[Minimally invasive treatment of intra-articular calcaneal fractures with the 2­point distractor]. / Minimal-invasive Versorgung intraartikulärer Fersenbeinfrakturen mit dem 2­Punkt-Distraktor.

OBJECTIVE: Open treatment of calcaneus fractures often has an increased risk of wound healing. Minimally invasive treatment with small incisions reduces complications. INDICATIONS: Calcaneal fractures with malalignment/comminution >1-2 mm; broadening, varus alignment of the calcaneal length axis or shortening; emergency surgery for open fractures or compartment syndrome. CONTRAINDICATIONS: Local or general contraindications. SURGICAL TECHNIQUE: Standardised positioning; restoration of length/axis with 2­point distractor under fluoroscopic control. Fragment reduction via small incisions. Fixation with 7.3 mm cannulated screws and 4.0 mm sustentaculum screws. POSTOPERATIVE MANAGEMENT: Cast-free and no weight bearing for 6 weeks; then weight bearing in a heel off-loading shoe for another 6 weeks with physiotherapy; if needed postoperative cast until soft tissue consolidation. RESULTS: Of 212 calcaneal fractures, 182 were treated with this technique. Wound healing complication rate was 2.7%; 4.7% of patients required secondary arthrodesis of the subtalar joint.

"Understanding burns": research project BurnCase 3D--overcome the limits of existing methods in burns documentation.

Understanding burns means knowing what is necessary for the successful treatment of burns. Nobody in science, economics, or quality control can comprehend this issue's complexity without thorough documentation of the work involved. BurnCase 3D is a non-profit research project whose aim, achieved through software of the same name, is a thorough and accurate burn-treatment documentation schema, facilitated by three-dimensional digital models tracked over time. Adapting these models on the basis of gender, height, weight, and body shape avoids systemic errors. Superimposing photos of the burned areas on the model prevents individual error and can be combined with methods of burn-depth evaluation. The program includes automatic encoding of diagnostic and therapeutic procedures. Model resolution is 1cm(2) and finer, so that even small scars' locations and extents can be documented, thus enabling registration of long-term results. The program's status as a multilingual data-collection tool brings together multiple international efforts in data collection, and makes it suitable for e-medicine and disaster relief. In its basic form, it provides essential functions in burn documentation, photo documentation, and reporting. The four-dimensional database allows registration of interactions over time and can demonstrate the influence of location, timing, and intervention on outcome.

Modelling human burn injuries in a three-dimensional virtual environment.

This paper gives a work-in-progress report on our research project BurnCase, a virtual environment for modelling human burn injuries. The goal of the project is to simplify and improve the diagnosis and medical treatment of burns. Due to the lack of electronic and computational support for current diagnosis methods, enormous variations regarding the approximated size of burned skin regions exist. And although Simplifications like the Rule-Of-Nines-Method ([Weidringer, 2002]), Lund and Browder ([LundBrowder, 1944]) and others try to compensate for these errors, the fact remains that different physicians overestimate the BSA (Body Surface Area) by 20% up to 50%, depending on the different experience and subjectivity of the approximation process. Nevertheless, different supporting mechanisms have been developed to assist the process of burn region transfer so that after transferring all burned regions on the virtual human body, calculations can be applied in order to evaluate standard indices like the ABSI (Abbreviated Burn Severity Index), and Baux ([Baux, 1989]) as well as ICD10 (International Classification of Diseases) diagnosis encoding. The virtual body simulation is based on state-of-the-art 3D computer graphics (OpenGL). Thus a simulation system, providing a graphical user interface, allows surgeons to transfer a patient's burn injury regions onto an appropriate 3-dimensional model. As such, the BurnCase system improves surface determination by calculating region surfaces up to a precision of one cm2. This improves the average variation to less than 5%, limited by the precision of the surface transfer onto the virtual model. The system already allows the transfer of burned regions by using standard input devices. For this purpose different reference models of human bodies have been created in order to receive appropriate results based on measured physical data of different patients. Moreover, an underlying database stores all entered case studies so that it is possible to perform comparisons of burn cases and animation sequences of the healing process of single wounds or whole bodies. When used as centralized burn accident registration service, a huge knowledge base of burn diagnoses and consequent medical treatment will emerge. This knowledge base will allow medical advices and diagnosis support for any kind of burn accidents, and it will consequently improve and support the primary diagnosis process of burn accidents. Thus, an enormous reduction of time and costs of medical burn treatment will be reached.

[Polytrauma and predicting fatality. Comparative evaluation of the value of the Kirkpatrick-Youmans Trauma Index (TI), Schreinlechner-Eber modified TI (TI mod.), and the Baker Injury Severity Score]. / Polytrauma und Letalitätsvorhersage. Vergleichende Prüfung des Aussagewertes von Traumaindex Kirkpatrick--Youmans (TI), TI modifiziert nach Schreinlechner-Eber (TI mod.), und Injury Severity Score nach Baker (ISS).

The Trauma Index (TI) of Kirkpatrick and Youmans modified by Schreinlechner and Eber performed better than the Injury Severity Score (ISS) in predicting case fatality of 234 patients with major trauma treated during the years 1985 through 1987. Logistic regression was used for determining the cut-points: Death was considered as predicted by ISS if it was greater than 53 or by TI if it was greater then 3.74. Specificity was 95% for ISS and 94% for TI. Sensitivity was 49% for ISS and 73% for TI.