Anterior approaches to the acetabulum

Since the 1960s the ilioinguinal approach by Letournel with the three anatomic windows has been successfully established for the treatment of acetabular fractures involving predominantly the anterior column. The previous standard approach, the iliofemoral approach by Smith-Petersen, is still used for the therapy of anterior wall or isolated femoral head fractures. The increase in acetabular fractures in the elderly with lateral compression fractures after lateral falls, characterized by medial displacement of the quadrilateral plate and superomedial dome impaction, led to the use of the intrapelvic modified Stoppa approach with or without the first window of the ilioinguinal approach in the 1990s. To combine the advantages of the second and third windows of the ilioinguinal approach and the medial view of the modified Stoppa approach the Berne research group recently introduced the pararectus approach in acetabular surgery, which can be used as a less invasive acetabular surgical (LIAS) technique especially in the elderly.

Disorders of serum sodium in emergency patients: salt in the soup of emergency medicine

Electrolyte disorders are common and potentially fatal laboratory findings in emergency patients. Approximately 20 % of patients in the emergency department present with either hyponatremia or hypernatremia. Recently it was shown that disorders of serum sodium are not only an expression of the severity of the underlying disease but independent predictors for the outcome of patients. They directly influence patient daily life by causing not only gait and concentration disturbances but also an increased tendency to fall together with a reduced bone mass. Given these new data it is even more important to detect and adequately correct dysnatremia in patients in the emergency department. Acute, symptomatic dysnatremia should be corrected promptly by use of 3 % NaCl for hyponatremia and 5 % glucose for hypernatremia. A close monitoring of serum sodium concentration is, however, essential in any case of correction of hyponatremia or hypernatremia in order to avoid rapid overcorrection and subsequent complications. A profound knowledge of the mechanisms underlying the development of hyponatremia, e.g. diuretics, syndrome of inappropriate antidiuretic hormone secretion (SIADH), heart failure and cirrhosis of the liver and hypernatremia, e.g. dehydration, infusions, diuretics and osmotic diuresis is essential. The present article describes the epidemiology, etiology and correction of hyponatremia and hypernatremia on the basis of current knowledge with special emphasis on emergency department patients.

Magnet resonance imaging in common injuries of the wrist

Falling on the outstretched hand is a common trauma mechanism. In contrast to fractures of the distal radius, which usually are diagnosed on plain film radiographs, identifying wrist injuries requires further diagnostic methods, e.g., MRI or CT. This article provides a review of the use of MRI in the most common traumatic wrist injuries, including scaphoid fractures, TFCC lesions, and tears of the scapholunate ligament. Early and selective use of MRI as a further diagnostic method in cases of adequate clinical suspicion helps to initiate the correct treatment and, thus, prevents long-term arthrotic injuries and reduces unnecessary absence due to illness. MRI shows a high reliability in the diagnosis of scaphoid fractures and the America College of Radiology recommends MRI as method of choice after X-ray images have been made. In the diagnosis of ligament and discoid lesions, MR arthrography (MRA) using intraarticular contrast agent has considerably higher accuracy than i.v.-enhanced and especially unenhanced MRI.

Physik vor Gericht. Die forensische Physik am Institut für Rechtsmedizin der Universität Bern

Die Physik ist als Teil der exakten Wissenschaften objektiv und beschreibt alle in unserer Umwelt vorkommenden Ereignisse und ist deshalb als „neutrale Zeugin“ vor Gericht von zunehmender Bedeutung. Die forensische Physik beschäftigt sich wie die Physik allgemein mit Fragen zu den Gesetzmäßigkeiten der Natur und basiert auf der mathematischen Beschreibung von Ursache und Wirkung. Sie beantwortet u. a. Fragestellungen aus dem Bereich der Justiz, wobei das Augenmerk auf mechanische Einwirkungen auf Strukturen des menschlichen Körpers gerichtet wird. Dabei beschränkt sie sich hauptsächlich auf stumpfe und scharfe Gewalteinwirkung, wobei erstere den Sturz mit einschließt. Geschosse, die bekanntlich auch mechanisch auf den Körper einwirken, werden in der forensischen Ballistik bearbeitet. Die physikalischen Gesetze und das Wissen aus der forensischen Physik werden genutzt, um Tathergänge zu rekonstruieren, Gewalteinwirkungen – auch potenzielle – nach ihrer Gefährlichkeit zu beurteilen und um Zeugenaussagen auf ihre Vereinbarkeit mit den physikalischen Gesetzen zu prüfen.