Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Trochanteric fixation nail advanced for trochanteric femoral fractures : Central cut-out as a new problem?]","authors":"Franz Müller, Bernd Füchtmeier, Alexander Hanke, Christian Wulbrand","doi":"10.1007/s00113-026-01713-y","DOIUrl":"https://doi.org/10.1007/s00113-026-01713-y","url":null,"abstract":"<p><strong>Introduction: </strong>Trochanteric femoral fractures (TF) are mostly treated with intramedullary nail osteosynthesis. An inherent but rare complication of the system is the central cut-out of the femoral neck helical blade, i.e., the dislocation through the femoral head towards the acetabulum. After switching from proximal femoral nail antirotation (PFNA) to the trochanteric fixation nail advanced (TFNA) by the manufacturer, this rare type of complication has repeatedly been observed.</p><p><strong>Material and method: </strong>The retrospective single center case-control study was based on a database which includes all TFs. Inclusion criteria were TF treated by short PFNA or short TFNA. Exclusion criteria were femoral neck fractures and subtrochanteric femoral fractures. Descriptive and multiple perioperative factors were evaluated for both groups. The primary endpoint was the detection of a central cut-out. Secondary endpoints were any revision, including cranial cut-out failure, infections and the 30-day mortality.</p><p><strong>Results: </strong>A total of 400 TFs were consecutively treated with short PFNA between 25 July 2020 and 13 December 2023. From 14 December 2023 until 23 September 2025 a total of 200 TF were stabilized with a short TFNA. Perioperative factors were balanced between the two groups. A total of 3/400 (0.8%) central cut-outs were documented for PFNA. For TFNA, the rate of central cut-outs was 8/200 (4.0%). This difference was statistically different (p = 0.008). The total revision rate, including infections and the 30-day mortality were comparable. In terms of time, central cut-out occurred significantly earlier in TFNA in comparison to PFNA (mean; 64 vs. 135 days).</p><p><strong>Conclusion: </strong>The treatment of TF demonstrated no superiority for TFNA in comparison to PFNA with respect to infection rates and total revision rate. However, the rate of central cut-out was significantly higher for the TFNA. The rare complication with PFNA should be recorded for TFNA in a geriatric trauma registry or reported to the manufacturer. The reason for the central cut-out is still unclear.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857855","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":"[Return to sports after cruciate ligament surgery : Retrospective evaluation of the results of return to sports (RTS) testing after anterior cruciate ligament (ACL) reconstruction in an acute care hospital].","authors":"Christoph Andreas Oratsch, Vinzenz Smekal","doi":"10.1007/s00113-026-01714-x","DOIUrl":"https://doi.org/10.1007/s00113-026-01714-x","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study investigates functional fitness and return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction at an acute care hospital. ACL injury often leads to functional knee impairment. Modern rehabilitation focuses on individualized, functional criteria rather than fixed time intervals to ensure a safe RTS.</p><p><strong>Objective: </strong>What is the functional and psychological status of patients approximately 1 year postsurgery based on the Knee Injury and Osteoarthritis Outcome Score (KOOS), ACL-RSI (RSI: Return to Sport after Injury scale), and RTS tests? Which factors influence the return to sport?</p><p><strong>Materials and methods: </strong>A total of 149 patients (aged 18-60) with isolated ACL reconstruction were retrospectively analyzed using KOOS, ACL-RSI, and a standardized test battery (including strength, jumping ability, and balance). The Limb Symmetry Index (LSI) with a 90% cut-off was used for functional assessment.</p><p><strong>Results: </strong>Significant and clinically relevant improvements in pain, function, and psychological readiness were observed across all age groups, especially in sports participation and quality of life. Limited single-leg jumping performance, especially in middle adulthood, and functional deficits under fatigue proved to be key limiting factors for athletic performance. Return to sport was significantly influenced by subjective sports function and psychological readiness, which were strongly correlated (KOOS Sport-ACL-RSI: ρ = 0.56; p < 0.001), while objective functional parameters such as single-leg jump performance were moderately or weakly associated.</p><p><strong>Conclusion: </strong>The combination of objective tests and psychological evaluation is essential for a safe RTS. Rehabilitation should specifically address functional deficits in middle-aged individuals.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847445","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":"[Primary arthrodesis-Does it have advantages?]","authors":"Ann-Sophie Clara Weigel, A Milstrey, S Gartung, K Horst, S Ochman","doi":"10.1007/s00113-026-01709-8","DOIUrl":"https://doi.org/10.1007/s00113-026-01709-8","url":null,"abstract":"<p><p>Ankle fractures are the third most common fractures in old age with an incidence of up to 150/100,000 inhabitants per year. While anatomical joint reconstruction of the ankle using open reduction and internal fixation (ORIF) achieves good results in younger patients, geriatric patients are particularly prone to complications after surgery due to osteoporosis, multimorbidity and limited ability to maintain partial weight-bearing. Primary arthrodesis, usually performed as retrograde tibiotalocalcaneal (TTC) nailing, does not follow the anatomical reconstruction of the joint but pursues a different goal of a load-stable fixation that enables immediate full weight-bearing and thus avoids complications associated with immobilization. Studies have shown union rates of 85-100%, moderate functional results and a tendency towards fewer soft tissue complications compared to anatomical joint reconstruction. The indications are strictly selective and include nonreconstructable fractures, critical soft tissue situations, inability to bear partial weight and frail low-demand patients; however, the level of evidence is not high enough to derive recommendations. The currently available studies only have a retrospective study design, so that prospective randomized studies are required.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847405","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":"[Knife stab injuries in Stuttgart 2014-2024: an epidemiological overview].","authors":"Tomás Da Silva, Sara Koja, Tobias Merkle, Christian Knop","doi":"10.1007/s00113-026-01708-9","DOIUrl":"https://doi.org/10.1007/s00113-026-01708-9","url":null,"abstract":"<p><strong>Background: </strong>Knife stab injuries are rare in Germany but are gaining increasing clinical, societal and political relevance. While nationwide crime statistics document a marked rise in knife attacks, there is currently a lack of robust clinical data on hospitalized cases.</p><p><strong>Objective: </strong>The aim of this study was to present the temporal development of such injuries in Stuttgart over the past 10 years.</p><p><strong>Methods: </strong>A retrospective, single-center cohort analysis was conducted of all patients hospitalized with knife stab injuries inflicted by third parties at the Klinikum Stuttgart between 2014 and 2024. Included were externally inflicted injuries occurring in Stuttgart; self-inflicted injuries, accidents without external involvement and cases treated exclusively on an outpatient basis were excluded.</p><p><strong>Results: </strong>There was a significant increase in hospitalized patients with stab injuries with a peak in 2021. Overall, this corresponds to an increase of approximately 100% over 10 years (10% per year). During the coronavirus disease 2019 (COVID-19) pandemic, around 70% more cases occurred compared to other years. The monthly distribution showed significant peaks in April, August and December. The clustering on Sundays and Mondays indicates an elevated risk during weekend nights. A total of 92% of affected individuals were male, with a mean age of 31.1 years.</p><p><strong>Conclusion: </strong>Hospitalized patients with knife stab injuries in Stuttgart significantly increased between 2014 and 2024, particularly during the COVID-19 years. The majority of the affected individuals were young men. The results confirm the clinical perception of an increasing number of severe knife stab injuries requiring hospital treatment in the Klinikum Stuttgart.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847381","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":"[Occupational options in outpatient and inpatient rehabilitation].","authors":"Christian Sturm","doi":"10.1007/s00113-025-01664-w","DOIUrl":"10.1007/s00113-025-01664-w","url":null,"abstract":"<p><p>The discipline of orthopedics and trauma surgery is very broad and offers a wide range of options. In the area of conservative treatment it also includes methods of physical medicine. Therefore, it is also possible to work in this large field of physical and rehabilitative medicine (PRM) and there is a great deal of overlap between the two. The outcome of good surgical treatment often depends on high-quality follow-up care. Conservative treatment also offers a wide range of treatment options that present a professional challenge. Experience of orthopedics and trauma surgery is a great advantage for both. Knowledge of surgery and rehabilitative care is particularly useful at the interfaces of rehabilitation. Career pathways for interested individuals can therefore vary greatly between the different fields and offer an exciting range of tasks and opportunities, especially in interprofessional collaboration and interdisciplinary cooperation.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"294-298"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795754","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":"[Why you should not drive home in the evening with a young man on a motorbike at the weekend in summer-Traffic epidemiology with the TraumaRegister DGU® : German Congress for Orthopedics and Trauma Surgery Science Slam 2025].","authors":"Rolf Lefering, Stefan Huber, Sebastian Imach","doi":"10.1007/s00113-026-01702-1","DOIUrl":"10.1007/s00113-026-01702-1","url":null,"abstract":"<p><strong>Introduction: </strong>The TraumaRegister DGU® of the German Society for Trauma Surgery (TR-DGU) has been collecting data on seriously injured persons for decades. Based on a few key data points about the accident, far-reaching insights into accident epidemiology can be derived. The present evaluation refers to traffic accident victims, who account for about half of all seriously injured persons in the register.</p><p><strong>Method: </strong>For a 10-year period (2015-2024) information on the accident victims (age, gender), the circumstances of the accident and the time of admission to hospital (date, time) was extracted from the TR-DGU. Only patients who were primarily admitted to and treated in a German trauma center and who met the criteria of the registry's population base were considered.</p><p><strong>Results: </strong>The analysis is based on 121,534 accident victims with an average age of 47.4 years and 71% were male. Car occupants were the largest subgroup (39%), followed by motorcyclists (25%), cyclists (22%) and pedestrians (10%). The proportion of male accident victims was almost always greater than the female proportion and in the 16-71 years age group it was more than twice as high. In relation to the German population 18-year-olds have the highest incidence with 40 per 100,000 per year. On weekends, 10-20% more people are involved in accidents and during the day the rate is highest in the late afternoon (4-6 p.m.). The number of accidents is about twice as high in the summer months as in winter, which is mainly due to 2‑wheeled vehicles. Other external factors such as a full moon or Friday the 13th have no effect on the number of serious injuries. With just a few details about the person, the time and the mechanism of traffic accident victims, it is possible to identify areas that lead to more accidents. These findings can also be effectively used for prevention purposes.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"347-353"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482768","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":"[Musculoskeletal research : Trauma surgery and space flight].","authors":"Bergita Ganse","doi":"10.1007/s00113-025-01665-9","DOIUrl":"10.1007/s00113-025-01665-9","url":null,"abstract":"<p><p>This article presents my career path, which combines trauma surgery with space medical research. I was asked to describe for young colleagues both my career path and my work as a research university professor, which combines clinical experimental trauma surgery research with human physiological research in the context of space travel. In addition to specializing in orthopedics and trauma surgery, I completed the residency in physiology at the Charité in Berlin and at the German Aerospace Center in Cologne, before completing my postdoctoral thesis on the musculoskeletal system in space flight. Together with international collaboration partners, I have been involved in experiments in international space projects for many years, for example in bed rest studies, in research in Antarctica and on the International Space Station. In this article I also reflect the advantages and disadvantages of my work and what inspires me about it.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"303-309"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Full-time medical expert : Once university clinic and back again].","authors":"Christoph Obermeyer","doi":"10.1007/s00113-025-01663-x","DOIUrl":"10.1007/s00113-025-01663-x","url":null,"abstract":"<p><p>The field of orthopedics and trauma surgery is more than just scalpels and screws: it combines craftsmanship, thinking and attitude. My path led me from university traumatology to elective orthopedics and rehabilitation to a field that is often overlooked: medical assessment. Where medicine, law and economics converge, new perspectives emerged for me and the idea of rethinking medical assessment. My model, which combines efficiency, quality and collegiality, developed from my clinical and assessment experience, curiosity and entrepreneurial spirit. My career path is an invitation to experience medicine and cooperation beyond traditional paths and to courageously forge your own path.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"291-293"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806412","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":"[Injuries of the toes].","authors":"Felix M Bläsius, Frank Hildebrand, Philipp Lichte","doi":"10.1007/s00113-026-01676-0","DOIUrl":"10.1007/s00113-026-01676-0","url":null,"abstract":"<p><p>Toe injuries are common in clinical practice and cover a wide spectrum, from simple fractures and dislocations to complex tendon and soft tissue injuries. While most injuries can be conservatively treated, displaced fractures, open injuries or relevant loss of function require a differentiated surgical approach. Rare but prognostically important entities, such as décollement injuries or proximal tendon ruptures pose a particular challenge. A structured clinical examination supported, if necessary, by imaging is essential for making the correct diagnosis and deciding on the appropriate treatment. This article provides a comprehensive overview of the diagnostics, surgical and conservative treatment options as well as possible complications and their management.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"329-338"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069321","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":"[Management of humeral shaft fractures in childhood and adolescence : Consensus report of the Pediatric Traumatology Section of the DGU].","authors":"Nikos Karvouniaris, Christian Illian, Michael Kertai, Sebastian Reineke, Hauke Rüther, Kristofer Wintges, Jörn Zwingmann","doi":"10.1007/s00113-026-01679-x","DOIUrl":"10.1007/s00113-026-01679-x","url":null,"abstract":"<p><p>Humeral shaft fractures are rare in childhood, accounting for less than 5% of all pediatric fractures. Indirect trauma predominates in younger children, whereas direct trauma is more common in older patients. To date, no uniform recommendations exist regarding diagnostic evaluation or treatment management. Therefore, during the 13th and 14th scientific meetings of the Pediatric Traumatology Section (SKT), the available evidence was reviewed, the management strategies were critically discussed within an expert panel and a consensus was formulated.The management remains predominantly conservative, although the number of surgically treated cases is increasing. Potential humeral length discrepancies are generally clinically not a problem, whereas angular deformities exceeding 10° are cosmetically relevant. Owing to the extensive range of motion of the shoulder, functional impairment is generally not expected. In conservative treatment immobilization is recommended for 3-6 weeks, depending on the fracture type and patient age. Absolute indications for operative intervention include open fractures (> type II), unstable multilevel injuries of the affected arm and severe soft tissue damage that precludes adequate immobilization. Relative indications comprise polytrauma, traumatic brain injury, multiple or bilateral injuries, simple transverse fractures due to inherent instability and prolonged healing, anticipated noncompliance and patient preference. Elastic stable intramedullary nailing (ESIN) represents the gold standard for surgical management. Typical complications include radial nerve injury, technical difficulties during fixation and nonunion.Traumatic radial nerve palsy occurs in approximately 4% of cases. The treatment approach selected based on fracture morphology should be maintained. Primary nerve exploration is not initially required. High-resolution ultrasonography of the radial nerve should be performed within 1-2 weeks in both primary and secondary palsy. Nonstructural lesions typically recover spontaneously within 3-6 months. Early physiotherapy and occupational therapy are recommended in the presence of nerve deficits. In cases of an inadequate trauma mechanism, pathological fractures or potential indicators of child abuse must be considered.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"320-328"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}