Zusammenfassung
Bei der Versorgung von Frakturen im Rahmen eines schweren Traumas müssen verschiedene Grundsätze beachtet werden. Dabei sind bei polytraumatisierten Patienten immunologische und physiologische Veränderungen von hoher Bedeutung für die operative Therapiestrategie. Darüber hinaus beeinflusst die Schwere der Weichteilverletzungen den Zeitpunkt der definitiven operativen Versorgung. Dieses Kapitel gibt einen Überblick über die initiale Einschätzung und Klassifikation von geschlossenen und offenen Frakturen. Ebenso werden die Etappen der Versorgung in Abhängigkeit von der klinischen Situation des Patienten und der Frakturklassifikation vorgestellt. Letztlich werden Hilfestellung zur Entscheidungsfindung für chirurgische Prioritäten und Strategien bei assoziierten Begleitverletzungen (Thorax- und Beckentrauma, Schädel-Hirn-Trauma etc.) dargestellt.
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Literatur
Banwell P, Withey S, Holten I (1998) The use of negative pressure to promote healing. Br J Plast Surg 51(1): 79
Baue AE, Durham RM, Faist E (1998) Systematic Inflammatory Response Syndrom (SIRS), Multiple Organ Dysfunction Syndrom (MODS), Multiple Organ Failure (MOF): Are we winning the Battle? Shock 10(2): 79–89
Bone RC (2008) Toward a theory regarding the pathogenesis of systemic inflammatory response syndrom: What we do and do not know about cytokine regulation. Crit Care Med 24: 163–172
Bottlang M, Simpson T, Sigg J, Krieg JC, Madey SM, Long WB (2002) Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma 16(6): 367–373
DeFranzo AJ, Marks MW, Argenta LC, Genecov DG (1999) Vacuum-assisted closure for the treatment of degloving injuries. Plast Reconstr Surg 104(7): 2145–2148
Desai KH, Tan CS, Leek JT, Maier RV, Tompkins RG, Storey JD (2011) Dissecting inflammatory complications in critically injured patients by within-patient gene expression changes: a longitudinal clinical genomics study. PLoS Med 8(9): e1001093
Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM (2003) Multiple Organ Failure in Trauma Patients. J Trauma 55: 608–616
Duwelius PJ, Huckfeldt R, Mullins RJ et al. (1997) The effects of femoral intramedullary reaming on pulmonary function in a sheep lung model. J Bone Joint Surg Am 79(2): 194–202
Fleischmann W, Lang E, Russ M (1997) Treatment of infection by vacuum sealing. Unfallchirurg 1997; 100(4): 301–304
Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: A new classification of Type III open fractures. J Trauma 24: 742–746
Hildebrand F, van Griensven M, Giannoudis P et al. (2005) Effects of hypothermia and re-warming on the inflammatory response in a murine multiple hit model of trauma. Cytokine 31: 382–393
Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr. (1990) Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 30(5): 568–572
Keel M, Trentz O (2005) Pathophysiology of polytrauma. Injury 36: 691–709
Kobbe P, Lichte P, Wellmann M et al. (2009a) Impact of hypothermia on the severely injured patient. Unfallchirurg 112(12): 1055–1061
Kobbe P, Lichte P, Pape HC (2009b) Complex extremity fractures following high energy injuries: the limited value of existing classifications and a proposal for a treatment-guide. Injury 40 Suppl 4: S69–S74
Meara JG, Guo L, Smith JD, Pribaz JJ, Breuing KH, Orgill DP (1999) Vacuum-assisted closure in the treatment of degloving injuries. Ann Plast Surg 42(6): 589–594
Miller JD (1985) Head injury and brain ischaemia--implications for therapy. Br J Anaesth 57(1): 120–130
Mullner T, Mrkonjic L, Kwasny O, Vecsei V (1997) The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg 50(3): 194–199
Nuytinck JK, Goris JA, Redl H, Schlag G, van Munster PJ (1986) Posttraumatic complications and inflammatory mediators. Arch Surg 121(8): 886–890
Oestern HJ, Tscherne H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. In fractures with soft tissue injuries. 1st ed, Spinger Berlin
Olson SA, Burgess A (2005) Classification and initial management of patients with unstable pelvic ring injuries. Instr Course Lect 54: 383–393
Pape HC, Remmers D, Grotz M et al. (1999) Reticuloendothelial system activity and organ failure in patients with multiple injuries. Arch Surg 134(4): 421–427
Pape HC, Schmidt R, Rice J et al. (2000) Biochemical chages after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28(10): 3441–3448
Pape HC, Giannoudis PV, Krettek C, Trentz O (2005) Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma 19(8): 551–562
Pape HC, Tornetta P, III, Tarkin I, Tzioupis C, Sabeson V, Olson SA (2009) Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg 17(9): 541–549
Pape HC, Probst C, Lohse R et al. (2010) Predictors of Late Clinical Outcome Following Orthopedic Injuries After Multiple Trauma. J Trauma 69(5): 1243–1251. doi: 10.1097/TA.0b013e3181ce1fa1
Regel G, Weltner T, Sturm JA, Tscherne H (1996) Pattern of Organ Failure Following severe Trauma. World J Surg 20(4): 422–429
Reinert M, Hoelper B, Doppenberg E, Zauner A, Bullock R (2000) Substrate delivery and ionic balance disturbance after severe human head injury. Acta Neurochir Suppl 76: 439–444
Routt ML, Jr., Falicov A, Woodhouse E, Schildhauer TA (2006) Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma 20(1 Suppl): S3–S6
Schemitsch EH, Jain R, Turchin DC et al. (1997) Pulmonary effects of fixation of a fracture with a plate compared with intramedullary nailing. A canine model of fat embolism and fracture fixation. J Bone Joint Surg Am 79(7): 984–996
Siegel JH, Gens DR, Mamantov T, Geisler FH, Goodarzi S, MacKenzie EJ (1991) Effect of associated injuries and blood volume replacement on death, rehabilitation needs, and disability in blunt traumatic brain injury. Crit Care Med 19(10): 1252–1265
Stellin G (1991) Survival in trauma victims with pulmonary contusion. Am Surg 57(12): 780–784
Sturm JA, Wisner DH, Oestern HJ, Kant CJ, Tscherne H, Creutzig H (1986) Increased lung capillary permeability after trauma: a prospective clinical study. J Trauma 26(5): 409–418
Ware LB (2006) Pathophysiology of Acute Lung Injury and the Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med 27: 337–349
Ware LB, Matthay MA (2000) The Acute Respiratory Distress Syndrome. N Engl J Med 342(18): 1334–1349
Warren HS, Elson CM, Hayden DL et al. (2009) A genomic score prognostic of outcome in trauma patients. Mol Med 15(7-8): 220–227
Weiland JE, Davis WB, Holter JF, Mohammed JR, Dorinsky PM, Gadek JE (1986) Lung neutrophils in the adult respiratory distress syndrome. Clinical and pathophysiologic significance. Am Rev Respir Dis 133(2): 218–225
Xiao W, Mindrinos MN, Seok J et al. (2011) A genimic storm in critically injured humans. J Exp Med 208(13): 2581–2590
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Pfeifer, R., Pape, HC. (2018). Management von Frakturen. In: Pape, HC., Hildebrand, F., Ruchholtz, S. (eds) Management des Schwerverletzten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54980-3_23
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