Der Unfallchirurg
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The quality of trauma care in Germany has been significantly increased due to the establishment of standards in the white paper on severe injury care and the S3 guidelines. A key issue of multiple trauma treatment is the trauma resuscitation unit (TRU)/emergency room management, which is associated with extensive material and human resources. From the very beginning of the introduction of structured care for the severely injured, the choice of the target hospital and the indications for TRU have been the focus of scientific research. Furthermore, a reduction of the TRU team for presumably less seriously injured patients is discussed. ⋯ A significant number of patients admitted to a TCU due to the cause of accident (the so-called B criteria of the white book), have severe and potentially life-threatening injuries, which necessitate a prioritized and immediate treatment by a TCU team. Whether a reduced TCU team is sufficient in this situation needs to be critically examined.
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The development of the numbers of cases involved in accident insurance consultant procedures (DAV), injury type procedures (VAV) and severe injury type procedures (SAV) after the introduction of the new injury type catalogue from 1 July 2018 is presented. Furthermore, possible alterations to organizational aspects, such as operating room times and average duration of hospitalization are presented. A first critical assessment of the modifications in the new catalogue was carried out, particularly with reference to the newly introduced section on complications (section 11).
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Orthogeriatric co-management of proximal femoral fractures has been proven to effectively reduce mortality rates. This involves extending resources in hospitals treating these patients as well as dealing with the possibility of prolonged periods of hospitalization. The increase in costs of orthogeriatric co-management are best illustrated by the implementation of geriatric early rehabilitation complex treatment. In view of the problems concerning billing this complex treatment, an online survey was carried among certified geriatric trauma centers of the German Trauma Society (DGU®). ⋯ The online survey revealed significantly higher assessment and rejection rates when compared to other hospital services. This could prove potentially detrimental to the future of orthogeriatric co-management.
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The surgical procedure for the life-threatening course of a necrotizing soft tissue infection of the leg after minor trauma is described. The necessary consistent resection of extensive fascial and muscular necroses required the reconstruction of soft tissue defects of the knee, the ankle joint and peroneal tendons exposed over a long distance. The functional outcome is presented 1 year after use of MatriDerm® and a split-thickness skin graft for defect coverage.