Der Unfallchirurg
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Spinopelvic instability is common in type IV fragility fractures of the pelvic ring (FFP) and type C traumatic pelvic fractures. This results in the indications for operative stabilization using a spinopelvic support. Due to the variety of surgical techniques for spinopelvic support it is unclear what importance a minimally invasive spinopelvic screw-rod osteosynthesis can have. ⋯ The triangular minimally invasive spinopelvic stabilization (TMSS) showed a stable and sufficient treatment of the type IV fragility fractures and in the slightly displaced type C traumatic pelvic fractures. Coarse fracture dislocations limit the procedure.
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Injuries to the subaxial cervical spine are increasing and have an increased neurological risk compared to the thoracic and lumbar spines. The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. ⋯ Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability and reconstruction/preservation of the physiological alignment.
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Trauma team alert (TTA) to the emergency room (ER) takes place in the event of disturbed vital signs or serious injuries (A criteria) or after a dangerous accident (B criteria). Due to low specificity and limited personnel resources, TTA is questioned for B criteria. The consequences would be an increase in undertriage and thus endangering patients. ⋯ The emergency intervention rate for A , B and NULL criteria was 75%, 6% and 2.1%, respectively. Differentiation according to the TTA criteria results in patient collectives with different injury severity and emergency intervention rates. This result justifies considerations to adjust team composition based on TTA criteria, as long as it is ensured that critical conditions can be identified and remedied by adapted teams.
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Observational Study
[Endoprosthetic treatment of pertrochanteric femoral fractures with concomitant coxarthrosis : A consecutive observational study with a control group].
Hip replacement for pertrochanteric femoral fractures (PF) is challenging due to its complexity. Studies regarding this procedures are limited, therefore this monocentric study was conducted. The null hypothesis was no effect between replacement and internal fixation according to revision and mortality. ⋯ In this study, a significantly higher rate of infection and mortality was observed in patients with hip replacement for a PF and with a concomitant coxarthrosis; compared to osteosynthesis of PF without coxarthrosis. Further studies are mandatory to provide the appropriate treatment for patients with this fracture pattern.