Der Unfallchirurg
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Due to the demographic development the proportion of older patients has increased. These show at least a higher rate of comorbidities, which affects the length of inpatient hospital stay. Until now no uniform recording exists for such comorbidities within the occupational insurance association system even if the clinical relevance is beyond dispute. Adaptations within the system with increased interdisciplinary treatment are necessary. ⋯ A changing age distribution with a tendency to an increased number of older patients and an increased frequency of comorbidities could be determined. In the present documentation system of the occupational insurance association treatment procedure these comorbidities are insufficiently recorded and considered, even though their clinical relevance is indisputable. Adaptations with respect to intensified interdisciplinary cooperation are necessary.
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The introduction of the diagnosis-related groups (DRG) in 2003 radically changed the billing of the treatment costs. From the very beginning, trauma surgeons questioned whether the introduction of the DRG could have a negative impact on the care of the severely injured. "Trauma centers in need" was the big catchword warning against shortfalls at trauma centers due to the billing via DRG. This situation was confirmed in the first publications after introduction of the DRG, showing a clearly deficient level of care of polytrauma cases. ⋯ Despite not including these expenses, the costs were never covered for any of these patients. For patients with slight injuries after trauma management in the emergency room, the present adjustments to the DRG system by increasing the basic case value seem to be insufficient. Additional remuneration for these patients seems absolutely justified to further ensure adequate quality of care.
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Comparative Study
[Biomechanical comparison of six different fixation techniques for treatment of metacarpal neck fractures].
The purpose of this study was to evaluate the primary stability of commonly used fixation techniques for metacarpal neck fractures and to compare it with that of an innovative osteosynthesis device: IlluminOss™, the photodynamic bone stabilization system™. ⋯ In summary, IlluminOss™ can be used as an intramedullary stabilization system for treatment of metacarpal neck fractures. In combination with locking screws the biomechanical characteristics of IlluminOss™ are comparable to the other fixation techniques.
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Case Reports
[A minimally invasive technique for removal of a firmly fixed Küntscher nail in primary hip arthroplasty].
This article reports the case of an 80-year-old male patient who presented to this hospital with symptomatic arthritis of the left hip. The special feature of this case was a Küntscher nail in the left femur that had been in situ for more than 50 years. ⋯ As the Küntscher nail is a rarity nowadays there is no standardized procedure for the removal of such a nail. This case report describes a minimally invasive possibility to remove a Küntscher nail in total hip arthroplasty.