Der Unfallchirurg
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A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. ⋯ In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.
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There is little evidence for the ideal aftercare of combined nerve and flexor tendon injuries of the hand. The aim of this study was to elicit whether concomitant nerve injuries are changing the individual treatment plans after flexor tendon repair in a survey of German centres for hand surgery. ⋯ There seem to be no uniform treatment guidelines for flexor tendon repair if concomitant nerve injury is present. Against the background of the current literature early controlled mobilization after tendon and nerve repair seems to be justified.
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Review Case Reports
[Hip dislocation and fracture of the femoral head caused by low impact trauma].
Hip dislocations and particularly fractures of the femoral head are very rare injuries. Various therapy options are described. ⋯ This specific "accident" was due to low impact trauma, which was previously considered to be insufficient to cause this type of injury. We report on the diagnostic and therapeutic measures and compare this procedure with information from the literature.
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The "100,000 lives campaign" initiated a wide-spread implementation of rapid response teams in the United States. A standardized rapid response system (RRS) is designed to reduce the preventable mortality of hospitalized patients who frequently have progressive signs of physiological deterioration minutes to hours before cardiac arrest. The implementation and maturation of a team-based RRS has been shown to significantly reduce the incidence of "COR zero" calls and, in some studies, the in-hospital mortality rate. ⋯ This clinical triggers program overcomes the classic limitations of a team-based system, such as the overuse of resources and the fragmentation of patient care. The present review outlines the basic RRS concept with a focus on the debate related to the "perfect" patient safety system, namely the validity of a distinct rapid response teams approach versus a trigger-based escalation modality. The implementation of a standardized RRS should also be considered in German hospitals with the aim of improving patient safety and reducing preventable in-hospital mortality.
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Fractures of the acetabulum are a challenge in terms of orientation and the surgical skills of the orthopedic trauma surgeon. Due to the surrounding soft tissues and because of the indirect reduction control, operative treatment of acetabular fractures can be very demanding. ⋯ In view of the high complication rate, the extended approaches are of less relevance. The therapeutic relevance of recent developments including navigation is discussed.