Der Unfallchirurg
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Multicenter Study Comparative Study
[The Trauma Registry of the German Society of Trauma Surgery as a basis for interclinical quality management. A multicenter study of the German Society of Trauma Surgery].
Based on the "Trauma Registry" of the German Society of Trauma Surgery, an interclinical quality management (QM) system was implemented. The principles of the QM system as well as the differences in the quality of outcome and treatment are presented. The analysis uses the data on 2,069 severely injured (ISS = 22 +/- 14) patients from 20 hospitals collected prospectively and anonymously between 2/93 and 12/97. ⋯ The hospitals participating in the Trauma Registry receive an annual analysis of their preclinical and acute clinical performance. Thus, every hospital can analyze and improve the quality of treatment based on reliable data that show which parts of the process have to be optimized. Furthermore, the data allow a comparison of the average and optimal results of the whole series.
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Multicenter Study
[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group].
Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). ⋯ Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.
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Multicenter Study
[Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients].
In a multi-center study in 14 trauma hospitals 328 patients with fractures and osteosyntheses of the femoral neck were investigated with reference to time between accident and operation implants used, early and late complications, and results in the years from 1974 to 1987. A follow-up examination was possible in 266 patients a mean of 46.7 months after their accidents. General postoperative complications were recorded in 12.2% and local complications in 11.6%. ⋯ The best results (significantly better than in other groups) were obtained in patients who were operated on early (< 24 h after trauma) (P < 0.05) and those in whom dynamic hip screws (DHS) were used (P < 0.01). Of all cases of aseptic necrosis 70% were seen within 3 years and 86% within 6 years after trauma. The rate was dependent on the degree of dislocation of the fracture (Garden III and IV), the time from trauma to operation, and the implant used (130 degrees blade plate 30.5%, DHS 9.2%).
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Multicenter Study
[2 years results of conservative therapy of unstable fractures of the pelvic ring in children].
Unstable fractures of the pelvic ring in children are usually treated conservatively. The results of this therapy were evaluated retrospectively in 17 children who had been under 13 years old at the time of injury. All but 4 of the children had additional injuries. ⋯ Only fracture healing in a near-anatomical position can ensure good clinical results in pelvic fractures in children. Considering the results presented here, operative reduction has to be recommended when reduction cannot be achieved by conservative means. However, there is no proof that open reduction and internal fixation provide better results than conservative therapy in unstable pelvic ring fractures in children.