Der Unfallchirurg
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Multicenter Study
[Interdisciplinary treatment in geriatric traumatology from the trauma surgeons' perspective : Results of a survey in Germany].
Many patients treated on trauma surgery wards are geriatric trauma patients. To improve treatment of these often multimorbid patients, various interdisciplinary treatment concepts have been established in Germany between trauma surgeons and geriatricians. ⋯ The results of this survey underline the impact and the positive experiences in orthogeriatric services. Solutions have to be found to address the emerging problem of capacity constraints.
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Posterior cruciate ligament (PCL) injuries are still often overlooked and treatment of a ruptured PCL is inherently different in comparison to anterior cruciate ligaments (ACL). Conservative treatment is the first-line therapy for acute isolated PCL injuries leading to good clinical and biomechanical results. ⋯ The same is true for high grade chronic PCL insufficiency. Meticulous classification of PCL injuries taking all stabilizing factors of the knee joint as well as the time from injury into account are essential for successful treatment of PCL injuries.
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Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. ⋯ Current guidelines and recommendations advocate the initiation of volume replacement at a reduced level in bleeding and hypotensive trauma patients in terms of "permissive hypotension," with the aim of maintaining mean arterial blood pressure (MAP) at 65 mm Hg and/or target systolic blood pressure at 80-90 mm Hg so as not to exacerbate the bleeding until its source can be controlled. Advanced Trauma Life Support principles, together with independent measurements of hemoglobin, base excess, and/or lactate, are recommended as sensitive tests for assessing the extent of bleeding and shock. Isotonic crystalloid solutions should be used as first-line volume replacement in bleeding, hypotensive trauma patients. Specific recommendations apply for patients with traumatic brain injury.
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Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented. ⋯ The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.
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Locking head systems are an additional option in the surgical treatment of metacarpal fractures. In this clinic 2.0 mm locking compression plates (LCP) are used, which provide the possibility of functional postoperative treatment even for complex and osteoporotic metacarpal fractures. For simple fractures and good bone quality the LCP system is used as a compression or neutralization plate. Depending on the type and localization of the fracture, different osteosynthesis techniques are used in order to achieve a functional postoperative treatment in as many patients as possible. ⋯ After osteosynthesis with 2.0 mm LCPs all types of metacarpal fractures can be treated without immobilization.