Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[The S2k guideline \"Clinical disaster medicine for Germany\" (LeiKliKatMeD)].","authors":"Axel Franke","doi":"10.1007/s00113-025-01613-7","DOIUrl":"https://doi.org/10.1007/s00113-025-01613-7","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 9","pages":"643-644"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981986","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":"[Prevalence of equinus deformity in inpatients treated at a university hospital].","authors":"Alexander Milstrey, Leo-Lion Eisfeld, Jeanette Köppe, Jens Minnerup, Michael J Raschke, Sabine Ochman, J Christoph Katthagen","doi":"10.1007/s00113-025-01582-x","DOIUrl":"10.1007/s00113-025-01582-x","url":null,"abstract":"<p><strong>Background: </strong>In the authors' opinion the prevalence of equinus foot deformities is an underestimated medical and socioeconomic problem that has not yet been adequately investigated. A  dorsiflexion in the ankle joint of < 10° can lead to limitations in gait.</p><p><strong>Objective: </strong>The aim of the present study was to determine the prevalence of equinus foot deformities based on the degree of restriction of dorsiflexion in the ankle joint in hospitalized patients.</p><p><strong>Material and methods: </strong>In this cross-sectional study the active range of motion of the ankle joint in 205 patients at Münster University Hospital was prospectively examined with a goniometer. Included in the study were 136 trauma surgery and 69 neurology patients. The association of restricted dorsiflexion with other clinical parameters was investigated using the χ²-test or Fischer's exact test. The significance level was set at p < 0.05.</p><p><strong>Results: </strong>In total, 205 patients with mean age of 59 years were included. There was a slight predominance of males (55.1%) in the gender distribution. The average dorsal extension of the ankle joint was 7.03°on the right side and 8.92° on the left side. Of the patients 72.2% had a dorsiflexion in the ankle joint of < 10°, 38.1% a dorsiflexion < 5° and 16.1% a dorsiflexion < 0° on at least one side. A relevant association between age, gender, duration of hospitalization and the reason for treatment with a restriction of dorsiflexion could not be observed.</p><p><strong>Conclusion: </strong>The results suggest that restriction of dorsiflexion is a frequent problem in our group of trauma surgery and neurology patients. In particular, the presence of a manifest equinus deformity of the foot of > 10% that could not achieve the neutral position is a relevant finding.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"693-698"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044269","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":"[Clinical disaster medicine: recommendations of the Surgical Working Group for Military and Emergency Surgery].","authors":"Christian Beltzer, Wolfgang E Thasler, Jürgen Tepel, Arnulf Willms, Aliona Wöhler, Lena Heidelmann, Andreas Westerfeld, Christof Schreyer, Clemens Schafmayer, Sebastian Schaaf, Christoph Güsgen","doi":"10.1007/s00113-025-01610-w","DOIUrl":"10.1007/s00113-025-01610-w","url":null,"abstract":"<p><p>In-hospital disaster medicine demands a structured, pragmatic and resource-efficient approach in the surgical treatment of patients under extreme conditions. The Surgical Working Group for Military and Emergency Surgery (CAMIN) of the German Society of General and Visceral Surgery (DGAV) has developed guideline-based recommendations for making decisions, prioritization and management in disaster scenarios. The guidelines address the special challenges of atypical trauma patterns, as can be found in terrorist attacks or situations with mass casualties, such as gunshot or blast injuries. They highlight the use of damage control surgery (DCS), the differentiated application of laparotomy, open abdominal management and the triage of general and oncological procedures. The clinical assessment, focused diagnostics (e.g., extended focussed assessment with sonography in trauma, eFAST) and staged surgical algorithms are at the heart of this concept, aiming to ensure the highest level of patient safety and effectiveness despite critical resource limitations. The overriding principle is: \"do the most for the most.\"</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"675-684"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755337","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 bony defects in femur and tibia : Established and new concepts].","authors":"Patrick Thomé, Jan von Recum, Paul Alfred Grützner, Gregor Reiter","doi":"10.1007/s00113-025-01607-5","DOIUrl":"https://doi.org/10.1007/s00113-025-01607-5","url":null,"abstract":"<p><p>Bone defects in the limbs may result from trauma, debridement during osteitis or pseudarthrosis resection or tumors [1]. Treating bone defects of the femur and tibia poses a substantial challenge in trauma surgery and orthopedics. Interdisciplinary orthoplastic treatment combined with soft tissue reconstruction is often necessary to preserve the extremity and its function. In addition to shortening surgery, various procedures are available for biological reconstruction, including autogenous and allogeneic bone transplantation, the use of osteoconductive bone substitutes, the induced membrane technique also known as the Masquelet technique, distraction osteogenesis and vascularized fibula transfer. Alternatively, megaprostheses can be used as metallic bone substitutes, especially for metaphyseal bone defects of the femur or proximal tibia [1].Bone defects up to 3 cm in size can usually be successfully treated with shortening or primary cancellous bone grafting; however, leg length difference is known to result in functional limitations [2]. The two-stage Masquelet technique can successfully be used to treat not only small and medium-sized defects but also larger defects through modification [2, 3]. Although the Masquelet technique can be used for larger defects, more complex surgical procedures are often employed in such cases. Callus distraction with segment transport is the most common procedure. In addition to external procedures with monorail or ring fixators, internal lengthening procedures with a transporting nail or plate-assisted bone segment transport (PABST) are now available as well [2].</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981961","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":"[Revision osteosynthesis by retrograde tibial nailing for complex open lower leg fracture with pseudarthrosis after callus distractions : A case report].","authors":"Ismail Sahan, Mergim Shabani, Katrin Schall, Christof Meyer","doi":"10.1007/s00113-025-01623-5","DOIUrl":"https://doi.org/10.1007/s00113-025-01623-5","url":null,"abstract":"<p><p>Retrograde intramedullary nailing of the tibia is not a routine clinical procedure but is a valuable treatment option in special cases, such as pseudarthrosis in the presence of a knee endoprosthesis. This article reports on a 61-year-old female patient with a grade III open fracture of the lower leg with complex vascular and soft tissue injuries and failure of the docking site to heal after repeated callus distractions and plate osteosynthesis. Successful surgical treatment included retrograde tibial nailing with cancellous bone grafting for complete bony consolidation and good functional recovery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981955","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":"[High-energy trauma with complex acetabular fracture and incarcerated fragment].","authors":"Mikolaj Bartosik, David Kern, Anne Sofie Vogelsang, Loretta Rother, Eckart Mayr, Ulf Culemann","doi":"10.1007/s00113-025-01624-4","DOIUrl":"https://doi.org/10.1007/s00113-025-01624-4","url":null,"abstract":"<p><p>Acetabular fractures with displaced fragments represent a complex intraoperative challenge. This case report describes the successful treatment of an acetabular fracture with native hip dislocation in a 56-year-old man following high-energy trauma. Open reduction and internal fixation using the Kocher-Langenbeck approach was initially unsuccessful due to a posterior wall fragment, necessitating a trochanteric flip osteotomy. The patient developed an avascular necrosis of the femoral head, which is a frequent complication of acetabular fractures associated with hip dislocation. This emphasizes the importance of regular control follow-up. Despite the high-energy mechanism of injury, the patient showed excellent results based on the Harris hip score (HHS).</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982012","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":"[Operative treatment of perilunate dislocations].","authors":"A Asmus, L Harhaus-Wähner, F Eichenauer","doi":"10.1007/s00113-025-01622-6","DOIUrl":"https://doi.org/10.1007/s00113-025-01622-6","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981976","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 treatment variation of displaced femoral neck fractures in certified centers for geriatric trauma DGU® and arthroplasty centers in Germany].","authors":"Yasmin Hartmann, Katherine Rascher, Miguel Pishnamaz, Filippo Migliorini, Klemens Horst, Matthias Knobe, Frank Hildebrand, Christian David Weber","doi":"10.1007/s00113-025-01619-1","DOIUrl":"https://doi.org/10.1007/s00113-025-01619-1","url":null,"abstract":"<p><strong>Background: </strong>There is an almost unique certification structure in Germany in which clinics can be certified either as trauma center DGU® (TraumaZentrum DGU®), geriatric trauma center DGU® (AltrsTraumaZentrum DGU®) or arthroplasty center (endoCert), among others. Geriatric patients with displaced femoral neck fractures represent a highly relevant entity. The structural and process quality are validated within the framework of certification as both an AltersTraumaZentrum DGU® (ATZ) and arthroplasty center (EPZ), which represents a methodologically challenging approach to the analysis of treatment reality.</p><p><strong>Objective: </strong>Is there a treatment variation between certified geriatric trauma centers (ATZ) and dual certified geriatric and arthroplasty centers (ATZ+EPZ) with respect to joint-preserving or joint replacement surgical procedures for geriatric displaced femoral neck fractures and short-term complications?</p><p><strong>Material and methods: </strong>Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) from 46 clinics with ATZ and 52 clinics with ATZ + EPZ were analyzed. The follow-up period included both the in-hospital stay and a 120-day follow-up interval. The primary outcome was mortality, secondary endpoints included mobility, reoperations and health status. Univariate and multivariate analyses were performed to calculate odds ratios (OR) after adjustment for age, gender, ASA score and concomitant injuries.</p><p><strong>Results: </strong>The median age of the collective (n = 7389) was 84 years, 29.6% and 29.8% respectively were male, the median time until surgery was 20.9 h (ATZ) vs. 20.5 h (ATZ + EPZ) and the median length of stay was 15.1 days for both types of center. The number of joint-preserving interventions was significantly increased in ATZ compared to clinics with dual certification (ATZ: 8.6% vs. ATZ + EPZ: 2.6%; OR = 3.63). The reoperation rate was comparable in the primary stay (3.7% vs. 3.9%) but was significantly increased over the 120-day course in clinics with dual certification (4.1% vs. 6.0%; p = 0.022). Revisions due to periprosthetic fractures occurred more frequently in ATZ without EPZ (8.2% vs. 3.5%). The multivariate analysis showed an increased mortality in the acute phase (OR 1.26; 1.02-1.56; p = 0.031), an increased rate of reoperations in the 120-day course (OR 1.45; 1.06-2.02; p = 0.024) and inpatient readmissions (OR 1.42, 1.02-2.00; p = 0.043) for centers with dual certification.</p><p><strong>Conclusion: </strong>In Germany an institutional treatment variation for geriatric displaced femoral neck fractures exists. In certified geriatric trauma centers without certified arthroplasty center there is a significantly increased rate of joint-preserving treatment with differences in terms of morbidity and mortality in the acute phase.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981969","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":"[Hoffa fractures : Rare, often overlooked, prone to complications].","authors":"Hannah Gablac, Michael Hoffmann","doi":"10.1007/s00113-025-01617-3","DOIUrl":"https://doi.org/10.1007/s00113-025-01617-3","url":null,"abstract":"<p><p>Hoffa fractures are coronal plane fractures of the femoral condyle and overall represent a rare fracture entity. These fractures are predominantly caused by high-energy trauma und usually involve the lateral femoral condyle. An axial load to the femoral condyle with the knee in 90° or more of flexion produces the typical fracture pattern. In the initial radiological diagnostics the fracture is often overlooked, therefore, a computed tomography (CT) examination is indicated for the diagnostics and planning of surgery (selection of the access and the implant). The operative treatment with an equivalent of the Herbert screw achieves a good functional result, which corresponds to the preferred osteosynthesis implant for simple Hoffa fractures without a debris zone. Meniscal, chondral and ligamentous lesions are frequent collateral injuries of Hoffa fractures and can impact on the functional outcome. Therefore, additional magnetic resonance imaging (MRI) diagnostics and intraoperative stability tests are recommended. Despite differentiated diagnostics and management the trajectory of Hoffa fractures is often associated with complications and therefore require a structured rehabilitation protocol and follow-up with radiological controls.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981994","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":"[Occupational risk: necrotizing fasciitis in an emergency physician after resuscitation of an infected female patient].","authors":"Konstantin Wehrkamp, Alexander M Keppler, Wolfgang Böcker, Ludwig Ney, Uwe Kreimeier, Paul Reidler, Philipp Lohse, Fabian Gilbert, Rouven Neudeck","doi":"10.1007/s00113-025-01591-w","DOIUrl":"10.1007/s00113-025-01591-w","url":null,"abstract":"<p><p>An emergency doctor became infected with group A streptococci during resuscitation and developed necrotizing fasciitis (NF) on his arm and thorax. The patient could be cured by antibiotic treatment and several operations. This case aims to increase the awareness for the risk of NF for medical personnel and makes an appeal to personnel involved in emergencies to consider the relevance of personal protective equipment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"623-627"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227814","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}