Der Unfallchirurg
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Usually, conventional radiographs are appropriate for injuries in the region of the thoracic and lumbar spine (TLS) in children and adolescents. The aim of our study was to determine the incidence of trauma-associated radiographic findings in this anatomical region and to present the therapeutic consequences. ⋯ With 5.6 % TLS-injuries in children and adolescents, the study revealed a low fracture rate in a highly radiosensitive region. With regard to an expected stable fracture morphology and the absent surgical consequences, the indication for emergency radiographs should be provided restrictively.
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The potential association of external factors such as time of day, lunar phases or specific weather conditions on the daily management and outcome of trauma emergencies remains under debate. We undertook this trauma centre investigation to detect possible worthwhile factors of influence in order to optimize the organizational structure of trauma admissions. ⋯ The study shows a significant relationship between specific weather conditions, such as higher daytime temperature or change in circulation, and the admission of major trauma patients. Due to the small effect in our setting, our results do not implicate any according change in the management of resources. Nevertheless, for hospitals in other geographic or more exposed weather regions, such effects could indeed be relevant and therefore should be tested.
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Traumatic hip dislocations in children are not frequent but constitute true emergencies. They require urgent reduction because of the risk of consecutive avascular necrosis of the femoral head. ⋯ Once home, X‑ray and CT diagnostics were completed by MRI. In future, long-term clinical and radiological investigations for avascular necrosis and growth disorders, as well as thoroughly informing the parents, should be mandatory.
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Patient safety has increasingly gained significance as criterion which clinics and doctors will be measured against in terms of ethics and finances. The "human factor" moved into focus regarding the question of how to reduce treatment errors in clinical daily routine. Nevertheless, systematic mediation of interpersonal competences only plays a minor role in the catalogue of requirements for medical specialization and professional training. ⋯ In aviation, apart from the training of procedural and technical abilities, regular soft skills training has become standard in the training of all Lufthansa staff. Several studies confirm that by improving communication, interaction, and teamwork skills not only a reduction of intolerable incidents is observed, but also a positive economic effect. Interpersonal competences should be firmly anchored in orthopedics and traumatology and thus be implemented as third post in specialist training.
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The results and immediate consequences of intraoperative three-dimensional (3D) imaging in the treatment of AO classification type C fractures of the distal radius, the tibial head and the tibial pilon were analyzed and compared with published results on general intraoperative revision rates following intraoperative 3D-imaging. ⋯ Intraoperative revision rates following 3D-imaging increased with the severity of the injury pattern. Intraoperative 3D-imaging should be routinely used in the treatment of fractures of the tibial head, tibial pilon and even in comminuted distal radius fractures due to the high intraoperative revision rates found in the present study. Alternatively, a postoperative computed tomography (CT) control should be performed.