Der Unfallchirurg
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The early clinical treatment of severely injured patients of today is based on modern technical resources as well as on refined therapeutic strategies involving a multidisciplinary team. In the meantime the requirements for and expectations towards best major trauma care have both increased considerably. In spite of a decline in mortality after major trauma during the last two decades still clinical deviations from actual treatment guidelines with proven influence on negative outcome are to be found. ⋯ Furthermore, by transferring the QM-system to another trauma center, we were able to show that the effects of the system in major trauma care are reproducible. Besides the internal efforts for quality optimization an external quality assessment comparing the own treatment results with other trauma centers should take place. For this purpose joining a multicentered trauma registry (i.e. the trauma registry of the German Society of Trauma Surgery for the German speaking countries) is recommended.
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A prospective study of 24 operative procedures involving minimal invasive techniques and fluoroscopic guidance was undertaken in order to measure the radiation exposure to the primary surgeon. Radiation was monitored with the use of high sensitive thermoluminescent dosimeters. At the spots of dosimetry (eyes, thyroid gland, hand and genitals under lead apron) the dose was uniformly low and ranged from 0.6 muSv at the eyes to 259.3 muSv at the hand. ⋯ On the basis of our results there is no likelihood of exceeding the limits of safety regulations even in a very busy operative environment, although a statistically increased incidence of thyroid cancer or a radiation-induced glaucoma is present. In vitro measurements with irradiation of a phantom resulted in the following recommendations: 1) fluoroscopy should be performed using the magnification-mechanism of the x-ray apparatus, 2) during lateral fluoroscopy the primary surgeon should be positioned close to the image intensifier. At least the surgeon should be familiar with the technique of closed reduction and instrumentation to reduce the duration of fluoroscopy which proved to be the most important factor for the amount of the radiation exposure.