Unfallchirurgie (Heidelberg, Germany)最新文献_第10页

[Traumatic injuries in ankylosing spinal diseases]. [强直性脊柱疾病中的创伤]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI: 10.1007/s00113-024-01484-4

Philipp Schleicher, Andreas Pingel, Alexander Wengert, Jonathan Neuhoff, Frank Kandziora

引用次数: 0

[Fasciocutaneous bridge flap to cover defects on the lower leg after compartment syndrome with a complication-prone course : An "almost" forgotten safe flap procedure]. [用筋膜皮桥瓣覆盖包室综合征后小腿缺损，并发症多发：一种 "几乎 "被遗忘的安全皮瓣手术]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-09-20 DOI: 10.1007/s00113-024-01481-7

Anton Borger, Tobias Karge, Rita Babeluk, Lukas Zak, Lorenz Semmler, Stefan Hajdu, Christine Radtke

{"title":"[Fasciocutaneous bridge flap to cover defects on the lower leg after compartment syndrome with a complication-prone course : An \"almost\" forgotten safe flap procedure].","authors":"Anton Borger, Tobias Karge, Rita Babeluk, Lukas Zak, Lorenz Semmler, Stefan Hajdu, Christine Radtke","doi":"10.1007/s00113-024-01481-7","DOIUrl":"10.1007/s00113-024-01481-7","url":null,"abstract":"This article reports on a complicated case of a soft tissue defect with challenging soft tissue coverage on the lower leg. After a lower leg fracture and treatment with a tibial nail, a 29-year-old man developed compartment syndrome due to massive secondary bleeding with a lesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with a soft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated a delayed incomplete healing over 8 months. In addition, X‑ray imaging revealed a nonunion and a resulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and a difficult local blood flow situation, the choice of reconstruction procedures was limited. A bridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1 year.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"818-823"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303029","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}

引用次数: 0

[Intramedullary nailing of coated and uncoated nails in infected tibial pseudarthrosis : Results of a retrospective examination of 56 patients]. [感染性胫骨假关节炎中涂层钉和非涂层钉的髓内钉：56 例患者的回顾性检查结果]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1007/s00113-024-01489-z

V Heck, M Glombitza, V Weichert, H Schöllmann, M Dudda, E Steinhausen

{"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":"10.1007/s00113-024-01489-z","url":null,"abstract":"Background: 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.Objective: 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.Material and methods: 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.Results: 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.Conclusion: 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.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"796-804"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","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}

引用次数: 0

[Clavicle nonunion]. [锁骨脱节］

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-07-25 DOI: 10.1007/s00113-024-01465-7

Axel Jubel, Maximilian Knopf, Jil Marie Jubel, Hannah Herbst, Moritz Antonie

{"title":"[Clavicle nonunion].","authors":"Axel Jubel, Maximilian Knopf, Jil Marie Jubel, Hannah Herbst, Moritz Antonie","doi":"10.1007/s00113-024-01465-7","DOIUrl":"10.1007/s00113-024-01465-7","url":null,"abstract":"After conservative treatment nonunion (pseudarthrosis) of the clavicle can be observed approximately 10 times more frequently (15-24%) than after surgical treatment (1.4%). Risk factors include the fracture location, displacement, fracture type, sex, the severity of the accident and refractures. The diagnosis of pseudarthrosis of the clavicle can be made by a thorough medical history, clinical examination and imaging procedures. The main symptom is pain, often accompanied by malalignment, instability, neurological symptoms and restricted mobility of the affected shoulder. The diagnosis is confirmed by X‑ray images and, if necessary, a computed tomography (CT) scan. Pseudoarthrosis is classified according to the morphological appearance in X‑ray images and the cause. A differentiation is made between vital and nonvital pseudarthroses. Only symptomatic pseudarthrosis requires treatment. Nonoperative methods, such as magnetic field therapy or ultrasound are minimally effective. Surgical interventions are indicated for pain, movement restrictions or neurovascular problems. The goals of surgical treatment are to restore the vitality, bone length and stability through angular stable osteosynthesis. In cases of surgical pretreatment the anteroinferior plate position offers a good alternative to the superior plate position. In some cases double plating osteosynthesis can be indicated. Autogenous bone material, allogeneic substitute material and vascularized grafts are used for bony defects. Surgical treatment shows high rates of healing but also carries an increased risk of infection.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"776-782"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763170","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}

引用次数: 0

[Clavicle fractures : From honey, minerals and stiff linen to light metals and long-chain polyethylene sutures]. [锁骨骨折：从蜂蜜、矿物质和硬麻布到轻金属和长链聚乙烯缝合线]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-11-05 DOI: 10.1007/s00113-024-01472-8

Tobias Helfen

引用次数: 0

[Stress fractures of the growth plates in the fingers of adolescent rock climbers]. [青少年攀岩者手指生长板应力性骨折]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI: 10.1007/s00113-024-01482-6

Volker Schöffl, Othmar Moser, Thomas Küpper

{"title":"[Stress fractures of the growth plates in the fingers of adolescent rock climbers].","authors":"Volker Schöffl, Othmar Moser, Thomas Küpper","doi":"10.1007/s00113-024-01482-6","DOIUrl":"10.1007/s00113-024-01482-6","url":null,"abstract":"Background: Primary periphyseal stress injuries (PPSI) of the hand and fingers are a rare condition overall but are most commonly seen in adolescent rock climbers and is the most common sport-specific injury in young climbers. Early diagnosis and treatment are crucial for a good treatment outcome and to avoid chronic sport-related injury.Objective: The aim of the study is to introduce the injury to a wider audience. Based on an analysis of the current literature, the pathophysiology is demonstrated and the diagnostic and treatment standards are analyzed. Prophylactic measures are also reported.Material and methods: Based on a systematic multiple database analysis, the current literature on PPSI of the hand and fingers in climbers were collected and further analyzed in a narrative review. The pathophysiology, diagnostic and treatment concepts are presented.Results: Most cases of PPSI to the hand and fingers are in young rock climbers; however, a few cases have been reported in gymnasts, baseball players and piano players. Overall, there are over 200 documented cases in the literature. Most are Salter-Harris III/Aitken II fractures but grade I, II and IV fractures have also been reported. Patients are mostly 13-15 years of age and within the main pubertal growth spurt. After diagnosis, usually by magnetic resonance imaging (MRI), treatment is often conservative, with an increasing number of cases requiring surgical revision. Surgery usually involves spot drilling of the growth plate to induce fusion.Discussion: Early diagnosis and treatment are critical for a good outcome. This includes specific education and information for athletes, coaches, parents and treating physicians. Also, the frequent use of the crimp position has also been shown to increase the risk of PPSI. Preventive aspects should target this as well as overall load management.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"824-831"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303030","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}

引用次数: 0

[Treatment concepts for the medial clavicle and the sternoclavicular joint]. [锁骨内侧和胸锁关节的治疗理念]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI: 10.1007/s00113-024-01461-x

J Gleich, T Helfen, C Lampert

{"title":"[Treatment concepts for the medial clavicle and the sternoclavicular joint].","authors":"J Gleich, T Helfen, C Lampert","doi":"10.1007/s00113-024-01461-x","DOIUrl":"10.1007/s00113-024-01461-x","url":null,"abstract":"Medial clavicle fractures and injuries to the sternoclavicular joint are rare injuries but can have life-threatening consequences. There are no standardized treatment algorithms or guidelines for the diagnostics and treatment. This article provides an overview of the individual topographies as well as the conservative and surgical treatment strategies.Conservative treatment is preferred for medial clavicle fractures. The indications for surgical treatment are variable but this is frequently carried out if there is a fracture displacement > 1 cm or 1 shaft width and high functional demands. In the case of accompanying injuries to neurovascular structures, an open fracture or the threat of perforation of the skin, surgical treatment is mandatory. Open reduction and internal fixation using (locking) plates is currently the preferred form of treatment.In the case of posterior dislocation of the sternoclavicular joint, an immediate closed reduction must be attempted with the patient under analgosedation and with emergency treatment on standby. This temporal urgency does not exist for anterior and superior dislocations. Surgical treatment is indicated in cases of unsuccessful reduction, persistent symptomatic instability or injuries of the neurovascular bundle. From a multitude of treatment options, arthrodesis with suture cerclage has shown good results. Tendon grafts as well as special hook plates are increasingly being used due to better biomechanical qualities. The surgical treatment of combined injuries is determined by the individual injury pattern.Despite the variety of treatment strategies, the long-term outcome has consistently been positively described.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"783-787"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141899087","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}

引用次数: 0

[Surgical access route and choice of implant in the region of the clavicle shaft]. [锁骨轴区域的手术入路和植入物选择]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-08-27 DOI: 10.1007/s00113-024-01470-w

Yannic Lecoultre, Bryan J M van de Wall, Frank J P Beeres, Reto Babst

{"title":"[Surgical access route and choice of implant in the region of the clavicle shaft].","authors":"Yannic Lecoultre, Bryan J M van de Wall, Frank J P Beeres, Reto Babst","doi":"10.1007/s00113-024-01470-w","DOIUrl":"10.1007/s00113-024-01470-w","url":null,"abstract":"Background: Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share a common disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal.Objective: The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with a specific focus on new implants which could help to reduce implant irritation.Results and conclusion: Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has a lower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers a good alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"769-775"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074747","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}

引用次数: 0

[Initial experiences with the audits of the German guidelines on treatment of proximal femoral fractures (QSFFx-RL) by the German medical service]. [德国医疗服务部门对德国股骨近端骨折治疗指南（QSFFx-RL）进行审核的初步经验]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI: 10.1007/s00113-024-01491-5

Carsten Schöneberg, Matthias Knobe

引用次数: 0

[Current treatment concepts of the lateral clavicle and the acromioclavicular joint]. [锁骨外侧和肩锁关节的当前治疗理念]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI: 10.1007/s00113-024-01464-8

Sabine Roth, Spiros Tsamassiotis, Roman Karkosch, Hauke Horstmann, Tomas Smith, Gunnar Jensen

引用次数: 0