Der Unfallchirurg
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Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. ⋯ Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.
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Comparative Study
[Comparison of MRI and CT for assessment of childhood fractures : Studies on a porcine model.]
The purpose of this study was to evaluate the capacity of MRI to achieve a diagnostic accuracy in pediatric fracture diagnosis comparable to CT. ⋯ MRI has a diagnostic accuracy in fracture diagnosis comparable to CT. Therefore, protocols of traumatology in infancy should be revised.
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Clinical Trial Observational Study
[Polytrauma with pelvic fractures and severe thoracic trauma : Does the timing of definitive pelvic fracture stabilization affect the clinical course?]
The aim of this study was to investigate the influence of the surgical timing in patients with pelvic fractures and severe chest trauma on the clinical course, especially on postoperative lung function. ⋯ In this study patients with pelvic fractures and thoracic trauma benefited positively from an earlier definitive pelvic fracture stabilization with respect to a shorter time of ventilation and stay in the intensive care unit due to a lower need for red cell concentrates.
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A continuing high number of patients suffer harm from medical treatment. In 60-70% of the cases the sources of harm can be attributed to the field of human factors (HFs) and teamwork; nevertheless, those topics are still neither part of medical education nor of basic and advanced training even though it has been known for many years and it has meanwhile also been demonstrated for surgical specialties that training in human factors and teamwork considerably reduces surgical mortality. Besides the medical field, the concept of crisis resource management (CRM) has already proven its worth in many other industries by improving teamwork and reducing errors in the domain of human factors. ⋯ The educational concept of the HOTT (hand over team training) courses for trauma room training offered by the DGU integrates these elements based on the current state of science. It is time to establish such training for all medical teams in emergency medicine and operative care. Accompanying safety measures, such as the development of a positive culture of safety in every department and the use of effective critical incident reporting systems (CIRs) should be pursued.
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Case Reports
[Percutaneous cement-augmented screw fixation of bilateral osteoporotic sacral fracture.]
We describe the case of a 71-year-old woman who presented with persisting painful symptoms of the back and pelvis which had begun 4 weeks previously. A preceding trauma was plausibly excluded. Diagnostics showed a slightly dislocated bilateral sacral fracture with underlying osteoporosis also known as an insufficiency fracture. We performed a percutaneous and cement-augmented bilateral iliosacral joint revision using screws and 6 months after surgery, imaging showed a stable fracture with appropriate screw positions.