Der Unfallchirurg
-
The physical examination of the knee in cases of suspected meniscal tears serves to increase the probability of a correct diagnosis. Although there is a large variety of functional tests, the quality of each diagnostic test is controversially discussed. ⋯ Meniscal injury can be detected by several functional tests. Using the Thessaly test can improve the physical examination by means of probability of the correct diagnosis, but the results are based on a single study. In patients with ambiguous findings in the physical examination or with suspected combined injury, further diagnostic procedures such as magnetic resonance imaging are necessary to confirm the diagnosis. In clinically certain cases the use of additional diagnostic imaging procedures should be avoided as other authors have shown that with few exceptions this has no influence on the therapy.
-
There is little evidence for the ideal aftercare of combined nerve and flexor tendon injuries of the hand. The aim of this study was to elicit whether concomitant nerve injuries are changing the individual treatment plans after flexor tendon repair in a survey of German centres for hand surgery. ⋯ There seem to be no uniform treatment guidelines for flexor tendon repair if concomitant nerve injury is present. Against the background of the current literature early controlled mobilization after tendon and nerve repair seems to be justified.
-
Review Meta Analysis
[Fractures of the neck of the femur in younger patients (15-50 years old). Systematic literature research on medial fractures of the neck of the femur in young patients].
Non-pathologic fractures of the neck of the femur in younger patients aged between 15 and 50 years old are rare injuries. These are so-called effectual injuries with very high energy induction due to traffic accidents, falls and sport accidents, causing healthy bones to be fractured and often leading to multiple injuries. The short-term and long-term complications of such injuries sometimes give rise to substantial problems, in particular from non-union fractures and avascular necrosis of the head of the femur. ⋯ This presentation has gone so far that in some cases the term "treatment malpractice" has been used in legal disputes (and judgments) (Judgment IU 5146/00, Higher Regional Court Munich; 2O 861/07 Hei, Regional District Court Ansbach; 118C 421/05, District Court Cologne). The authors have often been called upon as medical experts to comment on the current state of medical knowledge on the question of the biology of healing of fractures of the neck of the femur and the question of"verified" therapy strategies. With this in mind this article is designed to give a review of the current state of proven knowledge according to the available clinical and experimental data and last but not least to stimulate constructive discussion.
-
Meta Analysis Comparative Study
[Prehospital trauma care training course. Integration of emergency physician and rescue services].
With the emergence of a trauma network in the metropolitan area of Nuremberg, Germany, the question arose whether prehospital trauma management and emergency department management could be better integrated. A training scheme was designed for prehospital trauma care by the rescue services of the Workers' Samaritan Federation Germany (ASB), the Bavarian Red Cross, Maltese Ambulance, St. Johns Ambulance, representatives of the emergency physicians, and physicians of Rummelsberg Hospital. ⋯ Conversion into practice was facilitated by teamwork. The course is free of charge to all rescue services and members of the concept group. With a qualified prehospital system that works smoothly with the ATLS concepts, improved prehospital care for trauma patients seems possible.
-
Case Reports Meta Analysis
[Dislocation as a rare complication of resurfacing of the hip joint. Case report and meta-analysis].
Resurfacing of the hip joint experienced a revival in the 1990s. Today metal-on-metal bearing is a therapy option especially for younger, active patients. In comparison to stemmed total hip replacements resurfacing offers advantages, in particular in view of the femoral bone loss. ⋯ In comparison to conventional total hip replacement, dislocation is a rare complication. With conventional total hip replacement the dislocation rate is 2-5%. In the international literature the dislocation rate with resurfacing is 0.21%.