[Percutaneous stabilization of thoracolumbar fractures. Techniques of fracture reduction and spinal cord decompression]. / Perkutane dorsale Instrumentierung der thorakolumbalen Wirbelsäule. Technik der geschlossenen Frakturreposition bei gleichzeitiger Dekompression des Spinalkanals.

Minimally invasive percutaneous instrumentations are increasingly being used for stabilization of thoracolumbar fractures, mainly due to the advantages of reduced soft tissue damage. While percutaneous instrumentation can be generally used in less displaced fractures, it remains controversial whether such techniques should also be performed in patients with severe fracture dislocation. This includes patients with severe traumatic kyphosis and/or dislocation in the coronar plane, particularly in concomitant neurological deficits that require additional decompression surgery. Here we show the different indirect fracture reduction techniques in three cases with severe fracture dislocation and discuss the use of percutaneous stabilization techniques in combination with an additional midline approach for decompressing laminectomy.

Amputation of a lower extremity after severe trauma.

OBJECTIVE: Serious lower extremity injuries sometimes warrant emergency amputation. The goal of amputation in polytrauma patients is to increase chances of survival, while the goal of amputation in a single limb injury is to prevent further complications, e.g., infection, septic shock. INDICATIONS: Rescue from life-threatening lower extremity bleeding in a critically injured patient. Severe injury of a lower extremity: crushed, burned, frozen, advanced infection. CONTRAINDICATIONS: Patient refusal. SURGICAL TECHNIQUE: Supine position, determination of resection border, skin incision, identification of nerves and blood vessels, osteotomy, vessel ligation, separation of blood vessels and nerves, final removal of tissue with amputation knife, disposal of amputated extremity, skin closure. POSTOPERATIVE MANAGEMENT: Wound care, careful compression wraps beginning on postoperative day 7, early prosthesis fitting, mental health care consultation. RESULTS: From January 2008 until October 2010, 115 lower extremities were amputated at the BG Trauma Clinic in Ludwigshafen, Germany. A total of 42 amputations were posttraumatic and were performed in the clinic for trauma surgery and orthopedics. There were a total of 18 foot and toe amputations, 16 lower leg amputations, 5 knee amputations, and 3 above knee amputations. Comparison of the groups is difficult due to the varying mechanisms of injury and locations of amputation. Therapeutic decisions regarding emergency amputation are made with careful consideration of the patient.

[Does co-operation research provide approaches to explain the changes in the German hospital market?]. / Bietet die Kooperationsforschung Ansätze zur Erklärung des Wandels auf dem deutschen Krankenhausmarkt?

UNLABELLED: The German hospital market faces an extensive process of consolidation. In this change hospitals consider cooperation as one possibility to improve competitiveness. AIM: To investigate explanations of changes in the German hospital market by theoretical approaches of cooperation research. METHOD: The aims and mechanism of the theories, their relevance in terms of contents and their potential for empirical tests were used as criteria to assess the approaches, with current and future trends in the German hospital market providing the framework. Based on literature review, six theoretical approaches were investigated: industrial organization, transaction cost theory, game theory, resource dependency, institutional theory, and co-operative investment and finance theory. In addition, the data needed to empirically test the theories were specified. RESULTS: As a general problem, some of the theoretical approaches set a perfect market as a precondition. This precondition is not met by the heavily regulated German hospital market. Given the current regulations and the assessment criteria, industrial organization as well as resource-dependency and institutional theory approaches showed the highest potential to explain various aspects of the changes in the hospital market. CONCLUSION: So far, none of the approaches investigated provides a comprehensive and empirically tested explanation of the changes in the German hospital market. However, some of the approaches provide a theoretical background for part of the changes. As this dynamic market is economically of high significance, there is a need for further development and empirical testing of relevant theoretical approaches.