Technology and health care : official journal of the European Society for Engineering and Medicine
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Technol Health Care · Jan 2012
Comparative StudyComparison of helicopter and ground emergency medical service: a retrospective analysis of a German rescue helicopter base.
In consideration of rising cost pressure in the German health care system, the usefulness of helicopter emergency medical service (HEMS) in terms of time- and cost-effectiveness is controversially discussed. The aim of the present study was to investigate whether HEMS is associated with significantly decreased arrival and transportation times compared to ground EMS. ⋯ The results of the present study indicate the time-effectiveness of German air ambulance services with significantly decreased transportation times.
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Rotational malalignment following intramedullary nailing is a well-recognised problem. The threshold for clinically relevant malrotation has been established to be in the region of 15° whereas the incidence of significant malrotation following femoral nailing ranges from 22 to 43 percent. Many studies have been performed to address this issue with the major challenge acknowledged to be intraoperative control of femoral anteversion. ⋯ Statistically, there is no significant difference between the mean results for femoral antetorsion. The advantage of the method proposed in the current study, is the opportunity to enter the ventral femoral cortex during the surgical procedure without disturbing the process of femoral nailing. Thus, the surgeon can avail of continuous control of femoral rotation intra-operatively.
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Technol Health Care · Jan 2012
Ultrasound-based computer navigation: an accurate measurement tool for determining combined anteversion?
The present feasibility study examined the use of an ultrasound-based navigation system (UNS) for reliability of measurement the positions of both the femoral and acetabular components, a prerequisite to adjust the combined anteversion with sufficient accuracy when using a femur-first approach in total hip arthroplasty. ⋯ Our investigations suggest that the anteversion of stem and cup can be measured with accuracy sufficient enough to utilize the concept of combined anteversion using UNS. Hence, the advantage of utilizing UNS's in a femur-first approach is the ability to intraoperatively compensate for deviations from the targeted anteversion of the stem (which is often difficult to control) by adjusting the acetabular anteversion in the final step of the implantation. In doing so, the placement of the components follows the concept of combined anteversion. Avoiding extreme anteversion values of combined anteversion could be an important step towards reducing post-operative complications following total hip arthroplasty (THA).
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Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. ⋯ These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique.