Der Unfallchirurg
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After 6 years of development, the amended regulations for medical education were adopted by the German Medical Assembly in May 2018. The aim of the amendment is to move away from a predominantly chronologically standardized further training towards a content standardized further training with simultaneous definition of competence objectives. ⋯ Failure to achieve the training objective will result in the admission to the examination being refused. These high requirements seem to be attainable only if cognitive and action competences can be acquired before and during training in the real environment of the operating theatre in a standardized setting.
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The development of the healthcare system in Germany is increasingly approaching human and economic limits. A social consensus and a political concept at which point priorities are promoted and for which services the money should be primarily spent, do not exist on the whole. As soon as it becomes clear that resources are limited and that is now, prioritization has to be introduced to avoid the alternative threat of rationing of treatment benefits. ⋯ At the same time, unjustified claims for entitlement must be rejected just as a preservation of vested rights. Efficiency and economic considerations in diagnostics and treatment are not mutually exclusive. The physician acts as a mediator between the claims of the patient to be treated, the individual realization and the existing resources in the healthcare system.
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The 3D printing technology enables precise fracture models to be generated from volumetric digital imaging and communications in medicine (DICOM) computed tomography (CT) data. Apart from patient treatment, in the future this technology could potentially play a significant role in education and training in the field of orthopedic and trauma surgery. Preliminary results show that the understanding and classification of fractures can be improved when teaching medical students. ⋯ Especially for complex articular fractures, such as those of the acetabulum and tibial plateau, initial evidence shows patient benefits in terms of reduced surgery time and blood loss with the help of 3D models. The use of 3D printing on-site at the hospital is of particular interest in orthopedic and trauma surgery as it promises to provide products within a short time. The low investment and running costs and the increasing availability of convenient software solutions will spur increasing dissemination of this technology in the coming years.
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In older patients the optimal treatment strategy of complex bone and soft tissue injuries represents a new challenge. Currently, two treatment approaches are in competition. ⋯ A possible alternative to the currently frequently used multistep procedure for limb preservation with continuous negative pressure treatment is the fix and flap or emergency free flap approach. Based on the case of a convulsion trauma in an 85-year-old patient, this case report describes a treatment approach for Gustilo-Anderson type IIIc fractures using a fix and flap procedure for limb preservation.
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Review Meta Analysis
[Simple elbow dislocations in children : Systematic review and meta-analysis].
Simple elbow dislocations in childhood are rare. Nevertheless, they have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed. ⋯ Simple elbow dislocations in children are rare. They most commonly occur in posterior and posterolateral directions. The prognosis is favorable; however a timely diagnosis and correct reduction are relevant for a good outcome.