Der Unfallchirurg
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Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results. ⋯ Each case needs a thorough and individualized preoperative assessment along with exact planning and should therefore be reserved for experienced shoulder surgeons only.
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The management of glenohumeral osteoarthritis in younger patients with high activity levels remains a challenge to orthopedic surgeons. The clinical results of joint replacement surgery are commonly unsatisfactory in this particular cohort with the associated problem of limited longevity of the implant. ⋯ Arthroscopic procedures are a good option to treat young, active patients with osteoarthritis of the shoulder. Patient selection and setting a consensus for appropriate preoperative expectations are of particular relevance.
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Complications related to arthrodesis of the ankle or total ankle replacement require a critical assessment of the indication. Using denervation of the ankle, we have the possibility to delay the above-named surgical treatment for a number of years. The aim of this follow-up study was to review the results of ankle denervation after several years. ⋯ Ankle denervation can achieve good ankle pain reduction in the treatment of ankle arthrosis. Denervation should be considered a long-term treatment concept.
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Trauma-induced coagulopathy is common in patients with major trauma and requires early and appropriate treatment for bleeding control. Even in emergency laboratory, the availability of standard coagulation tests is associated with certain latencies and devices for viscoelastic haemostasis diagnosis (thromboelastometry) are not routinely established in major trauma centres. ⋯ We found a robust correlation of Hb and Quick in a single centre trauma population. These data suggest that especially severely injured trauma patients with persistent bleeding might benefit from an Hb-based algorithm for early correction of coagulation disorders. Further studies with larger trauma populations are required to confirm our findings.
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The treatment of open fractures is a challenge for the attending surgeon. Depending on the severity, the risk of infection rises up to 50%. ⋯ This potentially life-threating syndrome usually presents with the main symptoms of fever, hypotension and exanthema and is caused by toxins, such as toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins A-D. In some cases it is associated with cardiopulmonary decompensation and can rapidly progress to multiorgan failure.