[Missed injuries of the musculoskeletal system in multiple trauma--a retrospective study]. / Ubersehene Verletzungen des Stütz- und Bewegungsapparats beim Polytrauma--eine retrospektive Studie.

In order to quantify frequency, localisation and consequences of missed musculoskeletal injuries in multiple injured patients, 323 cases were retrospectively analyzed. 40 primarily missed injuries were found, 12 of them in patients, who had been transferred from another hospital. This rate of 12.4% corresponds with the literature. Four regions are mainly affected: 1. the cervical spine, especially the cervicothoracic transition, 2. the shoulder, 3. the ligaments of the knee especially with femur or tibia fractures at the same time, and 4. the forefoot. About half of the primary missed injuries are ligament lesions. Whereas spine injuries were diagnosed within the first 2 weeks (average 4 days), ligament injuries (average 28 days) and foot injuries (average 38 days) were discovered at the patient's mobilization phase. Reasons for non detecting the injuries are: Missing or inadequate x-rays, not consistently continued diagnostic steps, inaccurate or not repeated clinical examination, apparent insignificance of peripheral injuries in multiple trauma. The potential danger of neurologic deficits of vertebral fractures, delay of rehabilitation due to secondary correction surgery (e.g. secondary ligament reconstructions) and imminent permanent damage (e.g. posttraumatic foot deformities) show the importance of a quick diagnosis of all injuries, even those appearing at the first glance as unimportant.

[Costoclavicular syndrome--a rare complication of clavicular fracture]. / Das costoclaviculäre Syndrom--eine seltene Komplikation der Claviculafraktur.

Neurological or vascular complications in clavicle fractures as a primary lesion are rare. More often these complications develop later caused by large callus formation to encroach the costoclavicular space. That is due sometimes to an additional fracture of the clavicle, which healed under shortening. The prognosis of the costoclavicular syndrome can be improved by early resection of the callus formation and--in special cases--by reconstruction of the original length of the clavicle combined with a stable plate osteosynthesis.

[Injuries of the acromioclavicular joint]. / Verletzungen des Schultereckgelenkes.

The injuries of the acromio-clavicular joint require a differentiated diagnosis and treatment. The classification of the acromio-clavicular dislocations from grade I to grade III according to Tossy is proved. The diagnosis of a complete acromio-clavicular dislocation (Tossy III) is an indication for a surgical repair. Many and different methods are reported in the literature. 178 patients with a fresh acromio-clavicular dislocation (Typ Tossy II and III) were treated at the BG-Unfallklinik Tübingen from 1970 to 1987 by suturing the ligaments, inserting pins across the joint and tension wire bending. In old cases with Tossy III dislocation of the acromio-clavicular joint an oblique osteotomy combined with the reduction of the clavicle is recommended as a method of choice. The results of these procedures and there possible intra- and postoperative complications are reported. The incision along the clavicle quite often gives scar problems. Therefore the advantages of an arched incision across the acromio-clavicular joint is pointed out. Because of there biomechanical relationship fractures in the lateral third of the clavicle are similar to dislocations of the acromio-clavicular joint. The classification of these fractures according to Jäger, Buschle and Breitner allows a differentiated management of these lesions.