Der Unfallchirurg
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The white paper on the medical care of the severely injured published in 2006 is a collection of proposals and recommendations concerning structure, organization and equipment for the medical care of severely injured patients. Since its publication 50 networks ( http://www.dgu-traumanetzwerk.de/index ) have been established as part of the trauma network. This and the trauma register have helped to continuously improve the medical care of severely injured patients since 1993 [26]. ⋯ A highly critical view is taken of the new surgical specialists with respect to interdisciplinary and comprehensive emergency medical treatment and casualty care. The survey also revealed the continual conflict between managing costs and maintaining quality and resources. It gives an overview of patient treatment in the transition from preclinical to clinical care and provides insights into the targets achieved, current problems and conflicts.
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Osteoporotic fractures of the pelvis are an increasing problem in trauma surgery. Sufficient implant anchorage is reduced due to the poor bone stock; however, early mobilization is especially necessary for geriatric patients in order to prevent additional complications. ⋯ The use of special implants (cannulated and perforated screws) as well as intraoperative navigation and 3D imaging increase patient safety and help to make implant augmentation a low risk procedure.
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Coverage of extensive tissue defects is one of the tasks of plastic surgery. For the surgeon there are a series of possibilities differing in safety level and difficulty. With extensively exposed bones, however, there is mostly the indication for free tissue transfer. In the following case a possibility of wound closure of an extensive defect by one single free flap without preconditioning the tissue is demonstrated.
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Geriatric complex treatment (GCT) is a new type of early rehabilitative care. The main goal is to maintain personal autonomy. GCT includes 21 treatments by physio-, occupational and speech therapists, accompanied by specialized nurses. The aim of this study was to investigate how elderly patients benefit from the GCT after hip fractures (HF). ⋯ The GCT patients in our study were more likely to be dependent on care and have cognitive deficits. Only cognitively impaired patients were shown to benefit from GCT. In the remaining patients no difference was found, thus, only cognitively impaired patients currently undergo GCT at our clinic.
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Phlebothromboses represent alarming complications in accident victims since they can cause fatal pulmonary embolisms. More than half of those affected also develop post-thrombotic syndrome in the course of the illness. In addition to making clinical assessments, the traumatologist should also have fundamental knowledge about diagnostic methods and be familiar with interpreting internal findings. ⋯ It is not uncommon for post-thrombotic syndrome to be diagnosed for the first time during this process. An additional vascular appraisal is often required. An appreciation of social-medical and insurance-related aspects means a high degree of responsibility is placed on the expert.