Der Unfallchirurg
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The 3D printing technology enables precise fracture models to be generated from volumetric digital imaging and communications in medicine (DICOM) computed tomography (CT) data. Apart from patient treatment, in the future this technology could potentially play a significant role in education and training in the field of orthopedic and trauma surgery. Preliminary results show that the understanding and classification of fractures can be improved when teaching medical students. ⋯ Especially for complex articular fractures, such as those of the acetabulum and tibial plateau, initial evidence shows patient benefits in terms of reduced surgery time and blood loss with the help of 3D models. The use of 3D printing on-site at the hospital is of particular interest in orthopedic and trauma surgery as it promises to provide products within a short time. The low investment and running costs and the increasing availability of convenient software solutions will spur increasing dissemination of this technology in the coming years.
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Ankle fractures have many short and long-term consequences for patients. For this reason, psychosocial factors also play a role in the success of the treatment in addition to the surgical treatment. ⋯ In addition, an overview of the empirical data with respect to psychological influences and outcome factors in lower extremity fractures, specifically ankle fractures, is given. The current research indicates that psychosocial factors have a decisive influence on the physical and psychological outcome.
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Review
[Human patient simulators for training in emergency surgery : Needs, status quo and potential].
Surgical providers must maintain currency and competency for low-volume high-risk procedures for optimal outcomes. There are currently a number of methods available to train for these rare but vital skills, ranging from simple to complex and inexpensive to expensive. Traditionally, these skills have been taught using human cadaveric and animal models, which are limited by availability (cadavers) and social acceptability (animals). ⋯ Partially perfused human cadavers have recently been shown to be an important adjunct to established trauma training. Human patient simulators (HPS) and the associated technology is rapidly expanding, but currently lack consistent realism to be used for competence training, when compared to traditional models and are currently cost-prohibitive. It will be important for surgical trainers and trainees to remain engaged and facilitate the development of realistic cost-effective training tools.
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Fragility fractures of the pelvis are increasing in frequency. In most cases patients suffer a minor injury, have intense pain in the pelvic region and impaired mobility. The new fragility fractures of the pelvis (FFP) classification distinguishes between four types with increasing instability. ⋯ Alternative techniques for dorsal stabilization are iliosacral screw and transsacral bar osteosynthesis, transiliac internal fixator and lumbopelvic fixation. External fixation, retrograde transpubic screw fixation, anterior internal fixation and plate and screw osteosynthesis are alternatives for the anterior pelvic ring. Treatment of fragility fractures of the pelvis should be carried out as part of an orthogeriatric co-management.
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In older patients the optimal treatment strategy of complex bone and soft tissue injuries represents a new challenge. Currently, two treatment approaches are in competition. ⋯ A possible alternative to the currently frequently used multistep procedure for limb preservation with continuous negative pressure treatment is the fix and flap or emergency free flap approach. Based on the case of a convulsion trauma in an 85-year-old patient, this case report describes a treatment approach for Gustilo-Anderson type IIIc fractures using a fix and flap procedure for limb preservation.