RESUMEN
BACKGROUND AND HYPOTHESIS: The aim of this study was to address the inconsistency regarding the operative treatment of Rockwood type III acromioclavicular joint separation. We compared results after single- and double TightRope® reduction with results after acromioclavicular transfixation via K-wires only and additional ligament augmentation in acute acromioclavicular (AC) joint separations graded Rockwood type III, and hypothesized that the TightRope® technique leads to better clinical and radiological results. MATERIALS AND METHODS: We conducted a retrospective clinical cohort study and included 42 consecutive patients (mean age 43 years [24-66]) diagnosed and operatively treated between 2004 and 2012 (mean follow-up was 54.6 months [15-118]). Specific shoulder scores as well as scores reflecting the patients' overall mental and physical health status were used. Radiological evaluation was also performed. RESULTS: The SF12 test revealed comparability between all subgroups. Specific shoulder tests and a visual analogue scale demonstrated comparable results. Radiographic measurements showed a significant reduction in the AC distance and CC distance after surgery in all subgroups. The early complication rate was 9.5% for all patients, while late complications occurred in 14.3% of all cases. CONCLUSIONS: Compared to the established methods, the operative TightRope® procedures represent a safe alternative in Rockwood III injuries. All investigated techniques predominantly led to good and excellent clinical results in acute Rockwood type III AC joint instabilities. Avoidance of material removal and shorter hospital stays appear to speak in favour for the TightRope® technique. LEVEL OF EVIDENCE: IV.
Asunto(s)
Articulación Acromioclavicular/cirugía , Hilos Ortopédicos , Luxaciones Articulares/cirugía , Articulación Acromioclavicular/diagnóstico por imagen , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The treatment of patients with mild head injury is related to a continuous lack of finances. The current investigation summarises radiological costs of patients from a level I trauma centre and discusses the indication for CT scanning within the G-DRG system. MATERIAL AND METHODS: The study includes all patients who underwent a CCT scan in 2011. Diagnosis, length of stay and cost data were recorded for every patient. Finally, frequent diagnosis groups were summarised to clusters (Basis-DRG/MDC 21A). RESULTS: A total of 380 patients was treated. Within the largest group (G-DRG B80Z) the costs for a CCT already took up one quarter of the total proceedings. In combination with the high cost for monitoring patients with mild head injuries this causes an ongoing lack of finances. CONCLUSION: In spite of the often necessary CCT investigation in mild head injuries, the earnings do not cover the costs of the patients. To improve the situation clear guidelines for CCT scanning should be provided and the reimbursement in particular in the diagnosis group of the G-DRG B80Z has to be improved.
Asunto(s)
Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/economía , Grupos Diagnósticos Relacionados/economía , Honorarios y Precios/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Tomografía Computarizada por Rayos X/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas/epidemiología , Niño , Preescolar , Análisis Costo-Beneficio/métodos , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Lactante , Recién Nacido , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Prevalencia , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Since the implementation of the diagnosis-related system there has been a continuous lack of finances in the treatment of multiple injured patients. The current investigation summarizes consecutive patients from a level I trauma centre and tests the hypothesis that an injury severity score (ISS) based reimbursement would be an improvement in the cost-effectiveness of this patient population. METHODS: The study is based on multiple injured patients admitted to the emergency department in 2009. The ISS, intensive care unit (ICU) stay and cost data were recorded for every patient and two subgroups were formed: group I ISS < 16 and group II ISS ≥ 16. RESULTS: A total of 442 patients with an average age of 40.5 ± 9.1 years (ISS 12) were included. The average amount of coverage during an average length of stay of 13.15 ± 6.3 was -2,752