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Purpose of the Study: Between 01/02 and 01/03 four cases of ruptures of the pectoralis major muscle were treated in our hospital by suture. The data were retrospectively analysed, all patients underwent a follow up examination. We compared our results with the literature found by internet search., Patients and Methods: Between 01/02 and 01/03 four male patients with a rupture of the pectoralis major muscle (PM) were treated surgically by suture. Three of them had an acute rupture (75%), in one case the injury was older (25%). In three cases patients underwent MRI examination. All patients were examined for a follow up by the Constant score and the score of McEntire., Results: The median age of the patients was 36.5 (min: 27; max: 51) years; in three cases the left side was injured, in one case the right. All cases of the acute injury happened during weight bearing. The older rupture (1.5 years ago) was caused by a motorcycle accident. The follow up examination was performed after 8.5 (min: 7; max: 13) months. According to the score of McEntire the functional and clinical result was in all cases good to very good. The median value of the Constant score on the injured side was 90 (min: 63; max: 96) compared to 99 (min: 95; max: 100) on the other side., Conclusion: The rupture of the pectoralis major muscle is a rare entity and appears in young male patients. The most common reason for this injury is weight bearing or physical exercises, often in combination with anabolic steroids. Clinical and functional results after suture are good; patients normally reach the former level of activity and are able to practice their sports in the same way like they did before the trauma. According to our experiences, we recommend the surgical therapy.

In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure monitoring is recommended. The critical level of the absolute intracompartmental pressure is unclear. It is recommended to use a delta p pressure of 30 mm Hg. Below this pressure in the presence of clinical signs a fasciotomy of all compartments is the treatment of choice.

With an ever increasing percentage of elderly people among the population fracture management in the aged is of increasing importance in the field of traumatology, since people between the ages of 60 and 80 will constitute the largest subpopulation by 2030. Due to relevant interindividual differences concerning physical constitution and comorbidity this group resembles an extremely inhomogenic population of patients. Discrepancies between biologic and chronologic age make a careful selection of suitable therapeutic strategies individually adapted to a single patient's situation necessary. For the biologically younger patient with good compliance conservative treatment or minimal osteosynthetic procedures requiring partial weight bearing might constitute a reasonable and appropriate therapeutic option whereas for biologically older patients with relevant co-morbidity early mobilisation with short hospitalisation periods is of the highest priority. This is why in these cases osteosynthetic procedures with implants that allow full weight bearing initially after surgery should be preferred. Even though in advanced age there is an increasing risk of fractures in general -- due to increasing incidence of falls and decreasing bone mineral density -- the majority of fractures in elderly is located in the proximal femur, the proximal humerus and the distal radius. Therefore, therapy of fractures in these typical locations shall in recognition of the particular characteristics of the advanced age be displayed in this article.

We describe a case of the rare entity of a persistent ossicle on the top of the odontoid process. In a short review of the literature, we show developmental abnormalities of the odontoid process and its etiologies. The terminal ossicle (Bergmann) plays an important role in the differential diagnosis of a fracture of the odontoid process type I in adults using the classification of Anderson and D'Alonzo. If fracture and instability is excluded by plain radiographs, computed tomography and/or MRI, there is no need for additional therapy.

The treatment of dislocated proximal humeral fractures in elderly patients is still a subject of controversy. Newer techniques such as fixed angle plate fixation did not show better results despite theoretical advantages. Prospective randomized studies are necessary to evaluate treatment recommendations.

The scapho-capitate fracture syndrome is a rare but severe injury of the carpus. It is characterized by a rotation of the proximal fragment of the capitate bone of 90 or 180 degrees and a fracture of the navicular bone in the intermediate third. This injury is caused by a fall on the outstretched and dorsiflected hand. The scapho-capitate fracture syndrome was firstly described in 1956 by Fenton. There are 31 cases described in literature but none of these involves both hands. Here we describe the first case of scapho-capitate fracture syndrome in both hands, in a 21 year old woman who jumped out of a window with suicidal intentions. She was treated operatively by Herbert-screws and K-wires.

The importance of emergency medical treatment for avalanche victims in the pre-clinical and clinical sector is still real. Based on new investigations, guidelines for triage have been endorsed by the International Commission of the Alpine Rescue Services (ICAR) to reduce secondary deaths following the successful extrication of victims from the avalanche mass. Although hypothermia plays a secondary role in the total mortality of avalanche victims, the most important task if extrication lasts 35 min or more is the professional treatment of hypothermia. Avalanche emergencies in the southern part of the Black Forest are quite rare. In February 2002 one avalanche victim in this region survived despite a statistically bad prognosis. Based on the current literature, we provide an algorithm which conforms with the ICAR guidelines for emergency personnel and describe the possibilities and standard stage dependent treatment in cases of accidental hypothermia.

The SCIWORA-syndrome was firstly described by Pang and Wilberger in 1982 [11]. It is characterized by a neurological injury without radiological appearance. Since the standardized use of MRI in spinal cord diagnosis, the number of the "real" SCIWORA-syndromes decreases. By the case report of a 14 years old boy falling down from a wall of 2 meters height with a complete paraplegia from Th12 without radiographic abnormality (even in MRI) we will give a short review of the literature.

Fractures of the upper arm near the shoulder are common. A consensus on treatment only occurs for simple, un-dislocated fractures and with the complete destruction of the concha in elderly people. For most of the 2-4 component fractures, there exist a variety of, in part contradictory, recommendations in the literature. The most diverse statements mirror the conflict between the best anatomical solution and the practically most stable position with the least possible additional damage of the surrounding structures through surgery. Whether the implants with the most stable angle using the latest generation of plates will lead to an improvement in the results is at present a matter under clinical study. The indications are clearer for the shaft. The development of the latest plates and intramedullary implants provides a surgical improvement, and implant specific complications (e.g., pin movement) will be reduced with further development. Whether there are also advantages for the patient remain to be seen.

With the case of a 25 year old patient we will report of a rare injury, the isolated body fracture of a triquetrum bone. This kind of injury often happens in dorsalflected and ulnarducted hand position because of the anatomical position of the triquetral bone. The therapy of choice is conservative treatment with a volar splint for three to six weeks. Operation is only necessary in case of dislocation of a fragment [4]. Complications as an aseptic necrosis of a fragment is not reported. We found only one case of a pseudarthrosis [5]. Even in our case occurred a complete healing of the bone and a complete functional remission.

Method: Between 10/1997 and 2/2000 we treated eight patients (-66.5 y, 31-92 y, 5 male, 3 female). These cases were analyzed retrospectively., Results: In one case the the perforation was located in the cervical part, in three cases in the intermediate part, and in four cases in the distal part oesophagus. In seven cases the perforation was caused by endoscopic and one acid burn in suicidal intention. Surgical treatment was performed in seven cases (87.5%), five of them with primary suture, two with primary esophageal resection. The mortality rate was 50%. There was no insufficiency of the suture, but two patients died because of pulmonary complications, one patient with known hepatic cirrhosis (Child C) because of an uncontrollable bleeding of his fundus and esophageal complications 5 days after successful surgical treatment, and one patient because of fulminant sepsis after dislocation of an enteral catheter. Three of the patients were operated within 12 hours after perforation, seven of them were operated within less than 24 hours., Conclusions: Surgical treatment of esophageal perforation within 24 hours after perforation shows good results. The outcome of the treatment depends on whether there are postoperative pulmonary complications and concomitant diseases. Enteral nutrition should be avoided in cases of primary esophageal resection to facilitate the surgical reconstruction at the second operation.

Esophageal perforation after cervical spine surgery is a rare complication. Based on the case of a 77-year-old female patient with a late, asymptomatic esophageal perforation after a ventral spondylodesis of the cervical spine, the symptoms, diagnostics, and therapy of this complication are discussed. The therapy of choice is the operation. Nonoperative therapy should only be chosen--like in our case--for special indications. An esophageal perforation with symptoms should be treated operatively. Our patient was treated conservatively in consideration of her age and missing symptoms.

Mesenteric cysts are a rare cause of disease. In our hospital we treated one patient who suffered from bilateral ureteral obstruction followed by hydronephrosis, caused by a large mesenteric cyst. Because of its extent complete enucleation--the surgical procedure of choice--was not possible. We opened the cyst and made an external percutaneous drainage. After this treatment the patient recovered and even after 6 months there was no recurrence.