Der Unfallchirurg
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Controlled Clinical Trial
[Delayed indications for additive ventral treatment of thoracolumbar burst fractures : What correction loss is to be expected].
There is a general consensus that unstable vertebral body fractures of the thoracolumbar junction with a B type fracture or a high load shear index need to be surgically stabilized, primarily by a dorsal approach. The authors believe that there are indications for an additional ventral spondylodesis in cases of reduction loss or a relevant intervertebral disc lesion in magnetic resonance imaging (MRI) 6 weeks after dorsal stabilization. However, in cases of unstable vertebral fractures it remains unclear if a delayed anterior spondylodesis will lead to unacceptable loss of initial reduction. ⋯ Delayed indications for an additional ventral spondylodesis in patients with unstable thoracolumbar vertebral fractures and initial dorsal stabilization will cause no relevant reduction loss if monoaxial implants are used and laminectomy can be avoided. Additionally, cement augmentation of the pedicle screws seems to be beneficial in patients 60 years of age or older.
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Limiting the morbidity of open fractures requires highly specific initial treatment. In addition to a stringent surgical strategy, correct antibiotic prophylaxis seems to be associated with an improved outcome. In the current literature, the duration and type of antibiotic prophylaxis are under discussion. The aim of the study was to survey the current initial treatment regimes for open fractures in German emergency departments. ⋯ The early initiation of antibiotic prophylaxis seems to be the standard practice in German emergency departments as well as early surgery. Strategies to improve the communication between prehospital and in-hospital teams, as well as graded antibiotic prophylaxis depending on the severity of soft tissue damage are needed.
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In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position. The Junges Forum O&U presents survey data, which were collected from members of the German Society for Trauma Surgery (DGU), the German Society for Orthopaedics and Orthpaedic Surgery (DGOOC) and the German Society for Orthopaedics and Trauma (DGOU). ⋯ The activity as representative was mainly fulfilled in spare time. The major aspect was conflict resolution between colleagues. The Junge Forum O&U presents the recommendation for election, field of duty and meetings on a regular basis with the other residents or even the first-line management.
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Observational Study
[Prevalence of blood-borne pathogens among 275 trauma patients : A prospective observational study].
Previous studies have indicated that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients seems to be higher compared to the general population. ⋯ To the best of our knowledge this study is the first report on the prevalence of blood-borne infections among trauma patients at a level I trauma center in an urban area in Germany. Compared to the general population the prevalence of blood-borne infections was higher but considerably lower than indicated in previous international studies. Considering the broad implications of occupationally transmitted blood-borne infections occupational safety is of paramount importance.