Der Unfallchirurg
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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.
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The development of the healthcare system in Germany is increasingly approaching human and economic limits. A social consensus and a political concept at which point priorities are promoted and for which services the money should be primarily spent, do not exist on the whole. As soon as it becomes clear that resources are limited and that is now, prioritization has to be introduced to avoid the alternative threat of rationing of treatment benefits. ⋯ At the same time, unjustified claims for entitlement must be rejected just as a preservation of vested rights. Efficiency and economic considerations in diagnostics and treatment are not mutually exclusive. The physician acts as a mediator between the claims of the patient to be treated, the individual realization and the existing resources in the healthcare system.
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Numerous professional and societal developments nowadays fundamentally reduce the possibility of mastering all officially prescribed surgical training contents in sufficient quantities and in a target-oriented manner with sufficient operative internal clinical experience from the surgical daily routine. In order to learn key competences, modern simulation technology will have to be integrated into surgical training programs. ⋯ Financially, simulation is an expensive investment in training quality. The implementation of simulation technology can be a further impulse to design the structure of the continuing training landscape within the framework of a coordinated national or EU-wide overall training concept in such a way that the infrastructural, personnel and financial expenditure can be borne.
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After 6 years of development, the amended regulations for medical education were adopted by the German Medical Assembly in May 2018. The aim of the amendment is to move away from a predominantly chronologically standardized further training towards a content standardized further training with simultaneous definition of competence objectives. ⋯ Failure to achieve the training objective will result in the admission to the examination being refused. These high requirements seem to be attainable only if cognitive and action competences can be acquired before and during training in the real environment of the operating theatre in a standardized setting.
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Dislocations of the elbow during growth are rare but because of associated fractures a range of therapeutic methods are employed. The postoperative care is even more varied, so the scientific working group of the section for pediatric trauma of the DGU developed the following recommendations for the treatment of elbow dislocations in children and adolescents based on own experience and a review of the literature. Diagnosis is made from radiographs with at least one (preferably lateral) view showing the dislocation. ⋯ Mobilization is initially limited to the activities of daily life at first. 6 weeks after reduction physiotherapy may be initiated as warranted and patients can participate in sports again. An MRI of the elbow may be necessary if there are persistent problems. Even if a measurable loss of range of motion is often recorded, prognosis regarding a good functional outcome is favorable.