Closed reduction and immobilization of displaced distal radial fractures. Method of choice for the treatment of children?

PURPOSE: The therapy of distal radial fractures in children is expected to be as non-invasive as possible but also needs to deliver the definite care for gaining optimal reduction and stabilizing the fracture. Therefore, closed reduction and immobilization is competing with routine Kirschner wire fixation. The aim of our study was to investigate if closed reduction and immobilization without osteosynthesis can ensure stabilization of the fracture. METHODS: We chose a retrospective study design and analyzed 393 displaced distal radial fractures in children from 1 to 18 years with open epiphyseal plates studying medical files and X-rays. The Pearson's χ (2) test was applied. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an alpha level of P = 0.05. RESULTS: Of these studied fractures 263 cases were treated with closed reduction and immobilization. Only 38 of these needed secondary interventions, 28 of these underwent reduction after redisplacement and ten patients received secondary Kirschner wire fixation. The last follow-up examination after 4-6 weeks revealed that 96.4% of fractures initially treated with closed reduction and immobilization were measured within the limits of remodeling. 104 of the studied fractures were treated with cast immobilization alone when displacement was expected to correct due to remodeling. Here 22.1% of patients needed secondary reduction. Furthermore, primary Kirschner wire fixation was performed in only 25 children with unstable fractures and only one received further treatment. Interestingly, operative reports of primary closed reduction revealed that repeated maneuvers of reduction as well as residual displacement are risk factors for redisplacement. CONCLUSION: For the treatment of displaced distal radial fractures in children closed reduction and immobilization can be considered the method of choice. However, for cases with repeated reduction maneuvers or residual displacement we recommend primary Kirschner wire fixation to avoid redisplacement. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

[DRG and OPS-301: effects on the acquisition performance in radiology]. / DRG und OPS-301: Auswirkungen auf die Leistungserfassung in der Radiologie.

Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes.

[Improving productivity by implementing RIS and PACS throughout the clinic: a case study]. / Produktivitätsverbesserung durch klinikweite RIS und PACS: eine Fallstudie.

PROBLEM: How are improvements in productivity in connection with RIS/PACS to be defined? What do they cost? To limit the problem to the relevant topics, we first describe the objectives of a radiology department and the identified bottlenecks in the workflow. How to define and assess the improvements is discussed. METHODS: The case in question for this study is the RIS/PACS project at the "Klinikum der Universität München, Campus Grosshadern". The goals of the project and its present status are reviewed. The project is not yet completed, so this is a "midterm" report. RESULTS AND DISCUSSION: We describe the status of the achieved and not yet achieved goals and of the eliminated bottlenecks. On the plus side, for example, nearly 100% of all digitally generated images (except mammogramms) are digitally archived. They are accessible to the same percentage in radiology via PACS and in the hospital via the webbased intranet image distribution system when needed. In some radiology areas, such as multislice CT, already the reporting can no longer be performed without softcopy image interpretation. However, the full elimination of hardcopy images is still not reality, since the distribution to DICOM viewers for selected requesters with demands for almost reporting quality, high cost image displays is still in the testphase. To reduce film costs, images are being printed on a high resolution paper printer in addition to the intranet distribution during this transition period. On the negative side, due to a lack of job positions in the transcription rooms, about 40% of the reports are still being handwritten by radiologists. Furthermore, the dictated and transcribed reports are usually still not available early enough in the RIS and thereby in the intranet report distribution of the hospital. Here only a speech recognition system can remedy the situation. As soon as this problem is solved and the image distribution to the DICOM viewers works routinely, the reports and the images will be accessible within minutes to maximally within some hours after the examination. CONCLUSION: The goals reached so far suffered delays due to unforeseen problems and pitfalls. Altogether, a quieter operation and workflow in radiology has already been achieved, due to less inquiries from the requestors for unfinished examinations, images and/or image copies.

[The value of F-18 fluorodeoxyglucose in positron emission tomography diagnosis of breast carcinoma]. / Wertigkeit der F-18-Fluorodeoxy-Glukose-Positronenemissionstomographie-Diagnostik beim Mammakarzinom.

Fluorodeoxyglucose-positron emission tomography (F-18-FDG-PET) has become an important issue in the diagnosis of malignant tumors within the last years. In breast cancer PET has been established in the diagnosis of the primary tumor as well as in recurrences with a sensitivity of 90% and a specificity of 75%-100%; additional a sensitivity of more than 90% and a specificity of about 75% is also seen in axillary lymph nodes detection. With our own results we were able to prove sensitivity of positron emission tomography in diagnosing the primary lesion, locoregional lymph nodes and the staging of metastases. Furthermore, positron emission tomography seems to be superior to conventional imaging modalities in staging primary and recurrent breast cancer, distant metastases and lymph nodes outside the axilla.