Unfallchirurgie (Heidelberg, Germany)最新文献_第4页

OMW: Schnittverletzungen der Hand in der Erstversorgung. 在急救中手部受伤。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-15 DOI: 10.1007/s00113-026-01758-z

Martynas Tamulevicius, Florian Bucher, Nils Neubert, Peter M Vogt

引用次数: 0

OMW: Perioperatives Schmerzmanagement in der Alterstraumatologie. 老年创伤学中的围手术期疼痛管理。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-15 DOI: 10.1007/s00113-026-01759-y

Vera Smolka

引用次数: 0

[Injuries of the tibiofibular syndesmosis]. [胫腓联合损伤]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-14 DOI: 10.1007/s00113-026-01747-2

Christine Marx, Caroline Stöckigt, Stefan Rammelt

引用次数: 0

[Correction of malunited medial and lateral malleolar fractures]. 内外踝骨折愈合不良的矫治。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-12 DOI: 10.1007/s00113-026-01745-4

Fabian Krause

引用次数: 0

[Acute management of pilon fractures]. 枕部骨折的急性处理。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-11 DOI: 10.1007/s00113-026-01752-5

Christian Michelitsch, Philipp Florian Stillhard, Primoz Potocnik, Christoph Sommer

{"title":"[Acute management of pilon fractures].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Primoz Potocnik, Christoph Sommer","doi":"10.1007/s00113-026-01752-5","DOIUrl":"https://doi.org/10.1007/s00113-026-01752-5","url":null,"abstract":"Pilon fractures are complex injuries involving the weight-bearing articular surface of the distal tibia and are frequently associated with relevant soft tissue damage. The treatment requires a structured strategy in which the condition of the soft tissues plays a central role. These fractures result either from low-energy rotational injuries or high-energy axial compression trauma. While the former typically occur in older patients and are associated with limited soft tissue injury, the latter often lead to complex fracture patterns with severe articular impaction and metaphyseal comminution. Nowadays, a 2-stage treatment concept is considered the gold standard. Initial management consists of the placement of a joint-spanning external fixator to restore length, alignment and rotation while enabling relief of the soft tissues. Subsequently, computed tomography diagnostics and preoperative planning are performed according to the principle of span-scan-plan. Open fractures require immediate intravenous antibiotic administration, meticulous debridement and removal of avascular bone fragments. In cases of critical soft tissue conditions, early involvement of plastic surgeons is recommended. Soft tissue-threatening or irreducible fracture fragments must be addressed with minimally invasive techniques during the initial treatment phase. In contrast, emergency primary fibular osteosynthesis is generally not recommended as it can compromise subsequent anatomical reconstruction of the tibial plafond. Management of the fibula should usually be performed in conjunction with the definitive osteosynthesis of the pilon fracture. Successful treatment depends not only on precise osseous reconstruction but also above all on meticulous soft tissue management.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946238","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

[Strategies for the definitive management of pilon fractures]. [鞍部骨折的最终治疗策略]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-11 DOI: 10.1007/s00113-026-01751-6

Christian Michelitsch, Philipp Florian Stillhard, Primoz Potocnik, Christoph Sommer

{"title":"[Strategies for the definitive management of pilon fractures].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Primoz Potocnik, Christoph Sommer","doi":"10.1007/s00113-026-01751-6","DOIUrl":"https://doi.org/10.1007/s00113-026-01751-6","url":null,"abstract":"Pilon fractures are among the most challenging injuries of the lower extremities and are associated with a high complication rate due to the frequently severe soft tissue damage. The currently established 2‑stage treatment concept with initial stabilization using a joint-bridging external fixator, subsequent soft tissue conditioning and thorough preoperative planning represents the current gold standard of care. Computed tomography with multiplanar and three-dimensional reconstruction is indispensable for detailed analysis of the fracture morphology and the development of an individually adapted surgical strategy. Typically, three major fragments can be identified: the anterior, medial and posterior fragments. A thorough understanding of key anatomical structures, particularly the ligamentous attachments and potential soft tissue interposition, is essential for selecting the optimal reduction strategy and surgical approach. The primary goal of surgical treatment is anatomical reconstruction of the articular surface while preserving the surrounding soft tissues as much as possible. Despite advances in implant technology, the treatment principles originally described by Rüedi and Allgöwer remain the cornerstone of operative management. In complex complete articular fractures (type C), reconstruction can often be simplified by functionally converting the fracture into a type B or type A pattern before definitive fixation. Modern stabilization techniques should be tailored to both fracture morphology and the condition of the soft tissues while adhering to the principles of biological osteosynthesis. A structured treatment algorithm based on meticulous preoperative planning, anatomical joint reconstruction and careful soft tissue management is essential to minimize complications and optimize long-term functional outcomes.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946210","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

[Injuries of the tibiofibular syndesmosis: surgical technique]. 胫腓联合损伤：手术技术。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-07 DOI: 10.1007/s00113-026-01746-3

Stefan Rammelt, Christine Marx

引用次数: 0

[Peri-arrest emergency thoracotomy after trauma: a 5-year case series]. [创伤后停搏期紧急开胸术：5年病例分析]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-01 Epub Date: 2026-07-23 DOI: 10.1007/s00113-026-01734-7

Greta Ahrens, Michael Hoffmann, Nils Proksch

{"title":"[Peri-arrest emergency thoracotomy after trauma: a 5-year case series].","authors":"Greta Ahrens, Michael Hoffmann, Nils Proksch","doi":"10.1007/s00113-026-01734-7","DOIUrl":"10.1007/s00113-026-01734-7","url":null,"abstract":"Background: Emergency thoracotomy under cardiopulmonary resuscitation (CPR) conditions in polytrauma patients remains a high-risk intervention with significant mortality. This study aims to evaluate outcomes following emergency thoracotomy in this critically injured patient population.Methods: A retrospective analysis was conducted on patients who underwent emergency thoracotomy for polytrauma between 2019 and 2023. The primary outcome was survival to hospital discharge. Functional outcome was assessed using the Glasgow Outcome Scale (GOS).Results: In this study 29 patients were included, 69% sustained blunt trauma and 31% penetrating injuries. Overall survival was 17% (n = 5). Mean time from emergency department arrival to thoracotomy was 19 ± 16.9 min and the prehospital time averaged 62 ± 53.1 min. The median Injury Severity Score (ISS) was 68.16 ± 16.97. Survivors had significantly lower ISS scores (32.6 ± 16.62; p < 0.001). Among patients with isolated injuries (24%), the survival rate was 43%. All survivors achieved a favorable outcome (GOS = 5). Factors associated with survival included short prehospital time, stab wounds and preserved consciousness after trauma.Conclusion: Emergency thoracotomy in the context of severe polytrauma can be lifesaving, particularly in select patients with penetrating injuries and preserved neurological status. Survivors can achieve excellent functional outcomes. Further research is needed to define selection criteria and develop standardized treatment algorithms.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"634-640"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564117","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

[Osteosynthesis for tibial plateau fractures in geriatric patients]. [骨融合术治疗老年患者胫骨平台骨折]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-01 Epub Date: 2026-06-23 DOI: 10.1007/s00113-026-01726-7

Adrian Deichsel, Christian Peez, Jan Christoph Katthagen, Lucas Palma Kries, Thorben Briese, Christoph Kittl, Klemens Horst, Elmar Herbst

引用次数: 0

[Posttraumatic knee osteoarthritis in the geriatric patient : Strategies for conversion to total knee arthroplasty after tibial plateau fractures]. [老年患者创伤后膝骨关节炎：胫骨平台骨折后转向全膝关节置换术的策略]。

Unfallchirurgie (Heidelberg, Germany) Pub Date : 2026-09-01 Epub Date: 2026-05-22 DOI: 10.1007/s00113-026-01715-w

Hendrik Pott, Peter Savov, Nicolas Luhr, Max Ettinger, Ricarda Stauss

{"title":"[Posttraumatic knee osteoarthritis in the geriatric patient : Strategies for conversion to total knee arthroplasty after tibial plateau fractures].","authors":"Hendrik Pott, Peter Savov, Nicolas Luhr, Max Ettinger, Ricarda Stauss","doi":"10.1007/s00113-026-01715-w","DOIUrl":"10.1007/s00113-026-01715-w","url":null,"abstract":"Tibial plateau fractures are severe injuries of the knee joint and oftentimes lead to the development of posttraumatic osteoarthritis. A proportion of patients therefore requires secondary arthroplasty. Total knee arthroplasty after tibial plateau fracture, however, carries a markedly higher risk for complications when compared to primary arthroplasty, especially in geriatric patients. Bone defects, malalignment, instability, and a higher infection rate are major concerns in this subset of patients. Retained hardware and compromised soft tissues may further complicate surgical treatment. Careful preoperative surgical planning is therefore essential. Implant design, augmentation, and degree of constraint have to be adapted to individual soft-tissue tension and bony defects. Osseous defects are classified using the Anderson Orthopaedic Research Institute (AORI) classification and implant fixation is facilitated by respecting the concept of zonal fixation. Modern technologies such as robotic surgery systems and patient-specific instrumentation may further reduce surgical complexity in difficult cases. The following article provides an overview of challenges and surgical strategies in total knee arthroplasty after tibial plateau fractures. Three cases illustrate specific challenges and individualized treatment options.","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"616-622"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990347","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