Der Unfallchirurg
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The incidence of relevant posttraumatic functional deficits in the sense of elbow stiffness with less than 30 degrees in extension or flexion less than 120 degrees , is unknown. A differentiation can be made between intraarticular, extraarticular and combined causes. An open procedure is indicated in elbow stiffness after correct analysis of the situation and failure of conservative treatment. ⋯ Open arthrolysis for severe posttraumatic elbow stiffness carried out 10 months (range 3-24 months) after the accident led to good results in most cases with a clear improvement in functional mobility.
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Delegation of medical treatment and responsibility from doctors to nonphysicians are being advocated more and more by public health politicians. The opinion of the German Union of Orthopaedic and Trauma Surgery is outlined. ⋯ Delegating must not result in deterioration of patient care or destruction of the medical profession. Options and risks of delegation are discussed.
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Phalangeal fractures of the hand are characterized by a great diversity of fracture patterns. Various concepts exist for conservative and surgical treatment. A wide range of appropriate implants are available for internal fixation. ⋯ Protection of soft tissues and especially preservation of tendon sliding have to be weighed against anatomic reduction and absolute stability. Early mobilization with a high degree of patient cooperation is desirable. Treatment of phalangeal fractures always requires consideration of both the injury pattern and the patient's needs in each individual case.
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This paper describes the successful nonoperative treatment of a 31-year-old male patient with thoracic and abdominal gunshot wounds. Once stabilized in the emergency department (ED), he was transferred to our general surgical department. On the first day after his admission, diagnostic peritoneal lavage (DPL) was performed, revealing a small amount of hemorrhagic fluid. ⋯ The patient began to tolerate oral feeding quite soon; he was discharged from the general surgical department in a good state of wellbeing on day 13 after admission. This case report supports the idea that nonoperative treatment with repeated physical examination can be an alternative to laparatomy for abdominal gunshot injuries. Further clinical and experimental trials should be performed to test how safe this alternative is.
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The incidence of gunshot wounds is increasing also in Europe and surgeons in urban trauma centers are more frequently confronted with this type of injury. Since there is no established treatment algorithm for gunshot injuries to the extremities, the surgeon should rely on established soft tissue injury and fracture protocols. Gunshot fractures with minor soft tissue destruction should be treated as closed fractures. ⋯ Prophylactic intravenous antibiotics are mandatory and prophylactic fasciotomy is often required. Upon definitive internal stabilization, bone grafting should be considered since gunshot fractures are usually associated with a high degree of comminution. Articular gunshot injuries are treated as open joint injuries and require irrigation, debridement, foreign body removal and antibiotic prophylaxis.