Der Unfallchirurg
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There have been substantial changes in the management of multiply injured patients over the last decades. In the 1950s and 60s, perioperative care was limited and the surgical techniques were not well developed. It was therefore discussed that a patient might be "too sick to operate" and the general recommendation was to postpone surgical care of the extremities,until a patient had stabilized. ⋯ For these patients, the concept of initial temporary fixation and secondary conversion to a definitive procedure has recently been advocated, and the term "damage control orthopaedic surgery" was coined. Within recent years, an increased consensus has occurred across the countries and the oceans in regards to the acceptance of the concept of damage control. This manuscript documents the pathogenetic back grounds and the clinical results leading to a change in the management of orthopaedic injuries towards damage control.
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The outcome of patients with penetrating heart injuries depends to a great extent on aggressive primary care and fast transport to the closest appropriate trauma center. There, after confirming the diagnosis, the injured victim has to be transferred without any delay to the operating room where the penetrating injury can be dealt with. The importance of resolute emergency management is shown based on a case presentation and a review of the current literature. The employment of extracorporal circulation (heart-lung machine) is rather subordinate in the primary care of these patients.
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Comparative Study
[Prediction of mortality, mobility and admission to long-term care after hip fractures].
Surgical treatment, discharge planning and rehabilitation procedures are rarely based upon defined assessment procedures. It might therefore be useful to develop simple and reliable screening tools to identify patients for early discharge, intensified rehabilitation and limited treatment. ⋯ It seems feasible to improve postoperative resource allocation by predictor led stratification. This need to be tested in intervention trials under the specific condition of the German health care system.