Der Unfallchirurg
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Clinical Trial
[Anticoagulation medication for proximal femoral fractures : Prospective validation study of new institutional guidelines.]
Under current guidelines surgical care of hip fractures has to be initiated within 48 h which is a challenge for the management of patients on medical anticoagulation. The aim of this study was to evaluate the in-house standard operation procedure (SOP) concerning these patients. ⋯ Under this SOP anticoagulation has no impact on complication rates after hip fracture. The increased transfusion rates under ASS can be attributed to early blood transfusions. Antagonization of coumarin with vitamin K delays surgery but seems adequate. An analysis of more patients over a longer period of time should be conducted.
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Patient safety in hospitals is difficult to define and is not measurable by operational safety parameters as in other fields. So-called adverse events (AE) are a collective of complications, failures, mistakes, errors and violations. Estimations of at least 9.2 % AEs in surgery with 0.1 % fatalities are given worldwide but there are no correlations between objective quantification of AEs and subjective or public perception of safety during the perioperative period. ⋯ In spite of these facts, safety parameters for problems in anesthesia, blood transfusion, in retaining surgical instruments and so-called index events, such as patient and side identification errors are much higher. Patient safety is maintained in hospitals by objective means (surgical). Checklists have been proven to improve safety and critical incidence reporting, training and changing of attitudes could have further advantages but they are difficult to measure.
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Spinal deformities in Parkinson's disease are difficult to treat but with good indications, spinal surgery is a better treatment option taking into account all factors that accompany Parkinson's disease. Despite greater operational time and cost expenditure with a long rehabilitation period, long stretch segmental fusion is preferable to short stretch segment fusion due to the lower revision rate. An adequate postoperative rehabilitation and good patient care is essential for success. This case illustrates successful treatment of a patient with Parkinson's disease and camptocormia by long stretch segmental fusion.