Der Unfallchirurg
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Review Meta Analysis
[Titanium or steel as osteosynthesis material : Systematic literature search for clinical evidence].
The selection of the appropriate implant material, stainless steel or titanium, is still the decision of the surgeon and/or the affiliated institution. Additionally, remarkable international differences can be found between the different markets, which cannot really be explained. ⋯ This systematic literature search did not provide any clinical evidence for material-related differences between titanium or stainless steel implants for fracture fixation. Based on the current clinical evidence both titanium and steel implants can be considered to be of equal value. The reported difficulties with implant removal are not reflected in the published literature.
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Review Meta Analysis
[Compatibility and allergies of osteosynthesis materials].
Metal implants for osteosynthesis are nowadays standard in orthopedic and trauma surgery. Steel implants, especially cerclages, bands and wires, can show more corrosion due to friction and lead to encapsulation in connective tissue with fluid borders even without loosening. Corrosion and fluid borders are potentially more susceptible to incompatibility and infections. ⋯ Problems may occur in material removal, especially with titanium implants because material fractures occur more frequently. Particularly with fixed angle constructions, the blocking of titanium-titanium bonding and/or screws in bone can occur by adhesion and ingrowth. Apart from single case reports there is no evidence that modern steel implants cause more allergic reactions than titanium; therefore, in the treatment by osteosynthesis the stability, risk of loosening, manifestation of allergies and the possibility of material removal must always be considered.
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In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
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The German diagnosis-related groups remuneration system (G-DRG) was implemented in 2004 and patient-related diagnoses and procedures lead to allocation to specific DRGs. This system includes several codes, such as case mix (CM), case mix index (CMI) and number of cases. Seasonal distribution of these codes as well as distribution of diagnoses and DRGs may lead to logistical consequences for clinical management. ⋯ The significant clustering of injuries in specific months and seasons should lead to logistic consequences (e.g. operating room slots, availability of nursing and anesthesia staff). For a needs assessment the analysis of main diagnoses is more appropriate than DRGs.
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Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. ⋯ Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.