Der Unfallchirurg
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Randomized Controlled Trial Comparative Study
[The tele-visit as a telemedical technique in daily clinical practice. First results for elbow joint arthrolysis].
Technologies in telecommunication and information are being increasingly applied in the public health system of the western world. Also responsible for this development is the cost factor in the field of financing and maintenance of such a system of superior medical supply, as well as the concurrent patient' demand for optimized medical "24 h care and treatment". Pioneers in the use of telematic projects have, up until now, been large states such as the USA, Canada, Norway or Australia. ⋯ The functional outcome, duration of stay in hospital and the costs for treatment arising were determined. A standardized questionnaire was developed and the degree of satisfaction of the patients surveyed. A shorter stay in hospital was found together with lowered costs in medical treatment, while no differences in functional outcome could be found in comparison to the control group, although there was an additionally high grade of satisfaction with the new system.
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Case Reports Comparative Study
[Minimally invasive treatment of monocondylar tibial plateau fractures. Percutaneous reduction and small fragment osteosynthesis].
Treatment of displaced tibial plateau fractures is often complicated by high-energy trauma and soft tissue damage. Therefore, numerous techniques such as indirect or arthroscopically controlled reduction and percutaneous osteosynthesis have been described to reduce the additional surgical trauma. ⋯ Functional recovery showed a mean ROM of 114 degrees after 6 weeks and 121 degrees after 3 months. The radius T-plate offers enough stability to allow primary functional treatment due to early recovery of joint motion. Percutaneous reduction and small fragment osteosynthesis is a less invasive approach in the treatment of displaced monocondylar tibial plateau fractures.
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The success of modern burn therapy is based on an understanding of the pathophysiology and application of burn intensive care implying fluid resuscitation and management of pulmonary or other organ failure. With the development of early eschar excision and wound closure by immediate grafting, survival and cosmetic outcome were further improved. Especially in post-acute therapy, early physical rehabilitation, early reintegration, and early plastic surgical correction of the sequelae are indispensable for the outcome.
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Limitations to the range of motion of the knee reduce knee function and life quality. Flexion deficits inhibit using stairs and shoe closure, and may cause social deprivation. We present a pathophysiological concept of arthrolysis of the knee for flexion deficit. Our concept divides into intra- and extra-articular factors involving knee stiffness. Extra-articular problems can be located proximally in the quadriceps mechanism and distally in the patellar tendon. ⋯ A strict postoperative protocol is obligatory for pain control and physiotherapy. In 19 cases treated with this algorithm there was a mean flexion gain of 26 degrees. The AOSSM subjective outcome score was excellent in ten and good in seven cases after a mean follow-up of 8.2 months. This treatment protocol allows improvement in flexion, even in difficult revision cases.
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Case Reports
[Percutaneous reduction and stabilization of a dislocated acetabular fracture. Case report].
In the treatment of acetabular fractures, anatomic reconstruction of the joint is the primary aim. To achieve this, rather large approaches with approach-related morbidity are needed. Percutaneous stabilizations are still limited to nondisplaced or minimally displaced fractures. ⋯ Using the enhanced fluoroscopy technology with the ability to generate axial cuts and reconstructions comparable to CT clearly improves the reduction control also in acetabular surgery. Thus even displaced acetabular fractures can be reduced and stabilized percutaneously. Anatomic reconstruction of the joint remains the primary aim.