Der Unfallchirurg
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Comment Letter
[Gunshot and stabbing injuries : Look beyond the horizon].
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The initial diagnostic procedure of severely injured patients in the emergency room (ER) during the primary survey is first and foremost a clinical examination. The clinical S3 guidelines provide recommendations for the treatment of patients with severe and multiple injuries. ⋯ Key symptoms registered during the clinical examination are not sufficiently safe to be solely relied upon for further diagnostic and therapeutic decisions. This confirms the sense of purpose of the strict approach according to the advanced trauma life support (ATLS) algorithm. Red flags can serve as a warning to focus on relevant injuries early on. A rational imaging diagnostic procedure must follow.
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In order to ensure adequate treatment and to avoid complications, care bundles are increasingly being implemented. These are comprehensive and evidence-based procedures for the treatment of individual diseases or injuries which should be carried out for every patient. The aim of this study was to define a care bundle for the prehospital treatment of severely injured patients. ⋯ A bundle of six elements was suggested and a comprehensive summary of key items during prehospital management of severely injured patients was identified. In a next step the effectiveness of the care bundle should be evaluated in a clinical trial.
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Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. ⋯ Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.