Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Patient-specific implants and digital implant planning in trauma surgery].","authors":"Stephan Sehmisch","doi":"10.1007/s00113-025-01561-2","DOIUrl":"https://doi.org/10.1007/s00113-025-01561-2","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 5","pages":"327-328"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065048","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":"[3D printing/implants in traumatology].","authors":"Nico Bruns, Mohamed Omar","doi":"10.1007/s00113-025-01546-1","DOIUrl":"10.1007/s00113-025-01546-1","url":null,"abstract":"<p><p>The use of 3D printing offers numerous application possibilities in traumatology, including anatomic models, repositioning and drilling guides as well as patient-specific implants. The greatest challenge lies in the rapid availability as many procedures require an immediate intervention. Anatomic models support surgical planning by complementing visual impressions with tactile ones. Printed models not only help in the establishment of surgical strategies but also enhance patient clarification. Studies demonstrate that these models significantly reduce the operating time, duration of fluoroscopy and blood loss, particularly for joint fractures. Repositioning and drilling guides simplify complex procedures and improve outcomes; however, they require precise planning and critical evaluation by the surgeon. Intraoperative guides are helpful, for instance, in accurately placing screws, especially in difficult to access areas or in metaphyseal fractures lacking clear references. Individualized implants play a lesser role in acute care but are useful for posttraumatic defects or corrective osteotomy. In the conservative segment, such as customized splints, 3D printing is being tested but with mixed results. Key requirements for 3D printing in traumatology include high-resolution computed tomography (CT), precise data processing and swift production. Regulatory hurdles and lack of reimbursement currently limit the widespread use. An optimized collaboration between technology and medicine, along with standardized processes, are essential for effectively integrating this technology into practice.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"329-336"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598405","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":"[Composition of trauma room teams : Reality experienced in 12 transregional trauma centers].","authors":"Vera Pedersen, Christian Waydhas, Valentin Clemens, Orkun Özkurtul, Lisa Hackenberg, Tristan Pfläging, Rolf Lefering, André Nohl, Uwe Schweigkofler, Matthias Fröhlich, Fabian Laue, Markus Baacke, Philipp Störmann, Helena Düsing, Kai Sprengel, Thomas Paffrath, Kai Oliver Jensen, Philipp Faul, Tobias Ahnert, Sebastian Imach, Christian Kleber, Anette Keß, Dan Bieler, Heiko Trentzsch","doi":"10.1007/s00113-024-01532-z","DOIUrl":"10.1007/s00113-024-01532-z","url":null,"abstract":"<p><strong>Background: </strong>The provision of specialized trauma teams for the care of severely injured patients is mandatory according to the requirements of the S3 guidelines polytrauma and the composition is determined by the White Book Medical Care of the Severely Injured (Weißbuch Schwerverletztenversorgung). In each level of care the basic resuscitation room team is composed of four disciplines: orthopedics and trauma surgery, anesthesia, radiology and emergency medicine in the emergency department.</p><p><strong>Material and methods: </strong>A prospective, multicenter observational study was conducted in 12 supraregional trauma centers in Germany and Switzerland, where a total of 3753 patients were treated in the emergency department following accidents. Amongst them 964 patients (26%) were treated after prior trauma team activation.</p><p><strong>Results: </strong>In 94.7% of the trauma room care instances all 4 required disciplines were present, with an average of 6.6 individuals involved in the trauma room care. The 48‑h mortality rate was 3% among patients receiving trauma room care. In all deceased patients, all four disciplines were present during the trauma room care. At least one or more high-risk criteria for serious injuries were present in 40.8% of the patients. In these cases, a complete team consisting of all 4 disciplines was involved in 97.7% of the care instances.</p><p><strong>Conclusion: </strong>In nearly 98% of cases where high-risk criteria for serious injuries (category A activation criteria) all 4 required disciplines were present in the trauma room for patient care. This was associated with an average resource commitment of 6.6 individuals. The absence of one or more disciplines in trauma room care does not appear to significantly affect early mortality in the severely injured.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"366-374"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412060","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":"[First fracture in patients with osteoporosis : How does the \"fracture career\" of our patients with osteoporosis begin?]","authors":"Steffi S I Falk","doi":"10.1007/s00113-025-01535-4","DOIUrl":"10.1007/s00113-025-01535-4","url":null,"abstract":"<p><strong>Background: </strong>Given that a primary osteoporotic fracture can result in subsequent fractures and that the precise etiology of the typical fracture cascade remains uncertain, it is pertinent to determine the initiating factor and the specific fracture involved in this cascade.</p><p><strong>Method: </strong>All patients with a fracture of a long bone were consecutively screened over the 12-month study period. All participants were asked about existing risk factors (including previous fractures) in accordance with the applicable guidelines of the Umbrella Organization Osteology (DVO). The existing risk factors were employed to calculate the fracture risk and this formed the basis of the diagnosis and indications for treatment.</p><p><strong>Results: </strong>A total of 613 patients were included in the study. Of the total number of patients 378 were deemed to require pharmacological treatment for osteoporosis. In this cohort 182 fractures were reported. Among the previous fractures distal radius fractures were the most common, occurring in 54 patients followed by fractures of the proximal femur (n = 40) and proximal humerus (n = 27). As anticipated, a breakdown of the data by gender revealed a different picture. In line with the incidences it can be seen that men have fewer distal radius fractures and more fractures close to the hip joint.</p><p><strong>Discussion: </strong>The results indicate that women with a distal radius fracture have the potential to facilitate an early diagnosis and subsequent treatment for osteoporosis. In contrast, in men fractures in the region of the hip joint were the most common initial presentation, precluding the possibility of deriving an early indication of the presence of osteoporosis from previous fractures.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"359-365"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070299","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":"[Pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon in a high jump champion : A 15-year case study].","authors":"Hans Zwipp","doi":"10.1007/s00113-025-01566-x","DOIUrl":"10.1007/s00113-025-01566-x","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophy of the peroneal tubercle and/or a local cortisone injection promoted a pathological rupture of the distal peroneal retinaculum with dislocation of the peroneus longus tendon.</p><p><strong>Objective: </strong>Presentation of a distal peroneal retinaculum replacement using a periosteal flap after remodelling of the hypertrophied peroneal tubercle by creating the natural sulcus below it, which enable safe and permanent guidance of the peroneus longus tendon.</p><p><strong>Material and method: </strong>A 21-year-old high jump athlete suffered a painful crack on the outer left foot while running a right hand curve without any trauma. Clinically, there was a painful, palpable reproducible dislocation of the peroneus longus tendon probably due to an extremely oversized peroneal tubercle. A local cortisone injection had been given 5 months previously because of local pain. The X‑ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed substantial hypertrophy of the left peroneal tubercle with a riding dislocation of the peroneus longus tendon on it. As conservative therapy was known to be insufficient, surgery was indicated.</p><p><strong>Result: </strong>There was no recurrence over the course of 15 years. In the year following the operation, the patient became German champion in the high jump discipline and another 5 years later, German champion in the triple jump.</p><p><strong>Discussion: </strong>If hypertrophy of the peroneal tubercle and/or the local cortisone injection alone caused the pathological rupture of the distal retinaculum with dislocation of the tendon remained unclear. A secure and longstanding tendon guidance with restoration of full jumping strength can only be surgically achieved.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"387-393"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766100","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":"[Make fit to die? : An unusual situation with a planned assisted suicide].","authors":"Viktoria Bogner-Flatz, Thomas Fischer","doi":"10.1007/s00113-025-01556-z","DOIUrl":"10.1007/s00113-025-01556-z","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"394-399"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722956","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":"[Outpatient surgery in trauma surgery and orthopedics].","authors":"Johannes Wunder, Christoph Schirdewahn, Andreas Schöne, Hans-Georg Palm, Jakob Mayr, Guido Köhne, Frank Schemmann, Christoph Wilde, Christian von Rüden","doi":"10.1007/s00113-025-01559-w","DOIUrl":"https://doi.org/10.1007/s00113-025-01559-w","url":null,"abstract":"<p><p>Outpatient surgery is gaining in importance, not least due to the politically driven structural transformation in the German healthcare system. As a result, more and more trauma surgery and orthopedic procedures as well as corresponding inpatient services are being carried out on an outpatient basis. Assuming a correct selection of suitable patients and a comprehensive outpatient care structure, outpatient surgery is not only less expensive but is also associated with increased patient satisfaction and safety. While other countries already have established outpatient care systems in place, these still need to be developed and expanded in Germany. The outpatient trend in hospital medicine aims to relieve hospitals, create resources and counteract the rising costs in the healthcare system. This requires a financially sustainable, cost-effective and patient-centered approach that does not harm either the patient or the healthcare provider.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 5","pages":"375-382"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044527","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":"[Patient-specific 3D-printed implants and templates for elbow and forearm].","authors":"Christopher Cramer, Samuel Sperlich, Annika Hättich, Tobias Dust, Karl-Heinz Frosch, Konrad Mader","doi":"10.1007/s00113-025-01548-z","DOIUrl":"10.1007/s00113-025-01548-z","url":null,"abstract":"<p><p>The process of 3D printing has found its way into orthopedics and trauma surgery, particularly for complex interventions on the elbow and forearm. By producing patient-specific implants and surgical templates misalignments, fractures and deformities can be precisely corrected. It could be shown that this technology increases the surgical accuracy, shortens recovery times and reduces postoperative complications. Compared to conventional implants 3D-printed implants provide the advantage of individual adaptation to the anatomical situation of the patient. This is particularly relevant in complex cases, such as malunions, congenital malformations (e.g., Madelung's deformity) and tumor-related deformities. The preoperative planning with 3D models enables a detailed simulation of the procedure and optimizes the placement of the implants. Despite these advantages challenges still remain: the production of patient-specific implants is time-consuming and cost-intensive. In addition, the technology requires expertise and special resources, which limit its application in less specialized centers. Future developments, such as 4D printing with shape-changing implants, promise further progress. By combining precision, individualization and dynamic adaptability, 3D-printed implants could sustainably improve patient care in orthopedics and trauma surgery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"342-350"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544780","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":"[Finger loss during gardening : Necrotizing cellulitis of the index finger].","authors":"Güner Sönmez, Jan Janzen, Claudia Brun Del Re, Christian Karl Spies","doi":"10.1007/s00113-025-01552-3","DOIUrl":"10.1007/s00113-025-01552-3","url":null,"abstract":"<p><p>Injuries of the hand especially during gardening can entail profound consequences, particularly when the injuries are underestimated and adequate treatment is postponed.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"383-386"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574845","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":"[Current concepts and treatment options for complex glenoid bone defects : Patient-specific instrumentation and custom-made implants].","authors":"Roman Frederik Karkosch, Tomas Smith","doi":"10.1007/s00113-025-01544-3","DOIUrl":"10.1007/s00113-025-01544-3","url":null,"abstract":"<p><p>Glenoid bone defects are frequent and the etiology is multifactorial. To prevent increased loosening rates of the glenoid component in total shoulder arthroplasty (TSA), various techniques are available to address the loss of glenoid bone. When corrective reaming and bone grafting techniques are no longer sufficient, patient-specific instrumentation (PSI) and custom-made implants have become core strategies for managing these defects. Following precise planning based on computed tomography (CT) imaging and three-dimensional reconstruction of the bony surface, an individualized guide can be used to accurately position the implant. When the limits of bone reconstruction have been reached, specially prepared (custom-made) implants can be used to compensate for the bony defect. Patients often require minimal postoperative immobilization of the shoulder joint. The currently limited literature describes favorable clinical outcomes, although these findings are almost exclusively limited to reverse shoulder arthroplasty.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"337-341"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560298","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}