Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Austrian Society for Trauma Surgery Diploma-Austrian Trauma Days].","authors":"C Kammerlander, K Sahrarudi, V Smekal, A Hartmann, G Mattiassich, L Negrin","doi":"10.1007/s00113-025-01577-8","DOIUrl":"https://doi.org/10.1007/s00113-025-01577-8","url":null,"abstract":"<p><p>The increasing overlap between trauma surgery and orthopedics presents new challenges for medical training. However, specialized and structured training is essential, particularly in acute traumatology. With the Austrian Society for Trauma Surgery (ÖGU) diploma \"Advanced Trauma Surgery | Traumatology\", ÖGU offers a 3‑year training program that combines theoretical content with practice-oriented modules. The aim of the program is to optimally prepare specialists and residents for modern trauma care. The first round of the program will start in October 2025 as part of the Austrian Trauma Days.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Excess mortality of patients who negative for COVID-19 with proximal femoral fractures during the pandemic : What can we learn for future pandemics?]","authors":"Jakob Mayr, Anna Kurnoth, Nora Koenemann, Timon Röttinger, Leonhard Lisitano, Edgar Mayr, Annabel Fenwick","doi":"10.1007/s00113-025-01572-z","DOIUrl":"https://doi.org/10.1007/s00113-025-01572-z","url":null,"abstract":"<p><strong>Background: </strong>The global COVID-19 pandemic led to excess mortality, especially for vulnerable older patients with simultaneous comorbidities. Patients with proximal femoral fractures already have a high mortality risk of up to 30% during the first postoperative year. The purpose of this study was not only to investigate the impact of COVID-19 on the mortality of patients tested positive but also of negatively tested patients with proximal femoral fractures.</p><p><strong>Methods: </strong>A single center cohort study of 2186 patients (mean age 79.8 years) who were surgically treated for a proximal femoral fracture at a level I trauma center was retrospectively carried out. The mortality and complication rates before the COVID-19 pandemic (January 2016-February 2020) and during the pandemic (March 2020-October 2021) were compared. A standardized treatment protocol was carried out during the total observational period. Orthogeriatric co-management was negatively impaired by the pandemic. Patient data, COVID-19 infections, surgical procedure, time from admission to surgery, postoperative complications and mortality were analyzed.</p><p><strong>Results: </strong>The pandemic group included 596 patients with an average age of 79.7 years. During the pandemic 26 patients were tested positive for COVID-19 (18 women, 8 men, average age 81.4 years, minimum 63 years, maximum 99 years, SD 9 years). Patients who tested positive for COVID-19 had more comorbidities than COVID-19 negative patients during the same period (Charlson comorbidity index, CCI 6.26 vs.5.25 points p < 0.037). The prepandemic control group consisted of 1590 patients with an average age of 79.9 years and a mean CCI of 5.86 points. Patients tested positive had a much longer hospitalization and a longer duration on the intensive care unit (p < 0.001) and a complication rate of 62.5%, especially due to the occurrence of pneumonia (p < 0.001). The mortality rate during the pandemic did not differ between patients tested positive or patients tested negative but was significantly higher for both groups in comparison to the period before the pandemic (pandemic 14% vs. 15.4%, before the pandemic 3.1%).</p><p><strong>Conclusion: </strong>Patients suffering from COVID-19 infection and proximal femoral fractures have a high risk of complications and a high mortality. The total increase in mortality for all patients with critical injuries, such as hip fractures during the pandemic emphasizes the importance of early mobilization and orthogeriatric co-management, which was discontinued during the pandemic and the lockdown.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Potential applications of large language models in trauma surgery : Opportunities, risks and perspectives].","authors":"Jakob Cornelius, Johannes Knitza, Juliana Hack, Melina Pavlovic, Sebastian Kuhn","doi":"10.1007/s00113-025-01581-y","DOIUrl":"https://doi.org/10.1007/s00113-025-01581-y","url":null,"abstract":"<p><p>The integration of large language models (LLM) into the care of trauma surgery patients offers an exciting opportunity with immense potential to enhance the efficiency and quality of care. The LLM can serve as supportive tools for diagnosis, decision making and patient communication by efficiently providing medical knowledge and generating personalized treatment recommendations; however, there are also substantial challenges that must be addressed. The lack of transparency in the decision-making processes of LLM as well as currently unresolved legal and ethical issues, necessitate careful implementation and examination by medical professionals to ensure the safety and effectiveness of these technologies.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Centers for geriatric trauma DGU® : Distribution and development in Germany].","authors":"Josef Stolberg-Stolberg, Charlotte Ramadan, Jeanette Köppe, Janette Iking, Karen Fischhuber, Markus Blätzinger, Michael J Raschke, J Christoph Katthagen","doi":"10.1007/s00113-025-01568-9","DOIUrl":"https://doi.org/10.1007/s00113-025-01568-9","url":null,"abstract":"<p><strong>Background: </strong>Due to the demographic changes, including the need for more orthogeriatric co-management, addressing the healthcare of geriatric patients is an important issue.</p><p><strong>Objective: </strong>The aim of this study was to create an overview of the fundamental characteristics of centers for geriatric trauma ATZ-DGU including the distribution of departments and cooperations as well as the level of trauma care. The distribution of sites across Germany was compared to hospital and population data.</p><p><strong>Methods: </strong>Certified German ATZ-DGU were assigned to Trauma Center DGU^® (TC) certification data (levels III-I) via institutional numbers. They were evaluated descriptively and correlations with several parameters at the federal states level were added.</p><p><strong>Results: </strong>Due to cooperations 188 institutions formed 147 ATZ-DGU and 152 provided orthogeriatric co-management in domo. Of the facilities with trauma surgery departments 86% (n = 168) were certified as TCs (level II = 33% > III = 30% > I = 22%). The number of ATZ-DGU per German state was correlated with the number of hospitals (r_s = 0.88), inhabitants (r_s = 0.92) and cases in total (r_s = 0.92, p < 0.001 each) but not with the proportion of people older than 65 years (p > 0.05). With only 14 facilities, the new federal states of Germany seemed to be disadvantaged and also showed great disparities compared to each other.</p><p><strong>Conclusion: </strong>The levels of trauma care revealed a distribution referring to the different focus of the two certificates: treatment of the severely injured vs. geriatric co-treatment. On average, the population in the new German states was older, while there were less ATZ-DGU; however, there seemed to be a slight tendency towards improvement.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Robotically assisted placement of a pubic ramus screw and an SI-S1 screw].","authors":"Dominik M Haida, Iris Wagenblast, Stefan Huber-Wagner","doi":"10.1007/s00113-025-01580-z","DOIUrl":"https://doi.org/10.1007/s00113-025-01580-z","url":null,"abstract":"<p><strong>Objective of surgery: </strong>The aim of this operation is to stabilize the anterior pelvic ring fractures on both sides and the sacral fracture on the right using robotically assisted screw osteosynthesis and to restore the mobility of the patient.</p><p><strong>Indications: </strong>The indications arise from the patient's very severe pain, resulting immobility under conservative treatment measures and a fragility fracture of the pelvis grade II (FFP II).</p><p><strong>Contraindications: </strong>Typical contraindications for this type of operation are the same as for conventional techniques (mainly infection and swelling).</p><p><strong>Surgical technique: </strong>Performed in the 3D navigation hybrid operating theatre Robotic Suite with the following components: navigation unit \"Curve Navigation System\", movable robotic 3D cone beam computed tomography (CBCT) \"Loop‑X\", robotic arm \"Cirq Arm System\" and wall monitor \"BUZZ\" (Brainlab, Munich, Germany). The individual surgical steps are explained in the video online (English).</p><p><strong>Follow-up treatment: </strong>Full weight bearing, pain medication according to the World Health Organization (WHO) stage scheme, physiotherapy after the first postoperative day.</p><p><strong>Evidence: </strong>Navigated and robotically assisted techniques are mainly used on the spine. These techniques are also increasingly being used on the pelvis, whereby very high levels of accuracy can also be achieved.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevalence of equinus deformity in inpatients treated at a university hospital].","authors":"Alexander Milstrey, Leo-Lion Eisfeld, Jeanette Köppe, Jens Minnerup, Michael J Raschke, Sabine Ochman, J Christoph Katthagen","doi":"10.1007/s00113-025-01582-x","DOIUrl":"https://doi.org/10.1007/s00113-025-01582-x","url":null,"abstract":"<p><strong>Background: </strong>In the authors' opinion the prevalence of equinus foot deformities is an underestimated medical and socioeconomic problem that has not yet been adequately investigated. A  dorsiflexion in the ankle joint of < 10° can lead to limitations in gait.</p><p><strong>Objective: </strong>The aim of the present study was to determine the prevalence of equinus foot deformities based on the degree of restriction of dorsiflexion in the ankle joint in hospitalized patients.</p><p><strong>Material and methods: </strong>In this cross-sectional study the active range of motion of the ankle joint in 205 patients at Münster University Hospital was prospectively examined with a goniometer. Included in the study were 136 trauma surgery and 69 neurology patients. The association of restricted dorsiflexion with other clinical parameters was investigated using the χ²-test or Fischer's exact test. The significance level was set at p < 0.05.</p><p><strong>Results: </strong>In total, 205 patients with mean age of 59 years were included. There was a slight predominance of males (55.1%) in the gender distribution. The average dorsal extension of the ankle joint was 7.03°on the right side and 8.92° on the left side. Of the patients 72.2% had a dorsiflexion in the ankle joint of < 10°, 38.1% a dorsiflexion < 5° and 16.1% a dorsiflexion < 0° on at least one side. A relevant association between age, gender, duration of hospitalization and the reason for treatment with a restriction of dorsiflexion could not be observed.</p><p><strong>Conclusion: </strong>The results suggest that restriction of dorsiflexion is a frequent problem in our group of trauma surgery and neurology patients. In particular, the presence of a manifest equinus deformity of the foot of > 10% that could not achieve the neutral position is a relevant finding.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Fracture sequelae-when, how, what?]","authors":"Ole Somberg, Thomas Rosteius, Maria Bernstorff, Thomas A Schildhauer, Matthias Königshausen","doi":"10.1007/s00113-025-01584-9","DOIUrl":"https://doi.org/10.1007/s00113-025-01584-9","url":null,"abstract":"<p><p>The treatment of fracture sequelae following proximal humeral fractures presents a significant challenge, as they range from necrosis and pseudarthrosis to malunions. Classifications such as Boileau's facilitate diagnosis and treatment planning. Type 1 sequelae, characterized by necrosis, can be treated with either anatomical or reverse prostheses depending on the condition of the rotator cuff. Type 2 sequelae involve locked dislocations and may require bony reconstructions. Type 3 pseudarthrosis is managed either with joint-preserving techniques or prosthetic replacement, depending on the degree of degenerative changes. Type 4 malunions often benefit from corrective osteotomies and/or prosthesis implantation. Studies have demonstrated significant functional improvements following surgical intervention, with individual factors such as deformities or rotator cuff condition influencing treatment strategies.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The NIPPLE trial-On the secure placement of chest drains or why men and women may sometimes be really equal : German Congress for Orthopedics and Trauma Surgery (DKOU) Science Slam 2024].","authors":"P Beck, S Imach, J C Wagner, S Künle, H Düsing, M M Paul","doi":"10.1007/s00113-025-01578-7","DOIUrl":"https://doi.org/10.1007/s00113-025-01578-7","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[How does the preoperative waiting time affect hospital mortality and complication rates in geriatric patients with medial femoral neck fractures?]","authors":"Annette Keß, Johanna Krauße, Philipp Pieroh, Christian Kleber, Johannes Fakler, Georg Osterhoff","doi":"10.1007/s00113-025-01575-w","DOIUrl":"https://doi.org/10.1007/s00113-025-01575-w","url":null,"abstract":"<p><strong>Background: </strong>The current guidelines of the German Federal Joint Committee on the treatment of proximal femoral fractures require that patients with a proximal femoral fracture receive surgical treatment as soon as possible and within 24 h of admission. This is intended to reduce perioperative complication rate and mortality.</p><p><strong>Objective: </strong>The aim of this study was to analyze the hospital mortality as well as complication rates and types in relation to the preoperative waiting time.</p><p><strong>Methodology: </strong>From 2010 to 2020, a total of 575 patients with femoral neck fractures treated with a bipolar prosthesis were retrospectively analyzed with respect to hospital mortality and the occurrence of complications. Patients with pathological fractures, femoral neck fractures more than 4 weeks old and those treated with osteosynthesis were excluded. Patient-specific data, hospital mortality and complication rates and types were recorded.</p><p><strong>Results: </strong>During the study period, the implementation of the given guidelines resulted in a reduction in the preoperative waiting time from a median of 38 h in 2010 to 19 h in 2020. Surgical treatment was performed on average after 14.2 h in patients who had surgery within 24 h after admission and on average after 40.2 h for those who had surgery after 24 h. The average American Society of Anesthesiologists (ASA) score for all 575 patients was 2.76. The group of patients who had surgery after more than 24 h had a significantly higher ASA classification (p = 0.024). A total of 12 (4.2%) patients in the group surgically treated within 24 h died, compared to 24 (8.5%) deaths in the group surgically treated after 24 h (p = 0.035). The complication rate for the entire cohort was 15% (88 patients). There was no difference in the occurrence of complications and the overall complication rate with respect to the timing of surgery.</p><p><strong>Conclusion: </strong>During the study period the preoperative waiting time was halved from 39h to 19 h. Patients who were surgically treated within 24 h had a significantly lower hospital mortality than those surgically treated after 24 h; however, the group surgically treated after 24 h simultaneously showed higher baseline comorbidities and in the adjusted analysis for age and ASA score, the 24‑h threshold no longer emerged as an independent risk factor for hospital mortality. Regarding complication rates, no significant differences were found between the groups based on the timing of surgery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Patient specific implants and instruments in orthopaedic trauma: 3D prints and implants in perlvic and hip fractures].","authors":"Valentin Clemens, David Steimer, Nico Bruns, Axel Gänsslen, Rupert Meller","doi":"10.1007/s00113-025-01562-1","DOIUrl":"https://doi.org/10.1007/s00113-025-01562-1","url":null,"abstract":"<p><p>Modern pelvic surgery is essentially influenced by technological innovations. One of the most impressive advances in this field is the integration of 3D printing and the associated possibility for the production of 1:1 models of the pelvic skeleton. Using these models, conventional pelvic implants can preoperatively be more exactly and patient-specifically contoured. The use of this technology has the potential to substantially improve the quality of care and simultaneously to optimize the surgical results. By the use of 3D-printed implants, which are individually adapted to the anatomical conditions of the patient, operations can not only be carried out more quickly and efficiently but also with a greater accuracy and potentially fewer complications. This article presents two instructive cases. Case 1 demonstrates how a proximal femoral fracture with a pre-existing deformity of the femur can be treated with a patient-specific implant. Treatment with conventional intramedullary or extramedullary implants was not possible. Case 2 illustrates the treatment of a pelvic ring fracture and the advantage of 3D printing for the preoperative patient-specific contouring of conventional plate systems.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 5","pages":"351-358"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}