Der Unfallchirurg
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Hand surgery often needs only a short length of stay in hospital. Patients' comorbidity is low. Many hand surgery procedures do not need inpatient structures. Up until 2006 special procedures of hand surgery could not be coded. The DRG structure did not separate very complex and less complex operations. Specialized hospitals needed a proper case allocation of their patients within the G-DRG system. ⋯ The changes in the DRG structure and the implementation of the new OPS code for complex cases establish a strong basis for the identification of different patient costs. Different case allocation leads to different economic impacts on departments of hand surgery. Whether the new OPS code becomes a DRG splitting parameter has to be calculated by the German DRG Institute for further DRG versions.
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The fingertip is an extremely specialized end organ with a highly developed sense of touch. In this article, we present the different ways of reconstructing a traumatized fingertip. ⋯ The advantages and disadvantages of each flap are highlighted. We develop an algorithm to facilitate finding the correct type of reconstruction.
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Gunshot injuries to the head and brain are rare in Germany and the rest of western Europe. With the relatively low number of these injuries here, there are no standard methods of diagnosis and management, and there is some controversy over both. Quite a high proportion of such injuries result from suicide attempts and accidents. ⋯ The operative management depends on the extent and prognosis of the injury; a ventricular drain is probably indicated in most cases. Debridement of the bullet's path and removal of the projectile are more controversial. Mortality is extremely high after such injuries; if the victim does survive the prognosis is comparable to that following closed cranial injuries.