Der Unfallchirurg
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The development of the numbers of cases involved in accident insurance consultant procedures (DAV), injury type procedures (VAV) and severe injury type procedures (SAV) after the introduction of the new injury type catalogue from 1 July 2018 is presented. Furthermore, possible alterations to organizational aspects, such as operating room times and average duration of hospitalization are presented. A first critical assessment of the modifications in the new catalogue was carried out, particularly with reference to the newly introduced section on complications (section 11).
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A 50-year-old male suffered a crash landing while paragliding and sustained a posterior dislocation of the hip with a Pipkin fracture type 4 (fracture of the posterior acetabular wall and Pipkin fracture type 2) and a lesion of the sciatic nerve. After primary treatment in an external hospital, the patient was transferred to this hospital 4 days following the trauma. ⋯ Following fixation of the Pipkin fragment an autologous bone graft harvested from the intertrochanteric region was used to fill the defect. Subsequently, a collagen matrix was applied onto the filled defect and a perineural adaptation of the sciatic nerve was performed.
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Orthogeriatric co-management of proximal femoral fractures has been proven to effectively reduce mortality rates. This involves extending resources in hospitals treating these patients as well as dealing with the possibility of prolonged periods of hospitalization. The increase in costs of orthogeriatric co-management are best illustrated by the implementation of geriatric early rehabilitation complex treatment. In view of the problems concerning billing this complex treatment, an online survey was carried among certified geriatric trauma centers of the German Trauma Society (DGU®). ⋯ The online survey revealed significantly higher assessment and rejection rates when compared to other hospital services. This could prove potentially detrimental to the future of orthogeriatric co-management.
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The surgical procedure for the life-threatening course of a necrotizing soft tissue infection of the leg after minor trauma is described. The necessary consistent resection of extensive fascial and muscular necroses required the reconstruction of soft tissue defects of the knee, the ankle joint and peroneal tendons exposed over a long distance. The functional outcome is presented 1 year after use of MatriDerm® and a split-thickness skin graft for defect coverage.