Der Unfallchirurg
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Thoracic inlet syndrome is a rare venous obstruction of the upper extremity caused by narrowness of the costoclavicular angle. This case report describes an obstruction of the vena subclavia after percutaneous elastic stable medullary nailing of a comminuted fracture of the clavicle.
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Osteoarthritis of the knee is often diagnosed in the orthopedic trauma practice. One major cause is axial deformity with overload. In the case presented here osteomyelitis of the tibial diaphysis developed in childhood. ⋯ In this way it was possible to eradicate the osteomyelitis of the lower leg and to achieve osseous consolidation between the tibia and fibula. Despite the significant shortening of the lower limb and the varus axial deformity, the knee joint function was satisfactory in the subsequent development. After a long interval without symptoms the patient developed a medially accentuated osteoarthritis of the knee.
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The aim of this study was to document the present knowledge from the medical literature on (1) efficacy of aeromedical evacuation (helicopter emergency medical service, HEMS) and (2) influence of the level of the first receiving hospital on mortality of patients. ⋯ The analyzed studies showed a trend toward decreased mortality rates with the employment of HEMS. Considering the comparable hospital level and even longer rescue times with HEMS, these differences can be explained with higher quality of initial diagnosis and treatment of the HEMS rescue team. Furthermore, mortality rates can be lowered significantly through primary treatment at a level 1 trauma center. Thus, the more flexible choice of the first receiving hospital represents a specific, clinically relevant advantage of HEMS in emergency medicine.
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The endoprosthetic replacement of the hip joint or its components in fractures of the proximal femur is a standard method. Indications for replacement are strongly dislocated intracapsular femoral neck fractures in elderly patients, fractures with an existing arthritis of the hip joint, and profound osteoporosis. Improved perioperative management and more gentle anesthetic techniques have helped to reduce perioperative mortality from nearly 50% to 11.5% over the last 40 years. ⋯ Despite the high standard of endoprosthetics in Germany, the results are still improvable in comparison to other countries. Measures which preserve the joint as well as the bone will be increasingly important in prophylaxis of further complications. In addition, more attention should be paid to the prophylaxis of falls and a sufficiently guide-lined therapy of osteoporosis for the prophylaxis of fractures of the elderly.