Der Unfallchirurg
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The current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated. PATIENTS UND METHODS: A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.0 and 8.0) were risk-adjusted and evaluated. ⋯ The analyzed data support the rating of femoral neck fracture as requiring the intervention of urgent early surgery, as stated in the guideline. Percutaneous screw fixation can be considered for immobile and multimorbid patients with undislocated fractures. Advantages of total hip replacement compared to hemiarthroplasty cannot be supported by the QS-NRW data.
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Comparative Study Controlled Clinical Trial
[Elastic stable intramedullary nailing of clavicular midshaft fractures: comparison of open vs closed fracture reduction].
The aim of this study was to compare the outcome of open reduction versus closed reduction of midclavicular fractures using elastic stable intramedullary nailing (ESIN) in both groups. ⋯ There was no difference comparing right- and left-sided injuries and the outcomes were consistent irrespective of the treatment method. When appropriately indicated open and closed intramedullary nailing are very successful modalities of treatment. There were no significant differences in shoulder function after either procedure.
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Diagnosis-Related Groups (DRG) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis, we compared the Austrian and the German DRG systems. ⋯ Reimbursement of the top 15 diagnoses in hand surgery in Austria is 8% higher than in Germany. Except for one case, mean values as well as upper and lower thresholds of length of stay are considerably shorter in Austria. Comparison of international data to refine a national compensation system is advocated.
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Comparative Study
[Intraoperative 3-dimensional imaging - beneficial or necessary?].
With reference to two large retrospective studies we would like to make a contribution to the discussion whether intraoperative 3-dimensional imaging is only a helpful tool or state of the art for some special indications. ⋯ Correct assessment of alignment and joint line reconstruction are not possible by means of fluoroscopy in every case of syndesmotic injuries and calcaneal fractures. Therefore, intraoperative 3-dimensional imaging should be used in the treatment of these injuries due to the high intraoperative revision rates and the clinical relevance.
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Although rarely described, it is generally accepted that degloving injuries can successfully be treated by defatting the degloved skin and replacing it with a full-thickness graft. There have been few reports on the outcome of this reconstructive procedure in children. In this report, we describe the use of the VAC system to treat a case of degloving injury to both feet of a 4-year-old boy who was pulled into a luggage belt while standing on it.