Der Unfallchirurg
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Carpal bone fusions for secondary reconstruction are still indispensable despite state of the art diagnostic tools and modern treatment techniques for wrist lesions. The former fusions stabilize the wrist and enable sufficient residual carpal mobility. Pain can be reduced significantly by arthrodesis of destroyed joints and the progress of osteoarthritis may be stopped or delayed. This review presents commonly used fusions with their inherent indications, contraindications and complications.
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Review
[The significance of biofilm for the treatment of infections in orthopedic surgery : 2017 Update].
The increase in endoprosthetic and osteosynthetic surgical treatment is associated with a simultaneous increase in implant-associated infections (surgical site infections, SSI). Biofilms appear to play a significant role in the diagnosis and treatment of these infections and heavily contaminated wounds. This article aims to provide a current overview of biofilm and its relevance in orthopedic surgery. ⋯ The development of biofilm should be anticipated in strongly contaminated wounds as well as in acute and chronic infection sites. The best strategy to combat biofilms is to prevent their development. Standard microbiological culture methods do not enable the detection of biofilm. Therefore, the implementation of molecular biological detection methods (z. B. FISH) is important. Further anti-biofilm strategies are being investigated experimentally, but there are no real options for clinical use as of yet.
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Implant-associated infections represent a serious complication following fracture management. Due to biofilm formation, an optimized treatment strategy is required to treat these infections. ⋯ In general, the eradication of infection is possible with surgical debridement, change or removal of the implant and adequate antibiotic therapy. In some cases, suppressive therapy until consolidation of fracture and later removal of the implant is an option.
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Case Reports Comparative Study
[Reliability of venous blood gas analysis and radionuclide angiography in post-traumatic dystrophy].
The diagnosis "post-traumatic dystrophy" (PTD) was first defined with clinical and paraclinical criteria by Scola et al. in 2013. ⋯ The reliability of clinical and paraclinical criteria for PTD were confirmed. vBGA and RNA seem to be good parameters for confirming the diagnosis of PTD. "Rubor," a symptom traditionally interpreted as "hyperemia," contradicts the paraclinical findings and leads to the assumption that the cause of this post-traumatic syndrome is microvascular dysfunction.
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Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. ⋯ This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%. These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.