Der Unfallchirurg
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Multicenter Study
[The surgically treated gunshot injury : Securing evidence in hospitals without primary participation of police or legal medicine.]
Against the background of a problematic reconstruction of a hunting accident, the question arises how such cases can be handled in hospitals and how exhibits can be adequately dealt with. After evaluating a questionnaire on current conditions of securing evidence in cases of surgically treated gunshot wounds from 26 surgical institutions in Mecklenburg-Western Pomerania and in consideration of the certified advanced training in the field of legal medicine, recommendations are given regarding the securing of evidence within the clinical setting without primary involvement of police or legal medicine.
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Fractures of the distal third of the clavicle represent 10-30% of all clavicle fractures . Frequently, these fractures result in instability due to a combination of bony and ligamentous injury. Thus, assessment of the stability is essential for adequate treatment of these fractures. ⋯ Fractures to the distal third of the clavicle without instability can be treated conservatively with satisfactory outcome. In contrast, instability may result in symptomatic non-union under conservative treatment; therefore, distal clavicle fractures with instability should be treated operatively with respect to the functional demands of the patient. Operative treatment with locked plating in combination with coracoclavicular fixation results in excellent functional results. Arthroscopically assisted fracture fixation may be beneficial in terms of a minimally invasive approach as well as assessment and treatment of associated glenohumeral lesions.
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Case Reports
[Aseptic acetabular necrosis with recurrent luxation of a bipolar hemiarthroplasty into the retroperitoneum.]
In comparison to aseptic osteonecrosis of the femoral head, the occurrence of aseptic acetabular osteonecrosis is extremely rare. This article reports the case of a 77-year-old woman with a large defect of the posterior acetabular wall (type 3 AAOS/D'Antonio score). We present an option for treatment in cases of a combination of osteonecrosis with implanted bipolar hemiarthroplasty.
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The number of (seriously) injured children increased again for the first time in 2011. The aim of this study was to analyse differences compared to multiple injured adults and to show the reality of daily treatment. ⋯ The percentage of severely injured children in the overall population is only 7.4%. Because the majority of patients are primarily treated in supraregional trauma centers, trauma centers with specialisation in paediatric traumatology are mandatory.
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Using data between 2010 and 31 March 2012, a cohort study concerning complications of all discharged patients who had undergone surgery was performed. ⋯ Recording and evaluating of complications in surgery plays a major role for quality control. Certain factors (e.g., comorbidity and the age of the patient) cannot be influenced, but complications caused by technical problems could theoretically be avoided. Especially these cases must be analyzed in detail to reduce the percentage of complications requiring revision.