Zeitschrift für Orthopädie und Unfallchirurgie
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In the year 2005 the German DRG system underwent further differentiation in many areas compared to previous years. The effects of an improved coding quality by a specifically trained orthopaedic surgeon (KBFA) at an orthopaedic university department are analysed. ⋯ The establishment of a KBFA in an orthopaedic department improved the quality of revenue-relevant DRG coding and the reflection of the economic complexity level of the cases. Compared to other reports, an above-average increase of cost weight as well as specification depth for diagnoses and procedures was achieved.
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We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. ⋯ The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.
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Our study focuses to determine the medium range results of function and radiological findings of operatively treated fractures of the talus. Furthermore we had the intention to investigate risk-factors for posttraumatic arthrosis and necrosis of the talus. ⋯ Primary screw osteosynthesis is the treatment of choice depending on the lesions of the soft-tissue and accompanied injuries in combination with a fixateur externe. Nevertheless the primary osteosynthesis is not able to prevent necrosis of the talus completely, that occurs in a frequency of 15%. Risk factors for a posttraumatic arthritis in addition to the type of fracture and the result of reconstruction are an accompanied soft tissue defect and local capsule-band complex with necessary temporary transfixation. Early plastic reconstruction of defects can reduce the time of immobilisation and allows motion therapy. The functional results are positive compared with the radiological results that showed arthritis in 70%.