Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Digital technologies and strategies in amputation medicine].","authors":"Cosima Prahm, Michael Bressler, Johannes Heinzel, Henrik Lauer, Jana Ritter, Adrien Daigeler, Jonas Kolbenschlag","doi":"10.1007/s00113-024-01468-4","DOIUrl":"10.1007/s00113-024-01468-4","url":null,"abstract":"<p><p>Surgical techniques in amputation medicine did not change for a long time, while prosthesis technology underwent rapid development. The focus shifted to optimising the residual limb for prostheses use. At the same time, digital technologies such as gamification, virtual and mixed reality revolutionised rehabilitation. The use of gamification elements increases motivation and adherence to therapy, while immersive technologies enable realistic and interactive therapy experiences. This is particularly useful in the context of controlling modern prostheses and treating phantom pain. In addition, digital applications contribute to optimised documentation of symptoms and therapy successes. Overall, these technologies open up new, effective and personalised therapeutic approaches that can significantly improve the quality of life of amputation patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"637-643"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876931","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":"[Peer counseling for amputations : A somewhat different instrument in trauma surgery].","authors":"Melissa Beirau, Kristina Zappel, Claas Güthoff, Anne Steinbach, Axel Ekkernkamp","doi":"10.1007/s00113-024-01459-5","DOIUrl":"10.1007/s00113-024-01459-5","url":null,"abstract":"<p><p>The abrupt onset of the situation after a traumatic amputation and the preparatory discussions following unsuccessful attempts to preserve limbs with necessary amputation require a high level of empathy, attention and well-founded information individually tailored to the affected individuals. Optimization of the treatment process can only be achieved by considering these aspects.The self-motivation and cooperation of the patient should be encouraged. To achieve this goal, the professions involved are less suitable for counseling due to a lack of personal experience, whereas so-called peers, as knowledgeable and experienced advisors, are more appropriate. This insight can be derived from existing studies. Peer counseling has increasingly been integrated into routine treatment following amputations in trauma surgery, with positive effects. It is considered guideline-compliant therapy not only in rehabilitation. Against the background of long-standing legislation, especially the UN Convention on the Rights of Persons with Disabilities and the demands of those affected by amputation, the following presentation focuses on the instrumentalization and benefits of counseling. The structures of this particular counseling option, including regular training of counselors and established implementation, are currently not necessarily given but are continuously expanding and being adapted to needs. Concrete scientific evidence regarding measurable effects and positive impacts on outcomes is pending and are presented in a current research project.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"644-650"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731691","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":"[Innovative noninvasive gait-synchronized vibrotactile feedback system : \"I can feel myself walking again\"].","authors":"M N Kalff, V Witowski, V Hoursch, N Kirsten, L Niehage, H Kramer, A Gardetto, S Sehmisch, J Ernst","doi":"10.1007/s00113-024-01466-6","DOIUrl":"10.1007/s00113-024-01466-6","url":null,"abstract":"<p><p>Despite intensive research and development of systems for restoration of sensory information, these have so far only been the subject of study protocols. A new noninvasive feedback system translates pressure loads on the forefoot and hindfoot into gait-synchronized vibrotactile stimulation of a defined skin area. To increase the authenticity, this treatment can be supplemented by a surgical procedure. Targeted sensory reinnervation (TSR) describes a microsurgical procedure in which a defined skin area on the amputated stump of the residual limb is first denervated and then reinnervated by a specific, transposed sensory nerve harvested from the amputated part of the limb. This creates a sensory interface at the residual stump. This article presents the clinical and orthopedic technical treatment pathway with this innovative vibrotactile feedback system and explains in detail the surgical procedure of TSR after amputation of the lower limb.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"626-636"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972352","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":"[Replacement of the nail system in cases of cut out and implant failure after proximal femoral fractures].","authors":"Holger Siekmann","doi":"10.1007/s00113-024-01456-8","DOIUrl":"10.1007/s00113-024-01456-8","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"685-686"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857295","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":"[Fillet flap transfer as alternative to conventional lower limb amputation].","authors":"L Harnoncourt, C Gstoettner, L Pflaum, G Laengle, O C Aszmann","doi":"10.1007/s00113-024-01460-y","DOIUrl":"10.1007/s00113-024-01460-y","url":null,"abstract":"<p><strong>Background: </strong>The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect.</p><p><strong>Objective: </strong>An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts.</p><p><strong>Material and methods: </strong>A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, a clinical case is presented.</p><p><strong>Results and conclusion: </strong>The transfer of the sole of the foot as a fillet flap to the weight-bearing region of the amputation stump offers a number of benefits, such as creating a fully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"651-659"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565275","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":"[Transfemoral amputation due to uncontrollable infections after implantation of a total knee endoprosthesis].","authors":"Ralf-Achim Grünther","doi":"10.1007/s00113-024-01469-3","DOIUrl":"10.1007/s00113-024-01469-3","url":null,"abstract":"<p><strong>Introduction: </strong>In the evaluation of an internal analysis of data on the increased effort for nursing during rehabilitation of patients with amputations in the Baumrainklinik of the HELIOS Rehabilitation Center Bad Berleberg, the number of patients with transfemoral amputations (TFA) due to uncontrollable multiple infections after implantation of a total knee endoprosthesis (total knee arthroplasty, TKA) was clearly emphasized.</p><p><strong>Objective: </strong>This article discusses the results of a retrospective, patient-controlled trial (PCT) and compares these with the data of the German Endoprosthesis Registry (EPRD). The study concentrated on patients who were admitted to rehabilitation after a TFA due to an uncontrollable infection after implantation of a knee TKA. The primary aims were the identification of patients who developed an uncontrollable infection after TKA with subsequent TFA and the comparison with national and international revision and amputation rates after TKA.</p><p><strong>Method: </strong>An analysis of the medical history questionnaire was carried out for all 787 patients with amputation of the lower extremities who underwent rehabilitation in the time period from 1st January 2007 to 31st December 2015. The patient records were systematically analyzed based on the standardized documentation methods of the medical and nursing personnel using the Barthel index, the activity/function classes, phantom pain and length of stay, including demography, infection history and insurance company.</p><p><strong>Results: </strong>The analysis showed that 10 patients, 2.29% of all TFA, suffered the loss of a lower extremity due to an uncontrollable TKA infection. The revision rate 3 years after primary TKA in Germany is 3.0% (EPRD annual report 2023), whereas values of 1-4% are given in the international literature (status 2020). In the patient group of the EPRD, in 2022 revision surgery was necessary due to an infection in 15.0% of the cases. The current statistics of the EPRD (annual report 2023) show that 3 years after the initial revision surgery due to an infected TKA another revision was necessary in 23.5-30% of cases.</p><p><strong>Conclusion: </strong>These numbers are alarming and should be critically evaluated and monitored. The future aim is to identify the causes of infections, systematic errors in the TKA and the pathogens that lead to infections after TKA and to correlate the associations.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"620-625"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972353","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":"[Acute rupture of the Achilles tendon : Diagnostics, treatment and aftercare].","authors":"Sebastian Fischer","doi":"10.1007/s00113-024-01454-w","DOIUrl":"10.1007/s00113-024-01454-w","url":null,"abstract":"<p><p>With up to 50 incidents per 100,000 inhabitants, Achilles tendon ruptures are among the most frequent tendon injuries encountered in orthopedics and trauma surgery. Apart from high-risk forms of sport, degenerative processes are primarily responsible for weakening and ultimately rupture. In addition to assessing the typical clinical signs with inability to perform powerful plantar flexion, the diagnostics include easy to earn examination techniques, such as the Thompson test and ultrasound as the imaging gold standard. Conservative and surgical treatment are available depending on the constitution, age and requirements of the patient. The latter option is divided into conventional open, minimally invasive or percutaneous procedures. Good to very good results can be expected regardless of the form of treatment, provided that early functional rehabilitation is carried out. The average rerupture rate is 5% and the return to sport rate is around 80%.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"597-606"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581791","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":"[Esthetic reconstruction of traumatic defects by plastic surgery].","authors":"Y Molter, T Schulz, S Langer","doi":"10.1007/s00113-024-01452-y","DOIUrl":"10.1007/s00113-024-01452-y","url":null,"abstract":"<p><strong>Introduction: </strong>The primary goal is preservation of the affected extremity, which can be associated with limitations in tasks relevant for daily life and a distorted body image caused by the original trauma. Therefore, a secondary goal is to reduce the trauma sequelae.</p><p><strong>Results: </strong>For an esthetic outcome the choice of flap surgery is crucial. Factors such as tissue thickness, skin color, and hair covering need to be considered. The flap should blend seamlessly with the tissue surrounding the defect. The localization and closure of the defect are also important. The flaps undergo vascular, lymphatic and trophic postoperative changes caused by the so-called autonomization. Measures, such as compression therapy reshape the microcirculation and result in volume reduction of the transplant. It is important to preoperatively educate patients about this process. After completion of the conditioning surgical thinning procedures are available for persistent unattractive results, e.g., open surgical and liposuction techniques.</p><p><strong>Conclusion: </strong>Microsurgical defect coverage of traumatic skin and soft tissue defects is a compromise between limb preservation and functionality. In cases of missing local soft tissue, secure closure of the defect should be prioritized but initial esthetic considerations should also influence the choice of tissue transplant. Patients should be informed early about the development of the flap surgery and undergo postoperative compression therapy for conditioning. Secondary operative corrections are also possible.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"582-588"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749947","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":"[Reconstruction options for infection-related defects : Plastic surgery armamentarium].","authors":"Vincent März, Peter M Vogt, Frederik Schlottmann","doi":"10.1007/s00113-024-01439-9","DOIUrl":"10.1007/s00113-024-01439-9","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of infections has always been feared in all surgical disciplines. Plastic reconstructive surgery faces the challenge of treating infection-related defects on a patient-specific basis, which requires a multidisciplinary treatment concept. Satisfactory treatment success can only be achieved through radical debridement for infection cleansing, optimization of the perfusion situation paired with targeted anti-infective treatment and, if necessary, with soft tissue reconstruction by plastic surgery.</p><p><strong>Objective: </strong>This article presents the current possibilities of plastic and reconstructive surgery with respect to the reconstruction of infection-related defects.</p><p><strong>Material and methods: </strong>Proven and reliable strategies are presented and supplemented by promising experimental approaches.</p><p><strong>Results: </strong>Due to the often multilayered defect situation caused by infections, from the epidermis to cancellous bone, the entire armamentarium of plastic and reconstructive surgery is used for reconstruction.</p><p><strong>Conclusion: </strong>The early involvement of plastic surgery in the treatment of infections and the interdisciplinary and multimodal treatment approach have proven their worth in the treatment of complex infection situations.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"567-572"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924247","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":"[Is the 95°blade plate still important in the treatment of proximal femoral pseudarthrosis?]","authors":"Dag Grünewald, Annika Dolt, Stefan Barzen, Julia Rehme-Röhrl, Christian von Rüden, Reinhard Hoffmann, Uwe Schweigkofler","doi":"10.1007/s00113-024-01435-z","DOIUrl":"10.1007/s00113-024-01435-z","url":null,"abstract":"<p><p>Due to demographic changes, fractures and subsequently delayed fracture healing as well as pseudarthrosis of the proximal femur are on the increase. In the acute fracture situation, a load-stable treatment with an intramedullary implant (cephalomedullary nail) is generally sought. To date, there is no uniform consensus on the optimal treatment for complicated cases. The aim of this study was to evaluate the clinical and radiological outcome after revision of pseudarthrosis using a 95° blade plate in aseptic proximal femoral pseudarthrosis and to identify the specifications of blade plate treatment.The retrospective study design was used to evaluate data, some of which were prospectively collected. The study period covered January 2010 to December 2020 and 22 patients (10 women, 12 men) with an average age of 59 years were included in this single-center study. All patients showed pseudarthrosis after a femoral fracture type AO 31 A1-A3 or proximal femoral fracture type AO 32 A-C. Clinical and radiological follow-up were performed after 3, 6 and 12 months. Functional outcomes were assessed using the modified Harris hip score (mHHS), the numerical rating scale (NRS) and the short form health survey (SF-12).The postoperative radiological results after reosteosynthesis using a blade plate showed good results and 86.4% of the patient population were healed during the observation period. Pseudarthrosis persisted in four patients and was surgically revised.The functional results showed good results on average, albeit with a high dispersion of 17-91 points in the mHHS. The SF-12 averaged 42.6 (±10.4) points and the psychological score 49.4 (±9.6) points. The postoperative pain level was low both at rest and under stress.It was shown that reosteosynthesis with a blade plate is a surgically demanding but effective treatment option with a low potential for infection and safe bone consolidation, especially for the correction of high-grade axial deviation or varus malalignment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"589-596"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924215","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}