Der Unfallchirurg
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Concussion injury of the brain is still a frequently underestimated injury, which can be associated with long-lasting consequences. Compared to adults, the recovery phase is often prolonged in childhood. Primary treatment consists of symptom-dependent physical and mental activities. ⋯ Comparable concepts are not established in Germany. In addition to well-known standard return-to-play protocols for sport re-integration, it is urgently recommended to integrate gradual return-to-learn protocols. Thus, academic adaptations and support must be established as well as symptom-oriented organizational and teaching modules.
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Historical Article
[On the history of cementless implants in extremity surgery].
The aim of implantation of cementless hip prostheses is vital ingrowth of bone into the structured metal surface of the implant. Since the 1960s several implants with surfaces made of cobalt-based alloys have been produced for this purpose. In the 1980s a novel hip endoprosthesis with a spongiosa-metal surface was introduced. ⋯ These implants made of cobalt-based alloys can also be used in endo-exo prostheses. Titanium implants with a microstructured surface have also been used and very good osseintegration of the surface was also demonstrated by histomorphology. The optimization of the surface and design of the prostheses plays an increasingly more important role in the field of revision endoprostheses.
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Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. ⋯ For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. ⋯ Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.
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Transport statistics classify bicyclists in a separate road user collective. For medical reasons, this differentiation is applied as well. Much literature is published in this field. Nevertheless there is a lack of literature regarding the overall injury patterns in a defined injury severity collective. Most literature is about isolated injured regions in combination with a heterogeneous injury severity. Further parameters, such as injury patterns, epidemiological aspects, treatment focal points and characteristic outcomes, have also been studied. The aim of the present study was to evaluate and characterize injury patterns in a standardized and representative collective of severely injured bicyclists. Methods We analysed data from the Traumaregister DGU® from 2002 to 2010. In total, 2817 severely injured (ISS ≥ 9 and additional intensive/intermediate care unit) bicyclists were included. The primary endpoint was evaluation of injury patterns and injury focal points. In addition to that we analysed parameters like epidemiological aspects, circumstances of accident, treatment focal points and outcome. ⋯ The present study analysed the largest ever published collective of severely injured bicyclists. Traumatic brain injury could clearly be shown as the main injury in this collective. Moreover, one of five cases achieved the state "severely injured" due to mono-injury.