Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Utilization of registers to create an evidence-based approach in catastrophes and civil defence].","authors":"Sebastian Imach, Rolf Lefering, Benny Kölbel, Maximilian Wolf, Lisa Hackenberg, Dan Bieler","doi":"10.1007/s00113-024-01487-1","DOIUrl":"https://doi.org/10.1007/s00113-024-01487-1","url":null,"abstract":"<p><p>Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only the mortality of patients. For incidents outside the daily routine care in trauma surgery, such as natural disasters, accidents with multiple casualties and nonmilitary treatment of the domestic population in defence situations, such registers can provide data-based recommendations for action. These data, mainly obtained from routine traumatological treatment, enable a targeted resource management in the abovenamed incidents, which are associated with mass casualties. Due to the utilization of registers from the military field or from international registers, the perspective is additionally extended with respect to treatment strategies and injury patterns. Whether data can also be generated in a suitable manner for the abovenamed registers in specific disaster situations and can provide a direct gain of knowledge from the incident, must be critically discussed. The maintenance of the register datasets is time-consuming and has been subjected to a more stringent regulation at least since May 2018, when the European Union General Data Protection Regulation (EU-GDPR) came into force. The future Register Act in Germany will hopefully achieve greater simplification in the documentation of routine data.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402307","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":"[Fatal course of a fulminant gas gangrene of the right hemithorax].","authors":"Christoph J Neumann, Matthias Unterberg, Daniel Mesbah, Mark Sandfort, Rüdiger Smektala","doi":"10.1007/s00113-024-01490-6","DOIUrl":"https://doi.org/10.1007/s00113-024-01490-6","url":null,"abstract":"<p><p>The full clinical picture of a gas gangrene infection is an absolute rarity. The mechanism of development can be either traumatic or spontaneous (e.g., hematogenous seeding in occult colon carcinoma). In particular, the rare pathogen Clostridium septicum appears to be associated with spontaneously occurring gas gangrene. Diabetes mellitus is a significant risk factor. The mortality rate of the disease is around 50%, even with maximum therapeutic efforts, and the course of the disease is fulminant in the majority of cases. Initial symptoms are unspecific and make early diagnosis difficult. Treatment consists of high-dose antibiotics in combination with radical surgical debridement and, if necessary, supplementary hyperbaric oxygen therapy.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402306","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":"[Intramedullary nailing of coated and uncoated nails in infected tibial pseudarthrosis : Results of a retrospective examination of 56 patients].","authors":"V Heck, M Glombitza, V Weichert, H Schöllmann, M Dudda, E Steinhausen","doi":"10.1007/s00113-024-01489-z","DOIUrl":"https://doi.org/10.1007/s00113-024-01489-z","url":null,"abstract":"<p><strong>Background: </strong>In surgery for sepsis it is a well-established principle that no internal osteosynthetic material should be implanted in cases of chronic osteomyelitis. Therefore, the surgical treatment with intramedullary nails is so far used only rarely in cases of chronic osteomyelitis.</p><p><strong>Objective: </strong>This study analyzed whether the implantation of tibial intramedullary nails is an effective treatment for chronic osteomyelitis and how high is the rate of reinfection.</p><p><strong>Material and methods: </strong>A retrospective analysis of patients with an infected pseudarthrosis of the tibia in whom a gentamycin-coated nail (ETN) or an uncoated tibial intramedullary nail (UCN) was implanted between December 2011 and December 2019 was carried out. The preoperative, perioperative and postoperative results were evaluated.</p><p><strong>Results: </strong>During the study period 29 patients received a UCN and 27 patients received an ETN. Of the patients 95% (n = 53) had been previously unsuccessfully treated with external fixation. Postoperative complications occurred in 45% of the patients and more often in the ETN group (48% vs. 41%). Reexacerbation of the infection occurred in 20 patients and more frequently in the UCN group (38% vs. 33%). The nonunion already showed a bony consolidation at the time of the exacerbation in 10 patients (50%). At the end of the follow-up a consolidation was present in 48 patients (86%), more frequently in the UCN group (90% vs. 78%). Of the patients 50 (89%) reached full weight bearing without any differences between the groups.</p><p><strong>Conclusion: </strong>Despite a relatively high a rate of postoperative complications the risk of reinfection was acceptable with good functional and radiological results. The main general advantages of nailing are without doubt the high primary stability, the implantation with preservation of the soft tissue and the improved wearing comfort for patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395864","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":"[Total calcanectomy in osteomyelitis and soft tissue defect with complex secondary reconstruction of the hindfoot : Case report and literature comparison].","authors":"D Kolitsch, P Kobbe, S Langwald, M Hückstädt","doi":"10.1007/s00113-024-01488-0","DOIUrl":"https://doi.org/10.1007/s00113-024-01488-0","url":null,"abstract":"<p><p>The clinical picture and surgical treatment of implant-associated osteomyelitis of the calcaneus with soft tissue defect are presented based on this case study. Due to the fulminant infection, complete resection of the calcaneus and a two-stage complex reconstruction of the hindfoot were performed. As necrosis developed in the surgical access route, coverage with a free ALT flap became necessary.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395866","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":"[Possibilities of the utilization of trauma networks of the German Society for Trauma Surgery using digital solutions].","authors":"Wolfgang Lehmann, Sabine Blaschke, Uwe Schweigkofler, Christopher Spering","doi":"10.1007/s00113-024-01485-3","DOIUrl":"https://doi.org/10.1007/s00113-024-01485-3","url":null,"abstract":"<p><p>This paper describes the use of digital solutions to improve the care of trauma patients in Germany. The focus is on the trauma networks of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The use of digital solutions includes quality assurance through the TraumaRegister, which enables comprehensive data analysis as well as preregistration and resource utilization through programs such as the interdisciplinary proof of treatment IVENA eHealth, Rescuetrack and Rescue-Net. In addition, Predictive Hospital Resource Planning is presented, which optimizes resource forecasting using artificial intelligence (AI). Telemedical services such as Medgate and teleradiology solutions (Nexus/Chili) offer additional support, especially in rural areas. The paper shows how the digitalization of medical care is crucial to improving the efficiency and quality of treatment of trauma patients. In addition, the paper shows possible developments in the field of clinical decision making through AI.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395865","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":"[Rotationally stable screw anchor (RoSA) vs. Gamma3 Nail (G3N) in pertrochanteric femoral fractures : A functional outcome analysis].","authors":"Sven Löhnert, Klaus-Jürgen Maier, Peter Behrendt, Michael Hoffmann","doi":"10.1007/s00113-024-01479-1","DOIUrl":"https://doi.org/10.1007/s00113-024-01479-1","url":null,"abstract":"<p><strong>Background: </strong>The pertrochanteric femoral fracture (PFF) represents one of the most common fracture types throughout Germany. To enable early mobilization of patients, the primary surgical goal is load-stable osteosynthesis. Implant failure still represents the largest group of implant-related complications (>80%).</p><p><strong>Objective: </strong>The aim of the study was to document and analyze the influence of the implant on the functional outcome and an evaluation of the rotationally stable screw anchor (RoSA) vs. Gamma3 nail.</p><p><strong>Material and methods: </strong>In a retrospective study 43 patients with PFF (AO 31A1-A3) were included in the study. The influence of the implant on the functional outcome was assessed by 2 standardized questionnaires (SF-36, NMS (New Mobility Score)) and analyzed in a retrospective evaluation.</p><p><strong>Results: </strong>In the study no significant differences in functional outcome scores ≥ 1 year after osteosynthesis of the PFF could be shown depending on the implant used. There is an overall tendency for a better outcome in the G3N group.</p><p><strong>Discussion/conclusion: </strong>In the literature the superiority of intramedullary nailing over extramedullary implants is continually discussed. Implant failure is still the most frequent complication. In intramedullary implants, such as the G3N, the primary cause is failure of the head-neck component. For conventional extramedullary implants the biomechanical properties on the femoral shaft also pose a challenge in the case of unstable PFF. The further development of the RoSA to an intramedullary implant could combine the advantages of intramedullary load carriers with the advantages of the blade-screw combination in the head-neck fragment and lead to a reduction in implant-associated complications.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303035","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":"[Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process].","authors":"Amine Mellal, Jaad Mahlouly, Célia Guttmann, Charlotte Fröning, Stefan Bauer","doi":"10.1007/s00113-024-01457-7","DOIUrl":"10.1007/s00113-024-01457-7","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing a direct anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting.</p><p><strong>Indications: </strong>In cases with CCBL isolated ligament reconstruction harbors a high failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint.</p><p><strong>Contraindications: </strong>Usual contraindications to surgery, coronoid bone loss less than 40%.</p><p><strong>Surgical technique: </strong>The surgical procedure is thoroughly illustrated with a video of the operation that can be accessed online: reconstruction of the LUCL with a semitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with a direct anterior approach, freshening up of the graft bed. Temporary fixation of the graft with a Kirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a 2.4 mm buttress plate and screws.</p><p><strong>Follow-up: </strong>Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day 1 with an overhead motion protocol. Removable splint for 4 weeks, free mobilization at 6 weeks, return to sport at 3 months.</p><p><strong>Results: </strong>Durable elbow stability was achieved along with free ROM and high patient satisfaction.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899150","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":"[Complications in paediatric traumatology : \"It will grow out\"].","authors":"Dorien Schneidmueller","doi":"10.1007/s00113-024-01478-2","DOIUrl":"https://doi.org/10.1007/s00113-024-01478-2","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303031","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":"[Modified Masquelet technique for reconstruction of critical bone defects].","authors":"Marc Hückstädt, Christian Fischer, Michael Mitin, Friederike Klauke, Steffen Langwald, Thomas Mendel, Philipp Kobbe, Sandra Schipper","doi":"10.1007/s00113-024-01473-7","DOIUrl":"10.1007/s00113-024-01473-7","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984100","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":"[Radial neck fracture in children-\"A benign fracture?\"]","authors":"Sven-Oliver Dietz, Lotte Schierjott, Oliver Loose, Erol Gercek, Francisco Fernandez","doi":"10.1007/s00113-024-01475-5","DOIUrl":"https://doi.org/10.1007/s00113-024-01475-5","url":null,"abstract":"<p><p>Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of 8 and 12 years old are more frequently affected, whereby a cubitus valgus variant can be a predisposing factor. The main trauma mechanism is a fall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while a surgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using a elastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires a comprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303033","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}