Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Trauma room workload in German trauma centers : Reality of trauma care underrepresented in reform].","authors":"Cora R Schindler, Florian Pavlu, Philipp Faul, Philipp Störmann, Dan Bieler, Uwe Schweigkofler","doi":"10.1007/s00113-025-01538-1","DOIUrl":"https://doi.org/10.1007/s00113-025-01538-1","url":null,"abstract":"<p><strong>Introduction: </strong>The Federal Joint Committee (G-BA) published a regulation on a staged system for emergency structures in hospitals (according to Social Security Code V) in April 2018 and therefore established the foundations for emergency care in the inpatient sector. The structural requirements for the care of potentially severely injured patients is primarily defined by the specialist society and means a high provision of personnel with a simultaneous annual increase in the burden due to increasing numbers of patients. Critics fear that the reforms do not take sufficient account of trauma care both professionally and financially. The aim of the study was to record the actual workload of the emergency trauma rooms in certified German trauma centers.</p><p><strong>Method: </strong>A nationwide online survey was performed in Germany among 619 trauma centers certified by the German Society for Trauma Surgery (DGU®) to quantify the frequency of trauma room callouts. The results were retrospectively compared with the data from the annual reports of the TraumaRegister (TR) DGU® from 2021 and 2022.</p><p><strong>Results: </strong>The 167 participating hospitals reported 22,479 trauma room callouts in 2021 and 24,366 in 2022 (response rate of the online survey 24.1%). Of these callouts 70% concerned level 1 supraregional trauma centers. The comparative analysis showed that the actual number of callouts is 3-5 times higher than the data documented in the TR-DGU® . Of the trauma rooms 80% were not included in the register due to low injury severity. The study confirms the discrepancy between the documented and actual workload of the trauma rooms in German trauma centers and emphasizes the necessity to adjust the financial and personnel consideration of the trauma centers to the actual utilization in order to ensure a continuing high quality of care.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461056","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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412060","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":"[Update of the Amputation Registry Germany (AMP-Registry)].","authors":"Merkur Alimusaj, Kristina Michel, Julia Block, Urban Daub, Daniel Heitzmann, Thanh-Duc Nguyen, Maria Bisele, Sebastian I Wolf, Urs Schneider","doi":"10.1007/s00113-025-01539-0","DOIUrl":"https://doi.org/10.1007/s00113-025-01539-0","url":null,"abstract":"<p><strong>Background: </strong>Medical registries are used to collect valuable patient data in order to check and control the quality and effectiveness of treatment approaches. National registries in the field of amputation and patient care, such as the Swedish Amputation and Prosthetics Registry (SwedeAmp) and the Limb Loss and Preservation Registry (LLPR) in the USA, gather information on prosthetic devices, materials, procedures and patient-related outcomes such as mobility and quality of life. Since 2011 SwedeAmp could generate significant insights into long-term outcomes after amputations and improve prosthetic care in Sweden. In the USA the LLPR collects data on aspects ranging from clinical to psychosocial aspects, enabling international comparisons and the optimization of care.</p><p><strong>Material and methods: </strong>In Germany the AMP Registry makes significant contributions by documenting data on prosthetic fit, wearing comfort and the reasons for revisions. The aim of the AMP Registry is to create an evidence base through systematic data collection. The project includes the development of a user-friendly IT structure, a pilot phase for application evaluation and close collaboration with experts. Standardized datasets aim to identify deficits in care and develop evidence-based approaches. Data collection and storage are carried out in compliance with the General Data Protection Regulation (DSGVO) and secured through technical measures.</p><p><strong>Results and discussion: </strong>Initial results from the Heidelberg Study Center demonstrate the potential of the AMP Registry. Subgroup analyses support optimization of care and highlight the importance of regular assessments to improve long-term care.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412062","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":"Partial tear of the medial gastrocnemius head : A case report of meniscal symptoms in a 32-year-old recreational athlete.","authors":"Daniel P Berthold, Fabian Traub, Fabian Gilbert, Wolfgang Böcker, Boris Holzapfel, Markus Bormann","doi":"10.1007/s00113-025-01534-5","DOIUrl":"https://doi.org/10.1007/s00113-025-01534-5","url":null,"abstract":"<p><p>This case report presents the clinical findings and management of a 32-year-old male recreational athlete who presented with ongoing knee pain for 4 months, without a history of trauma. The patient experienced intermittent pain during walking, particularly after prolonged periods of sitting, and exhibited positive findings on meniscus tests. However, he was able to participate in sports activities without pain. Magnetic resonance imaging (MRI) revealed a partial tear of the medial gastrocnemius head, confirming the diagnosis. Conservative treatment, including rest, physical therapy, and a gradual return to sports activities, led to significant symptom improvement. This case highlights the importance of considering rare injuries, such as isolated tears of the medial gastrocnemius head, in patients with persistent knee pain and meniscal symptoms, even in the absence of traumatic events. Previous reports on this specific injury are sparse, indicating its rarity and underscoring the need for further understanding and documentation.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257493","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":"[Transosseous lacerations in the ankylosed cervical spine].","authors":"Tobias Driesen, Lukas Weiser, Katharina Jäckle, Friederike Sophie Klockner, Maximilian Reinhold, Wolfgang Lehmann, Paul Jonathan Roch","doi":"10.1007/s00113-024-01506-1","DOIUrl":"10.1007/s00113-024-01506-1","url":null,"abstract":"<p><p>Transosseous lacerations represent a particular type of discoligamentous injury of the cervical spine and occur in ankylosing diseases of the spine, with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) being the primary entities. The altered biomechanics of the spine due to the underlying disease pose special challenges in the diagnostics and treatment. Even low-energy trauma can cause severe injuries of the cervical spine, which are often difficult to accurately diagnose due to the difficult assessability of the conventional projection radiography used in the primary diagnostics. In addition to a correct diagnosis a differentiated treatment concept is crucial as treatment courses can be complicated by pre-existing comorbidities, which are present in the majority of cases. Due to a high rate of secondary neurological deficits without adequate stabilization, surgical stabilization is generally recommended. Unlike the treatment of \"classical\" discoligamentous injuries in the mobile cervical spine, long segment dorsal instrumented spondylodesis is the standard of care for these cases, whereby ventral stabilization is also of value, either as a stand-alone or possibly additive procedure. The intraoperative site, which deviates from that of a normal patient, can present an additional challenge.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788077","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":"[Which diagnostic tests are indicated in the emergency department after trauma to the cervical spine?]","authors":"Oliver Riesenbeck, Michael J Raschke","doi":"10.1007/s00113-024-01520-3","DOIUrl":"10.1007/s00113-024-01520-3","url":null,"abstract":"<p><p>Injuries to the cervical spine are a diagnostic challenge as, although they are rare in relation to the overall population, they should not be overlooked under any circumstances. This article presents the diagnostic procedure in the emergency department, starting with the patient's medical history and subsequently clinical and neurological examinations. As a result, the clinical decision tools national emergency X‑radiography utilization study (NEXUS) criteria and the Canadian C‑spine rule (CCR) are discussed. Finally, the current literature is reviewed considering the diagnostic examination options, taking the clinically relevant key questions into account.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933842","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 of geriatric odontoid fractures].","authors":"Andreas Sommer, Lukas Klein, Peter Obid","doi":"10.1007/s00113-024-01522-1","DOIUrl":"10.1007/s00113-024-01522-1","url":null,"abstract":"<p><p>The treatment of odontoid fractures in geriatric patients, particularly type II fractures, remains controversial. In biologically young patients, studies suggest advantages of surgical treatment in terms of mortality; however, this advantage is not observed in geriatric patients. While the mortality appears to be higher after conservative treatment in patients aged 65-80 years, there are studies that have shown no differences in mortality for patients aged 80 years or older and even showed advantages of conservative treatment in this age group. The complication rates of both surgical and conservative approaches are comparable. Although conservative treatment is associated with a higher rate of pseudarthrosis, healing in a \"rigid\" pseudarthrosis is associated with a good clinical outcome and can therefore be considered a treatment success. The central problem with the currently available literature, including the present prospective but nonrandomized data, is selection bias, which significantly limits the comparability of the patient cohorts. So far, no clear superiority of either treatment method has been demonstrated. Therefore, conservative treatment retains its importance in the geriatric patient population and the majority of these patients achieve a very good functional outcome with conservative treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017645","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":"[Pilon fractures : Treatment principles and surgical therapy strategy].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Christoph Sommer","doi":"10.1007/s00113-024-01511-4","DOIUrl":"10.1007/s00113-024-01511-4","url":null,"abstract":"<p><p>Pilon fractures typically result from high-energy trauma combined with axial compression. The surrounding soft tissues are often severely compromised, complicating treatment. These fractures are best classified according to the Working Group for Osteosynthesis Issues/Orthopedic Trauma Association (AO/OTA) classification system. Even with anatomical reduction of the joint surface there remains a high risk of suboptimal outcome. Advances in implant technology, minimally invasive surgical techniques and strategic management have successfully reduced complication rates in recent years. Despite several adaptations, the principles of Rüedi and Allgöwer remain valid today: correct reconstruction of the fibula (for simple fractures) facilitates subsequent joint reduction. Autologous bone grafts are beneficial in metaphyseal bone defects. Access routes tailored to the soft tissue conditions and fracture pattern enable stabilization, usually with angle stable plates.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"117-129"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960199","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":"[Conservative treatment of injuries to the cervical spine : Mobilization or immobilization].","authors":"Christian Arras, Julian Kylies, Lennart Viezens, Leon-Gordian Leonhardt","doi":"10.1007/s00113-024-01507-0","DOIUrl":"10.1007/s00113-024-01507-0","url":null,"abstract":"<p><p>Many injuries to the cervical spine can be treated conservatively. Treatment options include early functional, mobilizing and immobilizing procedures. If a structural injury can be ruled out by morphological imaging, early functional mobilization should be performed in combination with adequate analgesia according to the World Health Organization (WHO) step by step scheme to avoid chronification. If a structural injury to the cervical spine is present, a stability test is crucial for the decision on treatment. Stable fractures include, for example, types I, II and V fractures of the atlas according to Gehweiler, types I and III fractures of the dens axis according to Anderson and D'Alonzo and type A fractures of the subaxial cervical spine according to the AO. If the results of the imaging examination are inconclusive, functional imaging should be performed. If the injury is stable, external immobilization can be used for conservative treatment. Semirigid and rigid cervical orthotic devices as well as Minerva corsets and the halo fixator are available for this purpose. The degree of immobilization increases with the invasiveness of the procedure. Immobilization should be carried out under clinical and radiological monitoring until the injury has healed. An increase or persistence of symptoms during conservative treatment indicates treatment failure and should result in follow-up imaging. Immobilizing treatment should also be accompanied by isometric physiotherapeutic exercise and adequate analgesic treatment. In adult patients the external stabilization should be gradually reduced through physiotherapeutic exercise after completion of the immobilization treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"96-102"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788076","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":"[Takotsubo cardiomyopathy during trauma resuscitation].","authors":"Sonja Wassman, Gregor Römmermann, Michael Dommasch","doi":"10.1007/s00113-024-01497-z","DOIUrl":"10.1007/s00113-024-01497-z","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"141-143"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565070","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}