Der Unfallchirurg
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After a fall a 52-year-old female patient suffered an unstable fracture of lumbar vertebral body 3 and a stable fracture of thoracic vertebral body 12 without neurological deficits. In addition to the balloon kyphoplasty of thoracic vertebral body 12, percutaneous fixator internal instrumentation of lumbar vertebral bodies 2-4 was carried out with cement-augmented pedicle screws. ⋯ After the onset of detachment of the cement parts, we decided on an endovascular removal using the sling technique. The postinterventional course was uncomplicated.
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Pyogenic (unspecific) spondylodiscitis and implant-associated vertebral osteomyelitis (IAVO) are important diseases with the risk of neurological and septic complications. An early diagnosis is essential in which magnetic resonance imaging (MRI), histopathology and microbiological identification of the pathogen play key roles. The goals of conservative treatment in uncomplicated spondylodiscitis are antibiotic infection control and pain management. ⋯ In IAVO the formation of a mature biofilm represents the transition from acute to chronic infection. Acute infections can be treated by extensive debridement in combination with biofilm-active antibiotic treatment while retaining the implant. In chronic infections implant removal or exchange in combination with several weeks of antibiotic treatment is often necessary.
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Hospitals in Germany operate risk management, which can support the prevention of adverse events and to systematically process them. Safety culture is one aspect of this. In German-speaking countries, however, surveying the safety culture is still limited and almost exclusively carried out using quantitative instruments. In Germany, the discipline of orthopedics and trauma surgery is characterized by a high number of confirmed treatment errors and lack of risk clarification, Therefore, this study investigated the safety culture in this discipline. ⋯ The involvement of senior staff in the development of interventions to improve the safety culture in orthopedics and trauma surgery should be considered due to the importance of hierarchical structures.
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We report the case of a 28-year-old man who developed nonunion with complex deformity after treatment of a distal femoral fracture with an antegrade femoral nail. The resulting deformity was as follows: 10° varus, 21° external torsion, 1.8 cm of foreshortening and translation malalignment. After resection of the pseudarthrosis, a retrograde segmental transport nail was implanted. ⋯ The segment transport was performed using a magnetically driven internal transport nail. Seven months after surgery, bony consolidation of the distraction section and the docking site was observed. The leg axis was straight and the rotational movement ranges of the knee and hip corresponded the dimensions of the contralateral side.