Der Unfallchirurg
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Clinical Trial
[Percutaneous, 2D-fluoroscopic navigated iliosacral screw placement in the supine position: technique, possibilities, and limits].
In pelvic surgery, computer-assisted procedures are currently used predominantly for percutaneous iliosacral screw placement. The aim of this study was to evaluate the possibilities and limits of a 2D-fluoroscopic navigated procedure used for this indication. ⋯ The 2D-fluoroscopic navigated procedure used in this study can be recommended for percutaneous stabilisation of non or minor displaced injuries of the posterior pelvis. This procedure reduces intraoperative radiation exposure and improves intraoperative orientation but does not crucially enhance the precision of screw placement compared to the non-navigated technique. Finally, it is limited by its poor image resolution and lack of three-dimensionality.
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Hand surgery often needs only a short length of stay in hospital. Patients' comorbidity is low. Many hand surgery procedures do not need inpatient structures. Up until 2006 special procedures of hand surgery could not be coded. The DRG structure did not separate very complex and less complex operations. Specialized hospitals needed a proper case allocation of their patients within the G-DRG system. ⋯ The changes in the DRG structure and the implementation of the new OPS code for complex cases establish a strong basis for the identification of different patient costs. Different case allocation leads to different economic impacts on departments of hand surgery. Whether the new OPS code becomes a DRG splitting parameter has to be calculated by the German DRG Institute for further DRG versions.
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The fingertip is an extremely specialized end organ with a highly developed sense of touch. In this article, we present the different ways of reconstructing a traumatized fingertip. ⋯ The advantages and disadvantages of each flap are highlighted. We develop an algorithm to facilitate finding the correct type of reconstruction.
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Despite the use of intramedullary fixation devices for the stabilisation of intertrochanteric fractures, the rate of complications is still high. One of the main reasons for burdensome reinterventions in 9-15% of cases is the cutting out of the fixation device through both the spongious bone and the cortical bone at the apex of the femoral head. This phenomenon is strongly connected to the reduction of the fractures achieved, the technical performance of the operation with optimal implant positioning and the resistance of the trabecular bone in the femoral head against deformation by the fixation device. The latter is very low in cases of severe osteoporosis. To prevent the complication of cutting out, it seems sensible to find the limits of load-bearing capacity of individual osteoporosis-associated features (i.e. bone mineral density) at which special additional measures or other techniques for the treatment of these patients are desired. ⋯ In cases of bone density of >0.6 g/cm3 in the proximal femur (DEXA), the standard implants for the fixation of unstable trochanteric fractures could guarantee fixation without cutting out. The critical value of sufficient bone density in our few cases seems to be around 0.6 g/cm3 as measured by DEXA. Further investigation is needed to define the limits of bone mineral density for a successful osteosynthesis. An appropriate augmentation of the trabecular bone of the femoral head or a new design of the central loading device could increase the load-bearing capacity and thus help to reduce the cutting out phenomenon. Another alternative could be the primary implantation of an endoprosthesis in the treatment of these patients.