Der Unfallchirurg
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Nepal is one of the 20 poorest countries in the world. Thus, medical care in Nepal is dependent on significant medical and financial commitment from within and outside the country. Dhulikhel Hospital - Kathmandu University Hospital (DH-KUH) was founded in 1996 by Prof. ⋯ The structures in DH-KUH are influenced by a very close cooperation with a number of international (university) hospitals. Most of the DH-KUH departments have an amazingly high technical standard. Assuming this development and progress can be continued, a splendid future for DH-KUH can be predicted.
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The diagnosis of a scaphoid fracture, especially in the differentiation of a fresh fracture, the nonunion or a possible anatomical norm variant, can be difficult. We report on two patients who presented with stress-related, radiocarpal pain in our department. In both cases, radiological abnormalities were observed in the scaphoideal area, with a scaphoideum bipartitum on both sides, as well as an approximately 25-year-old scaphoid pseudarthrosis.
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To date, little attention has been given to greater tuberosity fractures (GTFs) in the literature. Several mechanisms of injury are described, but few authors report that a GTF is accompanied by a high rate of often unrecognized associated injuries. ⋯ The reason for a GTF seems to be an anterior shoulder dislocation or partial dislocation. In multifragmentary GTF or GTF with dislocation surgery is necessary frequently; without dislocation surgery is necessary less frequently. Associated injuries should be searched for selectively. An arthroscopy could be performed for diagnosis and therapy. In a GTF that can be treated conservatively, an MRI should be performed.
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Trauma surgery is a discipline in which the training phase for specialization requires a technical and time-intensive learning curve, including the repetitive training of manual skills. This results in prolonged operation times and thus elevated costs. ⋯ Surgical training of residents costs hospitals the appropriate amounts of time and money and reduces the overall number of procedures performed, justifying special consideration of the financing of training hospitals.
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Review Practice Guideline
[Orthopedic surgery with limited resources after mass disasters and during armed conflicts : First international guidelines for the management of limb injuries and the experience of Doctors Without Borders].
Disasters and armed conflicts are often the unfortunate basis for aid projects run by Doctors Without Borders/Médecins Sans Frontières (MSF). The nature of war and disasters means that surgery is an integral part of this medical emergency aid. In these situations, resources are usually limited. ⋯ The Field Guide to Manage Limb Injury in Disaster and Conflict has been written to help new surgeons who may face the challenges of disaster and war surgery and to avoid unnecessary suffering for patients ( https://icrc.aoeducation.org ). Under the guidance of the International Committee of the Red Cross (ICRC), with participation of the World Health Organization (WHO), financed by the AO Foundation, and featuring the experiences of experts from different organizations (amongst them MSF), the book details techniques and guidelines for surgery in low resource settings. The following article provides a short summary of some of the surgical challenges when working with limited resources and reflects on a few specific recommendations for so-called war surgery.