[Hand injuries by pyrotechnic articles--case report and reconstructive experimental investigations]. / Handverletzungen durch pyrotechnische Gegenstände. Falldarstellung und experimentell-rekonstruktive Untersuchungen.

Injuries caused by explosions of fireworks often involve people's hands. The case of a young man who suffered severe hand injuries as well as damage to both eardrums and one eye is described. Reconstructive experimental investigations of the explosive effect of six different pyrotechnic articles were carried out using human hands from body donors. With the most powerful firecrackers that used to be legally available in Germany ("Super-Böller A", "Kanonenschlag") and a self-made one with 36 g gunpowder only blackening of the skin occurred. Three pyrotechnic articles not allowed in Germany ("La Bomba", "Color salute" and "Vogelschreck") caused serious injury to the hand's soft tissue and bones.

[Fatal crossbow injury in an adolescent]. / Tödliche Armbrustverletzung im Jugendalter.

The authors present the case of a 14-year-old boy who died while handling a crossbow, which was a gift from a friend's mother. The bolt passed through the right nostril, penetrated the sinus sphenoidalis, the brain stem, the left occipital lobe and the occipital calvaria. Immediately after the accident, the victim was taken to a maximum care hospital. In spite of neurosurgical treatment and intensive care the victim died 4 days later. The case presented demonstrates that crossbows are not suitable as toys for underage persons, as they are deadly weapons which can cause serious penetrating injuries. In Germany, no license is required to buy and/or possess crossbows. In the authors' opinion, legal restrictions on the sale of crossbows and a special training of the users would be reasonable measures to reduce such accidents.

Patient satisfaction after anterior cervical discectomy and fusion is primarily driven by relieving pain.

OBJECTIVES: A prospective follow-up study of patients with anterior cervical discectomy and fusion (ACDF) for single-level cervical disc disease was conducted to determine the extent of impact of pain, sensory function, motor function, and range of motion (ROM) of the neck on patient satisfaction after ACDF. METHODS: A total of 67 ACDF patients were monitored by clinical examination (pain, motor function, sensory function, and ROM in the neck) preoperatively and at follow-up (mean, 217 d after surgery; range, 198 to 232 d) and by a satisfactory questionnaire (SQ) at follow-up only. According to the SQs, 4 patient groups were characterized. Inside each patient group for each examination parameter, the percentage of patients who showed improved, unchanged, or worsened clinical results was analyzed. RESULTS: Patient satisfaction was found to depend primarily on the improvement in pain (P=0.001). The development of motor function (P=0.056), sensory function (P=0.225), and ROM of the neck (P=0.565) did not demonstrate significant correlation with patient satisfaction. The Numerical Rating Scale score decreased from 6.2 before surgery to 2.1 on follow-up, whereas the level of analgesic use (World Health Organization scheme) decreased from 1.9 to 0.3. DISCUSSION: Improvement in pain seemed to be most important aspect in ACDF patients regarding the subjective SQ. Therefore, we strongly recommend focusing on pain-reducing therapies when choosing treatment for these patients during the postoperative period.

Equestrian injuries caused by horse kicks: first results of a prospective multicenter study.

OBJECTIVE: To analyze horse-related accidents caused by hoof kicks. DESIGN: Prospective study to evaluate hoof kick-related accidents. SETTING: Multicenter study, including 9 trauma centers in Hamburg, Germany. PATIENTS: Patients who were treated as the result of a hoof kick between January 1, 2010, and May 1, 2010, were included in the study. MAIN OUTCOME MEASURES: Horse and rider qualifications, riders' use of protective equipment, location and activity at time of accident, mechanism of injury, injuries sustained, and treatment required for these injuries. RESULTS: Twenty-four equestrians received hoof kicks. The average age was 22.6 years (range, 7-34 years). All accidents (100%) occurred while the equestrians were handing or grooming the horse. Two riders (8.3%) wore a helmet at time of accident. Sixteen riders (66.7%) suffered orbital, midface, or mandible fractures; 8 riders (33.3%) had injuries on other parts of the body. CONCLUSIONS: Hoof kick injuries account for a significant proportion of equine injuries and occur when riders are dismounted, most frequently when grooming without wearing protective equipment. Head and facial injuries occur most frequently and suggest that mandatory helmet and facial grill use should be considered during all horse-related activities.

Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score.

STUDY DESIGN: In a retrospective analysis we evaluated the achieved and the predicted survival times according to the Tokuhashi score for patients with spinal metastases of lung cancer (lc). OBJECTIVE: Our aim was to investigate the robustness of the Tokuhashi Score for this group of patients. SUMMARY OF BACKGROUND DATA: The decision on operative versus conservative treatment for cancer patients with vertebral metastases depend on their predicted lifespan. Although the score of Tokuhashi is commonly used for prognostic predictions, it's reliability for specific tumor types (e.g., lc), has not been validated. METHODS: Seventy-six patients who had undergone spinal surgery for lc metastases between 1999 and 2004 were verified according to the Tokuhashi score and predicted versus achieved survival times were compared. RESULTS: The median overall survival (OS) after surgery for all patients was 108 (3-1767) days (102 [5-1767] days for patients with NSCLC [n = 49; 64.5%] and 108 [3-473] days for patients with SCLC [n = 24; 31.6%]). Survival times differed depending on the time period of procedure performance (OS 81 [3-435] days for patients operated between 1999 and 2001 [n = 38], 135 [8-1767] days for patients who received surgery between 2002 and 2004 [n = 38]). Actual and predicted survival were similar in 51 of 76 cases (67.1%), while there was no correlation in 25 of 76 (32.9%) cases. Results were comparable for all histologic subgroups. CONCLUSION: Although the survival time of patients with vertebral metastases from lc has increased over the last 10 years, the overall outcome is still poor. For the prediction of an individual prognosis in the group of lc patients the score of Tokuhashi seems to be a suboptimal tool. We conclude that therapeutic decisions for such patients should be made based on interdisciplinary platforms, especially in the light of improved systemic treatment options.

[Risks in sport riding - a critical survey of safety standards in sport riding]. / Risikosport Reiten - eine kritische Darstellung der Sicherheitsstandards im Reitsport.

INTRODUCTION: Equitation is associated with a high rate of injuries and lethal accidents. The head is the most frequently concerned body part. Hence in the majority of the cases deaths results from head injuries. In this study injuries as well as causes of deaths were analyzed in 21 cases. Actual safety standards in equitation were appraised and suggestions for improvement were formulated. MATERIAL AND METHODS: Between 1996 and 2008 21 equestrians suffered from a fatal accident in the greater area of Hamburg. In a retrospective analysis, equestrians' records which bases on the documentation of the institute of forensic medicine as well as the insurance company ARAG were reviewed. Details of the accidents were reconstructed and pattern of injuries of those wearing a riding helmet were analyzed. RESULTS: The 21 equestrians had 29 injuries. Therefrom 86 % (18 / 21) suffered from head injuries which consequences were the causes for death. In 5 cases (24 %) equestrians wore riding helmets on the date of accident. Therefrom 80 % (4 / 5) suffered from head injuries which results in death. DISCUSSION: Actual safety standards in equitation are disappointing. The implementation of the obligation wearing a helmet as well as the improvement of the efficiency of protective clothing for equestrians is essential. Prospective studies in order to broad the state of knowledge in this context are necessary.

Dynamics of neurological deficit after surgical decompression of symptomatic vertebral metastases.

STUDY DESIGN: We conducted a retrospective study to examination the influence of preoperative duration of symptoms on the clinical outcome of patients that underwent surgical decompression because of neurologic deficit in metastatic disease of the spine. OBJECTIVES.: Our aim was to investigate possible correlations between the duration of neurologic deficit before surgery and postoperative outcome with respect to neural recovery in patients with spinal metastases, and second, based on those results, propose criteria for the timing of surgery in these patients. SUMMARY OF BACKGROUND DATA: It has not yet been determined whether the duration of preoperative symptoms has an influence on the postoperative outcome of patients with vertebral metastases. A standardized treatment or protocol defining a strategy of surgical treatment has yet to be designed. METHODS: This study includes 194 patients. The duration of symptoms before surgical treatment and the neurologic status before and after operation were determined and classified according to the Frankel score. RESULTS: Of 401 patients, who underwent surgery due to metastases to the spine, 194 suffered from neurologic deficit. Analyzing the postoperative neurostatus in these patients revealed an improvement in 78 patients (40%), impairment in 13 patients (7%), and in 103 patients it did not change. The relation of duration of neurologic symptoms before surgery, and the outcome after an operation was highly significant (P < 0.001). In patients with less than 3 days of neurologic deficit, the probability of improvement in neurostatus was highly significantly higher (P < 0.001) than in patients with neurologic deficit existing for more than 15 days. CONCLUSION: Patients with neurologic deficit because of spinal bone metastases benefit from early operative intervention. Urgent surgery is indicated in patients with less than 3 days of neurologic deficit.