Der Unfallchirurg
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Clinical Trial
[Primary total elbow replacement for complex intra-articular distal humerus fractures].
Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis. ⋯ Primary total elbow arthroplasty for complex intra-articular distal humerus fractures in elderly patients has good functional results and is an alternative to osteosynthesis.
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Autologous transplantation of the central third of the patella tendon with a bone-patellar tendon-bone (BTB) graft is one of the most commonly used techniques for anterior cruciate ligament (ACL) reconstruction. Frequently chosen alternative sources include semitendinosus and gracilis tendon autografts. ⋯ These predominantly occur during the early postoperative period. We present the case of a patellar tendon rupture in a healthy 36-year-old man, who suffered a skiing accident 10 years after uneventful ACL reconstruction with a BTB graft.
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Case Reports
[Posttraumatic tracheal stenosis after complex fracture of the upper cervical spine: a rare complication].
Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection. ⋯ Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue. Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.
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The German DRG (diagnosis-related groups) system has changed since the inauguration in 2005, whereby written inquiries and on-site auditing have been carried out by the medical inspection service for health insurance companies (MDK). Modifications in the G-DRG system are reflected in changes in the MDK visitations. This article describes exactly how these examinations have changed over time. In order to achieve this all auditing reports were evaluated. ⋯ To cope with the changes in the German DRG system hospitals have to be flexible. The experiences with the regular MDK visitations can positively influence hospital organizational structures.