Der Unfallchirurg
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Review Case Reports
[Does a physician have to inform the patient about the rare risk of priapism before administering an anticoagulant?]
There are no pharmaceuticals without side effects. Primary care physicians and especially hospital staff have to ask themselves every time they are administering medication whether they should inform the patient about possible risks and alternative treatment options. The "bizarre" side effects which can occur even from taking routine medication are illustrated by a legal case decided by the District Court of Hannover: After surgery a patient developed an anticoagulant-induced priapism. ⋯ The District Court now had to decide whether the hospital is duty bound provide patients with such detailed information in order to obtain informed consent. The Hannover Court, and also later the Court of Appeal in Celle, answered this question in the negative; however, the decision shows that it is not sufficient for the treating physician to refer the patient to the patient information leaflet. Instead the physician is legally bound to personally and orally inform the patient about the risks and possible side effects, even when they are rare but typically associated with the prescribed medication.
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Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. ⋯ Prerequisites for corrective osteotomy are a precise analysis of the deformity, precise osteotomy, exercise stable osteosynthesis and intensive follow-up treatment of the hand. Complications, such as implant failure, postoperative tendon and joint adhesions, joint contracture and nonunion are however possible.
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Over the last decade, the percentage of people >65 years has increased from 16.6% to 20.7%. In industrialized countries, the annual incidence in people >65 years with a proximal femur fracture is about 600-900 per 100,000 population. The incidence will increase by 3-5% per year. Guidelines advocate early surgery as soon as possible but within 24 h. External quality control requires surgical treatment within 48 h. In this study, the changes in the patient population with proximal femur fractures and their treatment during the last decade were investigated. ⋯ The increase in the number of patients, as well as the requirements of the guidelines and external quality control are relevant challenges for the hospitals. More human and material resources (e. g., surgical capacity) are needed. The increase in the age of the patients, their comorbidities, and medication must be taken into account, e. g., in the context of geriatric orthopedic trauma centers.
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Combinations of sternal and spinal fractures often occur due to high velocity accidents and are associated with a high incidence of concomitant injuries. The anterior thoracic wall is described as the fourth column of torso stability, which is why sternovertebral injuries (SVI) present a high risk of sagittal deformation of the trunk, in particular injuries of the thoracic spine. To date, no studies have been published on the frequency distribution of the involved vertebral bodies in large patient groups. ⋯ Of all patients with a SF 30.96% also suffered from a vertebral fracture. Of these 3.11% were SF as the main diagnosis and 60.89% the secondary diagnosis. While vertebral fractures generally occurred most frequently in the region of the thoracolumbar transition and the second cervical vertebral body, the SVI showed a further frequency peak in the range from the lower cervical spine to the middle thoracic spine. The present study was able to show a frequency distribution of accompanying vertebral body injuries in a large and representative collective in the case of SF for the first time.