Der Unfallchirurg
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To improve patient safety and quality in joint arthroplasty a certification of arthroplasty centers (EndoCert©) and a German arthroplasty register (EPRD) have been implemented. This should guarantee a long-term improvement in documentation of arthroplasty in the future. Although the stages of operations in elective and trauma-associated joint arthroplasty are comparable, the surgical preconditions are often quite different. As required by the German Society of Trauma Surgery (DGU) this study analyzed the current situation with respect to the proportion of fracture-associated joint arthroplasties among the total volume carried out in Germany. ⋯ The data analyzed in this study and the results obtained from known literature sources demonstrate that THA is the most frequently performed procedure in trauma management of femoral neck fractures. Because of the ubiquitous and high incidence and the need for emergency treatment due to correlated risks and complications of delayed treatment, a high and standardized around the clock (24 h and 7 days a week) treatment option is mandatory. Long waiting times to treatment or transfer are inacceptable due to the increased mortality and complications.
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Sacral insufficiency fractures develop due to a discrepancy between physiological load and load-bearing capacity. Besides osteoporosis as the main predisposing factor, other diseases lead to a loss of the bony elastic resistivity and therefore are able to cause these characteristic bilateral sacral stress fractures. Most patients complain of low back pain and show difficulties in mobilization. ⋯ We present the case of a 56-year-old man, in whom the progression of B-cell chronic lymphocytic leukemia (B-CLL) led to the development of osteolysis in the posterior pelvic ring and caused a sacral insufficiency fracture. Due to the progressive deterioration of mobilization and the persistent severe pain, we decided to stabilize the posterior pelvic ring. After surgery the patient could be mobilized and the pain was significantly reduced.
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Sports injuries and their treatment have become increasingly more important in recent years due to the leisure behaviour of our society. Besides the aspects of acute care and medical treatment there often remains the question of optimal rehabilitative care and return to sports. Overall, the correct early planning of rehabilitation has a great influence on the prognosis of sports injuries and the date of resumption of sporting activities. ⋯ A multidisciplinary and interdisciplinary, phase-dependent, individual treatment plan that also complies with the biopsychosocial background of the athlete must be created for this purpose. Increasingly relevant is also the sport psychological support during all phases of rehabilitation, including the use of cognitive behavioral therapy. Before an athlete returns to sports and competition, objectified sport-specific criteria must be met.
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The German statutory accident insurance (DGUV) has the statutory mandate to eliminate or to prevent an aggravation of the consequences of accidents by all appropriate means and is based on the principle of rehabilitation before pension. For this, special methods have been developed in recent decades, such as employer's mutual insurance inpatient further treatment (BGSW, Berufsgenossenschaftliche Stationäre Weiterbehandlung) and extended outpatient physiotherapy (EAP, Erweiterte Ambulante Physiotherapie). In 2012 the workplace-related musculoskeletal rehabilitation (ABMR, Arbeitsplatz-bezogene muskuloskelettale Rehabilitation) was added to these complex treatments. ⋯ An appropriate treatment of severely injured patients is important, for example through rehabilitation managers, which must not end with discharge from the rehabilitation hospital. The aim of all efforts is the reintegration into the working and social environment in addition to the best possible quality of life.
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The treatment of acute peripheral finger injuries is part of the daily routine of surgeons in emergency departments. This article presents the most common forms of peripheral finger injuries and the specific diagnostic and therapeutic aspects. The injuries include incision and tear injuries, injuries to the nailbed, distal extensor tendon injuries, severed flexor tendons of the distal joint, bite injuries, high-pressure injection injuries and amputation injuries of the distal phalanx of fingers. ⋯ Pathogenic organisms are detectable in more than 80 % of bite wounds so that prophylaxis and therapy of infections are of special importance. An adjuvant antibiotic therapy is necessary for infections as well as for high-pressure injection injuries. It is also important for the treating physician to recognize when a hand surgeon must be involved.