Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Packaging waste in the operating room].","authors":"Caroline Lopez Lopez, Marie-Jacqueline Reisener, Nikolaus Kreitz, Veit Kleine-Doepke, Sönke Landschoof, Christian A Kühne","doi":"10.1007/s00113-024-01508-z","DOIUrl":"10.1007/s00113-024-01508-z","url":null,"abstract":"<p><strong>Background: </strong>Climate change is a central issue for our future. The increase in the amount of greenhouse gases in the atmosphere promotes the so-called greenhouse effect, resulting in climate change. Worldwide, the amount of plastic waste amounts to approximately 8 billion tons. The healthcare sector is responsible for around 4.4% of global net emissions contributing to the greenhouse effect. Measures to reduce CO₂ emissions within the healthcare sector should be implemented accordingly. To make the issue of plastic waste in the operational sector more visible, in the present study we examined and calculated the packaging waste generated in the treatment of distal radius fractures.</p><p><strong>Material and methods: </strong>The clinic stocks two different implants (sterile packaging = group I vs. implant tray = group II) for the treatment of distal radius fractures. Over a period of 12 months (July 2022-July 2023), the packaging waste from all surgically treated distal radius fractures was collected and weighed. The time required to retrieve, unpack and provide the implants in both groups (referred to as preparation time) was measured. Patient data were recorded in a dedicated register and statistical significances were calculated.</p><p><strong>Results: </strong>A total of 124 distal radius fractures were treated. The average age of the cohort was 67.9 years with 74.2% being female. The system with sterile individual packaging (group I) was used for fracture treatment 29 times, while the system with the screw tray (group II) was used 94 times. For treatment with sterile packaging 104.5g of plastic waste and 67.4g of plastic-free packaging waste were generated per operation, while treatment with the implant tray resulted in 21.6g of plastic waste and 12.8g of plastic-free packaging waste (p = 0.0001). The average time for providing the screws in group I was significantly higher at 527.8 s compared to treatment with the implant tray in group II at 138 s (p = 0.0001).</p><p><strong>Discussion: </strong>In the present study we found a significant increase in plastic waste when using individually packaged implants. To reduce the production of plastic waste, mandatory guidelines for waste separation in the operating room appear to be sensible. Measures such as the return and recycling of recyclable plastic waste as well as improvements in packaging design and the use of bio-based biodegradable and compostable plastics, represent further possibilities for waste reduction.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808334","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":"[Injuries of the cervical spine : Challenges in diagnostics and treatment].","authors":"Lennart Viezens","doi":"10.1007/s00113-024-01523-0","DOIUrl":"https://doi.org/10.1007/s00113-024-01523-0","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 2","pages":"71-74"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054605","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":"[Infection from Baltic Sea water requires extensive mesh-skin transplantation at the University Hospital Ulm].","authors":"F Kreß, P Schenk, F Gebhard, K Schütze","doi":"10.1007/s00113-024-01501-6","DOIUrl":"10.1007/s00113-024-01501-6","url":null,"abstract":"<p><p>Vibrio vulnificus (V. vulnificus) is a gram-negative bacterium that can cause severe infections after entering the human body via open wounds or consumption of shellfish. An increased occurrence of bacteria is known at water temperatures > 20 °C. In addition, a low salt content of 5-25‰ is beneficial for the reproduction of Vibrio spp. In the review by Fleischmann et. al. the direct correlation between low salinity and high water temperature with the increased occurrence of V. vulnificus on German Baltic Sea coasts was demonstrated [7]. It can cause fulminant necrotizing fasciitis which can result in amputation, septic shock and death. This case report shows the successful surgical treatment in Germany of a fulminant lower leg infection with septic shock after coming into contact with Baltic Sea water. A rapid and extensive debridement was followed by the successful transplantation of cutaneous tissue using a mesh graft.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"136-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717354","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":"[Accident pension after fracture of the pelvic ring and acetabulum : Changes in pension claims and costs following isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019-A DGUV registry analysis].","authors":"Nico Hinz, Julius Dehoust, Stefan Mangelsdorf, Arndt-Peter Schulz, Karl-Heinz Frosch, Maximilian J Hartel","doi":"10.1007/s00113-024-01516-z","DOIUrl":"10.1007/s00113-024-01516-z","url":null,"abstract":"<p><strong>Background: </strong>It is known that fractures of the pelvic ring and acetabulum in work-related accidents are associated with long periods of incapacity to work, a high rate of reduction in earning capacity (MdE) and high costs for pension/severance pay.</p><p><strong>Objective: </strong>Investigation of changes in pension claims and costs from 2013 to 2019 after isolated fractures of the pelvic ring and acetabulum in work-related accidents in Germany.</p><p><strong>Material and methods: </strong>For all patients from the German Social Accident Insurance (DGUV) registry with isolated fractures of the pelvic ring or acetabulum in work-related accidents, linear trend analyses were carried out among others for the proportion of MdE ≥20%, the proportion of cases receiving pension/severance pay and total costs for pension/severance pay from 2013 to 2019. A logistic regression analysis for the likelihood of receiving a pension was also performed.</p><p><strong>Results: </strong>The proportion of MdE ≥20% decreased for fractures of the pelvic ring and acetabulum in total from 14.3% for 2013 to 8.2% for 2019 and there was a decreasing trend for the proportion of cases receiving pension/severance pay for fractures of the pelvic ring and acetabulum in total from 23.1% for 2013 to 13.6% for 2019 as well as for both fracture types individually. There was also a decrease in the costs for pensions/severance pay for fractures of the pelvic ring and acetabulum in total from € 1,542,531 for 2013 to € 1,006,887 for 2019. The likelihood of receiving a pension decreased by 8% per subsequent accident year between 2013 and 2019.</p><p><strong>Conclusion: </strong>The proportion of pension claims and thus the costs for pensions/severance pay decreased for isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019. The DGUV seems to fulfil its guideline Rehabilitation before pension.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"109-116"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911300","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 strategy of a complex fracture entity].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Christoph Sommer","doi":"10.1007/s00113-024-01514-1","DOIUrl":"10.1007/s00113-024-01514-1","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"130-135"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840544","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":"[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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070299","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 ankle osteoarthritis : Analysis of a German nationwide survey].","authors":"Dariusch Arbab, Julia Wollweber, Philipp Lichte, Natalia Gutteck, Ralph Akoto, Bertil Bouillon","doi":"10.1007/s00113-024-01524-z","DOIUrl":"https://doi.org/10.1007/s00113-024-01524-z","url":null,"abstract":"<p><strong>Background: </strong>In most cases osteoarthritis of the ankle is of posttraumatic origin. Younger people are more frequently affected, which makes treatment a particular challenge. In addition to conservative treatment numerous surgical procedures are available for the treatment of advanced arthrosis. The aim of this nationwide survey was to document the current status of the diagnostics and treatment of ankle arthritis in Germany.</p><p><strong>Material and methods: </strong>Members of the German Society for Orthopedics and Trauma Surgery (DGOU) were invited to participate in an anonymous online survey on the treatment of ankle joint osteoarthritis. The survey included 69 questions on the person, on the diagnostic and treatment approaches as well as 3 clinical and radiological patient cases. The evaluation of the results of the survey included differences in the subgroups of participants based on the discipline, the location of activity, position and certification.</p><p><strong>Results: </strong>From November 2019 to February 2020 a total of 343 members participated in the survey. For the diagnostics 96% requested conventional radiographs in a standing position and in 2 levels. Other native radiographs were considered necessary by less than half of respondents. Less than one third of participants sometimes (n = 87) or always (n = 18) use an outcome score. The therapeutic repertoire included supramalleolar osteotomy (n = 106), ankle arthroplasty (n = 100) and arthrodesis (n = 248). Open arthrodesis using screws through an anterior approach was the most frequently used surgical procedure.</p><p><strong>Conclusion: </strong>Diagnostic standards were regularly used in the treatment of ankle arthrosis. With respect to the surgical treatment there was a wide heterogeneity due to the pathological anatomy and preferences of the participants. Open arthrodesis was the most frequently selected procedure.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069673","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":"[Fatal course of a fulminant gas gangrene of the right hemithorax].","authors":"Christoph J Neumann, Matthias Unterberg, Daniel Mesbah, Mark Sandfort, Rüdiger Smektala","doi":"10.1007/s00113-024-01490-6","DOIUrl":"10.1007/s00113-024-01490-6","url":null,"abstract":"<p><p>The full clinical picture of a gas gangrene infection is an absolute rarity. The mechanism of development can be either traumatic or spontaneous (e.g., hematogenous seeding in occult colon carcinoma). In particular, the rare pathogen Clostridium septicum appears to be associated with spontaneously occurring gas gangrene. Diabetes mellitus is a significant risk factor. The mortality rate of the disease is around 50%, even with maximum therapeutic efforts, and the course of the disease is fulminant in the majority of cases. Initial symptoms are unspecific and make early diagnosis difficult. Treatment consists of high-dose antibiotics in combination with radical surgical debridement and, if necessary, supplementary hyperbaric oxygen therapy.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"59-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402306","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":"[Specialized in trauma surgery-Not a simple way].","authors":"Marie Samland","doi":"10.1007/s00113-024-01509-y","DOIUrl":"10.1007/s00113-024-01509-y","url":null,"abstract":"<p><p>The question of the need for generalists and specialists in trauma surgery is controversially discussed concerning the challenges in the healthcare system, the interdisciplinary nature of the discipline, and the consequences of increasing specialization. The hospital reform as well as the availability of personnel and financing are discussed as central points. For high-quality patient care it is essential that the balancing act between generalists and specialists is successful. Effective interdisciplinary collaboration and holistic thinking are crucial to overcome the challenges in the healthcare system and to fulfil the needs of patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803834","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":"[Doctor, when can I drive? Characterization of driving behavior of orthopedic and trauma surgery patients using a prospective questionnaire study].","authors":"Felix Lakomek, Falk Hilsmann, Erik Schiffner, Sebastian Gehrmann, Dominique Schöps, Max Prost, Joachim Windolf, David Latz","doi":"10.1007/s00113-024-01502-5","DOIUrl":"10.1007/s00113-024-01502-5","url":null,"abstract":"<p><strong>Background: </strong>Individual mobility in road traffic is of high importance in Germany, both individually and socioeconomically; however, diseases and injuries of the musculoskeletal system in particular can lead to temporary impairments. The aim of this prospective patient survey was to record how patients assessed their driving capability during an injury and the associated immobilization and on what basis the decision on driving capability was made on the part of the patients.</p><p><strong>Material and methods: </strong>A systematic questionnaire was used to analyze a total of 100 patients with a diagnosis in orthopedics/trauma surgery and associated joint immobilization. In addition to personal data and the injuries/illnesses, an analysis on risk tolerance was performed and patients were asked about their knowledge regarding driving capability. Finally, it was recorded which patients drove a motor vehicle and for what reasons despite immobilization.</p><p><strong>Results: </strong>Overall, 40.2% reported knowledge of the applicable laws regarding driving capability and 55.6% considered the treating physician to be responsible regarding the decision on driving capability. The patients who drove a motor vehicle reported higher personal and professional dependence on the motor vehicle (personal: 60.6% vs. 45.7%; professional: 48.5% vs. 36.1%). In the group of patients who drove a motor vehicle during immobilization, overall a fracture was less likely to be the reason for immobilization (33.3% vs. 51.0%).</p><p><strong>Conclusion: </strong>Overall, the patient population rated their knowledge of the law as low and viewed the treating physician as having the majority of the decision-making responsibility regarding driving capability. The patients who drove a motor vehicle during immobilization reported a higher personal as well as professional dependence on driving a motor vehicle. At the same time the injury severity had an influence on the decision, so that patients with fractures were more likely to avoid driving a motor vehicle. Further studies, particularly at the biomechanical level, are needed to ensure a better basis for the physician in making decisions with respect to the driving capability of orthopedic and trauma surgery patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"38-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717166","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}