Der Unfallchirurg
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The cost pressure in a competitive environment forces hospitals and physicians to optimize clinical processes. In order to secure competitive advantages, a continuous evaluation of relevant processes is necessary. ⋯ By analyzing the pathways and times of patients, various reasons for waiting times in the university outpatient clinic could be shown. This study shows that a structured application of lean management and a dedicated analysis create added value for patients by reducing waiting times.
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With a prevalence of approximately 0.4%, distal femoral fractures are a rare entity. Nevertheless, due to the high mortality rates, which are comparable to proximal femoral fractures, these fractures are highly important. The clinical symptoms are often quite striking. ⋯ The use of external fixation of the complete knee joint in the sense of damage control surgery, is useful. For definitive treatment retrograde intramedullary nailing and locking plates with angle stable screws are the main options. Modern angle stable and anatomically preformed implants enable surgical treatment using minimally invasive approaches to protect the soft tissues, with a better overall outcome.
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A 24-year-old male patient who suffered a periprosthetic fracture of the left distal femur due to an e‑scooter accident was referred to the outpatient department of tumor orthopedics. The patient had been diagnosed with Ewing's sarcoma of the left proximal tibia 11 years previously that was treated with a tumor endoprosthetic reconstruction. The current periprosthetic fracture required a further bony resection of the distal femur as well as a reconstruction with a knee revision implant. The aim of this case report is to raise awareness for a new potential source of danger in the presented risk group.
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A high level of hand hygiene compliance is the best way to prevent postoperative wound infections and is therefore an important starting point for interventions. Despite different campaigns the hand hygiene compliance of physicians remains to be improved. The aim was to analyze the effect of tailored and innovative interventions on the hand hygiene compliance of physicians. ⋯ Training concerning hand hygiene has to be improved to increase the prevention of infections. Tailored interventions with a high amount of practical relevance are suited to increase the compliance with preventive procedures (e.g. hand hygiene compliance). To improve the infection prevention for physicians in the long term, a firm knowledge about the indications for hand hygiene procedures is needed. This can be ensured by infection control training with a practical focus, small memory aids and permanent support from infection prevention professionals.
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Geriatric patients are currently responsible for almost one third of all emergency hospital admissions. An increase of 50% is expected in the next decade. This age redistribution poses new challenges for inpatient care and discharge management. The requirements of an orthopedic trauma surgery clinic in the care of this patient group can be clarified with the help of this first collaboratively created geriatric orthopedic trauma surgery complex treatment unit of a university hospital. ⋯ Patients with dementia are more likely to develop delirium postoperatively, which leads to an increase in the length of inpatient stay, an increase in treatment costs and more work for the discharge management team. In addition, the discharge to the patients' home is impaired by delirium, which means that the growing need for places in short-term care and nursing homes also creates socioeconomic burdens.