Der Unfallchirurg
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Scaphoid fractures are frequent but are overlooked in 20-40% of cases on initial radiographs. In so-called occult scaphoid fractures, i.e. clinical scaphoid fractures with negative X‑ray diagnostics, the hand of the patient is often empirically immobilized with a cast and the X‑ray diagnostics repeated 10 days later. ⋯ Pensioners and patients with low manual demands, however, can be treated according to the traditional algorithm. Additional use of computed tomography (CT) or magnetic resonance imaging (MRI) diagnostics with or without intra-articular contrast agent might be helpful if concomitant soft tissue injuries are suspected.
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For various reasons many patient groups are unable to perform high-intensity strength training. ⋯ The effectiveness of low-intensity BFR training is lower than for classical high-resistance training; however, it may be used as additional training method in rehabilitation programs.
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Needlestick injuries (NSI) are potentially infectious injuries from sharp or pointed medical instruments and through contact with blood on mucous membranes or nonintact skin. Although the European Union (EU) Council directive 2010/32/EU on the prevention of NSI was implemented in EU countries in 2013, information on the effectiveness of the measures is limited. ⋯ Implementation of the EU Council directive 2010/32/EU, resulted in an almost 50% reduction in NSIs over 1 year, including the complete prevention of NSIs due to scalpels. In addition, the anamnestic presence of immunization against hepatitis B and index patient identification were significantly increased.
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Observational Study
[The Berlin mass casualty hospital triage algorithm : Development, implementation and influence on exercise-based triage results].
Patient triage has a key function within the scope of the successful management of mass disasters and ensures the correct resource allocation. Analysis of unheralded hospital disaster training in Berlin hospitals revealed triage problems referring the correct classification of patients in the triage categories and relevant overtriaging and undertriaging. Therefore, a triage algorithm tailored to the clinical setting was developed in Berlin and after presentation and discussion within the circle of the representatives for clinical catastrophe protection, the algorithm was introduced as obligatory in 2015. This study was carried out to validate and investigate the effects of the triage algorithm. ⋯ The Berlin hospital triage algorithm was successfully validated. The triage category allocation was significantly improved in all relevant aspects after implementation with a significant reduction of overtriaging and undertriaging.
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Lesions of peripheral nerves substantially influence the long-term prognosis and functional outcome. Approximately 70% of peripheral nerval lesions are associated with vascular injuries and occur more frequently with certain fractures and osteosynthesis types. The prognosis and treatment depend on the severity of the injury and the presence of axonal lesions, in particular, determines the further procedure. ⋯ Iatrogenic vascular lesions occur particularly in percutaneous interventions and are reported in up to 8% of cases after operations involving the musculoskeletal system. Iatrogenic nerve lesions are almost exclusively the result of surgical procedures and represent up to 17.5% of traumatic nerve injuries. For all lesions the general principles of surgical treatment are valid and the rapid involvement of professional expertise is decisive.