Der Unfallchirurg
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Comparative Study
[Prediction of mortality, mobility and admission to long-term care after hip fractures].
Surgical treatment, discharge planning and rehabilitation procedures are rarely based upon defined assessment procedures. It might therefore be useful to develop simple and reliable screening tools to identify patients for early discharge, intensified rehabilitation and limited treatment. ⋯ It seems feasible to improve postoperative resource allocation by predictor led stratification. This need to be tested in intervention trials under the specific condition of the German health care system.
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Case Reports Comparative Study
[Heparin induced thrombocytopenia type II after the use of low-molecular weight heparin. Case report and review of the literature].
It has been suggested, that HIT-type-II can occur both after the use of low-molecular-weight and unfractionated heparin. The present study investigates the incidence of HIT-type-II after the use of low molecular weight heparin by reviewing the literature and describes one own case. ⋯ It is possible to suffer from a HIT-type-II after low molecular weight heparin. This study confirms the suspicion that the incidence of a HIT-type-II after low molecular weight is lower than after unfractionated heparin. Therefore the further use of unfractioned heparin for thrombosis prophylaxis has to be questioned and low molecular-weight heparin should be preferred.
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Comparative Study
[Thoracolumbar spine fractures after conservative and surgical treatment. Dependence of correction loss on fracture level].
This retrospective study presents results after conservative and operative treatment of thoracolumbar fractures as function of its localization. ⋯ In consequence of these results A1/A2-fractures in the upper thoracic spine (
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Comparative Study
[Stabilisation of unstable trochanteric femoral fractures. Dynamic hip screw (DHS) with trochanteric stabilisation plate vs. proximal femur nail (PFN)].
The dynamic hip screw (DHS) with trochanteric stabilisation plate (TSP) as the extramedullary power transmission system and the proximal femur nail (PFN) as the means of intramedullary stabilisation are both standard in the treatment of unstable trochanteric femoral fractures in the case of old people. A total of 129 patients (average age: 81,5 years) with 31 A2.2 and A2.3 as well as per-/subtrochanteric femoral fractures were treated by means of osteosynthesis with DHS and TSP (n=64) or with PFN (n=65),and the results plotted in a retro-/prospective study. At low complication rates, the radiological operation results are equally good. 6 revisions were necessary in the case of the DHS with TSP and 4 in the case of PFN. ⋯ In a follow-up 6 months after the operation, the PFN patients displayed a significantly lower pain intensity in the operated leg at the same score for ambulation and the same subjective degree of satisfaction. Unstable pertrochanteric and per-/subtrochanteric femoral comminuted fractures can be treated just as well with PFN as with DHS and TSP. Our study results,however, lead us to recommend treatment with PFN.
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Comparative Study
[Results of femoral shaft fractures in childhood in relation to different treatment modalities].
The clinical and radiological results of femoral shaft fractures in childhood were evaluated and compared in relation to different treatment modalities. One hundred and one children (mean age 5+/-0,4 years) were treated between 1990 to 1999. 38% of the patients were treated conservatively (mean age 2,2+/-0,5 years), 32% of the patients (mean age 6+/-0,5 years) were treated by external fixation, 17% were treated with elastic stable intramedullary nailing (ESIN, mean age 5,6+/-0,8 years) and 12% underwent other internal fixation procedures. The duration of hospital stay was significantly longer in the conservative treatment group (18+/-1,6 days) than in the external fixator (12+/-1,2 days) as well as in the ESIN group (8+/-0,9 days). ⋯ Also there is a limited possibility of fracture reduction in conservative treatment this method is indicated in younger children (<4 years) where spontaneous bone remodelling is likely. For older children the ESIN method showed a low rate of complications and demonstrates the best long term results. When ESIN is not possible because of local soft tissue damage,additional injuries,or in complex fractures, the external fixator proved to be an alternative treatment for femoral shaft fractures.