Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Navigated and minimally invasive screw osteosynthesis of a talus fracture].","authors":"Dominik M Haida, Thorsten Möhlig, Stefan Huber-Wagner","doi":"10.1007/s00113-024-01513-2","DOIUrl":"10.1007/s00113-024-01513-2","url":null,"abstract":"<p><strong>Objective of surgery: </strong>The aim of this surgery is to safeguard the multifragmentary and nondisplaced talus fracture (body and neck) against secondary dislocation in a navigated and minimally invasive manner using screw osteosynthesis.</p><p><strong>Indications: </strong>Due to the young age of the patient in the presented case and the risk of a possible secondary dislocation, the decision was made in favor of surgical treatment.</p><p><strong>Contraindications: </strong>Soft tissue swelling, wound infections and allergies to the osteosynthesis material.</p><p><strong>Surgical technique: </strong>The video is available online (in English) and shows the individual surgical steps in detail. Preoperative computed tomography (CT) imaging and screw planning. Attachment of the reference array. 1) Cone beam CT (CBCT) scan, image fusion and fusion control. Planning of the minimally invasive skin incisions. Skin incision, navigated drilling and insertion of the K‑wires. 2) CBCT scan and position check of the K‑wires, fine adjustment if necessary. Insertion of the screws. 3) CBCT scan with subsequent position check of the screws, retightening of the screws if necessary. Performed in the Robotic Suite (Brainlab, Munich, Germany) using the following elements: navigation unit curve navigation system, movable robotic 3D CBCT, \"Loop-X\" and wall monitor \"BUZZ\".</p><p><strong>Follow-up: </strong>Postoperative X‑ray and CT to control the position of the implants. Partial weight-bearing of the foot with 10 kg sole contact for 6 weeks. Physiotherapy with active and passive joint mobilization. Thrombosis prophylaxis with enoxaparin sodium. Optional implant removal after approximately 1 year.</p><p><strong>Evidence: </strong>Navigated operations are routine, so far mainly in the area of the spine. This article shows that navigated extremity surgery can be successfully performed in hybrid operating theaters.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"64-68"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848637","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":"[Specialized trauma surgery: do we need it at all?]","authors":"J C Katthagen, M F Lodde, C A Müller, M J Raschke, T Fuchs","doi":"10.1007/s00113-024-01512-3","DOIUrl":"10.1007/s00113-024-01512-3","url":null,"abstract":"<p><p>Despite maximally motivated and professionally outstanding young talent, the particularly stressful surgical disciplines have recruitment concerns. In recent years various sections and subsidiary societies of the German Society for Orthopedics and Trauma Surgery (DGOU) have developed and distributed personnel and institution-related certificates. Organ-specific and procedure-specific certificates are very popular to confer increased visibility to individuals and institutions. Many specialists for orthopedics and trauma surgery specialized early in fields, such as foot, knee, shoulder, elbow or arthroscopic surgery. General traumatology, treatment of polytrauma and complex traumatology of the chest and abdomen are becoming more and more unattractive. Knife attacks and also the \"truck attack\" at the Breitscheidplatz in Berlin illustrate the smoldering terror situation in Germany. The Federal Criminal Police Office also recently announced that the incidence of domestic violence increased by 6.5% in 2023 alone. This cannot be mastered with specialization alone. The visibility and the attractiveness of specialized trauma surgery must be increased and structures for appropriate specialization must be achieved. The possible introduction of a qualification \"specialized trauma surgery\" is discussed. In current considerations of the German Society of Trauma Surgery (DGU), the Academy for Trauma Surgery (AUC) and the Working Group for Osteosynthesis Issues (AO) Trauma Germany, a stepwise acquisition of defined knowledge from the principles on basic contents up to specialization and expert knowledge, could lead to the acquisition of the qualification in \"specialized trauma surgery\".</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"11-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866546","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":"Erratum zu: 45/m – Motorradunfall mit Sturz auf die rechte Hand.","authors":"Evi Fleischhacker, Elisabeth-Maria Haas-Lützenberger","doi":"10.1007/s00113-024-01529-8","DOIUrl":"10.1007/s00113-024-01529-8","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960034","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":"[Generalist vs. specialist in trauma surgery : Who do we need in our hospitals?]","authors":"Ulrich Stöckle","doi":"10.1007/s00113-024-01519-w","DOIUrl":"10.1007/s00113-024-01519-w","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848636","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 to the lateral ankle ligaments].","authors":"Konrad Kamin, Marcel Mäder, Christine Marx, Stefan Rammelt","doi":"10.1007/s00113-024-01503-4","DOIUrl":"10.1007/s00113-024-01503-4","url":null,"abstract":"<p><p>Acute sprains and ruptures of the lateral ankle ligaments are the most common injuries of the ankle joint. They are often related to sporting activity and predominantly affect individuals under 40 years old. Lateral ligament injuries occur due to supination trauma. The anterior talofibular ligament is most commonly affected often in combination with the calcaneofibular ligament. In contrast, ruptures of all three lateral ankle ligaments (luxatio pedis supinatoria) or complete ruptures of the medial and lateral ligaments (luxatio pedis cum talo) are extremely rare. The clinical diagnostics have a high sensitivity and specificity and X-ray images are used to exclude fractures and other accompanying injuries. In cases of acute injuries conservative treatment in an orthosis for 5-6 weeks to prevent supination is the method of choice. Surgical treatment is reserved for exceptional indications. For both operative and conservative forms of treatment the functional treatment with initial movement exercises in a semi-rigid orthosis and the following proprioceptive training are crucial for the success of treatment and show superior results compared to immobilization in a surgical cast.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"47-58"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803829","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":"[University trauma surgery and orthopedics: where is the journey going to?]","authors":"Josefa Greiser, Andreas Roth, Wolfgang Böcker","doi":"10.1007/s00113-024-01517-y","DOIUrl":"10.1007/s00113-024-01517-y","url":null,"abstract":"<p><p>In the field of tension between generalists and specialists, in modern university trauma and orthopedic surgery the question arises as to which expertise has the greatest importance for the future of clinical care. University medicine consists of three large pillars: Research, teaching and treatment of patients. Each of these pillars is faced with the challenge of increasing specialization; however, generalists are extremely important for the future of university trauma surgery and orthopedics. Generalists promote interdisciplinary collaboration through their broad training and are versatile in acute care situations. Specialists are characterized by in-depth specialist knowledge and technological expertise in specific areas of surgery. This article analyses the changing requirements in trauma surgical and orthopedic care in the context of innovation, technologization, digitalization and increasing specialization. It also examines how structural reforms, such as the Hospital Structure Act and the new licensing regulations, are influencing the role of generalists and specialists in university training and clinical practice. The article provides a differentiated view of which specialist skills will be necessary in hospitals in the coming years and discusses whether a balance between generalism and specialization is the solution for high-quality patient-centered care.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"18-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924281","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":"[Consideration and implementation of the elements of hospital mass casualty planning in the hospitals of the TraumaNetworks DGU® : An evaluation within the framework of the development process of the guidelines for clinical disaster medicine in Germany (LeiKliKatMeD) by the EKTC, NIS, AKUT, AUC].","authors":"Gerhard Achatz, Dan Bieler, Uwe Schweigkofler, Christine Hoefer, Wolfgang Lehmann, Axel Franke","doi":"10.1007/s00113-024-01494-2","DOIUrl":"10.1007/s00113-024-01494-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The protection and maintenance of hospital functionality and treatment capacity require preventative planning and preparation for a mass casualty incident with respect to the scenarios, disasters or catastrophes to be expected. The hospital alarm and operations (KAEP) or stockpiling plan should include and organize the procedures and measures in the respective clinics and hospitals. The aim of the present study was to evaluate the hospitals of the Trauma Networks of the German Society for Trauma Surgery® (TNW DGU®) with respect to the established organizational structures and contents of the KAEP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and method: &lt;/strong&gt;In this study 622 hospitals from the TNW DGU® were surveyed to determine current treatment capacities depending on the principles and standards of care. This was done via the DGU Academy of Trauma Surgery (AUC) and an online-based survey with voluntary participation via a web-based platform (SurveyMonkey Europe UC, Dublin, Ireland). The data presented here represent an excerpt of the overall data focused on the topic of this paper. Of the 622 certified clinics 252 (40%) took part in the survey in December 2022 and 250 data sets could be evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Level I, II, III trauma centers (LTZ, RTZ, ÜRTZ) took part in equal numbers. Of the participating clinics 90% have a KAEP that has been updated in the last 3 years. The manual of the Federal Office of Civil Protection and Disaster Assistance (BBK) was known in two thirds of the clinics surveyed. Only 30% of the clinics adapted their own KAEP after it was published and only 40% exercised it in the last 3 years. Elements for the care of those affected and injured (psychosocial network, end-of-life care, care of relatives) were included in 25-44% of hospitals. Regardless of the certification, it became obvious that around 80% of the hospitals rely exclusively on one alarm procedure and only 20% use a redundant system with 2 or more notification procedures. The survey showed that more than 75% of the hospitals already have the option of selective or partial alerting. Depending on the triage category, the LTZs were able to initially admit an average of 2 SK I and 4 SK II patients. These capacities were almost doubled by the RTZ and tripled by the ÜTZ.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The DGU Trauma Networks represent an essential part for the care in disaster and major disaster situations. The KAEP has been implemented in the majority of hospitals. Updating the KAEPs to current content, practicing and digital, selective and redundant systems for alerting represent a challenge. In addition, the harmonization of terms and organizational elements but also the establishment of care for relatives and the care and psychosocial emergency treatment (PSNV) have not yet been fully implemented. Ultimately, a KAEP must be implemented to make hospitals and the healthcare system more resilient to disasters and major disa","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"867-877"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607621","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":"[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":"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":" ","pages":"855-860"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","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":"[Crisis treatment in emergency and disaster medicine from the perspective \"trauma surgery\" : Terminology, scenarios, existing concepts and challenges].","authors":"Axel Franke, Dan Bieler, Gerhard Achatz","doi":"10.1007/s00113-024-01493-3","DOIUrl":"10.1007/s00113-024-01493-3","url":null,"abstract":"<p><p>The war in Ukraine and the pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have brought the resilience of our healthcare system and the preparation for disaster medical situations into the focus of a broad and current professional discussion. All measures to improve medical care in disasters can be subsumed under the umbrella term civil health protection. Most damage events that result from the realization of the risks in our daily lives in the sense of a catastrophe or damage situation result in an acute presentation of injured people with an exceedance or a restriction of the treatment capacity of a hospital. Both lead to a shortage situation that endangers patients and that may require applying the principles and concepts of disaster medicine and activating the hospital alarm and deployment plan for structured implementation. As the clinics of the TraumaNetworks DGU® represent an essential pillar of trauma care in the event of a disaster, a prerequisite for dealing with a damage situation is to know the elements of the organization, competences and responsibilities as well as to elucidate the role of the hospitals from the perspective of trauma surgery. This article presents the principles of the nomenclature of medical care in disasters, organization and possible coping strategies and discusses the principles of risk stratification in the preparation. All of this happens with the aim of optimizing the preparation and functioning of one's own hospital in the event of damage or a disaster.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"839-848"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670041","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 role of trauma surgery in civil protection and disaster medicine].","authors":"D Bieler, U Schweigkofler, S Imach, G Achatz, A Franke","doi":"10.1007/s00113-024-01496-0","DOIUrl":"10.1007/s00113-024-01496-0","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"127 12","pages":"837-838"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712160","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}