Trauma systems in Europe

Article Abstract:

Despite the emergence of a common European marketplace, the countries of Europe retain their diversity. Cultural and linguistic barriers limit the interchange among professionals who work in different countries. Although health care systems vary greatly from country to country, it was in Europe that trauma was recognized as ''the Cinderella of surgery.'' In the 1940s treatment of the trauma patient in Europe (and elsewhere in the world) was characterized by minimal surgical intervention and the philosophy was to save the life not the limb, perform minimal surgery, and let the patient have several days to recover from shock and its ''inevitable sequelae.'' However, previously, after World War I, an Austrian had shown that the outcome of trauma is significantly dependent on the method of treatment. Two physicians in Belgium developed the use of internal fixation devices (rather than plaster cast and traction) for fracture stabilization. Switzerland was an early user of air rescue of trauma patients, but it is Germany that now has a fully integrated (air and ambulance) rescue system. In Europe three systems of hospital care for the trauma patient have evolved. In Austria and Germany the general surgeon-traumatologist has total responsibility for the care of the patient. In Switzerland and Holland, general surgeons are responsible for trauma, including fractures. In the United Kingdom, as in the other European countries, treatment of the locomotor system is rendered by the orthopedist. The trend is to create trauma centers within large hospital settings. Although general surgeons would seem to be the best qualified to coordinate a trauma unit, this often is not the case. Europe needs more surgeons and orthopedic surgeons with a special interest in trauma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, United Kingdom, Europe, Germany, Switzerland, Practice, Demographic aspects, Trauma centers

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Successful repair of pediatric popliteal artery trauma

Article Abstract:

Injury to the popliteal artery in the area of the knee occurs rarely in children. This is a difficult injury to repair in adults, and in children there is the added difficulty of smaller sized vessels, along with the infrequent occurrence of vascular injuries in children. Seven patients under the age of 18 who were referred for popliteal artery injury are discussed; these patients represented 35 percent of all pediatric patients seen for vascular injuries. The age range was 11 to 17 years (average 13.2 years), and six of the seven patients were boys. Three of the injuries were caused by blunt trauma and four were penetrating injuries. In six of the patients, injuries were limited to the leg. The associated injuries included fractures, severe soft tissue injuries, and in one patient, nerve injury. All patients underwent angiography (X-ray examination of the blood vessels following injection of radio-opaque contrast dye); four angiography procedures were performed preoperatively and three were done during surgery. Angiography performed during surgery shortens the time to surgery and has the advantage of being performed under anesthesia, especially important in younger patients who are unable to tolerate the procedure without anesthesia. No deaths, amputations or reoperations were encountered. At follow-up (10 to 42 months after surgery), all patients had normal arterial pressure and pulses. These results suggest that with prompt treatment, a good outcome can be expected following popliteal artery repair. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Children, Pediatric injuries, Popliteal artery

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