Der Unfallchirurg
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Occult fractures in children and adults cannot by definition be diagnosed by conventional radiographs. These injuries are usually recognized as bone marrow edema by magnetic resonance imaging (MRI). There are no randomized controlled trials or prospective cohort studies concerning the correct management of occult fractures and, therefore, no evidence-based treatment guidelines can be drafted. ⋯ The clinical prognosis of occult fractures is generally good and there is no evidence that these lesions need specific treatment. Besides forensic applications and problems pursuant to insurance law, MRI examination is only indicated when conventional radiographs are unremarkable, pain persists for an unusually long period of time and when a relevant therapeutic consequence can be expected from the MRI results. Classical pitfalls are combinations of occult fractures with potentially unstable ligamentous injuries and patients with disordered pain perception as in cases of diabetic polyneuropathy, as the common therapeutic concept of weight bearing according to pain is not suitable for these patients and can lead to severe complications.
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Clinical Trial
[Biaxial reconstruction nail for pertrochanteric femoral fractures : Osteosynthesis.]
The steady rise in life expectancy of our population leads to an exponential increase in proximal femoral fractures. The growing increase of comorbidities in these patients requires continuous development of modern implant systems for internal fixation of proximal femoral fractures. ⋯ The results of this study showed a low rate of perioperative complications and implant loss anda decline in patient mobility was typically observed within 1 year.
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We describe the case of an 88-year-old woman who presented with painful symptoms of the pelvis after low-energy trauma. Conservative treatment with pain therapy and pain-adapted mobilization was unsuccessful. Diagnostics showed a fragility fracture of the pelvic ring; therefore, we performed photodynamic bone stabilization (IlluminOss™) of the pubic bone and percutaneous cement-augmented fixation of the iliosacral joint assisted by computed tomography (CT) fluoroscopy. Imaging showed a stable healed fracture 4 months after surgery.
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Comparative Study
[Deployment and efficacy of ground versus helicopter emergency service for severely injured patients : Analysis of a nationwide Swiss trauma center].
The influence of the transport mode, i.e. Helicopter Emergency Medical Service (HEMS) versus ground-based Emergency Medical Service (EMS) on the mortality of multiple trauma patients is still controversially discussed in the literature. ⋯ Using the newly established revised injury severity classification (RISC) score there was a tendency towards a better outcome for patients transported by HEMS (standardized mortality ratio 1.06 for HEMS versus 1.29 for EMS). Overall a short preclinical time and the presence of an emergency physician (EP) were associated with a better outcome.
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A 50-year-old patient presented with a lump in the main joint of the fourth finger of the left hand, which was suspected of being malignant, for an operation. Following surgery the lump was still present and, furthermore, the patient reported a wound resulting from surgery on the third finger accompanied by swelling, pain and a loss of mobility. The patient accused the physician of performing surgery without indications on the wrong finger together with failure to remove the lump. ⋯ The decision of the arbitration board differed from the expert opinion as the insufficient documentation presented at first could have been understood to mean that a tendon node on the fourth finger was to be removed which was not the case. Furthermore, the operation performed would only have been indicated if a "trigger finger" were present; therefore, the surgery as well as the resulting afflictions and follow-up treatment were to be assessed as faulty. The handwritten surgery report had several shortcomings as well and led to a reversal of the burden of proof.