Der Unfallchirurg
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Blood flow restriction (BFR) limits arterial and venous blood flow and leads to blood pooling, which could increase exercise-induced training effects. Strength training at lower intensities (20-30% of maximum strength) in combination with BFR showed similar effects on muscle hypertrophy as training with 70% without BFR. Low-intensity cycling endurance training with BFR improves muscle hypertrophy and endurance performance and activates angiogenesis. ⋯ The BFR training leads to a stronger activation of the muscular metabolic reflex and thus to a relatively greater increase in exercise blood pressure, so that cardiovascular parameters should be controlled during BFR training. First meta-analyses with small numbers of healthy people and patients indicate the effectiveness of BFR training. Standardization or guidelines for clinical use are still lacking.
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In the management of trauma patients in the resuscitation room many time-pressured and critical decisions must continuously be made in complex situations. Even experienced teams frequently make errors in this context. Computer-assisted decision-making systems can predict critical situations based on patient data continuously acquired online. Based on the calculated predictions these systems can suggest the next steps in managing the patient. This review summarizes the current literature on computer-assisted decision-making in the management of trauma patients. ⋯ Computer-assisted decision-making can help to improve the management of trauma patients; however, before a ubiquitous implementation a number of technological and legislative barriers have to be overcome.
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Training under conditions of blood flow restriction (BFR) has recently been advocated as an option for alternative training in athletes. ⋯ Various approaches for implementation of BFR in athletes can be found in the literature. These approaches differ in the frequency, force used, duration and finally type of implementation of BFR itself. Clear recommendations for training cannot be given to date and the individual weighing up of possibilities and supervised implementation of BFR in athlete training by the trainer are still necessary.
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For various reasons many patient groups are unable to perform high-intensity strength training. ⋯ The effectiveness of low-intensity BFR training is lower than for classical high-resistance training; however, it may be used as additional training method in rehabilitation programs.
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The treatment of flexor tendon injuries is still challenging, especially in the region of the narrow annular ligaments and tendon sheaths of the 3‑segment fingers and the thumb (zone 2). In the course of time, the primary suture of the flexor tendons has prevailed over traditional recommendations for a secondary tendon replacement after healing of the wound. Improvements regarding suture techniques and materials and, above all the follow-up treatment, have been crucial for better results and remarkable changes in flexor tendon surgery. ⋯ To achieve this an early functionally active protocol should be implemented. The tendon suture should enable this by having a high primary strength and therefore at least a 4-strand core suture technique with a ring suture should be given preference. Further important prerequisites for success are the undisturbed gliding of the repaired tendon in its "bed" paying special attention to the annular ligaments and preservation of the blood supply to the tendons.