Der Unfallchirurg
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A 28-year-old male patient was initially conservatively treated by a general physician for muscle strain of the right calf after a bowling game. Due to increasing pain and swelling of the lower leg 5 days later, the differential diagnosis of a deep vein thrombosis was considered. Furthermore, the onset of neurological deficits and problems with raising the foot prompted inclusion of compartment syndrome in the differential diagnosis for the first time. ⋯ The arbitration board ruled that the surgeon should have performed fasciotomy immediately on day 5 at the patient's consultation. The clinical presentation of progressive pain, swelling of the lower leg in combination with peroneal palsy must lead to the differential diagnosis of compartment syndrome resulting in adequate therapy. The delay of immediate surgery, therefore, was assessed to be faulty as this knowledge is to be expected of a surgeon.
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Case Reports
[Penetrating injury of two body cavities with a 20 cm long dagger-like sliver after falling into a glass door.]
In Germany the numbers of penetrating thoracic injuries are rare compared to Anglo-American countries; however, the number of cases has increased in recent years due to an increase in violent incidents. This article reports the case of a patient who suffered such a penetrating thoracic injury after a domestic accident. Operative treatment was performed according to the well-established standard treatment algorithms. Contrary to the initial assessment of the emergency doctor, substantially more severe injuries were found.
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Osteoporosis-associated fractures represent a growing challenge in the treatment of orthopedic patients. In November 2014 a new revision of the guidelines on osteoporosis by the German Osteology Society (Dachverband Osteologie DVO) was adopted, in which additional risk factors for fractures and further treatment options have been included. ⋯ This may reduce the treatment gap of osteoporosis in Germany. In this paper the changes in the DVO guidelines 2014 on osteoporosis are summarized, focusing on the most important changes with practical relevance for orthopedic surgeons.
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Expert opinions are subject to restrictions and must abide by the rules laid down by the legal system, much more so than therapies. Cardinal errors in expert opinions for the statutory accident insurance (GUV) are sometimes mistakes which can be found in all forms of expert opinions but in some cases where special questions of social law and the statutory accident insurance are concerned. The first group of mistakes are the differences between the requirements of an expert and a therapist with respect to the certainty of expert opinions, the responsibility of the commissioning authority alone for the non-medical components of an expert opinion, the generally valid principle of only giving opinions on areas of proven expertise and the extremely important aspect of personal responsibility. The second group of mistakes involve specific questions for the statutory accident insurance, such as the principles of causality, the rules of evidence, the estimation of the consequences of an accident with respect to reduction in earning capacity (MdE) and the significance of pre-existing damage.
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Through a more consistent diagnostics and treatment of osteoporosis, subsequent fractures and associated complications could be reduced in aged patients. Whereas anticoagulants are now standard in the treatment of fractures of the lower extremities to prevent thromboembolic complications in orthopedic surgery and an omission of anticoagulation can be regarded as medical malpractice, the management of osteoporosis following such fractures is very frequently disregarded. ⋯ In this case, evidence of a serious malpractice could be associated with civil, criminal and professional claims which could be linked with relevant legal consequences. Regardless of the legal consequences for omission of osteoporosis management following multiple fractures in aged patients, the management of osteoporosis should be an integral component in the treatment of these patients in the future.