Zentralblatt für Chirurgie
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Proximal humeral fractures are common in the elderly as distribution peaks in the 6th and 7th decade. Optimal operative strategy regarding complex proximal humeral fractures is still being discussed controversely. Aim of the study was to evaluate implant associated problems of angle-stable implants in comparison to other established osteosynthetic methods. ⋯ Using angle-stable implants in the operative treatment of complex proximal humeral fractures good results can be achieved in most cases. Nevertheless, in comparison to alternative operative solutions, the results do not show significant better functional outcome. Important for good functional outcome was an exact anatomical reduction as a material independent variable rather than the decision to use more expensive angle-stable implants. Those, who can fulfil such surgical demands, achieve similar results for the patient, even without using angle-stable implants.
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Reconvalescence after lung resections underlies several influences. The aim of this study was to outline the effect of patient and operative factors. ⋯ Malignant disease requiring anatomical lung resection is accompanied by delayed postoperative recovery when compared to lung resections for other reason. In contrast the width of opening of the retractor is of independent negative influence for reconvalescence. Once more the significance of a non-aggressive access procedure for lung resections is underlined.
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We examined the outcome of patients with ruptured abdominal aortic aneurysm and analysed factors that were responsible for the mortality. ⋯ The present study demonstrates that the severe situation of ruptured abdominal aortic aneurysm is not without a chance, many patients can be successfully managed. The success of treatment depends partly on factors which cannot be influenced by the surgeon, but other factors (for example hemoperitoneum und decreasing hemoglobin level) can be managed by quick diagnostics and expensive postoperative intensive care.
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After stabilization an optimal therapeutic strategy influences outcome in polytraumatized patients. A trauma team leader in early clinical course is necessary to optimize diagnostics and planning of further treatment. Special training systems like ATLS can help to standardize management of trauma patients. ⋯ Especially in patients with abdominal bleeding and severe brain injury time is the most critical factor. If he is not able to treat these injuries alone, physicians from other specialties must be involved. The trauma team leader must be aware of different treatment concepts like early total care and damage control orthopaedics.