The status of the large vessels of the neck was determined after emergency intubation in 65 primary atraumatic casualties in the endeavor to provide accident surgeons working under extreme conditions with a check on results to optimize their therapy. Besides the findings in the vertebral artery (shown in 35 cases), which was traumatized in one case, the main attention was dedicated to the injury pattern of the common carotid artery. In this artery, intimal ruptures within the bifurcation were found in three cases, combined in one case with a subintimal hemorrhage on the contralateral side. As compared to other forms of force leading to an injury of the common carotid artery, reanimation causing traction and hyperextension of the neck is also considered an injurious stress. The unconscious patient is especially endangered as he has no possibility of pain-elicited defense if a helper hyperextends the neck under pressure from below in the vertex of the lordosis.

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

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