Der Unfallchirurg
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Case Reports
[Injury to the subclavian and vertebral arteries in childhood following blunt force trauma].
Injuries of great vessels, such as the subclavian or vertebral arteries in childhood are rare. More frequent and therefore better described are dissections of the vertebral artery, which frequently occur following low energy trauma. ⋯ Therapeutic anticoagulation is the therapy of choice to avoid possible ischemic insults. The therapeutic approach of injuries to the subclavian artery remains unclear and is in the focus of discussions.
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Reconstruction of the anterior cruciate ligament (ACL) is a widely used procedure, but up to now no results have been published on an implant-free technique using a quadriceps tendon autograft and press-fit fixation. ⋯ Reconstruction of the ACL with an autologous quadriceps tendon and an implant-free technique yielded good results compared to established operative methods in the short-term and should be consistently followed-up for long-term confirmation.
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The successful management of open extremity injuries continues to represent a surgical challenge requiring a structured and multidisciplinary treatment concept. The treatment strategy depends on specific parameters, including the overall injury severity, life threatening trauma components, the degree oft soft tissue injury, the ischemia time, the contamination of the wound as well as the age and accompanying diseases of the patient. ⋯ The initial wound management includes radical and serial debridements and vessel reconstruction, followed by the gradual reconstruction of bone, tendons and nerves and a subsequent plastic soft tissue coverage. The sequential and priority-orientated implementation of these treatment steps is decisive for the long term outcome, which ideally results in an regular healing of bone and soft tissue without the presence of infection and good regain of extremity function.
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The German DRG (diagnosis-related groups) system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also additional and innovation payments. This paper analyzes and evaluates the relevant developments of the G-DRG System 2010 for orthopedics and traumatology from the medical and classification perspectives. ⋯ For the first time since the introduction of the G-DRG system, the pure numerical changes at the level of DRGs themselves are so marginal that only part of the DRG users in the hospitals will register them. The changes implemented not only a high selectivity between complex and less complex scenarios, but partly also unintended and unjustified revaluation of less complex measures. The G-DRG system has gained complexity again. Especially the G-DRG allocation of spinal surgery and multiple surgical interventions of the upper and/or lower extremities have reached such a complexity that only a few DRG users can follow them.
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Comparative Study
[Biomechanical investigation on refixation of tuberosities on shoulder prostheses. Does refixation with different suture materials offer enough stability?].
Elderly patients suffering from complex, non-reconstructable fractures of the proximal humerus are commonly treated by primary implantation of a shoulder endoprosthesis. One of the most critical factors for success or failure of treatment is still the refixation of the tuberosities. ⋯ Due to these results suture materials have a limited usefulness for refixation of tuberosities as an increased risk of obstruction for bony consolidation can result.