Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Cement augmentation in pertrochanteric fractures : Evidence, indication and surgical application].","authors":"Christian Kammerlander, Georg Kornhäusel, Carl Neuerburg","doi":"10.1007/s00113-026-01731-w","DOIUrl":"10.1007/s00113-026-01731-w","url":null,"abstract":"<p><p>Cement augmentation of cephalomedullary implants was developed to improve anchorage of the head element in osteoporotic pertrochanteric fractures and to reduce implant-related failure patterns such as cut-out or excessive sliding. The aim of this review article is to provide a clinical classification of cement augmentation in pertrochanteric fractures, with particular focus on clinical and socioeconomic aspects. Biomechanical studies consistently demonstrate improved rotational stability and cut-out resistance of augmented cephalomedullary fixations. Clinically, several prospective studies show a high level of technical safety and very low rates of mechanical failure. More recent cohort studies and a follow-up of a randomized trial suggest fewer cut-out events, particularly in unstable and osteoporotic fractures, but do not show a proven benefit in terms of mortality or mid-term function. From a socioeconomic perspective, cement augmentation is an effective method for achieving an overall reduction in costs in this area. Cement augmentation is not a routine procedure for every pertrochanteric fracture, but rather a selective add-on for situations with a high mechanical risk.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"684-688"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440541","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":"[Possible complications following pilon fractures and their management].","authors":"Primoz Potocnik, Christian Michelitsch, Philipp Florian Stillhard, Christoph Sommer","doi":"10.1007/s00113-026-01765-0","DOIUrl":"https://doi.org/10.1007/s00113-026-01765-0","url":null,"abstract":"<p><p>The management of pilon fractures presents major challenges for both the treating team and the patient. As these fractures are often caused by high-impact forces, it is not uncommon for the injury patterns to result in considerable damage to the bone, cartilage and soft tissues. Despite competent and prompt treatment, these fractures are characterized by a relatively high complication rate. Classical early and late complications can be distinguished. Various complications, such as impaired wound healing, infections, non-union and osteoarthritis, along with their risks and possible treatment strategies, are explained in this article. The aim is to raise awareness of complications and potential errors in the management of pilon fractures, thereby reducing their incidence through preventive measures and facilitating treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083327","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":"[Resection of a chondrosarcoma of the first metacarpal and reconstruction using composite osteosynthesis : Case report and literature review].","authors":"Johannes Wunder, Ahmet Mestan, David Griger, Veronika Koeppen, Moritz Billner, Christian von Rüden","doi":"10.1007/s00113-026-01766-z","DOIUrl":"https://doi.org/10.1007/s00113-026-01766-z","url":null,"abstract":"<p><strong>Background: </strong>Chondrosarcoma is the most common malignant bone tumor of the hand. As conventional chondrosarcomas generally respond poorly to radiotherapy and chemotherapy, surgical resection is crucial.</p><p><strong>Case report: </strong>A 76-year-old woman with a chondrosarcoma of the first metacarpal underwent 2‑stage reconstruction using composite osteosynthesis after tumor resection. After 18 months the functional outcome was satisfactory, with no local recurrence, metastases or implant-associated complications.</p><p><strong>Conclusion: </strong>Composite osteosynthesis can represent a function-preserving reconstructive option in selected patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066642","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":"[Job satisfaction in trauma surgery and orthopedics-How do we perceive our roles? : State of the art based on job characteristic theory and an online survey among members of the German Society for Orthopaedic and Trauma Surgery].","authors":"Axel Franke, Pauline Harlass, Judith Hattke, Phillipp Hube, Gerhard Achatz, Markus Göbel","doi":"10.1007/s00113-026-01757-0","DOIUrl":"https://doi.org/10.1007/s00113-026-01757-0","url":null,"abstract":"<p><p>There is a high demand within our society for resilient, sustainable and efficient trauma and orthpedic surgery (TOS). The shortage of young professionals threatens the provision of comprehensive care in TOS. Alongside factors, such as payment, working hours and work-life balance, the perceived attractiveness of the role is a key determinant of personal job satisfaction and fulfilment. The relationship between the perception of one's own role, the associated variety of tasks and the resulting job satisfaction, has scarcely been investigated among specialists in TOS. This study examines the self-perception and external perception of the role as well as the attributed job satisfaction, in relation to clinical practice and the stage of specialist training. The study was based, amongst other things, on Hackman and Oldham's 5‑dimensional job characteristics theory. A quantitative online survey was conducted among 8946 members of the German Society for Orthopaedic and Trauma Surgery (DGOU). The results show that job satisfaction is lowest amongst those at the start of their careers. The group comprising junior doctors and specialists describe task variety, the holistic nature of the role and feedback as important for their own satisfaction. At the same time, doctors and specialists in training associate career progression with an increase in scores across all five dimensions. In contrast, senior doctors attribute higher scores to the tasks of doctors and specialists in further training across all dimensions than those perceived by the trainees themselves. Feedback and interaction are crucial for how they interact and communicate with one another. The group of doctors and specialists in training regard feedback, diversity of tasks, the holistic nature of the role and autonomy as important and a lack of feedback as demotivating. Action is required, amongst other things, to strengthen mutual understanding in line with the activities perceived in the workplace. Key tools are communication and feedback. The authors identify shortcomings and propose solutions in this article.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042596","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":"[Generative artificial intelligence and language models in trauma surgery : Applications in clinical care, research and teaching].","authors":"S Kuhn","doi":"10.1007/s00113-026-01762-3","DOIUrl":"https://doi.org/10.1007/s00113-026-01762-3","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI) and large language models (LLM) are evolving from general purpose text assistants toward increasingly contextualized, multimodal systems integrated into clinical workflows.</p><p><strong>Objective: </strong>Presentation of current applications of generative AI and LLMs in trauma surgery, with a focus on clinical care and additional aspects of research and teaching.</p><p><strong>Material and methods: </strong>Narrative literature review based on a MEDLINE/PubMed search and supplementary hand search, including primary regulatory sources.</p><p><strong>Results: </strong>The most immediate clinical potential currently lies in documentation, information processing and patient communication. Initial studies demonstrate relevant time savings with AI-assisted documentation. Current systems achieve high performance in some clearly defined triage and decision-support tasks, whereas complex individualized and multimodal applications show lower and more heterogeneous reliability. In research and teaching LLMs can support standardized workflows, case generation and learning activities; however, the available evidence is still frequently based on retrospective or simulated studies.</p><p><strong>Conclusion: </strong>The safe implementation requires validation of the specific AI system in its intended context of use, reliable knowledge sources, sufficient clinical context, data protection and effective human control. As the clinical consequences of AI-generated outputs increase, so do the requirements for validation and physician responsibility in making decisions.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032244","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":"[Digitalization in trauma networks : Teleconsultation, real-time situation mapping and artificial intelligence-assisted triage].","authors":"Benjamin Gellhaus, Wolfgang Lehmann, Chistopher Spering","doi":"10.1007/s00113-026-01756-1","DOIUrl":"https://doi.org/10.1007/s00113-026-01756-1","url":null,"abstract":"<p><p>The care of severely injured patients within a trauma network requires cross-sectoral coordination from the prehospital setting through to rehabilitation. Digital applications, such as teleconsultations, real-time situational mapping and artificial intelligence (AI)-assisted decision support have the potential to accelerate information flow, enable more targeted use of resources and improve the quality of care. An analysis of the TKmed® transfer statistics at the University Medical Center Göttingen demonstrated a continuous increase in import and export volumes between 2015 and 2025. Teleconsultations enable the early involvement of specialist expertise and can support triage, treatment and transfer decisions while reducing unnecessary secondary transfers. The interdisciplinary care capacity proof system (IVENA) provides a shared real-time overview of available capacities and improves coordination and patient allocation, particularly during mass casualty incidents. Artificial intelligence (AI)-assisted triage systems can facilitate the earlier identification of critical clinical deterioration and reduce both overtriage and undertriage. In radiology AI systems can support the prioritization of abnormal findings and accelerate diagnostic processes. Prerequisites for a safe implementation are stable infrastructures, standardized interfaces, validated algorithms and clearly defined responsibilities. Digital systems should complement and not replace clinical decision-making.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032205","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":"[Perioperative antibiotic prophylaxis in trauma surgery and orthopedics].","authors":"Volker Alt, Susanne Bärtl, Frank Hanses","doi":"10.1007/s00113-026-01761-4","DOIUrl":"https://doi.org/10.1007/s00113-026-01761-4","url":null,"abstract":"<p><p>Perioperative antibiotic prophylaxis (PAP) is a key component of infection prevention in trauma surgery and orthopedics. The new German S3 guidelines recommend a single-shot PAP dose for most procedures, particularly joint arthroplasty, osteosynthesis of closed fractures and other elective operations. Open fractures require pre-emptive antibiotic treatment for a maximum of 24 h in type I and type II fractures and for a maximum of 72 h in type III open fractures. Patients with an open distal phalanx fracture of the finger should not receive PAP. In knee arthroscopy PAP is recommended when foreign material is implanted or when cartilage or bone procedures are performed. In shoulder arthroscopy PAP is generally recommended. In spinal surgery PAP is recommended irrespective of instrumentation. The standard is cefazolin 2 g i.v. or cefuroxime 1.5 g i.v., administered approximately 30 min before skin incision. Prolonged antibiotic administration should be avoided.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992930","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":"[Surgical access routes and their selection for osteosynthesis of pilon fractures].","authors":"Philipp Stillhard, Christian Michelitsch, Primoz Potocnik, Christoph Sommer","doi":"10.1007/s00113-026-01763-2","DOIUrl":"https://doi.org/10.1007/s00113-026-01763-2","url":null,"abstract":"<p><p>The operative management of pilon fractures requires individually tailored preoperative planning, taking the fracture morphology, the intended reconstruction strategy and the local soft tissue situation into account. The goal is the anatomical restoration of the articular surface by means of open reduction and internal fixation (ORIF), combined with soft tissue-preserving stabilization of the metadiaphyseal component using minimally invasive plate osteosynthesis (MIPO). The choice of surgical approach is based on the analysis of computed tomography (CT) imaging, particularly the location of the main articular fracture fragments and the planned implant positioning. The anterior fracture extension represents an important landmark for selecting the primary approach. Valgus and varus deformities influence the required direction of buttress support and, consequently, the final plate position. Articular reconstruction is preferably performed using an open-the-window technique with longitudinal arthrotomy and opening of the fracture along the main epimetaphyseal fracture line, enabling direct visualization of the articular surface and the talar dome. The different surgical approaches complement each other depending on the individual fracture configuration. Successful treatment of pilon fractures therefore relies on precise preoperative planning, anatomical reconstruction of the articular surface and consistent preservation of the soft tissues.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992933","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":"OMW: Internationales multidisziplinäres Konsensus-Statement zur perioperativen Nüchternheit bei Erwachsenen.","authors":"Anne Rüggeberg, Peter Kranke, Ehrenfried Schindler","doi":"10.1007/s00113-026-01760-5","DOIUrl":"https://doi.org/10.1007/s00113-026-01760-5","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992889","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":"[Typical pitfalls in the definitive reconstruction of pilon fractures].","authors":"Christoph Sommer, Christian Michelitsch, Primoz Potocnik, Philipp Florian Stillhard","doi":"10.1007/s00113-026-01753-4","DOIUrl":"https://doi.org/10.1007/s00113-026-01753-4","url":null,"abstract":"<p><p>The definitive reconstruction of a pilon fracture can be technically demanding and requires meticulous preoperative planning. Besides selecting the appropriate surgical approach and implant, particular attention must be paid to the reduction strategy, including the sequence of reconstruction, the required reduction maneuver and the necessary instruments. Successful execution of the surgical plan also depends on recognizing suboptimal reduction during the definitive reconstruction, a task that can be particularly challenging in the presence of extensive metaphyseal comminution. Various pitfalls can be encountered during definitive treatment, affecting both fracture reduction and stabilization of the tibia or the fibula. Malreduction of one bone, most commonly the fibula as it is frequently addressed first, often compromises the reduction of the other, thereby jeopardizing the anatomical reconstruction of the ankle joint. As the number and length of surgical approaches to the distal tibia are limited due to the often critical soft tissue envelope, assessment of the reduction quality can be hampered. There is also a tendency to minimize the number of implants, which can lead to the surgeon avoiding using an additional plate, which would actually be necessary based on the fracture pattern. This article highlights and illustrates several common pitfalls encountered during definitive reconstruction of pilon fractures. Recognizing these pitfalls and understanding appropriate strategies to avoid them may help surgeons optimize decision-making and improve the quality of definitive treatment and patient outcomes.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984392","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}