Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Treatment strategy for severe implosion injuries of the lateral chest wall].","authors":"Stefan Schulz-Drost, Christopher Spering","doi":"10.1007/s00113-023-01406-w","DOIUrl":"10.1007/s00113-023-01406-w","url":null,"abstract":"<p><p>In the majority of cases implosion injuries to the thoracic wall are caused by blunt, massive force acting on the thorax. Basically, different regions and directions of the acting energy have to be taken into account. In common usage, the term implosion injury has become established, especially for the sequelae of lateral energy impact. Particular attention should be paid to the stability of the shoulder girdle, the underlying hemithorax and its intrathoracic organs.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"188-196"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565540","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":"[Severe thoracic trauma : Indications, treatment strategies and management of complications].","authors":"Christopher Spering","doi":"10.1007/s00113-024-01412-6","DOIUrl":"10.1007/s00113-024-01412-6","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"127 3","pages":"169-170"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934600","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":"[Effects of the COVID-19 pandemic on the course of geriatric trauma patients with proximal femoral fractures].","authors":"Tom Knauf, Daphne Eschbach, Benjamin Bücking, Matthias Knobe, Katherine Rascher, Carsten Schoeneberg, Christopher Bliemel, Steffen Ruchholtz, Rene Aigner, Ulf Bökeler","doi":"10.1007/s00113-023-01384-z","DOIUrl":"10.1007/s00113-023-01384-z","url":null,"abstract":"<p><strong>Background/objective: </strong>In 2020 the COVID-19 pandemic posed a major challenge to the healthcare system. The hypothesis is that the COVID-19 pandemic in 2020 had an impact on the care of older adults with proximal femoral fractures due to resource scarcity, regardless of whether or not the patient was infected.</p><p><strong>Material and methods: </strong>This study analyzed the data of 87 hospitals which entered 15,289 patients in the Geriatric Trauma Register (\"AltersTraumaRegister DGU®\", ATR-DGU) in Germany in 2019 and 2020. In this study we analyzed the influence of the COVID-19 pandemic on the inpatient treatment of hip fractures as well as the mid-term follow-up during the first 120 days. For the main analysis, we compared patients documented during the COVID-19 pandemic in 2020 (April-December) with a control group in 2019 (April-December). Additionally, we performed a subgroup analysis of the periods with high COVID-19 incidence rates.</p><p><strong>Results: </strong>Between 2019 and 2020 a total of 11,669 patients (2020: n = 6002 patients vs. 2019: n = 5667 patients) were included in this study. Only minor differences were found between the patients treated during the pandemic; however, when the COVID-19 incidence in Germany was greater than 50/100,000 residents, significantly fewer patients (p < 0.001) were discharged to a geriatric rehabilitation ward (27.2% vs. 36.3%) and an increased mortality rate during inpatient treatment was determined (8.4% vs. 4.6%) (p < 0.001).</p><p><strong>Discussion: </strong>The healthcare system was able to respond to the pandemic and patients' clinical courses were not impaired as long as the incidences were low. Nevertheless, the healthcare system reached its limits in times of higher incidence, which was also directly reflected in the patient outcome, mortality and place of discharge.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"228-234"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296771","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 after conservative vs. operative treatment of severe thoracic trauma].","authors":"Lars Becker, Marcel Dudda, Christof Schreyer","doi":"10.1007/s00113-024-01411-7","DOIUrl":"10.1007/s00113-024-01411-7","url":null,"abstract":"<p><strong>Background: </strong>Thoracic trauma is a frequent injury in the routine treatment of injured patients. Due to the increasing demographic changes a further increase is to be expected, especially after low-energy trauma.</p><p><strong>Objective: </strong>Expected complications after conservative vs. operative treatment of various injury patterns of thoracic trauma.</p><p><strong>Material and methods: </strong>Evaluation of a selective literature search regarding possible complications after thoracic trauma and formulation of instructions for action as expert recommendations.</p><p><strong>Conclusion: </strong>Both conservative and operative treatment of thoracic trauma have their specific complications, which have to be known to the treating physician. Lung contusions are often underestimated in the initial radiological diagnostics but often lead to relevant problems during the further course of treatment. After conservative treatment of rib fractures persistent pain, functional limitations or even relevant deformities due to secondary dislocation, can remain. There is a significant risk of overlooking or underestimating relevant injuries during the initial diagnostics which then leads to secondary complications. By far the most frequent risk of surgical treatment is an incorrect positioning of chest tubes. Overall, postoperative infections after chest trauma are relatively rare.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"204-210"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572305","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":"[Disproportionately increased incidence of proximal femoral fractures in a level one trauma center : Epidemiological analysis from 2016 to 2022].","authors":"Philipp Schippers, Erol Gercek, Felix Wunderlich, Jochen Wollstädter, Yama Afghanyar, Charlotte Arand, Philipp Drees, Lukas Eckhard","doi":"10.1007/s00113-023-01359-0","DOIUrl":"10.1007/s00113-023-01359-0","url":null,"abstract":"<p><strong>Background: </strong>Proximal femoral fractures represent the most frequent fracture entity in Germany accounting for more than 20% of all fractures. According to a decision of the Federal Joint Committee from 2019, proximal femoral fractures also have to be surgically treated within 24 h. In order to quantify a subjectively perceived increase in workload in trauma surgery at a supraregional trauma center, a retrospective analysis of the number of surgically treated proximal femoral fractures was performed. Proximal femoral fractures were chosen due to their high incidence and homogeneous treatment.</p><p><strong>Methods: </strong>Using ICD-10 codes, all surgically treated proximal femoral fractures from 2016 to 2022, including the patient's zip code, were retrieved from the database of the trauma center.</p><p><strong>Results: </strong>The number of surgically treated proximal femoral fractures doubled from 2016 to 2022. The highest increase (60%) was recorded from 2020 to 2022. Heat maps show an increase in the catchment area radius as well.</p><p><strong>Conclusion: </strong>When compared (inter)nationally, a disproportionate increase in the amount of surgically treated proximal femoral fractures was recorded at the trauma center studied. The increase of the catchment area radius and the number of patients treated in the urban area show that less and less hospitals participate in emergency treatment. Possible explanations are a lack of resources aggravated by the recent COVID-19 pandemic and a lack of qualified personnel, interface problems between the federal states or the strict requirements of the Federal Joint Committee in the treatment of proximal femoral fractures. It must be assumed that there is a clearly increased workload for all professions involved in the trauma center investigated, although the infrastructure has remained unchanged.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"221-227"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10891192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109408","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":"[Treatment strategy for an unstable chest wall after cardiopulmonary resuscitation].","authors":"C C Dobroniak, W Lehmann, R Cagirici, V Lesche, U Olgemoeller, C Spering","doi":"10.1007/s00113-023-01386-x","DOIUrl":"10.1007/s00113-023-01386-x","url":null,"abstract":"<p><p>Every year ca. 60,000 people in Germany undergo cardiopulmonary resuscitation (CPR). The two most frequent underlying causes are of cardiopulmonary and traumatic origin. According to the current CPR guidelines chest compressions should be performed in the middle of the sternum with a pressure frequency of 100-120/min and to a depth of 5-6 cm. In contrast to trauma patients where different injury patterns can arise depending on the accident mechanism, both the type of trauma and the injury pattern are similar in patients after CPR due to repetitive thorax compression. It is known that an early reconstruction of the thoracic wall and the restoration of the physiological breathing mechanics in trauma patients with unstable thoracic injuries reduce the rates of pneumonia and weaning failure and shorten the length of stay in the intensive care unit. As a result, it is increasingly being propagated that an unstable thoracic injury as a result of CPR should also be subjected to surgical treatment as soon as possible. In the hospital of the authors an algorithm was formulated based on clinical experience and the underlying evidence in a traumatological context and a surgical treatment strategy was designed, which is presented and discussed taking the available evidence into account.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815175","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":"[Biomechanics of thoracic wall instability].","authors":"Christian Liebsch, Christopher Spering, Hans-Joachim Wilke","doi":"10.1007/s00113-023-01389-8","DOIUrl":"10.1007/s00113-023-01389-8","url":null,"abstract":"<p><p>Traumatic injuries of the thorax can entail thoracic wall instability (flail chest), which can affect both the shape of the thorax and the mechanics of respiration; however, so far little is known about the biomechanics of the unstable thoracic wall and the optimal surgical fixation. This review article summarizes the current state of research regarding experimental models and previous findings. The thoracic wall is primarily burdened by complex muscle and compression forces during respiration and the mechanical coupling to spinal movement. Previous experimental models focused on the burden caused by respiration, but are mostly not validated, barely established, and severely limited with respect to the simulation of physiologically occurring forces. Nevertheless, previous results suggested that osteosynthesis of an unstable thoracic wall is essential from a biomechanical point of view to restore the native respiratory mechanics, thoracic shape and spinal stability. Moreover, in vitro studies also showed better stabilizing properties of plate osteosynthesis compared to intramedullary splints, wires or screws. The optimum number and selection of ribs to be fixated for the different types of thoracic wall instability is still unknown from a biomechanical perspective. Future biomechanical investigations should simulate respiratory and spinal movement by means of validated models.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"180-187"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107606259","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":"[Treatment regimen for deep sternal wound infections after cardiac surgical interventions in an interdisciplinary approach].","authors":"D Bieler, A Franke, M Völlmecke, S Hentsch, A Markewitz, E Kollig","doi":"10.1007/s00113-023-01394-x","DOIUrl":"10.1007/s00113-023-01394-x","url":null,"abstract":"<p><p>The aim of this article is to present the importance of a structured and situation-adapted approach based on the diagnostic and therapeutic strategy in the interdisciplinary treatment of 54 patients with deep sternal wound infections (DSWI) after cardiac surgical interventions and the results achieved. The patients were 41 men and 13 women with an average age of 65.1 years, who developed a DSWI after a cardiac surgical intervention during the period 2003-2016. The treatment strategy included a thorough debridement including the removal of indwelling foreign material, the reconstruction with a stable re-osteosynthesis after overcoming the infection and if necessary, situation-related surgical flaps for a defect coverage with a good blood supply and mandatory avoidance of dead spaces. A total of 146 operations were necessary (average 2.7 operations/patient, range 1-7 operations). In 24.1 % of the cases a one-stage approach could be carried out. In 41 patients negative pressure wound therapy (NPWT) with programmed sponge changing was used for wound conditioning (mean 5 changes, standard deviation, SD± 5.6 changes over 22 days, SD± 23.9 days, change interval every 3-4 days in 40.7% of the cases). In 33 patients a bilateral myocutaneous pectoralis major flap was used, in 4 patients a vertical rectus abdominis myocutaneous (VRAM) flap and in 7 patients both were carried out. A total of 43 osteosynthesis procedures were carried out on the sternum with fixed-angle titanium plates. Of the patients 7 died during intensive care unit treatment (total mortality 13 %, n = 5, 9.3 % ≤ 30 days) or in the later course. Of the patients 47 (87.1 %) could be discharged with a cleansed infection. In 2 patients the implant was removed after 2 years due to loosening.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"211-220"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10891204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815174","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":"[Acute postoperative infections after dual head arthroplasty in geriatric patients].","authors":"Susanne Baertl, Nora Renz, Volker Alt, Carsten Perka, Stephanie Kirschbaum","doi":"10.1007/s00113-023-01376-z","DOIUrl":"10.1007/s00113-023-01376-z","url":null,"abstract":"<p><p>Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent a major challenge with a 1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. A therapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be a single-stage stem replacement in combination with implantation of a cup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16-82%). Surgical treatment should always be followed by antibiotic treatment with a total duration of 12 weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"110-116"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686048","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":"[Implant-associated infections in trauma surgery].","authors":"Volker Alt","doi":"10.1007/s00113-023-01404-y","DOIUrl":"10.1007/s00113-023-01404-y","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"127 2","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652332","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}