[Diaphragmatic ruptures: diagnosis--therapy--results, experiences with 64 patients]

From 1963 to 1993, 64 Patients with traumatic lesions of the diaphragm were treated. 58 Patients were admitted after blunt trauma, 6 Patients after a penetrating trauma. 87.5% of the patients were male with an average age of 37 years. In about 80% of cases other severe traumatic lesions were noted in association. With 64% extremities, 50% abdomen, 47% thoracic cavity and 38% head injuries were concomitant lesions. Due to the association with pelvic fractures (45%) a special diagnostic emphasis on diaphragmatic ruptures is recommended. In 83% the left diaphragm is involved. Over the last years the right-sided rupture of the diaphragm were found in an increasing extent from 3.7% up to 26%. Conventional radiography with gastrographin swallow is still the essential diagnostic tool. Hospital mortality (12%) was mainly influenced by complications of concomitant injuries, i.e. cardio-pulmonary insufficiency, Shock and multi-organ-failure.