Martin Mack

Publications (3)0.66 Total impact

• Article: Diagnosis, Timing and Treatment of Cervical Spine Injuries in Polytraumatized Patients

  André El Saman, Helmut Laurer, Bernd Maier, Hendrik Wyen, Martin Mack, Ingo Marzi
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  ABSTRACT: Treatment of polytrauma patients has been discussed extensively during the past decades. Management in the prehospital phase, on admission, and in the early postoperative/ICU-period has to refer to injury severity, priority of injuries, and likelihood of development of multi organ failure. Cervical spine injuries are reported in 4–34% of polytrauma cases. Securing the cervical spine by a hard collar is one of the basic procedures in the prehospital phase. Different strategies of assessing the cervical spine are still discussed controversially. Since plain radiographs, CT-scan, MRI, and flexion/extension fluoroscopy still play a role in early diagnosis of cervical spine injury, we present an analysis of cervical spine injuries in our multiple trauma patients to elucidate our algorithm. We reviewed our data between January 2003 and December 2006 concerning epidemiology, diagnosis and treatment of cervical spine injury in polytrauma patients. Multislice-CT (MSCT) or Multidetector-CT was used as standard diagnostic procedures in the polytraumatized patient. In 97% of patients, CT-scanning showed to be a reliable tool in detecting injuries of the cervical spine. Only in two patients (3%), additional MRI lead to a change in treatment strategy. Of 66 polytraumatized patients with significant cervical spine injury, 25 (37.9%) received surgical treatment within 24 h. Sixteen patients (24.2%) were treated surgically after stabilization on ICU. There was a better outcome concerning length of hospitalization in the “day-onesurgery” group. We consider MSCT as standard approach towards diagnosis of cervical spine injury in polytrauma patients. MRI and flexion/extension fluoroscopy can give additional information in selected cases.
  European Journal of Trauma and Emergency Surgery 04/2012; 33(5):501-511. · 0.33 Impact Factor
• Article: Five years experience of trauma care in a German urban level I university trauma center

  Hendrik Wyen, Sebastian Wutzler, Miriam Rüsseler, Martin Mack, Felix Walcher, Ingo Marzi
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  ABSTRACT: Background: A regionalized approach to trauma care with the implementation of designated level I trauma centers has been shown to improve survival after multiple injuries. Our study aimed to describe the current reality in an urban German level I university trauma center concerning the primary admission of patients into the emergency room. Materials and Methods: We performed a retrospective analysis of all multiple trauma patients that were prospectively documented in our documentation system TraumaWatch® from 2003 to 2007. Documentation included physiological findings as well as diagnostic and therapeutic procedures structured as: (A) preclinical phase; (B) emergency room treatment; (C) intensive care unit; and (D) final outcome according to the German Trauma Registry. Results: In total, 1,848 patients were completely documented and, thus, analyzed. The mean ± standard deviation (SD) Injury Severity Score (ISS) was 16.5 ± 14.1 points and the mean ± SD age was 38.7 ± 21.9 years. An increasing number of patients received whole-body computed tomography (48.8% in 2003 vs. 83.3%in 2007, p < 0.001) and, on average, the ISS increased over the years (14.4 points in 2003 vs. 17.9 points in 2007). The overall hospital mortality was 7.1%, without significant change over time. The completionofimagingdiagnostics became significantly faster for all of the documented procedures (X-ray pelvis, X-ray chest, whole-body CT, abdominal ultrasound) (p < 0.001). Discussion: Descriptive data on the current reality in urban level I trauma care can be derived from our study. Additionally, we achieved improved time intervals for emergency diagnostics and treatment, while hospital mortality remained constant, despite a higher injury severity. This is due to a standardized protocol which is applied during the 24-h in-house attending coverage. Conclusion: Regionalized trauma care with designated level I trauma centers is justified by the improvement of time intervals and outcome, but adequate resources are required.
  European Journal of Trauma and Emergency Surgery 04/2012; 35(5):448-454. · 0.33 Impact Factor
• Article: Navigation—Erfahrungen zu Kosten und Nutzen in der Extremitätenversorgung

  Johannes Frank, Matthias Militz, Volker Bühren, Martin Mack, Ingo Marzi
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  ABSTRACT: Seit November 2002 wird in den Kliniken der Autoren ein Traumanavigationssystem getestet, welches eine kabellose Navigation mit einer Systemplattform ermglicht, die ber eine Infrarotkamera speziell entwickelte Patienten- und Tooltracker, Zeigeinstrumente, Kalibrierstation und den Tracker des Fluoroskops im Raum erkennt und am Computerbildschirm virtuell darstellt. Die Bilder werden den entsprechenden Rntgenbildern berlagert. Das System wurde inzwischen bei verschiedenen operativen Eingriffen eingesetzt und verbessert. Durch den Einsatz des Verfahrens konnte die Durchleuchtungszeit deutlich reduziert werden, die Verlngerung der Operationszeit betrug zwischen 15 und 30min. Ungenauigkeiten bzw. ein Versagen des Systems waren meist durch Lockerung des Patiententrackers und die Instabilitt bzw. Verbiegung des Bohrers bei der Navigation bedingt. Die Navigation der Frakturreposition am Oberschenkel hat sich als schwierig erwiesen und ist nicht bei allen Frakturtypen mglich. Das Navigationssystems ist fr die Frakturversorgung im Bereich der Extremitten einsetzbar. Es werden insbesondere die Strahlenbelastung reduziert und die Genauigkeit verbessert. Bis zum Routineeinsatz sind jedoch noch Optimierungen notwendig.Since November 2002 the authors are testing a trauma navigation system in their departments. It allows cord-free navigation with a system platform that recognizes especially developed patient trackers, tool trackers, pointers, and a calibration station and the tracker of the fluoroscope in space by means of an infrared camera. These virtual objects are shown on the computer monitor. These images are superimposed on the corresponding X-ray pictures. The system has meanwhile been used during various operative procedures, in addition to which further anchoring systems and navigation instruments have been developed. The use of this navigating system has lead to a remarkable reduction of X-ray exposure, while the operating time has been extended between 15 and 30min. Inaccuracies or failures of the system were usually caused by loosening of the patient tracker and instability or deformation of the drill during navigation. Navigation has proved to be difficult in the case of a fracture realignment in the thigh and is not applicable to all types of fracture. This navigation system can thus be used for the treatment of fractures in the region of the extremities. In particular, its use reduces the exposure to radiation and improves accuracy. However, some improvements are needed before it can be used routinely.
  Trauma und Berufskrankheit 06/2004; 6:S191-S196.