Unfallchirurgie (Heidelberg, Germany)最新文献_第3页

[Biphasic plate-Controlled instability in fracture healing]. [骨折愈合中的双相钢板控制不稳定性]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-09 DOI: 10.1007/s00113-025-01629-z

Christoph Sommer, Moritz Lodde, Ladina Hofmann-Fliri, Michael J Raschke

{"title":"[Biphasic plate-Controlled instability in fracture healing].","authors":"Christoph Sommer, Moritz Lodde, Ladina Hofmann-Fliri, Michael J Raschke","doi":"10.1007/s00113-025-01629-z","DOIUrl":"https://doi.org/10.1007/s00113-025-01629-z","url":null,"abstract":"The bony consolidation of fractures depends on various factors. Under optimal conditions fracture healing takes place within a few weeks. An essential requirement for fracture healing is the restoration of adequate biomechanical stability with an interfragmentary movement which is as ideal as possible. Distal femoral fractures can be particularly challenging especially in the presence of extensive soft tissue damage, multiple fragmented fractures and involvement of the joint. The currently applied surgical techniques of single lateral plate, double plate and intramedullary nail osteosynthesis as well as combination procedures have a relatively high complication rate. The principle of the biphasic plate is based on the transverse and longitudinal slots placed in the plate, which enables a \"controlled instability\". This results in a relatively high interfragmentary movement even at low loads (flexible phase) and a low movement at high loads (stiff phase). Therefore, the implant becomes more rigid at higher mechanical demands. In biomechanical tests the stress distribution of the implant, the number of cycles up to failure and the maximum load are superior compared to the locking compression plate distal femur (LCP-DF). Future studies will need to compare and evaluate the potential clinical and economic benefits in direct comparison to the currently established surgical techniques. Preclinical studies have so far demonstrated the safety and applicability of the biphasic plate and the innovative principle of controlled instability in fracture healing.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024887","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

[Polyaxial angle stability]. [多轴角稳定性]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-03 DOI: 10.1007/s00113-025-01628-0

Mark Lenz, Mirko Rocci, Martin Altmann, Boyko Gueorguiev

{"title":"[Polyaxial angle stability].","authors":"Mark Lenz, Mirko Rocci, Martin Altmann, Boyko Gueorguiev","doi":"10.1007/s00113-025-01628-0","DOIUrl":"10.1007/s00113-025-01628-0","url":null,"abstract":"Polyaxial screw systems are the state of the art in the field of fracture fixation. In contrast to conventional monoaxial systems, the polyaxial constructs enable variable screw angulation, enhancing the adaptability of plate-screw configurations in different surgical scenarios and different anatomical circumstances. This article provides a comprehensive overview of the functional principles, clinical applications and inherent limitations of polyaxial stability. The conventional monaxial technology restricts screw positioning, potentially compromising fixation in some fracture situations or anatomical regions. In contrast, polyaxial systems enable adapted screw placement, addressing specific requirements arising during surgery. Various locking mechanisms based on friction, deformation, thread forms and engagement techniques, play crucial roles in achieving stability. The article discusses the key currently used technologies, their mechanical characteristics and comparative behavior as the biomechanical interaction between screws and plates is crucial for achieving maximum stability and preventing failure modes that could compromise fracture healing. This article emphasizes that while polyaxial systems offer enhanced fragment-specific screw positioning, their successful application relies on careful surgical technique and an understanding of the mechanics involved. By integrating insights from clinical experiences, biomechanics, and the literature, we aim to raise awareness and support decision-making in fracture management using polyaxial systems. Ultimately, the article advocates a balanced understanding of both the benefits and challenges associated with polyaxial fracture fixation in modern orthopedic trauma surgery.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981950","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

[Intramedullary nailing of the tibia : Tips and tricks in borderline indications]. [胫骨髓内钉：边缘适应症的提示和技巧]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-02 DOI: 10.1007/s00113-025-01620-8

Martin Henri Hessmann, Varsha Badarla, Michael Buhl

{"title":"[Intramedullary nailing of the tibia : Tips and tricks in borderline indications].","authors":"Martin Henri Hessmann, Varsha Badarla, Michael Buhl","doi":"10.1007/s00113-025-01620-8","DOIUrl":"https://doi.org/10.1007/s00113-025-01620-8","url":null,"abstract":"The indications for tibial nailing are increasingly extending into periarticular regions, often under critical and challenging soft tissue conditions. Furthermore, due to the demographic development fractures of compromised osteoporotic bone must increasingly be surgically treated.Suprapatellar and parapatellar approaches have emerged as effective alternatives to the traditional infrapatellar approach, which simplify the operative technique of reduction and nail insertion, reduce the duration of intraoperative fluoroscopy time and yield improved reduction outcomes particularly in complex periarticular fractures.The insertion of the intramedullary locking nail into the medullary canal does not automatically guarantee an adequate reduction outcome. This article outlines key operative tips and tricks aimed at supporting the orthopedic surgeon in obtaining reproducible optimal surgical outcomes especially in borderline indications.Technological advancements in nail design and fixation methods enable more reliable and precise reduction even in complex cases, especially with fractures involving short metaphyseal fracture fragments. This article also addresses the specific requirements for achieving stable intramedullary fixation.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982001","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

[Robotically assisted and navigated pedicle screw placement at the subaxial cervical spine]. [机器人辅助和导航椎弓根螺钉置入颈椎下轴位]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-07-12 DOI: 10.1007/s00113-025-01599-2

Dominik M Haida, Mike Holl, Oybek Khakimov, Stefan Huber-Wagner

{"title":"[Robotically assisted and navigated pedicle screw placement at the subaxial cervical spine].","authors":"Dominik M Haida, Mike Holl, Oybek Khakimov, Stefan Huber-Wagner","doi":"10.1007/s00113-025-01599-2","DOIUrl":"10.1007/s00113-025-01599-2","url":null,"abstract":"Objective of surgery: The aim of this surgery is to stabilize an unstable cervical spine injury.Indications: Type B2 injury according to the AOSpine classification for injuries of the subaxial cervical spine and the associated instability. Guidelines and treatment recommendations for this injury.Contraindications: Robotically assisted and navigated techniques have no special contraindications.Surgical technique: Performed in the 3D navigation hybrid operating theatre \"Robotic Suite\" consisting of navigation unit \"Curve Navigation System\", robotic 3D cone beam computed tomography (CBCT) \"Loop-X\", robotic arm \"Cirq Arm System\" and wall monitor \"BUZZ\" (Brainlab, Munich, Germany). The individual surgical steps are explained in the video (English), available on the website under \"Supplementary Information\" or via the QR code.Surgical steps: Preoperative: planning CT and screw planning.Intraoperative: Carbon table, prone position and Mayfield clamp. Dorsal approach. Attachment of the reference array. 1) CBCT scan. Image fusion. Control of fusion result. Robot arm approach to the drilling trajectory, robotically assisted drilling. Insertion of the K‑wire. Navigated threading and navigated screw placement. 2) CBCT scan, control of the screw positions. Satisfactory screw position, insertion of connecting rods and bone substitute material, sterile wound closure.Follow-up: No cervical orthosis necessary. Isometric physiotherapy. Adapted pain therapy as needed and according to WHO scheme. X‑ray control after 6 and 12 weeks. No metal removal.Evidence: The video material shown is from a routine clinical operation. Robotically assisted and navigated operations at the subaxial cervical spine are performed with good surgical results and a high accuracy.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"722-726"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621519","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

[Hygiene and infection prevention in disaster events with decompensated crisis treatment]. [灾害事件中的卫生和感染预防与失代偿危机处理]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-07-17 DOI: 10.1007/s00113-025-01611-9

S Schulz-Stübner, C Herr, A Hinrichs, M Möckel, G Michels, I F Chaberny

{"title":"[Hygiene and infection prevention in disaster events with decompensated crisis treatment].","authors":"S Schulz-Stübner, C Herr, A Hinrichs, M Möckel, G Michels, I F Chaberny","doi":"10.1007/s00113-025-01611-9","DOIUrl":"10.1007/s00113-025-01611-9","url":null,"abstract":"In the event of a disaster, compliance with basic hygiene measures is crucial. These measures are carried out regardless of the colonization or infection status of the patient in order to prevent the transmission of pathogens to other patients and personnel and to minimize the risk of a nosocomial distribution of (potential) infectious pathogens. This primarily includes hygienic hand disinfection and the use of special barrier precautions and personal protective equipement depending on the situation as well as safe injection and infusion techniques, proper processing of medical products and full vaccination protection of the personnel. When consistently applied basic hygiene measures also protect against the transmission of multidrug-resistant pathogens in undetected colonized patients and many viral infections. Due to a massive increase in demand (e.g., during the pandemic), disruptions in supply chains or breakdowns in facility-specific structures, prolonged shortages of materials that are important for implementing basic hygiene can occur. In these situations, substitution strategies are required, e.g., for the in-house production of hand and surface disinfectants, the handling of drinking water, alternative ways of processing medical products, wound care and the use of antibiotics.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"685-692"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661244","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

[Fractures of the finger and metacarpal bones II-V : Diagnostics and treatment]. [手指和掌骨骨折II-V：诊断和治疗]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-08-01 DOI: 10.1007/s00113-025-01602-w

Jan Wulf, Frank Unglaub, Julie Boever, Christian K Spies, Wolfgang Böcker, Boris M Holzapfel, Adrian Cavalcanti Kußmaul

引用次数: 0

[Medical decision-making in clinical disaster medicine and in healthcare crises : Applying ethics and law in resource allocation]. 临床灾难医学和医疗危机中的医疗决策：在资源配置中的伦理和法律应用

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-08-05 DOI: 10.1007/s00113-025-01614-6

Axel R Heller, Thomas Wurmb, Axel Franke

{"title":"[Medical decision-making in clinical disaster medicine and in healthcare crises : Applying ethics and law in resource allocation].","authors":"Axel R Heller, Thomas Wurmb, Axel Franke","doi":"10.1007/s00113-025-01614-6","DOIUrl":"10.1007/s00113-025-01614-6","url":null,"abstract":"In health crises marked by severe resource scarcity, such as during the COVID-19 pandemic and in anticipated scenarios of national or state defence, hospitals face the challenge of maintaining the best possible medical care under ethically and legally responsible conditions. This article analyzes the ethical, legal and operational foundations of resource allocation in clinical disaster medicine. Central to this are the principles of utility maximization, fairness and transparency, which necessitate a shift from standard individual-centered care to a population-oriented crisis response. Medical indication forms the cornerstone of any treatment and must be evidence-based and patient-centered, even under crisis conditions. Therapeutic goals and prognostic assessment within the given resource constraints serve as key criteria for prioritization and allocation decisions. The use of triage category IV (blue) and the implementation of tertiary (ex-post) triage within hospitals are only conceivable under conditions of existential scarcity and require clear legal and ethical justification. Clinical ethics committees and independent triage teams play a pivotal role in decision-making and communication. The legal interpretation, particularly in the context of § 5c of the German Infection Protection Act, remains controversial and demands nuanced evaluation. The article underlines the necessity of consistent decision-making processes, structured documentation and the inclusion of vulnerable populations in crisis planning. Finally, operational strategies, such as tactical abbreviated surgical care (TASC), are presented as resource-efficient approaches to care. The overarching goal is to enable as many patients as possible to access the best achievable medical care, even under extreme conditions, while upholding ethical standards.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"660-674"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786160","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

[Postinfectious dislocation of the tibialis posterior tendon in a prima ballerina : A 13-year case report]. [初级芭蕾舞演员感染后胫骨后肌腱脱位：13年病例报告]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-06-30 DOI: 10.1007/s00113-025-01597-4

Hans Zwipp

{"title":"[Postinfectious dislocation of the tibialis posterior tendon in a prima ballerina : A 13-year case report].","authors":"Hans Zwipp","doi":"10.1007/s00113-025-01597-4","DOIUrl":"10.1007/s00113-025-01597-4","url":null,"abstract":"Background: The most frequent side effect of local corticosteroid injections in athletes is the rupture of collagenic tissues, such as fascia and tendons.Objective: 1. Warning against cortisone injections in the vicinity of tendons, fascia and retinacula. 2. Presentation of the anatomical restoration of the osteofibrous quiver of the tibialis posterior tendon. 3. Introduction of a pathogenetic classification of tibialis posterior tendon dislocation.Material and method: A 23-year-old female ballet dancer suffered from pain and significant loss of strength despite stiff taping while dancing en pointe 8 months after radical debridement for a putrid infection with Klebsiella pneumoniae of the left tibialis posterior tendon with a sonographically detectable dislocation. After debridement and reduction of the partially ruptured, scarred and split tendon, an anatomical restoration of the osteofibrous tendon quiver was performed with local tissue and transosseous sutures. The targeted perioperative administration of antibiotics, a postoperative lower leg cast for 6 weeks with thrombosis prophylaxis and subsequent intensive rehabilitation measures resulted in the complete ability to work after 8 weeks.Result: There were no recurrences over the 13-year period. With pain-free dancing en pointe without taping, the now 36-year-old soloist is still the lead female dancer at a renowned German opera house, is the mother of two children and believes that she dances better today than before.Discussion: Whether the initial local corticosteroid injection caused a pathological retinaculum rupture with dislocation of the tibialis posterior tendon or whether it was originally caused by the putrid infection after tendon revision surgery or whether a necrotic retinaculum was ultimately subjected to radical debridement, must remain an open question.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"713-720"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531532","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

[Hospital emergency and contingency planning as central element of the structuring of robust hospitals for coping with disasters and crises]. [医院紧急情况和应急计划是建立健全医院以应对灾害和危机的核心要素]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-07-31 DOI: 10.1007/s00113-025-01609-3

T Wurmb, F Kolibay, A R Heller, A Franke

{"title":"[Hospital emergency and contingency planning as central element of the structuring of robust hospitals for coping with disasters and crises].","authors":"T Wurmb, F Kolibay, A R Heller, A Franke","doi":"10.1007/s00113-025-01609-3","DOIUrl":"10.1007/s00113-025-01609-3","url":null,"abstract":"There is an increasing focus on preparation for disasters, crises and wars. The ability to react to such exceptional situations affects many pillars of a society. A key component of crisis response is the maintenance of medical care. This, in turn, has a significant impact on care in the outpatient and inpatient settings. Accordingly, hospitals must be prepared for such situations. An important element of such preparation is the hospital emergency and contingency planning (HECP). This requires detailed organization, structuring, planning, training and practice. Important elements of HECP are leadership, communication, zoning and the management of personnel, space and resources. The establishment of a leader of the HECP who coordinates and implements the planning is important and must be accompanied by an appropriate indemnification. Funding must be considered but cannot be an argument for failing to make serious and effective planning. Disasters that hit us unprepared will seriously jeopardize the healthcare system and thus the health of the population. Robust healthcare systems and robust hospitals can play their part in reducing the medical and social impact of disasters.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"654-659"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755338","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

[Framework conditions and basic assumptions in the preparation of a German guideline on clinical disaster medicine (LeiKliKatMeD)]. [制定德国临床灾难医学指南（LeiKliKatMeD）的框架条件和基本假设]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2025-09-01 Epub Date: 2025-08-12 DOI: 10.1007/s00113-025-01608-4

Axel Franke, Patric Tralls, Thomas Wurmb, Axel R Heller

{"title":"[Framework conditions and basic assumptions in the preparation of a German guideline on clinical disaster medicine (LeiKliKatMeD)].","authors":"Axel Franke, Patric Tralls, Thomas Wurmb, Axel R Heller","doi":"10.1007/s00113-025-01608-4","DOIUrl":"10.1007/s00113-025-01608-4","url":null,"abstract":"In order to prepare hospitals better for the necessary crisis care in a shortage situation, the Clinical Disaster Medicine Germany (LeiKliKatMeD) guidelines are currently being developed. They are funded by a research and development project of the Federal Office of Civil Protection and Disaster Assistance (BBK) and are being developed by the section assignment, disaster and tactical surgery (EKTC) of the German Society for Trauma Surgery (DGU) in collaboration with 38 specialist societies. This article describes the framework conditions and basic assumptions that were taken into account. In addition to recommendations for the treatment of typical injury and illness patterns in disasters, crises and war, the guidelines describe, for example, the requirements of hospital alert and operational planning as well as general points. After successful preparation and implementation these can lead to a reduction in the workload of medical treatment facilities in a crisis, so that the stage of compensated crisis care can be maintained for as long as possible in the exceptional situation of an extensive or prolonged damage position. For the prioritization and disposition of medical treatment measures in this situation, the categorization according to the urgency of treatment as part of the initial triage is an important point for the successful management of a damage situation. As a preview of the content of the guidelines, which are expected to be completed by the end of this year, these points are summarized and explained in order to facilitate the successful consideration and implementation of the expected recommendations even now.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"645-653"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823371","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