Der Unfallchirurg
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The German DRG-System was advanced into version 2009. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. ⋯ G-DRG-System gained complexity again. 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 was improved. Nevertheless, further adjustments of the G-DRG-System especially for cases with severe injuries are necessary.
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Although seldom dangerous to life, these degloving injuries are all potentially infected and, unless treated as acute surgical emergencies, inevitably lead to serious complications. Diagnostic is done according to a standardized protocol, which eventually must be integrated in the standard polytrauma management. Multidisciplinary (orthopedic surgery, plastic surgery, dermatology, physiotherapy) defect management is of utmost importance and requires an "integrated therapy concept". ⋯ A second look operation 24 to 72 hours later should be planned. Secondary surgery is necessary in almost every patient in order to improve the functional or aesthetic result. Adjuvant procedures such as physiotherapy, standardized scar treatment, orthesis, orthopedic shoes, etc. may be useful at any time of treatment.
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Multicenter Study
[Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Part I: epidemiology].
The Spine Study Group (AG WS) of the German Trauma Association (DGU) has now been in existence for more than a decade. Its main objective is the evaluation and optimization of the operative treatment for traumatic spinal injuries. The authors present the results of the second prospective internet-based multicenter study (MCS II) of the AG WS in three consecutive parts: epidemiology, surgical treatment and radiologic findings and follow-up results. ⋯ Of the fractures 68.8% were located at the thoracolumbar junction (T11-L2). Type B and type C injuries carried a higher risk for concomitant injuries, neurological deficits and additional vertebral fractures. The average initial VAS spine score, representing the status before the trauma, varied between treatment subgroups (OP 80, KONS 75, PLASTIE 72) and declined with increasing patient age (p<0.01).
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Persistent dysphagia after ventral instrumentation of a patient with a cervical spine fracture and diffuse idiopathic skeletal hyperostosis (DISH, or Forestier's disease) is a rare but dramatic complication. In this case report some pathogenetic factors are discussed. Accurate resection of the spondylophytes should be considered to avoid a ventral protrusion of the plate.
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Clinical Trial
[3D navigated osteosynthesis of calcaneal fractures. Open and minimally invasive techniques].
It is hypothesized that misplacement of sustentacular screws during osteosynthesis of intraarticular calcaneal fractures can be reduced with the help of navigation. A method for three-dimensional (3D) navigated placement of sustentacular screws for treating intraarticular calcaneal fractures is presented and evaluated. ⋯ Through a combination of intraoperative 3D imaging and navigation, placement of sustentacular screws is possible and can yield precise and reliable results. Especially in minimally invasive treatment, a high quality of osteosynthesis can be achieved.