Der Unfallchirurg
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This article reviews current knowledge about scaphoid fractures in children and adolescents, including the development of the scaphoid, its injuries and age-specific treatment for acute and late presenting fractures. The following recommendations are based on the literature, although scientific evidence to support treatment strategies is scarce. The diagnosis of scaphoid fractures is often missed on initial X-rays. ⋯ Unlike in adults, evidence has not been provided for a benefit of routine surgical therapy. Late presenting non-unions that have not yet been treated adequately warrant a trial of conservative therapy, because healing can be expected under prolonged immobilisation. Surgical treatment should be reserved for dislocated fractures, established pseudarthroses that have not united under adequate conservative treatment or for patients to whom prolonged immobilisation does not appear to be acceptable.
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The optimal treatment for fractures in the diametaphyseal transition zone of the forearm is still a matter of debate. Stable fractures should be immobilized or treated by closed reduction when non-tolerably displaced. Unstable and displaced fractures can be treated by various operative techniques, which are all characterized by technical impracticability or disadvantages for the patient. ⋯ The external fixator is indicated in some multifragmentary fractures. The choice of treatment option often results from an individual decision based on the patient's age, complexity and stability of the fracture and interest of the patient. The priority objective of all treatment modalities is a fully functional upper extremity, i.e. full range of motion.
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Controlled Clinical Trial
[Earlier postoperative mobilization with minimally invasive hip hemiarthroplasty].
Treatment of medial femoral fractures in elderly patients with cemented hip hemiarthroplasty (HEP) is a widely established procedure. The main problems with this procedure are complications associated with soft tissue damage and prolonged immobilization. The aim of this study was to compare the clinical and radiological results after HEP implantation using either an anterior minimally invasive (MIS) approach or a regular transgluteal (TG) approach. ⋯ In the MIS group the number of perioperative complications was less than in the TG group (MIS 7% vs. TG 17%, p <0.05). The early functional advantages of MIS after HEP implantation for medial femoral fractures are evident also within an elderly group of patients.
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Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. ⋯ A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.