Der Unfallchirurg
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Multicenter Study
[Treatment of proximal humeral fractures in Germany : Influence of the level of hospital care and the frequency of treatment.]
Various treatment options exist for displaced proximal humeral fractures. The impact of the level of hospital care and frequency of treatment on current treatment regimens in Germany was analyzed. ⋯ Independent of the level of hospital care and frequency of treatment, there is a trend for head-preserving angular-stable surgery with a homogenous level of treatment in Germany.
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Pilon fractures are articular fractures of the distal tibia which involve the weight bearing part of the ankle joint. Assessment of the fracture is carried out with computed tomography and evaluation of the skin and soft tissue damage. ⋯ The surgical approaches are preferably local and when necessary multiple (up to three) and performed simultaneously but the localization also depends on the trauma-induced damage. The surgical strategy includes joint distraction, sequential joint reconstruction and joint axis correction as well as early non-weight bearing joint mobilization.
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The rising incidence of osteoporotic fractures requires novel treatment strategies. ⋯ Implant augmentation offers high biomechanical potential to prevent mechanical complications after fracture fixation in osteoporotic bone. Early and confident mobilization of elderly patients therefore appears to be possible. With appropriate handling, associated risks seem controllable; however, implant augmentation cannot be applied as a routine concept for osteoporotic fracture management. The application requires careful evaluation on a case by case basis under comprehensive consideration of mechanical and biological factors.
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Proximal femur fractures are common and treatment is expensive. The aim of the present study was - after matching of hospital and health insurance data - to evaluate the influence of early operation on certain outcome parameters. Data from a German health insurance were used to identify then influence of the day of operation after admittance on the rate of mortality, decubitus, and revision surgery during the hospital stay and on the care level of the patients up to 1 year and in some cases longer after operation. ⋯ The present study clearly presents the importance of analysis of routine records after discharge and it demonstrates that longer periods up to 1 year and more can be evaluated. The data show that a longer time period between hospital admission and operation negatively influences all outcome parameters. The care data give impressive evidence for a significant loss of quality of life and the importance of intense postoperative rehabilitation.
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We report on two cases of posttraumatic ileus after pelvic ring fracture in two patients aged 73 and 74 years, respectively. Although all conservative measures were exhausted, in both cases the ileus resulted in additional operative procedures and a significant extension of the hospital stay. ⋯ Only the trauma-related motility disorder led to a clinical manifestation. Pathophysiological mechanisms and their implications on prophylaxis and therapy are discussed.