Zusammenfassung Hintergrund Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat. Fragestellung Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern? Material und Methoden Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat. Ergebnisse Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt. Diskussion Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.
Geissler's classification is widely accepted in arthroscopic diagnostics of scapholunate (SL) ligament injury. Thereby, probe insertion into the SL gap from the midcarpal would indicate treatment necessity in patients with SL tear as seen from radiocarpal view. In this review, the SL gap width, examined by the probe from midcarpal, was arthroscopically assessed in patients with intact SL ligaments, who were treated for ulnar impaction syndrome. The review examined how often lax SL joints can be found in patients with no complaints with respect to the SL ligaments and in which the SL ligaments were proven to be intact from radiocarpal view. We suspected that probe insertion, as an indicator for a lax joint, does not affect the outcome in ulnar impaction treatment. A total of 32 patients with clinically diagnosed ulnar impaction syndrome were arthroscopically treated by central resection and debridement of the triangular fibrocartilage; 8 patients underwent concurrent ulnar shortening, and 4 of them finally hardware removal. All patients were examined preoperatively as well as after 3, 6, and 12 months following arthroscopy, respectively, after ulnar shortening or hardware removal. In 14 patients, the probe could not, in 18 patients, the probe could be inserted into the SL gap. There was neither any significant difference in the improvement of pain, grip strength, Krimmer, or DASH score, nor for any of the radiographic angles between the two groups. Laxity of the SL ligament allows the probe to be inserted into the SL gap from midcarpal in some patients. This finding, therefore, does not necessarily imply the necessity of treatment when there is partial rupture seen from radiocarpal view. Level III, case-control study.
Injuries to the thumb collateral ligament are common whose acute surgery gives good functional results. But they are often unrecognized and surgical procedures for chronic instability are still being discussed. The aim of this study was to compare retrospectively the clinical and radiological results of the 3 main treatments for chronic instability of the metacarpophalangeal (MCP) joint of the thumb to identify trends and optimize outcome. Materials and Methods: In this retrospective and monocentric study, we included all the patients operated between 2000 and 2012 from a chronic posttraumatic instability of the MCP joint of the thumb by 1 of 3 techniques: primary repair (37 cases), ligament reconstruction (14 cases), and arthrodesis (43 cases). Patients with hyperextension instability, degenerative instability, and a follow-up less than 2 years were excluded from this study. Subjective and objective results and rates of complications and recurrence were compared at end of the follow-up. Results: Sixty-seven patients were included, 55 followed up for a mean 84 months (range, 24-164 months). Whichever the procedure, all patients considered themselves improved or healed. Forty-eight patients (87.3%) were satisfied or very satisfied. The relief of pain was significantly better in the arthrodesis group. The mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) for primary repair group were 17.4 (0-89.5), for ligament reconstruction group 25.7 (0-58.3), and for the arthrodesis group 17.8 (0-50). Pinch strength, on average of the value on the unoperated side, was 89% for primary repair group, 84% for ligament reconstruction group, and 94% for the arthrodesis group. Six of 10 ligament reconstructions had MCP joint laxity at end of follow-up. There were significantly fewer patients who considered themselves cured in the ligament reconstruction group. There were 4 failures by end of follow-up: 1 associated with primary repair, 1 with arthrodesis, and 2 with ligament reconstruction. Discussion and Conclusion: Surgery in treating chronic instability of the MCP joint of the thumb gives generally good results. Primary repair should be considered as much as possible. In contrast to literature report, ligament reconstruction does not give better results than arthrodesis.
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