Behandlungsprotokoll zur Anwendung kommen. Nachfolgend ist ein solches für die frühe intensivmedizinische Behandlungsphase bei Thoraxtrauma mit Lungenkontusion dargestellt. Seine Hauptmerkmale sind eine augmentierte Spontanatmung mit hohem PEEP bei flacher Sedierungstiefe und die gleichzeitige kinetische Lagerungstherapie. Begleitend werden standardisiert weitere adjuvante Maßnahmen durchgeführt.

Vielen Dank für den interessanten Ansatz zur präklinischen Erfassung der Verletzungsschwere aufgrund bestimmter technischer Parameter am Unfallort. In diesem Beitrag wird auf die bereits häufig beschriebene Relevanz nichtmedizinischer, d. h. unfalltechnischer Parameter am Unfallort für den klinischen Verlauf hingewiesen. Diese liefern in der Klinik wertvolle Hinweise auf Verletzungsmuster und -schwere. Hier wurde der Einfluss von Anprallrichtung, Intrusion sowie Gurt und Airbag auf das Verletzungsmuster untersucht. Leider fanden anerkannte besonders relevante Parameter wie Kollisionsgegner, Anprallart, Geschwindigkeit und Richtung der Gewalteinwirkung keine Berücksichtigung [1]. Kollisionsgegner können andere Verkehrsteilnehmer oder Objekte in Straßennähe sein. Die Anprallart kann einfach, mehrfach oder auch ein Überschlag sein. Während die Richtung sich selbst definiert, ist die Geschwindigkeit in der Unfallforschung komplexer definiert: Bei Fahrzeuginsassen und Motorradaufsassen stellt die Geschwindigkeitsänderung Delta-v, bzw. die Relativgeschwindigkeit in Folge der Kollision den wichtigsten Parameter für die Unfallschwere dar [2, 3].

BACKGROUND:The purpose of the study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. METHODS:Technical and medical data were prospectively collected shortly after the crash at the crash scenes. RESULTS:Included were 4,264 injured bicyclists from 1985 to 2003. Fifty-five percent of the bicyclists were male and 45% were women. The mean age of bicyclists was 52.0 years. The crashes took place in urban areas in 95.2% of the cases, and in rural areas in 4.8% of the cases. Collision opponents were cars in 65.8%, trucks in 7.2%, bicyclists in 7.4%, standing objects in 8.8%, multiple opponents or objects in 4.3%, and others in 6.5%. The mean collision speed was 21.3 km/h. The helmet use rate was 1.7%. Fifty-five percent of bicyclists used bicycle traffic lanes before the crash. The mean Maximum Abbreviated Injury Scale/Injury Severity Score (ISS) was 1.45 of 3.9. The incidence of multiple injuries (ISS>16)/death was 2.0%/1.5%. The ISS/Maximum Abbreviated Injury Scale score was higher in bicyclists without a helmet than in bicyclists with a helmet, and in bicyclists who had not used bicycle traffic lanes than in bicyclists who had used bicycle traffic lanes (t test, p<0.05). CONCLUSION:In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets. More consequent helmet use and an extension of bicycle traffic lanes for a better separation of bicyclists and motorized vehicles would be simple but very effective preventive measures.

Unfalltechnische Analyse, Verletzungsschwere und -verteilung eingeklemmter PKW- und LKW-Insassen der Jahre 1985–2003 anhand von prospektiv am Unfallort sowie der erstversorgenden medizinischen Institution erhobener Befunde.

Die Intensivmedizin stellt einen wesentlichen Kernbereich in der Versorgung von unfallchirurgischen Patienten dar und geht speziell in der Behandlung des Polytraumas weit über eine postoperative intensivmedizinische Überwachung von Vitalfunktionen hinaus. Die Organisationsform dieser kosten- und personalintensiven Behandlungsphase begründete sich in der Vergangenheit auf jeweils historisch gewachsene, lokale Gegebenheiten. Derzeit unterliegt die Intensivmedizin – speziell auch die unfallchirurgische Intensivmedizin – einem Strukturwandel, dem ökonomisch-effiziente Beweggründe zugrunde liegen und der von einer Vielzahl an Empfehlungen und Vereinbarungen berufspolitischer Gesellschaften begleitet wird. Dennoch lassen sich allgemeingültige Strukturvoraussetzungen definieren, unabhängig von der zugrunde liegenden Organisationsform. Als wesentliche und unabdingbare Voraussetzung ist dabei die permanente Präsenz unfallchirurgischer Kompetenz zu nennen, die den speziellen pathophysiologischen Besonderheiten der traumatologischen Intensivbehandlung gerecht wird und diese in den Gesamtkontext der unfallchirurgischen Behandlung einzuordnen weiß.