Der Unfallchirurg
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Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability and varus malalignment. We present the indications, operative technique, and results for the combined operation of high tibial osteotomy and cruciate ligament reconstruction. ⋯ Unstable knees with varus malalignment can be sufficiently treated by osteotomy and cruciate ligament reconstruction at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost-effective therapy delaying the progression of osteoarthritis and minimizing clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and the return of these patients to the activities of daily living and sports.
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Emergency room management means time management. A time and four color based algorithm is described to improve workflow, follow up of diagnostic procedures and initial treatment. As a result introducing the time based interdisciplinary emergency algorithm within 60 minutes all necessary treatment and diagnostic procedures were completed. This algorithm is an effective tool to improve emergency room treatment.
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The authors report 118 consecutive cases of patients with traumatic extradural hematoma (EDH) which were analyzed according to different clinical parameters and treatment modalities. Patients, treated for EDH between 1992 and 1998 in our department were distributed into 5 treatment groups depending on their clinical and neuroradiological findings on admission and during the hospitalization. Group I consisted of 75 patients (64%) who required immediate surgical evacuation of the hematoma after admission. ⋯ The decision for non-operative treatment of EDH and the timing of a delayed intervention has to be made individually in each case in dependence of parameters like patient age, hematoma-size and -location and neurological status and course. Chronic EDH should be operated immediately, as well as hematomas presenting with an increase in size. Delayed developing EDH imply worse outcome and make adequate surveillance of high-risk patients mandatory.
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Infections with Methicillin-resistant Staphylococcus aureus are reported increasingly in intensive care unit and ward, that means not only a dangerous disease but also a considerable expenditure factor. ⋯ Linezolid represents an efficient new reserve antibiotic. In case of pneumonia, severe skin and soft tissue infections good results can be expected. The treatment of osteomyelitis has been reported only in single cases.