Der Unfallchirurg
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Well-designed, prospective, multicenter, randomized clinical trials (RCTs) define the gold standard of evidence-based medicine. The results of such trials represent the most solid rationale for therapeutic recommendations in the S3 guideline of medical societies (http://www.leitlinie.de). The performance of studies according to good clinical practice (GCP) guidelines (Guidelines of the International Conference on Harmonization on Good Clinical Practice) is extremely demanding. ⋯ Without a doubt, this RCT is one of the most important studies carried out in the field of care for the critically injured patient, because the results will have a profound influence on the future management of femoral shaft fractures in multiple trauma patients and because successful completion of this study will underline the high scientific competence and skills claimed by German trauma surgeons. At the same time, ironically, the success of this study is endangered by the dilemma of an as yet insufficient recruitment of suitable patients to be enrolled into the trial. In this article possible explanations for this problem will be discussed based on a case report and the specific challenges in performing RCTs that scrutinize questions in the field of surgery will be analyzed.
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Bite injuries of the hand have a clearly increased risk for infection compared with other regions. Surgical treatment of the wound is indicated, and the debridement must be done thoroughly and with consideration of the wound closure. ⋯ Common complications in cases of deficient primary therapy are flexor tenosynovitis, purulent arthritis, and phlegmons of the dorsal hand. These are emergencies and need immediate surgical intervention.
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Multicenter Study
[Ultrasound diagnosis of forearm fractures in children: a prospective multicenter study].
Metaphyseal forearm fractures are a common pathology in any emergency department. The standard diagnostic procedure involves X-rays of the forearm and wrist. As former studies have shown that these fractures can be visualized using ultrasound, we compared the accuracy of sonographic and X-ray diagnostics. ⋯ Ultrasound seems to be a valuable and safe alternative to X-ray diagnosis. Patients with inconclusive findings should undergo X-ray diagnosis.
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Comparative Study
[Treatment results of pertrochanteric and subtrochanteric femoral fractures: a retrospective comparison of PFN and PFNA].
Can the helical blade in proximal femur nailing antirotation (PFNA) reach a better bony fixation than proximal femur nailing (PFN), thereby decreasing complication rates and improving clinical outcomes especially in osteoporotic bone? ⋯ The philosophy of the PFNA blade with better fixation through an increased implant-bone-interface and smaller cross-section, compaction of cancellous bone as well as an antirotational fixation, seems to show advantages compared to the double screw system of the PFN.
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The German DRG (diagnosis-related groups) system has changed since the inauguration in 2005, whereby written inquiries and on-site auditing have been carried out by the medical inspection service for health insurance companies (MDK). Modifications in the G-DRG system are reflected in changes in the MDK visitations. This article describes exactly how these examinations have changed over time. In order to achieve this all auditing reports were evaluated. ⋯ To cope with the changes in the German DRG system hospitals have to be flexible. The experiences with the regular MDK visitations can positively influence hospital organizational structures.