36. Besonderheiten bei Verbrennungen im Kindesalter

Zusammenfassung Im Gegensatz zum Erwachsenen führt der Protein- und Energieverlust beim Kind rasch zu einer katabolen Stoffwechsellage, weil seine Glykogen- und Fettreserven begrenzt sind. Ausdruck des Katabolismus ist das rasche Abmagern durch Abbau der Strukturproteine. In diesem Referat werden die therapeutischen Konsequenzen erörtert. Außerdem wird dargestellt, wie ausgedehnte drittgradige Verbrennungen mit gemischten allogenen/autologen Transplantaten behandelt werden können.     

Dringlichkeitsstufen bei Verbrennungen im Katastrophenfalle

Ohne ZusammenfassungMit 1 Abbildung     

Invagination im Kindesalter

Ohne Zusammenfassung Hannoversche Kinderheilanstalt. (Prof. Dr.Becker.)     

Handwurzelfrakturen im Kindesalter

Within a period of ten years 13 children with fractures of the carpal bones were treated in the Department of Pediatric Surgery at the University of Mainz: ten times the os naviculare was broken, once each the os pisiforme, the os triquetrum and the os lunatum. The youngest patient was ten years, the oldest one 14 years old. Ten children showed simple fractures; in three cases a pseudarthrosis had developed after fractures of the os naviculare. One child with pseudarthrosis was treated surgically, the other cases and the remaining fractures were treated conservatively. After an immobilisation of 2 to 7 weeks all fractures were united. In cases of pseudarthrosis the process of healing required nine months. 1 to 7,5 years after treatment 11 of the 13 children could be followed-up. Nine children showed a very good, one a good and one a moderate result (according to the definitions outlined in Table 5). The moderateresult was seen in one case of pseudarthrosis It is very essential to immobilize all fractures of the carpal bones, because — independent of the patient’s age — a pseudarthrosis might develop. A pseudarthrosis will heal through conservative treatment, if consequent immobilization is applied long enough.     

Schenkelhalsfrakturen im Kindesalter

Zusammenfassung Die Probleme der Behandlung frühkindlicher Schenkelhalsfrakturen werden aufgrund eigener Untersuchungen sowie in Form einer Literaturstudie diskutiert.12 Fälle aus unserer Klinik wurden nachuntersucht, wobei die Patienten zum Zeitpunkt des Unfalls ein durchschnittliches Lebensalter von 7,5 Jahren aufwiesen. Die Durchschnittszeit zwischen Unfall und der letzten Nachuntersuchung betrug 12 Jahre.Operationstechnik, vor- und nachoperative Versorgung, Spätkomplikationen sowie die Frage der Indikation für konservative Behandlung werden untersucht.Unserer Meinung nach sollten alle besprochenen Frakturarten operativ behandelt werden. In praktisch allen Fällen ist die Fixation mit Kirschnerdrähten ausreichend und verursacht keinen Schaden an der Epiphysenplatte. Postoperative Ruhigstellung im Beckenbeinfußgips für die Dauer von 6 Wochen hat sich bewährt. Für den Fall, daß die operative Behandlung intrakapsulärer Frakturen erst verzögert durchgeführt werden kann, muß das intraartikuläre Hämatom abpunktiert werden.Traumatische Epiphysiolysen sollten unserer Meinung nach geschlossen oder offen reponiert werden und mit Kirschnerdrähten fixiert werden. Die Behandlung der Wahl kindlicher Pseudarthrosen im coxalen Femurende stellt die Osteosynthese mit Spananlagerung dar. Späte Valgus- oder Varusdeformationen bedürfen der Korrektur durch eine intertrochantere Osteotomie.

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Fractures of the neck of femur in young children

Summary The problems of femoral neck fractures in young children are discussed. Results of 12 own cases are reviewed with an average age of the patients of 7.5 years at the time of accident. The average time between accident and last examination was 12 years.The operative technique, pre- and postoperative care, indications for conservative treatment and late complications are discussed.All types of fractures should be treated operatively. K-wire fixation is sufficient in most cases and does not damage the epiphyseal plate. Immobilization in POP spika is advisable for 6 weeks. With delayed operative treatment of intracapsulare fractures the intraarticular haematoma should be aspirated.Traumatic epiphyseolysis should be reduced by manipulation or operatively and stabilized by K-wires. The treatment of pseudarthrosis is by internal fixation and bone grafting. Late valgus and especially varus deformations should be corrected by intertrochanteric osteotomy.

     

Schenkelhalsfrakturen im Kindesalter

Ohne ZusammenfassungMit 6 Textabbildungen     

Operationen im Kindesalter

European Journal of Trauma and Emergency Surgery -     

Thymustumoren im Kindesalter

Zusammenfassung Im Kindesalter sind die Thymustumoren selten. An der Kinderchirurgischen Klinik in Bremen wurden bis heute 5 Thymustumoren operiert und nachbehandelt. 4mal lag ein Thymom vor. 1mal blieb die histologische Diagnose ungekl?rt. 3 Kinder starben, 2 überlebten. Interessantes bietet die Krankengeschichte eines knapp 11 Jahre alten M?dchens, dessen Thymom vom Typ eines kleinzelligen Thymuscarcinoms nicht mehr radikal entfernt werden konnte. Multiple Metastasen traten auf. R?ntgenstrahlen und Endoxan führten jedoch zu einer v?lligen Heilung.

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Summary Tumors of the thymus are seen infrequently during childhood. Hitherto 5 thymus tumors have been operated and followed at the Pediatric Surgical Clinic in Bremen. In 4 patients a thymoma was found. Once the histological diagnosis could not be established. 3 children died and 2 survived. The case history of a barely 11-year-old girl is interesting. This patient had a thymoma which was a small-cell thymus carcinoma and radical removal was no longer possible. Multiple metastases occurred. However, radiotherapy and endoxan produced a complete cure.

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a. G.     

Femurschaftfrakturen im Kindesalter

Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. In over 90% of these cases elastic stable intramedullary nailing (ESIN) is the premier treatment option. Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.     

Augenverletzungen im Kindesalter

Most frequent injuries of the eye in the paediatric age are chemical or thermal injuries, corneal erosion, corneal foreign body, ocular contusion, blow-out-fracture, penetrating eye injury, endophthalmitis and traumatic retinopathy. The number of eye injuries per year is about 12 of 100.000. At least one third of these injuries occur at an age of <12 years. They represent the most frequent cause for an unilateral blindness. Age below 5 years, sex (male > female), care by parents are known risk factors for an eye injury in the paediatric age. Visual rehabilitation after eye injury can be affected by a quick and adequate therapy as well as several social factors (e. g., compliance in wearing glasses or treatment for amblyopia). This article presents diagnosis, (initial) therapy, and prognosis of various ocular injuries in the childhood.     

Spondylodiszitis im Kindesalter

Spondylitis is a rare disease in childhood and atypical symptoms frequently retard the diagnosis. From 1968 to 1988, 25 children with a diagnosis of spondylitis were treated in our orthopedic hospital. Anamneses, clinical symptoms, roentgenograms, and differential diagnoses are described for these cases. Spondylodiskitis represents a mild course of the disease in childhood. Tuberculous spondylitis was not present in any of the cases. The prognosis of childhood spondylitis is favorable, and surgical interventions were not necessary in our patients. Spondylitis healed with an ankylosis of one segment of the spine without essential disturbance of spinal function.     

Hiatushernien im Kindesalter

Zusammenfassung Die hiatelen Gleibrüche im frühen Kindesalter neigen in besoderem Ma?e zu refluxbedingten Oesophagusstenosen. Es ist deshalb an Stelle der oft langwierigen konservativen Behandlung die Frühoperation indiziert. Hierzu hat sich die technisch einfache Fundoplicatio nachNissen auf abdominalem Wege als Antirefluxoperation bestens bew?hrt. Bei bereits entwickelten peptischen Stenosen ist die Bougierung mit oder ohne Gastrostomie zu empfehlen.

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Summary The sliding hiatal hernia of early childhood especially tend to oesophaeal stenosis due to gastro-oesophageal reflux. Therefore, instead of a time consuming conservative treatment an early operation is indicated. The fundoplication ofNissen by abdominal way has proved a technical simple and most effective antireflux-operation. In cases already complicated by stenosis bouginage with or without gastrostomy is recommended.

     

Traumatologie im Kindesalter

Ohne Zusammenfassung     

Weichteilsarkome im Kindesalter

Zusammenfassung Von 1955–1980 wurden am Chirurgischen Zentrum der Universität Heidelberg 477 Patienten mit Weichteilsarkomen, darunter 87 Kinder (18,2%) operiert. Unter den soliden Malignomen (außer Tumoren des Zentralnervensystems) des Kindesalters betrug der Anteil der Weichteilsarkome 22,8%. In der pädiatrischen Altersgruppe dominieren anteilmäßig mit 30% das Rhabdomyosarkom und mit 20% das angioblastische Sarkom. Seit Einsatz der kombinierten Tumortherapie (Operation/Radiotherapie/Cytostatika) konnte die Überlebensrate im eigenen Krankengut von 29% auf 58% angehoben werden.

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Soft tissue sarcomas in childhood

Summary 477 patients with soft tissue sarcomas, including 87 children (18.2%) were treated at the Surgical Center of the University of Heidelberg between 1950 and 1980. 22.8% of the patients with solid tumors (excluding brain tumors) in childhood were soft tissue sarcomas. In the pediatric age group there were 30% rhabdomysarcoma and 20% angioblastic sarcoma. Since introduction of combined tumor therapy (surgery, radiation, and chemotherapy) the survival rate increased impressively from 29% to 58%.

     

Urolithiasis im Kindesalter

Urinary stone disease is relatively rare in children with an overall incidence of 1-2 %; however, it is often associated with metabolic abnormalities that may lead to recurrent stone formation. Stone analysis and subsequent metabolic evaluation is therefore mandatory for this high-risk group after the first stone event. The objectives of stone management in children should be complete stone clearance, prevention of stone recurrence, preservation of renal function, control of urinary tract infections, correction of anatomical abnormalities and correction of the underlying metabolic disorders. The full range of minimally invasive procedures is available if active stone removal is necessary. The majority of stones in children can be managed either with extracorporeal shock wave lithotripsy which has a higher efficacy in children than in adults, percutaneous nephrolithotomy, ureterorenoscopy or a combination of these modalities while open or laparoscopic surgery is limited to well-selected cases with underlying anatomical abnormalities.     

Sprunggelenkverletzungen im Kindesalter

Background

Ankle joint injuries are one of the most common injuries in childhood. Studies on large series investigating epidemiology and long-term outcome are rare.

Methods

Employing a retrospective analysis of the well-documented school or kindergarten accidents over a 10-year period a total of 623 ankle injuries in children and adolescents (<?14 years of age) could be identified and analysed regarding epidemiology, treatment, complications and long-term outcome.

Results

Accidents during physical education (33?%), during break (24?%) and in the hallway (18?%) were most common. Ligament injuries occurred in 21?%, fractures of the ankle in 79?% of patients. The mean treatment period was 45 days. Eleven patients underwent a physical examination for physical disability assessment; very mild partial disability was assessed in 4 cases. The outcome of ankle injuries in school and kindergarten is good and long-term handicap is very rare.