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[Perioperative management of trochanteric femoral fractures : Fasting, fluid therapy and multimodal pain management as underappreciated factors]. [股骨粗隆骨折的围手术期处理：禁食、液体治疗和多模式疼痛管理是未被重视的因素]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-08-03 DOI: 10.1007/s00113-026-01732-9
Björn-Christian Link, Pascal C Haefeli, Manuela Rohner-Spengler, Bryan van de Wall, Frank J P Beeres
{"title":"[Perioperative management of trochanteric femoral fractures : Fasting, fluid therapy and multimodal pain management as underappreciated factors].","authors":"Björn-Christian Link, Pascal C Haefeli, Manuela Rohner-Spengler, Bryan van de Wall, Frank J P Beeres","doi":"10.1007/s00113-026-01732-9","DOIUrl":"10.1007/s00113-026-01732-9","url":null,"abstract":"<p><strong>Background: </strong>Trochanteric femoral fracture is the most frequent proximal femur fracture in older adults and is associated with substantial perioperative morbidity and mortality. While surgical technique, anticoagulation and orthogeriatric care are widely discussed, the nursing and organisational levers of the perioperative pathway, namely fasting, fluid therapy and pain management, often remain underappreciated.</p><p><strong>Objective: </strong>To review the evidence on a liberalised preoperative fasting policy (sip till send), goal-directed fluid therapy, and peripheral nerve blocks with and without continuous catheters with regard to pain control, postoperative delirium and functional outcome.</p><p><strong>Methods: </strong>Selective narrative review of literature published within the last decade, including systematic reviews, randomised trials and national recommendations.</p><p><strong>Conclusion: </strong>Clear fluids up to the call to theatre are safe and reduce thirst, hunger and volume depletion. Liberal intraoperative fluid administration is associated with higher complication rates; goal-directed therapy with balanced crystalloids is therefore preferable. Peripheral nerve blocks reduce pain, opioid consumption and the incidence of postoperative delirium. Continuous nerve catheters are an attractive option in case of prolonged preoperative waiting times. Bundling these measures within an enhanced-recovery framework is associated with shorter length of stay and improved recovery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"675-683"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664905","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
[Differentiated interpretation of health economic cost calculation models : Supplementation of patient-related care needs and personnel assessment]. [卫生经济成本计算模型的差异化解释：患者相关护理需求和人员评估的补充]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1007/s00113-026-01755-2
Katja Hierl, Laura Schörner, Volker Alt
{"title":"[Differentiated interpretation of health economic cost calculation models : Supplementation of patient-related care needs and personnel assessment].","authors":"Katja Hierl, Laura Schörner, Volker Alt","doi":"10.1007/s00113-026-01755-2","DOIUrl":"10.1007/s00113-026-01755-2","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"735-736"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876993","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
Personalkostenkalkulation und patientenbezogener Pflegebedarf – zwei Perspektiven einer bedarfsgerechten Personalplanung. 人力资源管理和人力资源管理：从人力资源管理的两个角度。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-09-01 DOI: 10.1007/s00113-026-01749-0
Tilmann Müller-Wolff, Carsten Hermes, Lars Krüger, Marina Ufelmann, Benjamin Schiller, Denise Schindele
{"title":"Personalkostenkalkulation und patientenbezogener Pflegebedarf – zwei Perspektiven einer bedarfsgerechten Personalplanung.","authors":"Tilmann Müller-Wolff, Carsten Hermes, Lars Krüger, Marina Ufelmann, Benjamin Schiller, Denise Schindele","doi":"10.1007/s00113-026-01749-0","DOIUrl":"10.1007/s00113-026-01749-0","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"733-734"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877034","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
[Masked pediatric pathological femoral fracture : Case report of a sarcoma-associated femoral fracture after adequate trauma]. [隐蔽性小儿病理性股骨骨折：一例肉瘤相关性股骨骨折后充分创伤]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-09-11 DOI: 10.1007/s00113-026-01744-5
Felix Jung, Katrin Luise Voith, Francisco Ferandez
{"title":"[Masked pediatric pathological femoral fracture : Case report of a sarcoma-associated femoral fracture after adequate trauma].","authors":"Felix Jung, Katrin Luise Voith, Francisco Ferandez","doi":"10.1007/s00113-026-01744-5","DOIUrl":"10.1007/s00113-026-01744-5","url":null,"abstract":"<p><p>A 9-year-old boy initially presented with a closed metaphyseal transverse fracture of the distal right femur following a fall from a trampoline. Due to the adequate trauma and lack of initial radiological indications for an underlying pathological bone lesion, the fracture was primarily treated with antegrade elastic stable intramedullary nailing (ESIN). Postoperatively, the patient developed persistent pain, progressive soft tissue swelling and highly atypical callus formation accompanied by osteolytic lesions. Following referral to our pediatric trauma center, the radiological diagnostics of the surrounding region raised the suspicion of a telangiectatic osteosarcoma, further complicated by iatrogenic tumor cell seeding along the intramedullary path of the ESIN in the sense of a skip lesion. The diagnosis was confirmed by reference histopathology. Following neoadjuvant chemotherapy according to the EURAMOS/COSS protocol, the iatrogenic tumor cell dissemination necessitated a total femoral en bloc resection and reconstruction using a modular total endoprosthesis.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"721-726"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946185","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
[63/m-Acetabular fracture : Preparation for the medical specialist examination: part 87]. [63/m-髋臼骨折：医学专家检查的准备：第87部分]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-07-27 DOI: 10.1007/s00113-026-01735-6
Christian von Rüden
{"title":"[63/m-Acetabular fracture : Preparation for the medical specialist examination: part 87].","authors":"Christian von Rüden","doi":"10.1007/s00113-026-01735-6","DOIUrl":"10.1007/s00113-026-01735-6","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"728-732"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610821","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
[Pathological fractures in childhood]. [儿童期病理性骨折]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-07-28 DOI: 10.1007/s00113-026-01738-3
Alexander S Spiro, Alexandra Doerell, Dirk W Sommerfeldt, Matthias Priemel, Kiril Mladenov, Anne Andresen
{"title":"[Pathological fractures in childhood].","authors":"Alexander S Spiro, Alexandra Doerell, Dirk W Sommerfeldt, Matthias Priemel, Kiril Mladenov, Anne Andresen","doi":"10.1007/s00113-026-01738-3","DOIUrl":"10.1007/s00113-026-01738-3","url":null,"abstract":"<p><p>Pathological fractures in children are most commonly caused by benign bone tumors, while malignant tumors rarely occur; however, the consequences of a missed pathological fracture due to malignancy or inadequate treatment of these fractures are severe. Localization, grade of Lodwick classification, tumor matrix and periosteal reaction of the bone tumor should be assessed on plain X‑radiographs. Conservative treatment is indicated in nondislocated fractures where there is a suspicion of benign or intermediate bone tumors. In dislocated pathological fractures and the suspicion of a benign or intermediate lesion, magnetic resonance imaging (MRI) is recommended because it can substantially influence the choice of surgical treatment. A biopsy should also be taken during surgery. In the case of pathological fractures caused by potentially malignant bone tumors patients should immediately be immobilized and transferred to a musculoskeletal tumor center for extended diagnostics and treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"709-720"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610834","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
[Geriatric care concepts in the treatment of patients with trochanteric femoral fractures]. [老年护理理念在股骨粗隆骨折治疗中的应用]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-08-24 DOI: 10.1007/s00113-026-01742-7
Vera Smolka, Katrin Singler
{"title":"[Geriatric care concepts in the treatment of patients with trochanteric femoral fractures].","authors":"Vera Smolka, Katrin Singler","doi":"10.1007/s00113-026-01742-7","DOIUrl":"10.1007/s00113-026-01742-7","url":null,"abstract":"<p><p>Due to the convincing evidence showing sustained reduction in mortality due to interdisciplinary multidimensional management of geriatric hip fracture patients, the \"Guidelines for the care of proximal femoral fractures\" of the German Federal Joint Committee came into force stepwise from 2021 onwards. The interdisciplinary concept enables a holistic view and multidimensional treatment approaches for geriatric trauma patients. The team approach and joint responsibility enables addressing the special needs of this vulnerable patient group  effectively during the inpatient stay. The aim is the avoidance of complications by adequate management of perioperative pain, early mobilization, management of delirium and nutrition, a critical review of the list of medications and a clarification of modifiable factors for the risk of falling beyond the acute inpatient stay and the management of osteoporosis, to reduce the risk of sustaining further fractures. Early patient-centered discharge management helps to ensure adequate care after the acute hospitalization phase according to the patient's abilities and needs.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"689-695"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815187","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
Pertrochantäre Femurfrakturen. Pertrochantäre Femurfrakturen .
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-09-23 DOI: 10.1007/s00113-026-01743-6
Carl Neuerburg
{"title":"Pertrochantäre Femurfrakturen.","authors":"Carl Neuerburg","doi":"10.1007/s00113-026-01743-6","DOIUrl":"https://doi.org/10.1007/s00113-026-01743-6","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"129 10","pages":"663-665"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032163","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 of proximal femur fractures in patients on direct oral anticoagulants (DOACs) : Review of perioperative management]. [直接口服抗凝剂（DOACs）治疗股骨近端骨折患者：围手术期管理回顾]。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-07-15 DOI: 10.1007/s00113-026-01733-8
Jannis Christoffel, Marc Maegele
{"title":"[Treatment of proximal femur fractures in patients on direct oral anticoagulants (DOACs) : Review of perioperative management].","authors":"Jannis Christoffel, Marc Maegele","doi":"10.1007/s00113-026-01733-8","DOIUrl":"10.1007/s00113-026-01733-8","url":null,"abstract":"<p><strong>Background: </strong>Proximal femur fractures are common injuries in older adults and, according to guidelines, require prompt surgical treatment. With the increasing use of direct oral anticoagulants (DOACs), uncertainties have arisen regarding the timing of surgery, the risk of bleeding, and perioperative management.</p><p><strong>Research question: </strong>The aim is to evaluate the influence of DOACs on the timing of surgery, the risk of bleeding, and the safety of early surgical treatment for proximal femur fractures.</p><p><strong>Materials and methods: </strong>Narrative review of the current literature, systematic reviews, meta-analyses, and current guideline recommendations (AWMF S3-LL).</p><p><strong>Results: </strong>Patients on DOACs sometimes exhibit significantly prolonged time to surgery (TTS), often due to uncertainties in perioperative management. However, prolonged TTS is not consistently associated with increased mortality. The majority of studies show no significant difference in blood loss or transfusion requirements between DOAC-treated and nonanticoagulated patients when treated early. Calibrated laboratory methods are the gold standard, but are only available to a limited extent. Prothrombin complex concentrate (PPSB) and antidotes allow for reversal; however, the latter sometimes carry specific risks.</p><p><strong>Conclusion: </strong>Based on current data, early surgery for proximal femur fractures can be performed despite DOAC use, particularly for minimally invasive procedures with a low risk of bleeding. Individual risk assessment, taking into account comorbidities, residual DOAC levels, and the type and extent of the procedure, remains crucial.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"666-674"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450652","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
OMW: Frakturassoziierte Infektion – Diagnostik. 骨折相关感染-诊断。
Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-10-01 Epub Date: 2026-08-27 DOI: 10.1007/s00113-026-01750-7
Susanne Bärtl, Volker Alt
{"title":"OMW: Frakturassoziierte Infektion – Diagnostik.","authors":"Susanne Bärtl, Volker Alt","doi":"10.1007/s00113-026-01750-7","DOIUrl":"10.1007/s00113-026-01750-7","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"727"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842368","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
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