Der Unfallchirurg
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Proximal humeral fractures are common in the elderly population and are often associated with osteoporosis. Fixation of unstable proximal humeral fractures is problematic due to loss of fixation in osteoporotic bone. Fixed-angle devices are intended to provide superior mechanical stability due to the principle of an internal fixator. The NCB(R)-PH (non-contact-bridging proximal humerus) plate is a new fixed-angle device that locks the screws to the plate by secondary insertion of a locking cap. The aim of this study was to investigate if and to what extent NCB-PH plates applied in the locked mode provide higher mechanical stability in a proximal humerus fracture model. ⋯ The NCB-PH plate provides superior interfragmentary stability when used in the locked mode in a human cadaveric proximal humerus fracture model. Therefore, we recommend that all screws should be inserted in the locked mode. The results suggest that the NCB-PH plate in the locked mode provides higher primary postoperative stability thus permitting early functional treatment of the patient.
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Since 1992 the German Bundeswehr has been deployed for securing peace and peacekeeping abroad. Since then 83 German soldiers have been killed and overall 129 wounded in action as of 07.12.2009. In Northern Afghanistan the German Bundeswehr runs a combat support hospital (role 3) in Mazar-e-Sharif providing a multidisciplinary capability profile. ⋯ The German Navy also has two equivalent role 2 medical treatment facilities (Naval Rescue Centers) aboard its two combat support ships (CSS) "Berlin" and "Frankfurt am Main" to support maritime task groups operating worldwide. These floating field hospitals provide an indispensable asset in the medical emergency care of naval operations with difficult space-time factors. Due to the specific operating alliance between CSS and Naval Rescue Center, special operations as well as evacuation and humanitarian missions following disasters near the coastline can be effectively accomplished.
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Epidemiological analyses of injury patterns and mechanisms help to identify the expertise military surgeons need in a combat setting and accordingly help to adjust infrastructure and training requirements. Therefore, a MEDLINE search (1949-2009), World Wide Web search (keywords "combat, casualties, war, military, wounded and neurosurgery") and an analysis of deaths among allied war casualties in Afghanistan and Iraq were performed. Up to 10th December 2009 there had been 4,688 allied military deaths in Iraq and 1,538 in Afghanistan. ⋯ Military surgeons must have an excellent expertise in a wide variety of surgical specialties. Life saving emergency care, especially in the fields of thoracic, visceral and vascular surgery as well as practical skills in the fields of neurosurgery and oral and maxillofacial surgery are required. Additionally, it is of vital importance to ensure the availability of sufficient tactical and strategic medical evacuation capabilities for the wounded.
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Kyphoplasty has been the standard procedure for osteoporotic fractures for more than 5 years but the material costs are still very high. The aim of this study was to clarify whether pain reduction could be achieved without increasing the rate of new fractures and also in what areas costs could possibly be reduced. From 15.01.2007 until 15.01.2008, a total of 100 patients with 126 recent osteoporotic spinal fractures were treated by kyphoplasty with an average operation time of 38 min and follow-up times up to 12 months. ⋯ Within 12 months 6 new fractures occurred despite medicinal prophylactic treatment which could also be successfully treated by kyphoplasty. The average visual analogous scale after 12 months was 2.1 points. Kyphoplasty still causes financial deficits due to high material costs, however, patients benefit from a reduction of pain.
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Comparative Study
[How much competence in emergency vascular surgery does a modern trauma surgeon need?: experiences regarding deployment as a military surgeon].
Management of combat-related major vascular injuries is a challenge to all surgeons and a vascular specialist will not always be available in a wartime setting; therefore, every surgeon deployed to a war setting must be able to cope with these life and limb-threatening injuries. Data obtained from searching Medline and Google on the localization and treatment of combat-related vascular injuries of the USA strike forces in Afghanistan and Iraq were analyzed and adjusted to the requirements of the German Armed Forces. ⋯ Basic vascular surgical techniques which all military surgeons need to know are presented taking the austere conditions of a wartime environment into consideration. Preparation of all surgeons for deployment to a wartime situation must include basic knowledge and skills in vascular surgery including emergency and vascular reconstruction techniques.