Zeitschrift für Orthopädie und Unfallchirurgie
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In numerous legal areas, expert assessments are needed to clarify the causality of herniated discs: Was the damage caused by an accident? The literature mentions specific requirements regarding the trauma mechanism as well as temporal criteria, which prescribe the causality test. These are essentially high-energy traumas with immediate functional impairments. ⋯ Since the legal requirements of the causality test differ in civil and social law, legal norms need to be taken into account. We present a test scheme that supports the assessment process through entry, implementation and decision-making levels.
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Review Meta Analysis
Dual Energy CT - a Novel Technique for Diagnostic Testing of Fragility Fractures of the Pelvis.
Background The incidence of fragility fractures of the pelvis is increasing. Established methods to diagnose this condition include X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Dual energy CT (DECT) is a modern technology for the imaging of bone oedema/bruises and has been used in injuries of the extremities and spine. ⋯ Conclusion Although DECT is already established for other indications and is regarded as a promising method by all respondents of the "AG Becken III", DECT is not yet routinely used for diagnostic testing of fragility fractures of the pelvis. Potential advantages of DECT include its greater sensitivity than CT in detecting bone oedema with equal radiation exposure. Unlike MRI, it is available 24 hours/7 days.
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In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. ⋯ Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.
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Periprosthetic femoral fractures can be categorized into proximal fractures around a hip stem or distally around a knee arthroplasty. This paper focuses on the proximal periprosthetic fractures. It is important to classify the fracture at diagnosis and to perform accurate planning of the surgery. ⋯ Due to rising numbers of primary arthroplasties and more elderly patients an increase of periprosthetic fractures can be expected. The treatment of periprosthetic fractures is an economic and surgical challenge. It is important to provide competence for these cases concerning both operative techniques and interdisciplinary treatment.
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Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. ⋯ The result is a so-called "clear the pelvis algorithm" which describes a structured approach according to specific criteria and which specifies the circumstances under which the pelvic binder can be opened. Additional studies are necessary to analyse the applicability and safety of this algorithm in a clinical context. Our advice is not to "clear" the pelvis if no X-rays or CT scans of the pelvis have been carried out without (or with an opened) pelvic binder.