Der Unfallchirurg
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Cuboid fractures in children are rare. Missed fractures of the cuboid may lead to severe alterations in foot mechanics and function. In the case described a 9-year-old girl suffered a compression fracture of the cuboid after falling from a tree. ⋯ Bone grafting was not necessary. Due to continuing growth the plate was removed 6 months after the operation. Physical and radiological examinations revealed an excellent result.
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The lack of clinical residents especially in the surgical domains, including orthopaedics and trauma surgery, is not only omnipresent but also a topic of lively discussions. This lack originates from sociopolitical and healthcare policy issues as well as from a loss of attractiveness of all surgical disciplines. The loss is caused by the high workload and disadvantageous working hours especially in those disciplines with a high rate of emergencies, e.g. trauma surgery. ⋯ D. candidates). Contextual and structural improvements of the practical year are indispensable to arouse students' interest in our discipline. These options conjoined with the actual offers for students provided by our scientific society, such as guided tours during the annual congress, travelling grants and the recently inaugurated summer school, might provide the basis for clearly structured information and offer a distinct stimulus to apply for residency in our field.
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The rate of clinically relevant neurovascular injuries after proximal intramedullary nailing of the tibia remains unclear. The anatomical risk of iatrogenic damage to these structures should be estimated in a prospective MRI examination. ⋯ Triple proximal interlocking in tibial nailing procedures can be considered a safe procedure if care is taken with the correct operation technique and careful image intensification control of drilling procedures. A rotated nail insertion to avoid a strict anterior-posterior positioning of proximal interlocking screw is not to be recommended.
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The WHO International Classification of Functioning, Disability and Health (ICF) allows a standardized description of functioning and disability based on individual and contextual factors. The ICF adopts a biopsychosocial model of disability and functioning and is complementary to the ICD-10 (International Classification of Diseases). ⋯ These consist of the ICF categories which are most relevant for patients with specific diseases or in specific health care situations. In trauma care the ICF and ICF core sets can be applied in defined health problems and treatment situations for documentation of functioning, structured planning and implementation of interventions as well as outcome assessment.
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Health-related quality of life is a multidimensional concept which describes relevant aspects of physical, emotional and social well-being as reported by patients. Numerous generic and disease-specific instruments for measuring health-related quality of life have been developed and in addition preference-based instruments are available for use in health economic evaluation. ⋯ In the context of a brief description of these questionnaires several examples of their use in studies of patients after trauma are given. These examples show that successful conceptual and methodological developments in quality of life research provide a sound basis for patient-oriented outcome assessment after trauma.