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The influence of the transport mode, i.e. Helicopter Emergency Medical Service (HEMS) versus ground-based Emergency Medical Service (EMS) on the mortality of multiple trauma patients is still controversially discussed in the literature. In this study a total of 333 multiple trauma patients treated over a 1-year period in a level I trauma center in Switzerland were analyzed. Using the newly established revised injury severity classification (RISC) score there was a tendency towards a better outcome for patients transported by HEMS (standardized mortality ratio 1.06 for HEMS versus 1.29 for EMS). Overall a short preclinical time and the presence of an emergency physician (EP) were associated with a better outcome.

Spinal metastases are a common concomitant phenomenon of advanced tumor disease. Beside the lung and liver, the spine is the third most common localization of manifestation. Apart from chronic and increasing pain, spinal metastases lead to neurological deficits due to destruction of the vertebral body and subsequent epidural growth expansion. The aim of a surgical treatment is the reduction of pain and the maintenance of neurological function as well as spine stability. The indication for surgery should be determined individually in an interdisciplinary consultation. The purpose of this article was to provide a brief overview regarding diagnostics and therapy of metastatic spine tumors.

The management of tibial plateau fractures can be challenging because of the scarcity of soft tissue associated with a high rate of wound healing disorders. Classic open reduction and internal plate fixation require extensive soft tissue dissection and periosteal stripping, and elevation of depressed fragments and maintenance of the reduction is difficult. In the current report the authors describe a novel operative approach to percutaneously reduce depressed tibial plateau fractures using an inflatable balloon in combination with minimally invasive plate fixation. The results of the first 5 cases treated with this technique are reported.

Osteoporotic fractures most frequently first occur in the axial skeleton, especially in the vertebral bodies of the thoracolumbar transition. Beside pain, these fractures cause increasing kyphosis leading to changes in statics and a shift of the bodies' center of gravity. This results in physiological, functional as well as neurological consequences that cannot be managed by means of a conservative therapy. The purpose of this article is to provide a brief overview on diagnostics and therapy of such fractures. Furthermore, fractures of the pubic rami need to be mentioned. They pose another frequent location for osteoporotic fractures and are also associated with a high rate of morbidity and mortality.

Delayed splenic injuries are rare but nevertheless well known and very dangerous complications after blunt abdominal trauma. The highest incidence is reported between four and eight days after trauma; however some cases with a latent period of weeks have been published. We present a case of delayed splenic rupture 13 days after trauma where most computed tomography (CT) examinations were interpreted as normal and present a review of the pathophysiology of delayed rupture, diagnosis and therapy.

In hohen Dosierungen hemmt niedermolekulares Heparin die Osteoblastenproliferation sowie die Expression von Osteocalcin und Cbfa-1 in vitro. Der bislang ungeklarte Mechanismus der Heparininduzierten Osteoporose scheint somit eine gestorte Osteoblastendifferenzierung zu beinhalten. Fondaparinux zeigt in vitro keine Beeinflussung der Osteoblastenproliferation und Differenzierung. Eine mogliche Erklarung ist die in vivo gegenuber Heparin deutlich verminderte Proteinbindungsfahigkeit von Fondaparinux. Parallel zum verminderten Risiko einer Thrombozytopenie scheint Fondaparinux auch keine Wirkung auf das Knochen-Remodelling zu haben.

In endotoxin-exposed rat livers, G-CSF caused a reduction of CINC gene transcripts in the nonparenchymal cell fraction, which might be the mechanism for attenuation of microvascular leukocyte adherence and leukocyte-dependent tissue injury, as observed upon G-CSF application in a model of endotoxin-induced hepatotoxicity.

The effect of rG-CSF on wound healing in neutropenic mice was studied in the wound healing model on the ear of hairless mice. Animals were treated with a daily dose of rG-CSF (i.p.; 3 micrograms). rG-CSF significantly improved wound healing probably by modulation of the cellulary immune response.

Interleukin-6 seems to have a predictive value for the multiple organ dysfunction syndrome (MODS) in the early period after trauma.