Der Unfallchirurg
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The incidence of gunshot wounds is increasing also in Europe and surgeons in urban trauma centers are more frequently confronted with this type of injury. Since there is no established treatment algorithm for gunshot injuries to the extremities, the surgeon should rely on established soft tissue injury and fracture protocols. Gunshot fractures with minor soft tissue destruction should be treated as closed fractures. ⋯ Prophylactic intravenous antibiotics are mandatory and prophylactic fasciotomy is often required. Upon definitive internal stabilization, bone grafting should be considered since gunshot fractures are usually associated with a high degree of comminution. Articular gunshot injuries are treated as open joint injuries and require irrigation, debridement, foreign body removal and antibiotic prophylaxis.
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Neuro-osteoarthropathy is accompanied by the destruction of single or multiple joints involving little or no pain. Diabetic patients suffering from symmetric distal polyneuropathy are the main risk group. The main location is the foot (Charcot foot). ⋯ Surgery is an essential part of treatment and should be integrated into the overall treatment plan. The main indications for orthopedic reconstruction are non-plantigrade foot and ankle deformities or instabilities with concomitant ulcers that cannot be adequately addressed by non-operative measures, mainly in the chronic stage of Charcot foot. As such, surgical reconstruction can contribute to the long-term preservation of the affected foot and help to maintain or improve the patient's mobility and quality of life.
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It is rare for there to be healing problems after anterior pelvic fractures. An internet search produced only a small number of hits. ⋯ Stable internal fixation with locking plates eventually led to successful healing after both nonunion of the ischial ramus and nonunion of the transitional zone between the inferior pubic ramus and the ischial ramus, and also of nonunion of the superior pubic ramus, in both patients. The study demonstrates that it is possible to stabilise nonunion of the superior pubic ramus by internal fixation of the ischial ramus and of the transitional zone between the inferior pubic ramus and the ischial ramus with locking plates.
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Antegrade or retrograde intramedullary nailing is a common and well established procedure for the treatment of femoral shaft fractures. One drawback of this technique is the high incidence of clinically relevant malalignment. Despite intra-operative and radiological improvements this problem has not yet been solved efficiently. The aim of this study was the evaluation of the mechanical influence on the antetorsion angle of intramedullary nails during and after interlocking in femoral shaft fractures. ⋯ It could be shown that mechanical stability as well as the interlocking itself of femoral nails have a relevant impact on the antetorsional angle of the femur. Potential sources of error of the femoral antetorsion angle can be caused by the interlocking process as well as by forced rotation of the femur after interlocking. Clinical studies are needed to improve our findings, while the observed effects might have an essential influence on the incidence of femoral malalignment after osteosynthesis by intramedullary nailing of the femur.
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The German DRG (diagnosis-related groups) system has been modified and updated into version 2008. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and the DRG structure were made. The modified version has been analyzed in order to ascertain whether the DRG system is suitably qualified to fulfill the demands of the reimbursement system or whether further improvements are necessary. ⋯ G-DRG system has become even more complex and the new regulations have also resulted in new problems associated with complications.. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case allocation within the G-DRG system has been improved. Nevertheless, further improvements of the G-DRG system are necessary, especially for cases with severe injuries.