Der Unfallchirurg
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Therapy of cartilage damage is a frequent problem, especially in the young and active patient. For the treatment of a cartilage damage we have to consider the size of the defect, age and weight of the patient, meniscal tears, ligament instabilities and varus-/valgus-malalignment. ⋯ Microfracturing seems to be an effective alternative for small defects. The restoration of the cartilage surface with the use of autologous chondrocyte transplantation, osteochondral autograft transplantation and posterior condyle transfer seems to be an adequate treatment for younger patients.
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Between January 1993 and December 1998 26.005 patients with hip fractures underwent treatment in departments of general surgery and traumatology in Westfalia-Lippe, Germany. Data of these patients were reported to the chamber of physicians where a report card system for external quality assurance has been established since 1991. 1.747 patients were between 10 and 60 years of age. Treatment according to the guideline of hip fractures of the German College of Traumatology is compared to treatment in reality. ⋯ The reality of treatment of hip fractures does not meet the criteria of the guideline. Further efforts have to be undertaken for the benefit of relatively young patients with hip fractures.
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To analyze a prototype mobile C-arm image amplifier (Iso-C3D) in the evaluation of different joint fractures of the upper and lower limbs using multiplanar reconstruction (MPR). Different cadaver joint specimens (n = 14) were examined with a prototype (Iso-C3D, Siemens AG, Erlangen, Germany), plain radiographs (CR), and spiral computed tomography (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119-mm data cube. ⋯ Initial data show that fractures were easily depicted and correctly classified on MPR images with the Iso-C3D and that there was no difference between the Iso-C and CT in the detection of fractures. The preliminary results suggest a remarkably good detection of joint fractures with the Iso-C3D. Studies in an adequate number of patients are required to elucidate whether these promising results can also be obtained in a clinical setting.
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The goal of blood management in orthopedic and trauma surgery is to minimize exposure to allogenic blood transfusion in elective surgical procedures. Pre-, intra- and postoperative techniques are available. In a retrospective study at our department we could show, that postoperative reinfusion in primary knee arthroplasty is an effective way to avoid allogenic blood transfusion. ⋯ Group II required per patient 1.3 units of allogenic blood (totally 26 units), group I needed only 0.25 units of allogenic blood per patient (totally 5 units) by using the same guidelines for transfusion in both groups. There were similar preoperative and postoperativ hemoglobin and hematocrit levels in both groups. We recommend the use of postoperative reinfusion in addition with other blood saving techniques to reduce allogenic blood transfusion in primary knee arthroplasty.
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For young athletic patients with a primary traumatic shoulder dislocation a surgical treatment is recommended. The operation of choice is the Bankart-Repair. ⋯ In the surgical treatment of a traumatic shoulder dislocation, the open Bankart-Repair remains the "gold standard". In reviewing the literature, arthroscopic Bankart-Repair has not been shown to be equal or superior to the open technique.