Der Unfallchirurg
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Comparative Study
[Comparison of regional distribution of cancellous bone in osteoporotic and non-osteoporotic distal radii].
In cases of distal radius fractures information about the regional distribution of cancellous bone is essential for adequate fixation of osteosynthesis material. ⋯ In osteoporotic distal radii cancellous bone density decrease occurs homogeneously in all regions and is least pronounced beneath the joint surface. Comparing the regional cancellous bone density (radial versus ulnar and palmar versus dorsal) significant differences were mainly found near the joint surface in both groups.
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The indications, technical principals, and results after vertebroplasty and kyphoplasty are presented in detail. We focus on the complications of both procedures. The benefit of vertebroplasty has been fundamentally questioned by two papers which have recently been published in the New England Journal of Medicine. ⋯ New procedures like stent-kyphoplasty or lordoplasty are briefly described. However, at present an assessment of these new techniques is impossible. A similar situation is give for the application of resorbable bone cements.
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Traumatic physeal separations (SH I/II) of the lower extremities are rare. Complications are reported in 2.2-39.6%. The current study is intended to provide recent data concerning epidemiology and treatment decisions in physeal separation of the distal tibia. ⋯ The investigation confirmed epidemiological data of former studies. For the first time data concerning the treatment reality of physeal separations of the distal tibia were recorded. They consistently follow the recommendations of the appropriate literature.
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Within the framework of restructuring for the certification to a regional trauma centre of the DGU (German Society for Casualty Surgery), a uniform algorithm for multiple trauma was developed in the medical centre of Wolfsburg. The Wolfsburg multiple trauma algorithm is based on ATLS (advanced trauma life support) with integration of FAST (focused assessment with sonography for trauma), as well as the white paper of the DGU and regional-specific features. Thus structural, instrumental, organizational and personnel conditions were created to improve the care of multiply traumatized patients even further. The conditions for transition to a regional trauma centre of the DGU were confirmed by a successful audit.
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The relationship between severe, moderate and mild traumatic brain injury (TBI) as well as the course of treatment and quality management, were studied in a 1-year prospective study in regions of Hannover and Münster Germany. A total of 6,783 patients were documented at the initial examination (58.4% male, 28.1% children <16 years old) and 63.5% participated in the follow-up survey 1 year after the accident. Of these TBI patients 5,220 (73%) were admitted to hospital for clinical treatment but only 258 (<4%) received inpatient rehabilitation. ⋯ An immediate x-ray of the skull with a doubtful evidential value was made in 82%. Of the participants 35.9% were still receiving medical treatment 1 year after the accident although the majority only suffered mild TBI. An overabundance of severe socioeconomic consequences, e.g. loss of job, accommodation, family, were also found following only mild TBI.