Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20–30° of flexion and the use of specific protection tubes to preserve intra-articular structures. Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20–30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.

BackgroundWhole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions.MethodsIn this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses (E, mSV) was calculated. Patients were assigned to two groups according to placement on a plastic transfer mat (PTM, group 1) or on the Trauma Transfer™-Board (TTB, group 2). Data were collected for each group with arm placement on the abdomen (a) or in raising position (b), respectively. The maximum ventro-dorsal diameter [VDD] at the trunk was measured.Results100 patients with potentially life-threatening injuries were analysed. Patient demographics and VDD did not differ in the two groups. Radiation exposure in term of E did not reveal any significant differences between the two positioning boards using same arm position [group 1a (n=26) vs. 2a (n=24) (mSV): 16.7±4.7 vs. 17.1±4.4, group 1b (n=26) vs. 2b (n=24) (mSV): 13.1±3.9 vs. 14.3±1.5]. The arm raising positioning showed a significant reduction in E in comparison to the placement on abdomen position [group 1b vs. 1a (mSV): 13.1±3.9 vs. 16.7±4.7, p<0.05, group 2b vs. 2a (mSV): 14.3±1.5 vs. 17.1±4.4, p<0.05].ConclusionsPatient arm positioning for WBCT has an important influence on radiation exposure. Effective dose was 16–22% lower when arms were raised. An individual placement algorithm may lead to a relevant reduction of radiation exposure of severely injured patients.

Ziele: Die Multidetektor-Computertomographie (MDCT) hat einen zentralen Stellenwert in der Schockraumdiagnostik des Schwerverletzten, ist aber mit einer nicht unerheblichen Strahlenbelastung assoziiert. Ziel der vorliegenden Untersuchung war es, diese Strahlenbelastung durch den Einsatz verschiedener Lagerungshilfen und unterschiedlichen Lagerungstechniken zu reduzieren. Methode: In der retrospektiven Untersuchung wurde die mit einem 16-Zeilen-MDCT assoziierte Strahlendosis [DLP (mGy*cm)] des Thorax-Abdomenscans (geräteseitige Angaben im Dosisprotokoll) und der maximale ventro-dorsale Querdurchmesser [VDD (cm)] am Körperstamm erfasst. Es wurden zwei Patientengruppen unterschieden: (1) Lagerung auf flexibler Plastikumlagerungshilfe, (2) Lagerung auf Trauma TransferTM–Board (TTB, MedicalSCA, Wien, Österreich). Jeweils Gruppe 1 und 2 mit Lagerung der Arme auf dem Körperstamm (a) vs. Arme über Kopf (b). Ergebnis: Der VDD zeigte in allen Gruppen keinen signifikanten Unterschied [VDD (cm): 1a: 26,7±3,7 vs. 1b: 25,8±4,7 vs. 2a: 25,0±2,8 vs. 2b: 24,4±3,1, p=n.s.]. Die Verwendung des TTB führte nicht zu einer erhöhten Strahlenbelastung im Vergleich zu einer flexiblen Plastikumlagerungshilfe [DLP (mGy*cm): 1a: 1082,1±279,1 vs. 2a: 1087,5±258,3, p=n.s.; 1b: 846,5±250,8 vs. 2b: 891,5±171,6, p=n.s.]. Durch die Lagerung der Arme über Kopf des Patienten konnte im Vergleich zur Lagerung der Arme auf dem Körperstamm unter Berücksichtigung der gleichen Lagerungshilfe eine Dosisreduktion von 20% erreicht werden [DLP (mGy*cm): 1a: 1082±279,1 vs. 1b: 846,5±250,9, p<0,01; DLP (mGy*cm) 2a: 1087,5±258,3 vs. 2b: 891,5±171,6, p<0,01]. Schlussfolgerung: Als Lagerungsalgorithmus werden zur Reduktion der Strahlenbelastung spontanatmende, kreislaufstabile Patienten mit lagerungsfähiger oberer Extremität ("Arme hoch") von spontanatmenden, kreislaufstabilen Patienten mit Verletzung der oberen Extremität bzw. intubiert/beatmeten Patienten ("Arme auf Körperstamm") unterschieden.

Pelvic ring fractures represent a negative prognostic factor for what concerns morbidity and mortality of a polytraumatized patient. The subjective and functional prognosis of a pelvic ring fracture is dependent upon its degree of instability. Associated severe peripelvic soft tissue injuries and neurovascular lesions (complex pelvic trauma) affect outcome negatively. Although high rates of anatomic reduction and stable fixation have been achieved in recent years, only 60% of patients have an excellent or good clinical result. Sequelae of neurologic lesions and genitorurinary injuries are typically associated with considerable rates of persistent functional impairment. Chronic pain and disability are often very difficult to treat. Health-related quality of life and life satisfaction after pelvic ring fractures caused by high-energy trauma is substantially lower when compared to a reference population.