Der Unfallchirurg
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Intraoperative imaging during spinal interventions has experienced significant developments over the last two decades. By the introduction of flat screen detectors, 3D imaging has been made possible and easier and by developing compact and mobile systems computed tomography can even be used in the operating theater. ⋯ The advantages of intraoperative 3D imaging with a clear improvement of visualization for spinal surgeons and the certain control of materials at the end of the operation are obvious. Even the use of navigation has been greatly simplified and can therefore lead to an even greater precision and less radiation exposure. There are even more sophisticated developments, such as operation suites and intraoperative computed tomography but these are initially reserved for selected centers.
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Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. ⋯ In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.
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The results and immediate consequences of intraoperative three-dimensional (3D) imaging in the treatment of AO classification type C fractures of the distal radius, the tibial head and the tibial pilon were analyzed and compared with published results on general intraoperative revision rates following intraoperative 3D-imaging. ⋯ Intraoperative revision rates following 3D-imaging increased with the severity of the injury pattern. Intraoperative 3D-imaging should be routinely used in the treatment of fractures of the tibial head, tibial pilon and even in comminuted distal radius fractures due to the high intraoperative revision rates found in the present study. Alternatively, a postoperative computed tomography (CT) control should be performed.
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Booby traps and gun-like devices for vole control can lead to complex trauma requiring emergency medical care. We present a case series of patients who suffered severe hand and facial trauma through detonation of booby traps and paraphernalia (n = 9, Ø 60 years of age). All patients were admitted to the emergency department of Hannover Medical School for primary care. ⋯ Six of these patients also presented fractures or lesions of capsular or tendon structures. Therapies included debridement as well as skin grafts or flaps for tissue defect coverage. We informed the Department for Commercial Safety (Gewerbeaufsicht Hannover) in 2014 because we believe that these traps pose a serious safety hazard.
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Three-dimensional (3D) imaging can enhance trauma care by allowing better evaluation of bony detail and implant position compared to conventional fluoroscopy or x‑ray. Intraoperative 3D imaging further improves this evaluation by allowing any necessary revisions to be made in the operating room prior to the patient emerging from anesthesia. ⋯ Improved image volume, resolution, and software capability have allowed surgeons to obtain high quality, wide field views of bony anatomy that can include the uninjured side as a comparison. In this paper, the evolution of intraoperative 3D imaging over the past 25 years is discussed.