Der Unfallchirurg
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Large financial resources are needed to treat fractures. Surprisingly little is, however, known about actual numbers, treatment methods or outcomes. A large population-based observational study can add valuable knowledge, especially if patient-reported results are included. ⋯ More than 285,000 fractures have been registered. The database is increasing at a rate of 70,000 fractures a year, i. e. one fracture every 7 min. The aim of this article is to describe the first seven years in the history of the SFR, with opportunities for the future as well as limitations.
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This overview article highlights the central role of health services research (HSR) for the further development of the healthcare system. As a young scientific discipline in Germany, HSR covers five important elements with different weighting in different definitions, which are elaborated in some detail in this article: patient orientation, results and outcome orientation at the patient and population levels, implementation perspectives and context relation, complex interventions and improvement, multidisciplinarity and multiprofessionalism. One of the fundamental pillars of HRS is related to the insufficient implementation of scientifically proven treatment methods and improvement strategies into routine patient care. ⋯ The scientific methods used in HSR clearly extend beyond the spectrum of (clinical) epidemiology. The methodological standards are developed as consensus memoranda of members of the German network of HSR, which serve as orientation points for qualitatively good HSR. Finally, various perspectives for the long-term safeguarding and improvement of the quality of HSR in Germany are proposed.
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The principle of self-assessment is performed successfully in a wide variety of medical disciplines and is increasingly gaining importance in orthopedic trauma surgery. Through the development and validation of joint-specific self-assessment questionnaires that enable estimation of the range of motion, a large number of patient-based instruments are available for comprehensive follow-up examination. A recently performed proof of concept study showed a high patient acceptance and therefore the development of a prospective, patient-centered fracture register based on the self-assessment functional analysis seems to be promising. The data obtained should reflect not only the reality of fracture treatment but also generate valuable epidemiological data with which evidence-based guidelines can be formed.
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Simultaneous fracture of the acromion and coracoid process represents a double disruption of the superior shoulder suspensory complex (SSSC). To date, the two largest reported series have comprised five and eight cases. The aim of this study was to investigate the functional outcome in patients who sustained this rare injury and to provide a review of the relevant literature. ⋯ This rare injury pattern is usually caused by high-impact trauma, and concomitant injuries frequently occur. Nevertheless, surgical stabilization of at least one of the fracture sites showed satisfactory functional results.
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Supramalleolar deformities require surgical correction to avoid posttraumatic osteoarthrosis of the knee or ankle joint and to prevent definitive treatment options, such as total ankle arthroplasty or arthrodesis of the ankle joint. Various methods for the operative correction of supramalleolar deformities have been described in the literature. ⋯ Supramalleolar dome type osteotomy is a technically difficult method for acute correction of supramalleolar deformities. The functional results and complication rates are comparable to those in the literature for alternative osteotomy techniques.