Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Long-term outcomes after ankle fracture-Where do we stand?]","authors":"Sebastian F Baumbach, Kiriakos Daniilidis, Hans Polzer","doi":"10.1007/s00113-026-01767-y","DOIUrl":"https://doi.org/10.1007/s00113-026-01767-y","url":null,"abstract":"<p><p>With an incidence of approximately 74 per 100,000 people per year, ankle fractures are among the most frequent fractures in adults and are considered a major cause of posttraumatic ankle osteoarthritis. Reliable long-term data (≥ 10 years) are scarce. The aim of this study was to review the existing literature regarding long-term treatment outcomes following surgical management of ankle fractures. A narrative literature review was conducted. Studies were identified that reported on the treatment outcomes of surgically managed ankle fractures with a follow-up period of at least 10 years. A total of 20 studies with a mean follow-up period of 12.9 years were identified. On average the long-term outcomes were good to very good; however, depending on the patient population and scoring system 11-30% of patients reported only moderate to poor outcomes. Moderate to severe osteoarthritis was radiologically found in 18-100% of cases, although it was often asymptomatic. The conversion rate to arthrodesis or endoprosthesis ranged from 0-3% across all studies. Across the studies, only fracture complexity, development of osteoarthritis over time and depression had an impact on the outcome. In our own cohort, the number of fractured malleoli was the only significant influencing factor. Overall, the quality of the studies was at times unsatisfactory and, above all, comparability was limited. In the future, a standardization of the parameters collated would be valuable in order, for example, to evaluate the effectiveness of different surgical procedures across multiple studies.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208278","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":"[Clinical analysis of 369 deaths within 30 days following surgical treatment of proximal femur fracture].","authors":"Moritz Schenk, Christian Wulbrand, Andreas Proske, Bernd Füchtmeier, Franz Müller","doi":"10.1007/s00113-026-01769-w","DOIUrl":"https://doi.org/10.1007/s00113-026-01769-w","url":null,"abstract":"<p><strong>Background: </strong>The 30-day mortality rate after surgical treatment of proximal femur fractures (PF) is reported in the literature to be up to 10%. Clinical studies in German-speaking countries on the suspected causes or underlying diagnoses have not yet been available, which is the reason for this study.</p><p><strong>Materials and methods: </strong>The retrospective single-center cohort study is based on a database that records PF. Patients who died within 30 days postoperatively between 2006 and 2025 were included. The primary study endpoint was the causes of death, as documented in the final discharge summary. The secondary study endpoint was a descriptive analysis of deaths occurring within 24 h (day 0) postoperatively, as well as an assessment of variables associated with mortality between postoperative days 1-15 and days 16-30.</p><p><strong>Results: </strong>The overall cohort comprised 5431 patients with PF. Of these, 369 patients (6.8%) died within 30 days. The mean age was 85.2 years (53-101 years). Compared with the preceding 5‑year periods, the mortality rate decreased significantly in the last period (2021-2025; p = 0.007). The causes of death were respiratory (n = 105) and cardiovascular events (n = 54), multiorgan failure (n = 44), palliative condition (n = 32), renal events (n = 23), acute gastrointestinal diseases (n = 24), cerebral events (n = 15), periprosthetic infection including sepsis (n = 2), and other causes (n = 3). In 67 individuals, the cause of death was unclear. Within 24 h (day 0), 29 patients died, of whom n = 11 died from bone cement embolism or fat embolism syndrome. Five patients died in the operating room. More patients died between days 1 and 15 compared with the second half of the observation period (n = 216 vs. n = 124; p = 0.001), particularly during the first week (n =  145). In the first half, more women (p = 0.016) and patients treated with joint arthroplasty (p = 0.002) also died. All other variables were not statistically significant. With regard to the causes of death, both groups showed a similar distribution (p = 0.056).</p><p><strong>Conclusion: </strong>In our cohort of patients with PF, the first postoperative week was the most vulnerable period for death. The causes of death provide an approximation to this previously largely overlooked topic, but they are consistent with registry or autopsy data. Over the 20-year analysis, mortality most recently declined significantly.</p><p><strong>Evidence: </strong>III; retrospective cohort study.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198318","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 acute orthoplastic patient : Definition and initial management recommendations: consensus statement of the Orthoplastic Surgery Working Group of the German Society for Trauma Surgery (DGU) and the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC)].","authors":"Klemens Horst, Benjamin Thomas, Jörg Böhme, Justus Beier","doi":"10.1007/s00113-026-01773-0","DOIUrl":"https://doi.org/10.1007/s00113-026-01773-0","url":null,"abstract":"<p><p>Orthoplastic surgery combines the expertise of trauma and orthopedic surgery with plastic and reconstructive surgery for the management of complex musculoskeletal injuries associated with extensive soft tissue defects. Its primary aim is to provide early, coordinated interdisciplinary care to restore skeletal stability, achieve durable soft tissue coverage, and maximize long-term function. An acute orthoplastic patient is defined as an individual with complex musculoskeletal and soft tissue injuries requiring close interdisciplinary collaboration between trauma, plastic, and, where appropriate, additional surgical specialties. Furthermore, associated factors such as vascular injuries, infection, or relevant comorbidities may necessitate an orthoplastic treatment approach. The following recommendations were agreed upon: Patients who are hemodynamically stable and without an acutely threatened limb should be transferred to an orthoplastic competence center as early as possible, ideally within 24 h after injury. If immediate transfer is not feasible, early structured telemedical consultation with standardized transmission of clinical information, imaging, and photographic documentation of the soft tissue injury is recommended. Management should follow a standardized treatment pathway including prompt initiation of empirical antibiotic therapy, interdisciplinary radical debridement, restoration of bone stability, early vascular assessment, and timely definitive reconstruction. Whenever feasible, definitive fracture fixation and soft tissue reconstruction should be performed simultaneously or within a short time interval. These consensus recommendations provide the first structured framework for defining, triaging, and managing acute orthoplastic patients and aim to promote standardized orthoplastic care in specialized centers.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198375","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":"[Artificial intelligence in traumatological imaging : Evidence, integration into the clinical pathway and limits].","authors":"Philipp Locherer, Lukas Müller, Daniel Pinto Dos Santos","doi":"10.1007/s00113-026-01754-3","DOIUrl":"https://doi.org/10.1007/s00113-026-01754-3","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly being integrated into clinical radiology workflows and has the potential to make a significant contribution to patient care in the future. Although there is currently insufficient evidence to enable a definitive assessment, it is nonetheless worthwhile to gain experience with AI software in the context of imaging in traumatology. While impressive performance can already be observed in clinical practice, users must remain aware of the regulatory framework and critically evaluate AI results with a vigilant eye.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198231","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":"[From functional assessment to estimating the reduction in earning capacity : A three-step guide to medicolegal assessment in orthopedics and trauma surgery within German statutory accident insurance].","authors":"Martin Husen, Klaus Büscher, Marcus Schiltenwolf","doi":"10.1007/s00113-026-01770-3","DOIUrl":"https://doi.org/10.1007/s00113-026-01770-3","url":null,"abstract":"<p><strong>Background: </strong>The December 2025 DGUV (Deutsche Gesetzliche Unfallversicherung) consensus paper provides reference values for selected musculoskeletal injury outcomes in pensions granted for an indefinite period. These values are comparators, not a formula. Each assessment must therefore identify the reference condition that most closely reflects the documented functional impairment.</p><p><strong>Objective: </strong>To provide a concise and accessible guide that leads less experienced or occasional medical experts from clarification of the mandate to a transparent estimate of the reduction in earning capacity (MdE).</p><p><strong>Materials and methods: </strong>The 2025 DGUV consensus paper was the starting point. Statutory provisions, case law, and supplementary medicolegal literature were reviewed narratively to structure the case-specific reference comparison into three steps. The reference values were adopted without modification. Three case examples illustrate their application.</p><p><strong>Results: </strong>The guide follows three steps: clarify the mandate, assessment date, and accepted consequences; describe the documented impairment and its impact on general work demands; and identify the closest reference condition. Six guiding questions make the comparison and estimate explicit.</p><p><strong>Conclusion: </strong>The approach supports clear and verifiable reasoning, especially for beginners, and may aid training and quality control. It does not replace individual expert judgement and has not yet been evaluated empirically.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186854","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":"[Digital operating room-From dream to workflow].","authors":"Antonia von Helden, Georg Osterhoff, David Alexander Back, Lena Wenzke","doi":"10.1007/s00113-026-01779-8","DOIUrl":"https://doi.org/10.1007/s00113-026-01779-8","url":null,"abstract":"<p><p>The challenging transformation of medicine in the twenty-first century, involving robotics, artificial intelligence (AI) and the digitalization of daily work routines, is hampered by bureaucratic hurdles, a shortage of skilled workers and socioeconomic pressures within an aging healthcare system. This article provides an overview of current possibilities and applications of AI in the (peri)operative care of trauma patients. Even before surgeons enter the operating room, preoperative AI planning tools could increase efficiency in the future. Intraoperatively, navigation and robotics are already well-established and improve precision. In the future, ambient AI and digital twins can be expected to also link perioperative data as well as optimizing workflows and making decisions. The AI-supported surgical documentation increasingly relieves the workload for physicians but it still poses risks and interoperability issues. Key hurdles for AI in the operating room remain data heterogeneity, a lack of standardization and costs. It is also important, especially in the operating room, that the ethical responsibility for controlling (semi)autonomous systems remains with humans.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171455","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":"OMW: Lokale Infiltrationsanästhesie bei Hüftfrakturen.","authors":"Christoph Konitz, Carl Neuerburg, Christoph Beyersdorf","doi":"10.1007/s00113-026-01777-w","DOIUrl":"https://doi.org/10.1007/s00113-026-01777-w","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148622","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":"[Nonunion: cause before treatment : From time-based definition to cause-directed treatment].","authors":"Houmam Anees, Thaqif El Khassawna, Christian Heiss","doi":"10.1007/s00113-026-01771-2","DOIUrl":"10.1007/s00113-026-01771-2","url":null,"abstract":"<p><p>Fracture nonunion is a multifactorial complication of fracture healing. A solely time-based definition does not adequately reflect the underlying disturbances in healing and provides an insufficient basis for treatment decisions. Instead, management should be guided by a systematic assessment of the factors preventing osseous union. These include fracture-related infection, mechanical deficits, impaired biological healing potential, and patient-related risk factors. Occult infection should also be considered in clinically presumed aseptic nonunion. Mechanical instability requires restoration of adequate stability, whereas biological deficits may necessitate targeted augmentation. Modifiable patient-related risk factors should be optimized in parallel. As several contributing factors may coexist, treatment should not be based solely on temporal or morphological criteria but should address the individual causes of impaired fracture healing. A systematic, cause-directed approach therefore enables targeted treatment and, in multifactorial cases, the appropriate combination of therapeutic strategies.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119623","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":"[Trauma networks of the future: where is the trend headed?]","authors":"G Matthes, G Schiffer","doi":"10.1007/s00113-026-01772-1","DOIUrl":"https://doi.org/10.1007/s00113-026-01772-1","url":null,"abstract":"<p><p>The idea of establishing certified trauma networks to ensure nationwide, high-quality care for severely injured patients emerged in the early 2000s. Since then, it has been continuously developed. Currently, 278 local, 240 regional, and 122 supraregional trauma centers in 48 trauma networks are certified in Germany. An increasing number of other countries are adopting the TraumaNetwork within their own structures. The far-reaching changes currently taking place in German health policy, the integration of other countries with different healthcare systems into the TraumaNetwork, and the growing need to focus on care structures in terms of disaster, crisis, and war are creating new challenges.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119620","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":"[Diagnostic algorithm for the management of patients ≥ 65 years with a mild traumatic brain injury in the emergency department].","authors":"Anne Neubert, Astrid Göldner, Stefanie Williams, Michael Bernhard, Carina Jaekel, Denise Schulz, Joachim Windolf, Dan Bieler","doi":"10.1007/s00113-026-01737-4","DOIUrl":"10.1007/s00113-026-01737-4","url":null,"abstract":"<p><strong>Background: </strong>Mild traumatic brain injury (TBI) following low-impact trauma, such as falls from ground level, frequently affects older patients in the emergency department. Due to the demographic change, an increase in this type of injury in emergency departments is to be expected. The aim of this study was to develop an evidence-based diagnostic algorithm for patients ≥ 65 years of age with mild TBI who present to the emergency department.</p><p><strong>Methods: </strong>Systematic reviews with literature searches in MEDLINE (English/German) and manual searches of references were conducted for three diagnostic questions. Studies were evaluated using the  Methodological index for nonrandomized studies. Data synthesis was performed using vote counting based on direction of effect and the evaluation of clinical influencing factors.</p><p><strong>Results: </strong>A database search yielded 52 studies involving 142,037 patients. For initial cranial imaging using cranial computed tomography (cCT), an approach based on six clinical influencing factors could be an alternative to routine imaging. In asymptomatic patients with no neurological abnormalities, neurological monitoring without standardized control cCT is conceivable; however, there are no reliable data available on the optimal design. The modalities of neurological monitoring need to be further investigated. The role of anticoagulation and antiplatelet treatment remains unclear.</p><p><strong>Conclusion: </strong>The results form the basis for an algorithm for the diagnosis of mild TBI in older patients. The evidence-based design of neurological monitoring and the influence of anticoagulant medication require further research.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"696-708"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664838","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}