Der Unfallchirurg
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Fractures of the knee region in childhood and adolescence are rare but are an important group of injuries due to the high incidence of secondary complications from growth disturbances. Meticulous primary diagnostics and fracture treatment with clear indications for surgical treatment are essential for avoiding posttraumatic deformities, although these can occur even despite correct primary treatment and are therefore inherent to specific fractures and therefore often unavoidable. In cases of growth disturbance where a deformity is imminent or has already taken place, watchful waiting until closure of the growth plate is only rarely indicated due to the progress made in directing growth via surgical means. Even surgeons who are primarily working in the field of fracture treatment must be aware of current strategies for correction of posttraumatic deformities in order to prevent or treat them in time or at least be able to prophylactically inform patients and parents during primary fracture treatment.
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Review Meta Analysis
[Geriatric fracture centers : Improved patient care and economic benefits].
The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. ⋯ These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients.
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In the elderly, fractures and other severe injuries frequently lead to substantial restrictions in the activities of daily living (ADLs) resulting in dependency. Typical complications following a fracture include acute delirium, deep vein thrombosis, pneumonia and other infections. It has been demonstrated that early surgery (osteosynthesis) and early mobilization significantly decrease the risk of these complications. ⋯ The role of the geriatrician in the treatment of orthogeriatric patients includes treatment of internal medical comorbidities, geriatric assessments, coordination of the geriatric team as well as diagnostics and treatment of osteoporosis. In the future, the geriatrician's task will include the preoperative evaluation of orthogeriatric patients, which is already a routine procedure in many orthogeriatric centers. The aim of this article is to summarize the evidence from the currently available literature for interdisciplinary treatment of orthogeriatric patients and to give an overview of the diagnostic and therapeutic interventions relevant to the routine practice for the orthopedic surgeon.