Der Unfallchirurg
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Percutaneous internal fixation of pelvic fractures is increasing in popularity with multiple new techniques reported. ⋯ Percutaneous fixation of pelvic fractures requires high-quality imaging and can be aided by computer navigation. Safe techniques are reproducible; however, not all patients and fracture patterns can be treated using these techniques.
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Instable pelvic injuries are often associated with a high blood loss, which can effectively be curtailed by rapid external stabilization of the pelvis. The S3 guidelines on the treatment of multiple trauma and the severely injured recommend an initial stability testing in cases of an instable pelvis and hemodynamic instability even though the sensitivity is very low, with subsequent external stabilization. Radiological diagnostic procedures are also becoming more important for early diagnostics. ⋯ In cases of persisting hemorrhage in spite of external stabilization, most participants preferred a pelvic tamponade but angioembolization was also highly rated. Because many of the participants relied on their own findings from stability testing for a decision on external emergency stabilization despite the very low sensitivity, in cases of false negative testing there is a risk of insufficient treatment resulting in life-threatening hemorrhage. From our viewpoint, it therefore makes sense to treat patients with a suspicion of instable pelvic fractures based on the trauma mechanism and clinical examination (without mechanical stability testing) with non-invasive external pelvic stabilization as early as possible.
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The operative treatment of unstable distal radius fractures primarily aims for the anatomical reduction of the joint while addressing accompanying injuries. Anatomical reduction, stable fixation and early functional movement of the joint are the three cornerstones of modern treatment concepts of distal radius fractures. ⋯ The biomechanical aspects, anatomical findings and clinical evaluation that have influenced current design features and trends in new developments of the latest plates are emphasized. This is an ongoing process that is supported through the investigation and feedback of clinical science.
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The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. ⋯ Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.