Der Unfallchirurg
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The pelvic subcutaneous cross-over internal fixator is a minimally invasive technique for the fixation of instable anterior pelvic ring fractures. A USS-II-VAS screw is anchored bilaterally in the supra-acetabular region of the os ileum by a mini-incision approach. An angled fixation rod is inserted subcutaneously and after successful closed reduction attached to the screws forming a locking internal fixation. ⋯ The main benefits are a simple surgical technique preventing damage to soft tissue, a low risk of neurovascular lesions and the avoidance of pin infections. Moreover patients with multiple trauma profit from a shorter time of surgery and greater comfort allowing a prone position. The new procedure combines the advantages of internal osteosynthesis and a minimally invasive technique, providing early mobilization under full-weight bearing for instable pelvic fractures.
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Case Reports
[Multiple femur and tibia shaft fractures in the severely injured. A therapeutic challenge].
Nowadays, there is a trend towards the concept of damage control in the management of multiple trauma patients. However, the question remains whether all patients benefit from this concept. We report the primary total definitive treatment of a patient with multiple fractures of the lower extremities. Postoperative respiratory insufficiency was treated successfully by non-invasive ventilation.
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Wrong site surgery leads to substantial individual injury to the affected patient. Therefore, organizations such as the WHO, the Joint Commission International (JCI) and the Action Alliance Patient Safety (APS) have developed procedures for avoidance of wrong site surgery. ⋯ In the DRK Clinics in Berlin the procedure for avoidance of wrong site surgery was introduced before the second recertification by the JCI for implementation of the patient safety recommendations and compliance with the four stages documented in a standard form. For successful implementation all members of staff and in particular the heads of the clinics and departments must be actively involved in order to obtain the acceptance permanently and to ensure that wrong site surgery no longer occurs in the DRK Clinics Berlin.
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In the Center for Plastic Surgery of the Trauma Hospital Berlin, between the years 2000 and 2007 we observed a total of 10 deep dermal alkali burns caused by screed. ⋯ The existing safety advice insufficiently reflects the potential risk of injury. The author demands a change in the safety warnings from "irritant" to "can cause alkali burns"; with such a change, workers may be better aware of the dangers of working with screed.
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The major goal in the treatment of metacarpal fractures is to restore the normal function of the hand. Radiological criteria and the clinical extent of displacement should be individually considered when taking the decision for or against conservative treatment. ⋯ In instable and displaced fractures of the base of the first metacarpal, surgery is regularly performed to restore the bony shape and articular surface. To prevent functional impairments, early mobilization is desirable both during conservative treatment and following internal fixation.