Der Unfallchirurg
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Review
[Management of pre-existing anticoagulation for timely treatment of proximal femoral fractures].
Proximal femoral fractures are urgent indications for surgery. In cases of delayed surgical treatment more than 48 h after hospital admittance, increased rates of general complications, local complications and mortality have been proven. Since 2015, the quality target for the external quality assurance by order of the Federal Joint Committee (G-BA) is surgical treatment within 24 h after hospital admittance for osteosynthesis and within 48 h for joint replacement. ⋯ For 15% of each group of patients a prolonged preoperative preparation is accepted. In the structured dialog within the external quality management anticoagulants are quoted as the most frequent reason for delayed surgery. The present review provides a way to achieve compliance with statutory provisions, to minimize the risks of both bleeding and thromboembolism and to achieve surgical treatment of proximal femoral fractures within the agreed time limit.
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Luxation of the elbow occurs around the age of 7 years instead of a supracondylar humeral fracture. The most common complication is a fracture of the medial epicondyle of the ulna in the sense of a bony avulsion of the ligament. There are only few case reports regarding collateral injuries of the brachial artery. All authors have described this complication as being very rare. ⋯ The clinical suspicion of an injury of the brachial artery justifies a rapid diagnostic investigation by CT angiography and an open vascular intervention as the only possibility to recreate a sufficient blood flow.
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A mass casualty event (MCE) poses an enormous challenge for rescue services and hospitals. In addition to a hospital emergency plan, employee training and practice exercises are essential to be prepared for such an event. ⋯ Depending on the size (number of patients) and scope (extent of departments involved) of the MCE exercise in a hospital, a full-size MCE drill may entail costs between 10,000 and 100,000€. Since the execution of such exercises is essential in the sense of preparedness and considering quality management aspects, possibilities of refinancing and more cost-efficient training must be developed.
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Fractures of the lateral humeral condyle with displacement (>2 mm; <2 mm articular gap) require open reduction and stabilization. Non-displaced fractures should be treated conservatively; however, there are difficulties in the differentiation of complete (potentially unstable) an incomplete (stable) articular fractures. The aim of this study was to analyze the frequency of conservative and operative treatment approaches as well as the accuracy of treatment decisions based on fracture stability displayed on repetitive X‑rays. ⋯ Treatment decisions in pediatric lateral humeral condyle fractures are based on the primary and secondary fracture stability as observed in staged follow-up radiographs. Stable fractures, whether complete or incomplete, healed with good results after conservative treatment and overtreatment could be avoided. Unstable fractures, whether primary or secondary during the course, need to be recognized as such and operative treatment with a stable osteosynthesis must be initiated.
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Iatrogenic damage to the ulnar nerve after crossed Kirschner wire osteosynthesis of supracondylar humeral fractures is a preventable complication in pediatric traumatology, which occurs in up to 10% of cases. There are strategies in the literature for avoiding this complication but no consistent suggestions for action in the presence of the damage. ⋯ Respondents used the clinical extent of the lesion, the timing of the diagnosis and the nature of primary care as criteria for the indications in postoperative ulnar nerve damage. Differences in outcome between invasive and waiting strategies cannot be derived from the study.