Der Unfallchirurg
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Intraoperative 3-D visualization using the Siremobil Iso C(3D) (Siemens, Erlangen, Germany) has been approved for use in spine and long bone surgery since its recent clinical launch. In preparation for the clinical use of the Siremobil Iso C(3D) in pelvic surgery, the aim of this study was to grade the quality of visualization in comparison with the gold standard of computer tomography in four therapy relevant pelvic regions in eight human cadavers, including SI screws to exemplify implants in the dorsal pelvic ring. Besides the influence of the body mass index and the interference of metal artefacts, visualization quality was evaluated in different pelvic regions (sacroiliac joint, acetabulum, femoral neck and anterior pelvic ring) using a score with five subgroups, rating the applicability of Siremobil Iso C(3D) in pelvic surgery. ⋯ Implants positioned in the dorsal pelvic ring reduced visualization quality, but sufficient estimation of bony structures was still possible. For primary diagnostics, computer tomography remains a clearly superior option due to better image quality. For intraoperative control of the reduction and positioning of implants in pelvic surgery, however, the additional intraoperative use of Siremobil Iso C(3D) is considered to offer clear advantages over current 2-D C-arm visualization tools.
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Fillet flaps offer an additional reconstruction opportunity for complex hand defects after trauma, burns, tumors or infections. This retrospective study elucidates the concept of fillet flaps and presents the results of an overall of 34 plastic surgical reconstructions of the hands in 31 patients. Pedicled axial pattern flaps were used predominantly, except 2 cross finger flaps. ⋯ Another case was left to secondary healing. Prior to any amputation, possible use of spare parts for defect reconstruction should be considered as a matter of principle. Our data suggest that the concept of fillet flaps is suitable for the reconstruction of complex defects of the hands without additional donor site morbidity.
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Comparative Study
[Age and survival likelihood of polytrauma patients. "Local tailoring" of the DGU prognosis model].
Age is one of five prognostic parameters identified based on data of the trauma registry of the German Association for Trauma Surgery (DGU). We asked ourselves if the suggested prognostic model provides the same predictive power of data from an independent hospital. Furthermore, we investigated whether age itself or age-associated comorbidity causes an unfavorable prognostic effect. ⋯ The suggested prognostic model based on multicenter data evaluation can be applied to a single center with only minimal loss of discriminatory power. In this context, age seems to have a prognostic value independent of comorbidity.
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An 18-year-old male patient sustained right-sided femoral and 2nd degree open tibial shaft fractures following a motorcycle accident. Further injuries, and thoracic injury in particular, were excluded clinically and radiologically. ⋯ Subsequently, the patient's gas exchange parameters improved allowing extubation 1 week after the accident. Secondary tibia nailing and further recovery of the patient were uneventful.