Der Unfallchirurg
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The trauma registry of the German Trauma Society (TraumaRegister DGU®) is not only a tool for quality management but also for research purposes. ⋯ The number and impact factors of publications from the TraumaRegister DGU® rose steeply during the last 10 years and in the last 3 years consisted of 25 publications per year. More than two thirds of them were published in high quality international journals and reflect the great scientific importance. For the German speaking readership and the specific aspects of treatment of the severely injured relevant to Germany, the large number of German language articles are just as important. Independent of the impact factor publications in Deutsches Ärzteblatt, the journal with the highest circulation and Der Unfallchirurg play the most important role. A large amount of scientific information gained from the TraumaRegister DGU® has been included in treatment guidelines and structures. The register is a basic prerequisite for the TraumaNetzwerk DGU®. Since almost all severely injured patients in Germany are now included in the registry, it is possible to obtain epidemiologically reliable data of treatment and outcomes for these patient groups.
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Registries are becoming increasingly more important in clinical research. The TraumaRegister DGU® of the German Society for Trauma Surgery plays an excellent role with respect to the care of severely injured patients. ⋯ The present investigation underlines the importance of standardized checks concerning data provided for registries in order to be able to guarantee an improvement in entering data.
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Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires. ⋯ In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.
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Operative treatment of clavicle fractures by intramedullary nailing with titanium elastic nailing (TEN) has been established as an alternative to plate osteosynthesis for many years. The main complication after TEN osteosynthesis is nail migration. The goal of this study was evaluation of predictors for medial nail migration and comparison with plate osteosynthesis. ⋯ Advantages of TEN are a shorter surgery time as well as a shorter duration until implant removal. The TEN osteosynthesis led to a significantly increased complication rate, with nail migration representing the major reason. When predictors for medial TEN migration are considered, type B and C fractures can also be sufficiently treated by a large diameter TEN.
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The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. ⋯ After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.