Der Unfallchirurg
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Patients presenting in the emergency department with a mild injury to the head pose a particular challenge due to their high prevalence but low rate of traumatic brain injury. However, missed traumatic brain injuries may result in fatal consequences. Therefore we investigated the diagnostic performance of serological protein S100B measurement in adult patients presenting with mild head injury and a GCS 13-15 to identify traumatic brain injury. ⋯ Serological protein S100B measurement may be helpful as a screening test to identify patients with higher risk of traumatic brain injury for further diagnostic assessment.
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Current techniques of acromioclavicular (AC) joint repair primarily focus on the reconstruction of the coracoclavicular (CC) ligaments. However, it is not clear if this approach is sufficient to restore vertical as well as horizontal AC joint stability and kinematics. This review focuses on the epidemiology of AC joint injuries and the coincidence of intra-articular pathologies. ⋯ In conclusion a biomechanically effective treatment of AC joint separation should analyze the individual instability pattern in the first step. Therefore, the radiological standard according to Rockwood should be supplemented by specific stress x-rays for quantification of dynamic horizontal AC joint instability. In the second step an adequate surgical treatment considering CC and AC stabilization should be performed meeting the individual patient requirements.
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Failed conservative treatment or surgical procedures for acute AC joint seperations create the demand for revision or salvage procedures to successfully treat persistent AC joint instability. Besides the classic Weaver-Dunn procedure and its modifications lately new procedures combining a more or less rigid implant for primary stability with a biologic augmentation using an autologous tendon graft have been developed. These procedures are performed arthroscopically or arthroscopically assisted.
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The introduction of diagnosis-related groups (DRG) in Germany comprises the risk of a non-cost-effective reimbursement in complex medical treatments. The aim of this study was to compare the reimbursement between the DRG system and the system of hospital per diem charge in effect until now. ⋯ A revision of the G-DRG definition of polytrauma is necessary to ensure adequate reimbursement for management of patients with multiple injuries. The severity of a trauma has to be considered in the DRG system.
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Editorial Historical Article
[90 years of the German Society for Trauma Surgery: origins and foundation].