Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"OMW: Schlaf und Schlafmittel in der Unfallchirurgie.","authors":"Carla Stenmanns, Helmut Frohnhofen","doi":"10.1007/s00113-026-01720-z","DOIUrl":"10.1007/s00113-026-01720-z","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"587"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007519","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-speed luge trauma with complex trauma of the foot and acute compartment syndrome in an 8-year-old child : Late result at 18 years follow-up].","authors":"Hans Zwipp, Achim Biewener, Guido Fitze, Stefan Rammelt","doi":"10.1007/s00113-026-01718-7","DOIUrl":"10.1007/s00113-026-01718-7","url":null,"abstract":"<p><strong>Background: </strong>Complex trauma of the foot with acute compartment syndrome (CS) in children is an absolute rarity for which there are barely any treatment recommendations in the literature.</p><p><strong>Objective: </strong>Presentation of a staged operative management that yielded an excellent long-term result despite severe bone, joint and soft tissue injuries.</p><p><strong>Material and method: </strong>During luge training an 8‑year-old child collided with the barrier at approximately 90 km/h with the left foot, resulting in complex trauma to the foot (6 points according to Zwipp) with serial fractures of the talus, calcaneus (5 fragments/3 joints) with 50° varus deformity, cuboid and fifth metatarsal with acute foot CS. A 3‑stage treatment consisting of acute dorsomedial compartment release (Hanover approach) plus tibiometatarsal external fixation (day 1), intermediate skin adaptation (day 5) and definitive open anatomical joint reconstruction of the calcaneus (day 8) enabled an uneventful healing process. The below knee cast and K‑wires were removed 6 weeks after the third surgery. The child was exempted from physical education for 10 months and received intermittent physiotherapy for 12 months.</p><p><strong>Results: </strong>The patient, 18 years after the complex trauma of the left foot, is working full time as an industrial master painter in a 3-shift system. He can play soccer and do weight training without pain with full ankle, foot and toe function. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score at 18 years follow-up is 100, the foot function index is 2.36, and the EuroQoL-5L5D score is 100 points. Weight-bearing computed tomography (CT) shows conservatively treated well-healed fractures of the talus, cuboid and fifth metatarsal. The anatomically realigned calcaneus is free of arthrosis with congruent posterior, medial and cuboid joint facets.</p><p><strong>Discussion: </strong>Urgent relief of acute foot CS within 6 h of trauma is also essential in children. A staged surgical approach is recommended for complex foot trauma with severe soft tissue injury.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"578-586"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145833","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":"[Adjunctive therapies in geriatric ankle fracture patients].","authors":"Richard Stange, Daniel Kronenberg","doi":"10.1007/s00113-026-01729-4","DOIUrl":"10.1007/s00113-026-01729-4","url":null,"abstract":"<p><p>Ankle fractures are among the most common fragility fractures in older adults. Osteoporosis, age-related impairment of bone regeneration, and multimorbidity increase the risk of delayed union, nonunion, and postoperative complications. Besides anatomical reduction and stable fixation, adjunctive therapies aimed at enhancing biological fracture healing have gained growing interest. This review summarizes the pathophysiological aspects of fracture healing in elderly patients and evaluates current biological, pharmacological, and physical strategies to promote healing after geriatric ankle fractures. Osteoporosis is the major risk factor for impaired fracture healing, affecting both bone regeneration and implant stability. Comprehensive osteoporosis management forms the basis of adjunctive treatment. Antiresorptive therapies mainly reduce the risk of subsequent fragility fractures without significantly impairing fracture consolidation. Among osteoanabolic agents, teriparatide has shown promising effects on callus formation and fracture union. Growth factors such as bone morphogenetic proteins (BMPs) and platelet-derived growth factor (PDGF) possess osteoinductive properties but are limited to selected indications. Although platelet-rich plasma (PRP) is biologically attractive, current evidence does not support its routine use in geriatric ankle fractures. Cell-based therapies and biophysical stimulation techniques, including low-intensity pulsed ultrasound, may benefit selected high-risk patients but require further clinical validation. Early functional mobilization remains a key component of successful treatment. Enhancing fracture healing in geriatric ankle fractures requires a multimodal approach combining mechanical stability with biological augmentation.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"528-537"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440470","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":"Behandlung von Sprunggelenkfrakturen beim geriatrischen Patienten.","authors":"S Ochman","doi":"10.1007/s00113-026-01730-x","DOIUrl":"https://doi.org/10.1007/s00113-026-01730-x","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"129 8","pages":"507-508"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623151","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":"[Intramedullary limb lengthening and bone segment transport].","authors":"Markus Laubach, Antonia Donat, Raquel Huybrechts, Wolfgang Böcker, Peter H Thaller","doi":"10.1007/s00113-026-01716-9","DOIUrl":"10.1007/s00113-026-01716-9","url":null,"abstract":"<p><p>The treatment of leg length discrepancies, bone defects and deformities is highly complex. Distraction osteogenesis (callus distraction) is often used for this purpose. Nowadays, the previously used external fixators have increasingly been replaced by intramedullary, fully implantable motorized systems. These are used in combination with innovative planning methods and minimally invasive surgical techniques. This enables reliable and safe treatment with improved patient comfort. In contrast to external fixation, particularly modern external hexapod systems, intramedullary devices once implanted fix the bone fragments in both axial alignment and rotation. Thus, meticulous analysis and planning as well as exact intraoperative execution, are essential for successful treatment outcomes. This article summarizes the relevant intramedullary techniques and indications as well as the practical implementation, taking the current published evidence into account.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"565-577"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152495","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":"[Full weight-bearing after geriatric ankle fractures-No problem?]","authors":"Sebastian F Baumbach, F T Spindler, H Polzer","doi":"10.1007/s00113-026-01719-6","DOIUrl":"10.1007/s00113-026-01719-6","url":null,"abstract":"<p><p>As the population ages the incidence and complexity of ankle fractures in older adults are increasing; however, treating this older population presents particular challenges. One of these challenges is the postoperative treatment as older adults are often unable to perform partial weight-bearing. This article reviews the current literature on the reality of care and the impact of postoperative rehabilitation on functional outcomes and complication rates in older adults. The current state of care was analyzed based on recent, high-quality studies on the surgical management of ankle fractures. In the vast majority of these studies, restrictive postoperative protocols involving partial or complete weight-bearing restrictions in combination with immobilization were employed. In 14 (quasi)randomized studies different postoperative protocols were compared, including patients over the age of 65 years. Early protective full weight-bearing, compared to non- or partial weight-bearing, led to significantly better short-term (up to 3 months) subjective treatment outcomes in 7 out of 10 studies. Early functional treatment did not lead to an increase in the complication rate in any of the included studies; however, there is a lack of studies focusing exclusively on a geriatric patient population. Accordingly, high-quality studies specifically analyzing geriatric patients are urgently needed. Nevertheless, the existing studies support the trend toward early full weight-bearing and mobilization.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"538-546"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977802","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 ankle fractures-what about biomechanics? : From angle stability to nail fixation].","authors":"Stefan Förch, P Bonhorst, E Mayr","doi":"10.1007/s00113-026-01694-y","DOIUrl":"10.1007/s00113-026-01694-y","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures in geriatric patients represent a relevant and not yet definitively resolved problem in everyday trauma surgery practice.</p><p><strong>Objective: </strong>Are there biomechanical studies on different osteosynthesis techniques for treatment of the fibula in geriatric ankle fractures, and can the superiority of one method be demonstrated?</p><p><strong>Materials and methods: </strong>The article comprises a systematic literature review on the biomechanics of various osteosynthesis techniques for geriatric ankle fractures.</p><p><strong>Results: </strong>There are several biomechanical studies on different osteosynthesis techniques. However, only isolated studies are available on additional Kirschner wires, plates with quadrocortical screws, double-plate osteosynthesis, and intramedullary nail fixation. The dorsal antiglide plate has been studied more extensively; however, no advantage over the angular-stable lateral plate could be demonstrated. The strongest body of evidence exists for angular-stable plate osteosynthesis. Nevertheless, a meta-analysis was unable to demonstrate overall superiority, although it suggests a theoretical advantage in osteoporotic bone.</p><p><strong>Conclusion: </strong>From a biomechanical perspective, the ideal osteosynthesis technique for treatment of the fibula in geriatric ankle fractures has not yet been identified.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"524-527"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367737","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":"[Trochanteric fixation nail advanced for trochanteric femoral fractures : Central cut-out as a new problem?]","authors":"Franz Müller, Bernd Füchtmeier, Alexander Hanke, Christian Wulbrand","doi":"10.1007/s00113-026-01713-y","DOIUrl":"10.1007/s00113-026-01713-y","url":null,"abstract":"<p><strong>Introduction: </strong>Trochanteric femoral fractures (TF) are mostly treated with intramedullary nail osteosynthesis. An inherent but rare complication of the system is the central cut-out of the femoral neck helical blade, i.e., the dislocation through the femoral head towards the acetabulum. After switching from proximal femoral nail antirotation (PFNA) to the trochanteric fixation nail advanced (TFNA) by the manufacturer, this rare type of complication has repeatedly been observed.</p><p><strong>Material and method: </strong>The retrospective single center case-control study was based on a database which includes all TFs. Inclusion criteria were TF treated by short PFNA or short TFNA. Exclusion criteria were femoral neck fractures and subtrochanteric femoral fractures. Descriptive and multiple perioperative factors were evaluated for both groups. The primary endpoint was the detection of a central cut-out. Secondary endpoints were any revision, including cranial cut-out failure, infections and the 30-day mortality.</p><p><strong>Results: </strong>A total of 400 TFs were consecutively treated with short PFNA between 25 July 2020 and 13 December 2023. From 14 December 2023 until 23 September 2025 a total of 200 TF were stabilized with a short TFNA. Perioperative factors were balanced between the two groups. A total of 3/400 (0.8%) central cut-outs were documented for PFNA. For TFNA, the rate of central cut-outs was 8/200 (4.0%). This difference was statistically different (p = 0.008). The total revision rate, including infections and the 30-day mortality were comparable. In terms of time, central cut-out occurred significantly earlier in TFNA in comparison to PFNA (mean; 64 vs. 135 days).</p><p><strong>Conclusion: </strong>The treatment of TF demonstrated no superiority for TFNA in comparison to PFNA with respect to infection rates and total revision rate. However, the rate of central cut-out was significantly higher for the TFNA. The rare complication with PFNA should be recorded for TFNA in a geriatric trauma registry or reported to the manufacturer. The reason for the central cut-out is still unclear.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"557-564"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857855","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":"[Open traumatic brain injury with tension pneumocephalus-Endonasal endoscopic skull base reconstruction].","authors":"Pascal Martin, Ludwig Jägerhuber, Wolfgang Böcker, Julius Schütz","doi":"10.1007/s00113-026-01741-8","DOIUrl":"https://doi.org/10.1007/s00113-026-01741-8","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623065","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":"[Assessment of reusable textiles in the operating room under the aspect of sustainability].","authors":"Annika Steinmeier, Nicole Feder, Robert Mahlow, Ulrich Stöckle, Oliver Birkelbach, Robert Zahn","doi":"10.1007/s00113-026-01740-9","DOIUrl":"https://doi.org/10.1007/s00113-026-01740-9","url":null,"abstract":"<p><strong>Background: </strong>Waste management in hospitals is an important factor with respect to environmental sustainability. Surgical waste disposal causes substantial CO₂ emissions. In addition to recycling, waste reduction is an essential strategy for reducing emissions. Reusable textiles offer a promising approach to decrease waste in operating rooms.</p><p><strong>Objective: </strong>Assessment of reusable textiles in terms of waste generation, operational processes and staff acceptance.</p><p><strong>Material and methods: </strong>This prospective observational study compared waste generation when using disposable or reusable drapes in 272 orthopedic and trauma operations over periods of 2 weeks each. Waste volume and weight as well as preparation, clean-up and surgery times were recorded and statistically analyzed. Surgical staff were then asked about their experiences with reusable textiles.</p><p><strong>Results and discussion: </strong>The use of disposable drapes resulted in 93.59l (± 75.16l) and 5.32kg (± 2.04kg) of hospital-specific waste per operation. The introduction of reusable drapes reduced waste volume by 40% and weight by 34% (p < 0.001) without affecting preparation, clean-up or surgical time. Of the staff 96% considered the use of reusable textiles to be unproblematic. The use of reusable textiles significantly reduces waste in operating rooms without affecting workflows and is supported by operating room staff. The implementation represents a practical and effective measure towards greater sustainability in operating rooms.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610897","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}