Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Missed injuries in pediatric trauma care : Still a challenge].","authors":"Nikos Karvouniaris, Kerstin Kuminack, Jonas Strohm, Hagen Schmal","doi":"10.1007/s00113-025-01545-2","DOIUrl":"10.1007/s00113-025-01545-2","url":null,"abstract":"<p><p>Missed injuries (MI) in children and adolescents with multiple injuries represent a major challenge in pediatric trauma care despite the availability of standard examination protocols and imaging procedures. In the initial phase of care the primary survey is essentially important for the detection and treatment of life-threatening injuries and is well established. After stabilization of the patient in the trauma room and the first phase of treatment, a secondary survey and a tertiary survey should be carried out in order to detect initially MI in the further course and avoid longer term consequences. The majority of MI involve head, thoracic and extremity injuries. Risk factors for MI are younger patient age, the presence of multiple trauma, a higher injury severity score (ISS), a lower value on the Glasgow coma scale (GCS) and a prolonged stay in the intensive care unit. While MI are frequently described in severely or multiply injured children, a high proportion of MIs are also found in children transferred from other institutions. Therefore, two case studies from a pediatric trauma center at a maximum care hospital and a literature analysis are used to analyze typical MIs. These case examples underline the importance of adhering to a standardized treatment regimen for this patient group. It is advisable to develop a standard operating procedure (SOP) with a corresponding risk score, which regulates the tertiary survey, the times of the follow-up examinations and the corresponding (specialist) specific responsibilities.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"403-409"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588499","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":"[MANSCAL(mass casualty incident) hospital alert : \"The first 10 minutes\"].","authors":"Nina Thies, P Fischer, T Kohlmann, A Bayer, V Pedersen, W Böcker, S Prückner, M Klein","doi":"10.1007/s00113-025-01554-1","DOIUrl":"10.1007/s00113-025-01554-1","url":null,"abstract":"<p><strong>Background: </strong>In the event of a mass casualty incident (MASCAL) decisions on the spatial, personnel and organizational restructuring of the emergency department have to be made in a very short time from the initial alert to the arrival of the first patient at the hospitals. Due to the rarity of a MASCAL this complex task is a special challenge.</p><p><strong>Aim: </strong>The aim of the study was to optimize the immediate preparation phase after a MASCAL alarm by means of concise instructions for action and to shorten the time to the automated external alerting.</p><p><strong>Material and methods: </strong>In a structured dialogue involving the departments of emergency medicine, anesthesia and surgery, the critical issues in the initial organization after a MASCAL activation were identified and a flow chart for the first relevant decision-making processes was developed. The time required for the decisions to be made was compared before and after the implementation of the instructions for action \"The first 10 minutes\" in practical simulations.</p><p><strong>Results: </strong>The compiled checklists \"The first 10 minutes\" contain a clearly structured guide to master the necessary tasks by decision-makers on site in the initial phase. By introducing the concept the duration of the initial decision-making process was reduced by an average of 14.3 min.</p><p><strong>Conclusion: </strong>The development of instructions for action optimized for the location with a structured checklist leads to a significant acceleration of the initial decision-making processes when a MASCAL is activated.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"441-448"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733536","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":"[Complication management of shaft fractures of the upper extremities : From revision surgery to rehabilitation].","authors":"Laura A Hruby, Raffaela Morgenbesser, Florian Wichlas, Alexander Auffarth, Thomas Freude","doi":"10.1007/s00113-025-01592-9","DOIUrl":"https://doi.org/10.1007/s00113-025-01592-9","url":null,"abstract":"<p><p>The management of shaft fractures of the upper extremities is an integral part of trauma surgery in the clinical routine. While sport-associated injuries predominate in young adults, the incidence of osteoporotic fractures greatly increases in older patients. Despite established treatment strategies, complications such as wound healing disorders, infections, neurovascular injuries, malalignment, pseudarthrosis and implant failure are frequent. An effective complication management requires detailed knowledge of the morphological features of fractures, individual risk factors and differentiated revision strategies. With the presentation of two clinical cases, we aim to highlight the necessity of individualized treatment concepts. Due to the increasing number of war casualties transferred for secondary treatment to Central Europe, the likelihood of encountering unfamiliar injury patterns, such as blast or gunshot wounds, is rising. This development presents new challenges in daily clinical practice. Physiotherapeutic and occupational therapy support play a central role in achieving favorable functional outcomes following revision surgery for diaphyseal fractures of the upper extremities. In geriatric care, orthogeriatric concepts have significantly decreased mortality and improved mobilization as well as self-sufficiency among older patients. Managing patient expectations and providing close supervision throughout the rehabilitation process are decisive factors for successful recovery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188613","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":"[Excess mortality of patients who negative for COVID-19 with proximal femoral fractures during the pandemic : What can we learn for future pandemics?]","authors":"Jakob Mayr, Anna Kurnoth, Nora Koenemann, Timon Röttinger, Leonhard Lisitano, Edgar Mayr, Annabel Fenwick","doi":"10.1007/s00113-025-01572-z","DOIUrl":"https://doi.org/10.1007/s00113-025-01572-z","url":null,"abstract":"<p><strong>Background: </strong>The global COVID-19 pandemic led to excess mortality, especially for vulnerable older patients with simultaneous comorbidities. Patients with proximal femoral fractures already have a high mortality risk of up to 30% during the first postoperative year. The purpose of this study was not only to investigate the impact of COVID-19 on the mortality of patients tested positive but also of negatively tested patients with proximal femoral fractures.</p><p><strong>Methods: </strong>A single center cohort study of 2186 patients (mean age 79.8 years) who were surgically treated for a proximal femoral fracture at a level I trauma center was retrospectively carried out. The mortality and complication rates before the COVID-19 pandemic (January 2016-February 2020) and during the pandemic (March 2020-October 2021) were compared. A standardized treatment protocol was carried out during the total observational period. Orthogeriatric co-management was negatively impaired by the pandemic. Patient data, COVID-19 infections, surgical procedure, time from admission to surgery, postoperative complications and mortality were analyzed.</p><p><strong>Results: </strong>The pandemic group included 596 patients with an average age of 79.7 years. During the pandemic 26 patients were tested positive for COVID-19 (18 women, 8 men, average age 81.4 years, minimum 63 years, maximum 99 years, SD 9 years). Patients who tested positive for COVID-19 had more comorbidities than COVID-19 negative patients during the same period (Charlson comorbidity index, CCI 6.26 vs.5.25 points p < 0.037). The prepandemic control group consisted of 1590 patients with an average age of 79.9 years and a mean CCI of 5.86 points. Patients tested positive had a much longer hospitalization and a longer duration on the intensive care unit (p < 0.001) and a complication rate of 62.5%, especially due to the occurrence of pneumonia (p < 0.001). The mortality rate during the pandemic did not differ between patients tested positive or patients tested negative but was significantly higher for both groups in comparison to the period before the pandemic (pandemic 14% vs. 15.4%, before the pandemic 3.1%).</p><p><strong>Conclusion: </strong>Patients suffering from COVID-19 infection and proximal femoral fractures have a high risk of complications and a high mortality. The total increase in mortality for all patients with critical injuries, such as hip fractures during the pandemic emphasizes the importance of early mobilization and orthogeriatric co-management, which was discontinued during the pandemic and the lockdown.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082363","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":"[Potential applications of large language models in trauma surgery : Opportunities, risks and perspectives].","authors":"Jakob Cornelius, Johannes Knitza, Juliana Hack, Melina Pavlovic, Sebastian Kuhn","doi":"10.1007/s00113-025-01581-y","DOIUrl":"https://doi.org/10.1007/s00113-025-01581-y","url":null,"abstract":"<p><p>The integration of large language models (LLM) into the care of trauma surgery patients offers an exciting opportunity with immense potential to enhance the efficiency and quality of care. The LLM can serve as supportive tools for diagnosis, decision making and patient communication by efficiently providing medical knowledge and generating personalized treatment recommendations; however, there are also substantial challenges that must be addressed. The lack of transparency in the decision-making processes of LLM as well as currently unresolved legal and ethical issues, necessitate careful implementation and examination by medical professionals to ensure the safety and effectiveness of these technologies.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058896","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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044269","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":"[How does the preoperative waiting time affect hospital mortality and complication rates in geriatric patients with medial femoral neck fractures?]","authors":"Annette Keß, Johanna Krauße, Philipp Pieroh, Christian Kleber, Johannes Fakler, Georg Osterhoff","doi":"10.1007/s00113-025-01575-w","DOIUrl":"https://doi.org/10.1007/s00113-025-01575-w","url":null,"abstract":"<p><strong>Background: </strong>The current guidelines of the German Federal Joint Committee on the treatment of proximal femoral fractures require that patients with a proximal femoral fracture receive surgical treatment as soon as possible and within 24 h of admission. This is intended to reduce perioperative complication rate and mortality.</p><p><strong>Objective: </strong>The aim of this study was to analyze the hospital mortality as well as complication rates and types in relation to the preoperative waiting time.</p><p><strong>Methodology: </strong>From 2010 to 2020, a total of 575 patients with femoral neck fractures treated with a bipolar prosthesis were retrospectively analyzed with respect to hospital mortality and the occurrence of complications. Patients with pathological fractures, femoral neck fractures more than 4 weeks old and those treated with osteosynthesis were excluded. Patient-specific data, hospital mortality and complication rates and types were recorded.</p><p><strong>Results: </strong>During the study period, the implementation of the given guidelines resulted in a reduction in the preoperative waiting time from a median of 38 h in 2010 to 19 h in 2020. Surgical treatment was performed on average after 14.2 h in patients who had surgery within 24 h after admission and on average after 40.2 h for those who had surgery after 24 h. The average American Society of Anesthesiologists (ASA) score for all 575 patients was 2.76. The group of patients who had surgery after more than 24 h had a significantly higher ASA classification (p = 0.024). A total of 12 (4.2%) patients in the group surgically treated within 24 h died, compared to 24 (8.5%) deaths in the group surgically treated after 24 h (p = 0.035). The complication rate for the entire cohort was 15% (88 patients). There was no difference in the occurrence of complications and the overall complication rate with respect to the timing of surgery.</p><p><strong>Conclusion: </strong>During the study period the preoperative waiting time was halved from 39h to 19 h. Patients who were surgically treated within 24 h had a significantly lower hospital mortality than those surgically treated after 24 h; however, the group surgically treated after 24 h simultaneously showed higher baseline comorbidities and in the adjusted analysis for age and ASA score, the 24‑h threshold no longer emerged as an independent risk factor for hospital mortality. Regarding complication rates, no significant differences were found between the groups based on the timing of surgery.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060761","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":"[Patient specific implants and instruments in orthopaedic trauma: 3D prints and implants in perlvic and hip fractures].","authors":"Valentin Clemens, David Steimer, Nico Bruns, Axel Gänsslen, Rupert Meller","doi":"10.1007/s00113-025-01562-1","DOIUrl":"https://doi.org/10.1007/s00113-025-01562-1","url":null,"abstract":"<p><p>Modern pelvic surgery is essentially influenced by technological innovations. One of the most impressive advances in this field is the integration of 3D printing and the associated possibility for the production of 1:1 models of the pelvic skeleton. Using these models, conventional pelvic implants can preoperatively be more exactly and patient-specifically contoured. The use of this technology has the potential to substantially improve the quality of care and simultaneously to optimize the surgical results. By the use of 3D-printed implants, which are individually adapted to the anatomical conditions of the patient, operations can not only be carried out more quickly and efficiently but also with a greater accuracy and potentially fewer complications. This article presents two instructive cases. Case 1 demonstrates how a proximal femoral fracture with a pre-existing deformity of the femur can be treated with a patient-specific implant. Treatment with conventional intramedullary or extramedullary implants was not possible. Case 2 illustrates the treatment of a pelvic ring fracture and the advantage of 3D printing for the preoperative patient-specific contouring of conventional plate systems.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 5","pages":"351-358"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045562","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":"[Patient-specific implants and digital implant planning in trauma surgery].","authors":"Stephan Sehmisch","doi":"10.1007/s00113-025-01561-2","DOIUrl":"https://doi.org/10.1007/s00113-025-01561-2","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 5","pages":"327-328"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065048","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":"[3D printing/implants in traumatology].","authors":"Nico Bruns, Mohamed Omar","doi":"10.1007/s00113-025-01546-1","DOIUrl":"10.1007/s00113-025-01546-1","url":null,"abstract":"<p><p>The use of 3D printing offers numerous application possibilities in traumatology, including anatomic models, repositioning and drilling guides as well as patient-specific implants. The greatest challenge lies in the rapid availability as many procedures require an immediate intervention. Anatomic models support surgical planning by complementing visual impressions with tactile ones. Printed models not only help in the establishment of surgical strategies but also enhance patient clarification. Studies demonstrate that these models significantly reduce the operating time, duration of fluoroscopy and blood loss, particularly for joint fractures. Repositioning and drilling guides simplify complex procedures and improve outcomes; however, they require precise planning and critical evaluation by the surgeon. Intraoperative guides are helpful, for instance, in accurately placing screws, especially in difficult to access areas or in metaphyseal fractures lacking clear references. Individualized implants play a lesser role in acute care but are useful for posttraumatic defects or corrective osteotomy. In the conservative segment, such as customized splints, 3D printing is being tested but with mixed results. Key requirements for 3D printing in traumatology include high-resolution computed tomography (CT), precise data processing and swift production. Regulatory hurdles and lack of reimbursement currently limit the widespread use. An optimized collaboration between technology and medicine, along with standardized processes, are essential for effectively integrating this technology into practice.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"329-336"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598405","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}