Der Unfallchirurg
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The primary goal in the treatment of carpal fractures is the preservation of a painless wrist function. Scaphoid fractures are the most common carpal fractures and when such a fracture is clinically suspected CT or MRI scans are usually advisable. Only stable and non-displaced scaphoid fractures can be treated conservatively, all other fractures require internal fixation with restoration of normal anatomy. ⋯ Perilunate fracture dislocations of the carpus deserve special attention. In these severe injuries a fracture line can run through all carpal bones but the scaphoid is mostly affected. Accurate reduction and internal fixation by screws and K-wires are indicated not only in these cases, but also in carpometacarpal fracture dislocations.
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Hind foot tendinopathies mainly involve the Achilles tendon. Color and Power-Doppler ultrasound visualizes pathological neovessels in painful tendons, which are associated with pain mediating nerve fibres. These neovessels are characterized by an increased capillary blood flow at the point of pain. ⋯ Cryotherapy sessions of 3-times 10 min of reduce pain and capillary blood flow (evidence level Ib). The role of proprioceptive training in tendinopathy has to be determined in future trials (evidence level II). Anecdotical treatment of hindfoot tendinopathies has been replaced by evidence-based recommendations.
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The objective structured clinical exam (OSCE) has become an established form of examination. However, for general and orthopedic surgery it has barely been evaluated. Therefore, the present study was performed to analyze the OSCE in surgery by the students of the University of Ulm. ⋯ The evaluation of the OSCE by the medical students at the University of Ulm showed a high acceptance rate as well as a high clinical relevance.
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Due to the development of trauma care systems the treatment results of multiply injured patients have clearly improved during the last decades. More sophisticated preclinical algorithms, standardized procedures in the emergency room, calculated surgical strategies during the early phases and the subsequent intensive care (ICU) treatment as well as the implementation of trauma registries have all contributed to an improvement in trauma care. Different national trauma care systems have been developed due to the structural, geographic and demographic differences of the compared countries. ⋯ To cope with financial losses in multiple trauma care, huge efforts of all the personnel involved are necessary to maintain the maximum treatment quality. In this context, national trauma registries, as well as the recently established trauma networks in Germany, might be helpful. Due to improvements in comprehensive trauma care and identification of expensive, but not prognosis improving treatment strategies, costs can be reduced by trauma registries and trauma networks.
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Injuries of the internal mammary artery after blunt thoracic trauma are rare but potentially fatal. A specific characteristic of these injuries is that they can become symptomatic even after a delay of several weeks. This article reports on the diagnosis and treatment of a 41-year-old motorcycle rider who suffered bilateral injuries of the internal mammary artery after a motorcycle accident without any additional bony lesions.