Der Unfallchirurg
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Despite the use of modern antibiotics as well as complex perioperative, intraoperative and postoperative prophylactic measures, the rate of surgical site infections (SSI) could not be significantly reduced. The introduction of biocompatible antiseptic drugs with a high microbiocidal effect provided a successful alternative for infection prevention and therapy, particularly in a time of increasing occurrence of multi-drug resistant pathogens. Hence, questions about the risk-benefit ratio of antiseptic wound irrigation solutions, the prophylactic use of wound irrigation solutions for the reduction of SSI and the effect of negative pressure wound therapy combined with instillation (NPWTi) need to be answered. ⋯ As the basic equipment in trauma surgery, a selection of three different antiseptic wound irrigation solutions for the reduction of the rates of posttraumatic and SSI can be recommended. The use of antiseptics should be reviewed on an ongoing basis in the daily clinical routine and particular attention should be paid to unwanted effects in the course of the healing process. After application of 7-14 days, the indications for continuing the use of the antiseptic solutions must be carefully re-evaluated.
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The treatment of complex elbow dislocation fractures is a challenge to both the treating surgeon as well as to the patient due to the complex bony and soft tissue anatomy of the joint. In order to establish an expedient treatment algorithm, all osseous and ligamentous injuries need to be thoroughly assessed. ⋯ Any unnecessary delay in treatment of this complex injury can result in posttraumatic functional disorders, recurrent instability and secondary arthrosis. In conclusion, the goals of surgical treatment must be the correct restoration of the joint anatomy and stability as the prerequisites for any successful treatment of elbow fracture dislocations in order to enable early motion of the joint.
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Since 2014, hospitals with ortho-geriatric fracture centres could be certified as AltersTraumaZentrum DGU® in Germany. To measure the quality of treatment in these centres, a geriatric trauma registry (AltersTraumaRegister DGU®) was established. ⋯ Based on the timing of surgery and anti-osteoporotic therapy, the treatment seems to be successful in the ortho-geriatric fracture centres. For a better evaluation of treatment quality in the AltersTraumaZentren DGU®, implementation of follow-up examinations in the AltersTraumaRegister DGU® is essential.
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The reconstruction of the medial patellofemoral ligament has been an increasingly popular approach for patellar instability over the last ten years. It is a conglomeration of symptoms with varying degree of severity. For pinpointed surgery planning, magnetic resonance imaging is now the obligate diagnosic tool. Therefore, in the preoperative stage, collateral pathology can be observed.
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The present case shows the long-term follow-up of a rare injury due to blunt abdominal trauma in childhood. The patient suffered from a traumatic transsection to the A. iliaca communis, which was restored by the combination of a direct suture with a venous autologous patch. ⋯ Due to the limited number of experiences with this rare injury reported in the literature, there is a lack of consensus on the suture technique and use of patches or grafts. The demonstrated technique supplies a possible treatment for this rare injury to infantine arteries.