Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Indications for surgical treatment of traumatic fractures of the thoracic spine and lumbar spine].","authors":"Philipp Pieroh, Christoph-E Heyde","doi":"10.1007/s00113-024-01518-x","DOIUrl":"10.1007/s00113-024-01518-x","url":null,"abstract":"<p><p>Fractures of the thoracic (Th) and lumbar (L) vertebrae are among the most frequent fracture entities in Germany and particularly affect the thoracolumbar junction (TLJ; Th11-L2). Based on expert recommendations and consensus meetings, the thoracolumbar AOSpine injury score was established for patients with healthy bone and the osteoporotic fracture (OF) score for geriatric patients with the respective classifications for treatment decisions. In both cohorts, the treatment decision is based on the fracture morphology, neurological status and patient-specific contextual factors. In terms of fracture morphology, surgical treatment is generally indicated for distraction and rotation/translation injuries. The treatment decision for compression fractures is more complex as additional factors must be taken into consideration. The decision in patients with healthy bone is primarily influenced by imaging morphological criteria (deformity and destruction) whereas in osteoporotic patients the decision is influenced by individual criteria, such as the general condition, the possibility of low pain mobilization and concomitant diseases. Overall, the treatment decision for fractures of the TLJ is not dogmatic as individual factors must be considered and high-quality studies are lacking.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"156-166"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048952","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":"[Traumatic fractures of the thoracolumbar spine].","authors":"Ulrich Spiegl","doi":"10.1007/s00113-025-01533-6","DOIUrl":"https://doi.org/10.1007/s00113-025-01533-6","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 3","pages":"145-146"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484998","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":"[Current surgical treatment concepts for traumatic thoracic and lumbar vertebral fractures in adults with good bone quality].","authors":"Ulrich Spiegl, Robert Pätzold, J Krause, Mario Perl","doi":"10.1007/s00113-024-01505-2","DOIUrl":"10.1007/s00113-024-01505-2","url":null,"abstract":"<p><p>The surgical treatment of traumatic vertebral body fractures in patients with good bone quality is controversially discussed. The data situation is unclear and only of limited help due to mainly insufficient evidence. The surgical measures include an axially aligned reduction and an osteosynthesis which is stable under load so that immediate mobilization of the patient is possible. This requires anatomical restoration of the alignment and the biomechanical challenge of fracture healing or fusion in the correct position without relevant loss of reduction must be taken into account. The aim should be the lowest possible loss of function. In the case of existing or impending neurological deficits it is crucial to prevent deterioration of the neurological situation and to achieve the prerequisites for recovery. Posterior stabilization primarily plays the decisive role in the operative treatment. If possible, this should be a minimally invasive procedure and over short distances. For bisegmental treatment monoaxial screws and the use of index screws improve construct stability. In addition, stable cobalt rods should be used as 5mm longitudinal support. Special minimally invasive reduction instruments are helpful in restoring the sagittal and coronal relationships. The indications for an additional ventral column depend on the rigidity of the posterior stabilization, the extent of the injury of the anterior column and the intervertebral disc. Anterior fusion can often be delayed or avoided altogether, depending on the course with corresponding clinical signs.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"167-180"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792966","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":"[Major amputations of the lower extremity].","authors":"Patrick Schröter, Marc Hückstädt, Steffen Langwald, Bianca Schröter, Philipp Kobbe","doi":"10.1007/s00113-024-01530-1","DOIUrl":"10.1007/s00113-024-01530-1","url":null,"abstract":"<p><p>In Germany there are approximately 18,500 major amputations of the lower extremity each year, primarily transtibial or transfemoral. For successful rehabilitation, knowledge about the desired optimal stump condition and specific amputation techniques are essential. Biomechanical considerations regarding the amputation stump play a crucial role in the selection of the surgical technique as do the reasons for the amputation. Techniques such as myodesis, myoplasty or Gottschalk plastic surgery help to maintain muscle tension and optimize prosthesis control.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"209-221"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191578","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":"[Current surgical treatment concepts for traumatic fractures of the thoracic and lumbar spine with osteoporotic bone substance].","authors":"Max J Scheyerer, Klaus Schnake, Bernhard Ullrich, Ulrich Spiegl","doi":"10.1007/s00113-024-01525-y","DOIUrl":"10.1007/s00113-024-01525-y","url":null,"abstract":"<p><p>Osteoporosis-related vertebral fractures are among the most frequent fracture entities in geriatric patients. They are associated with far-reaching individual and socioeconomic consequences. Adequate diagnostics and treatment are therefore essential. The osteoporotic fracture (OF) score is a central element in determining the right treatment. Although the majority of fractures can be healed with conservative treatment, a change of treatment should be considered in good time in cases of failure. Isolated cement augmentation procedures are particularly suitable for reducing pain in primarily stable osteoporotic vertebral fractures with a preserved framework structure (OF types 1-3) and a largely intact posterior edge. Dorsal cement-augmented stabilization with cementing of the fractured vertebral body leads to good results in unstable OF types 3 and 4 fractures. Dorsoventral procedures with cement-augmented internal fixator from the dorsal side and vertebral body replacement from the ventral side play a more subordinate role. Purely ventral procedures should be avoided in this patient group.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"181-191"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030445","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":"[Injuries to the thoracic and lumbar spine in children under 16 years of age-Reality of care in German-speaking countries: a registry study].","authors":"Hauke Rüther, Saleh Alayesh, Christoph-E Heyde, Dina Wiersbicki, Yasmin Youssef, Julia Bolte, Pia Brecht, Alexander Carl Disch, Jan-Sven Jarvers","doi":"10.1007/s00113-024-01504-3","DOIUrl":"10.1007/s00113-024-01504-3","url":null,"abstract":"<p><strong>Background: </strong>Spinal injuries in childhood are rare. There are few meaningful data for German-speaking countries.</p><p><strong>Questions/aim of the study: </strong>Evaluation of the registry data of the German Spine Society (DWG) with respect to the reality of care for thoracolumbar injuries in childhood.</p><p><strong>Material and methods: </strong>This retrospective study was initiated by the Spinal Trauma in Childhood Working Group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery (DGOU). All patients under the age of 16 years who underwent surgery between 1 January 2017 and 31 June 2023 were included. An anonymized evaluation of the demographic data was carried out with respect to age, gender, level of injury, neurological impairment, classification and treatment performed with intraoperative and postoperative complications. The specified documentation in the spine register served as the information basis. Regarding age classification 3 groups were used: I: 0-6 years, II: 7-9 years, III: 10-16 years.</p><p><strong>Results: </strong>Data from 83 children with 150 injuries in the thoracic and lumbar spine areas with a mean age of 11.4 (± 3.45) years were analyzed. A total of 78 (52%) thoracic and 72 (48%) lumbar injuries were found. Type A injuries were most common (n = 89; 59.2%). Type B injuries were found in 32.2% (n = 48) and occurred mainly in group III. According to the AO neurological injury classification 18 (21%) patients had incomplete and 4 (4.8%) patients had complete paraplegia. Various methods were used for surgical treatment, the most common being dorsal stabilization (n = 73; 87.9%). The majority of operations were uncomplicated (n = 75; 90.4%).</p><p><strong>Discussion: </strong>According to the registry data 83 children were treated surgically with an acceptable complication rate. Older children and adolescents (group III) had a significantly higher injury severity compared to younger children. As with most registry studies, only limited conclusions can be drawn about surgical strategies, indications and techniques.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"192-200"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792968","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":"[Trauma room workload in German trauma centers : Reality of trauma care underrepresented in reform].","authors":"Cora R Schindler, Florian Pavlu, Philipp Faul, Philipp Störmann, Dan Bieler, Uwe Schweigkofler","doi":"10.1007/s00113-025-01538-1","DOIUrl":"https://doi.org/10.1007/s00113-025-01538-1","url":null,"abstract":"<p><strong>Introduction: </strong>The Federal Joint Committee (G-BA) published a regulation on a staged system for emergency structures in hospitals (according to Social Security Code V) in April 2018 and therefore established the foundations for emergency care in the inpatient sector. The structural requirements for the care of potentially severely injured patients is primarily defined by the specialist society and means a high provision of personnel with a simultaneous annual increase in the burden due to increasing numbers of patients. Critics fear that the reforms do not take sufficient account of trauma care both professionally and financially. The aim of the study was to record the actual workload of the emergency trauma rooms in certified German trauma centers.</p><p><strong>Method: </strong>A nationwide online survey was performed in Germany among 619 trauma centers certified by the German Society for Trauma Surgery (DGU®) to quantify the frequency of trauma room callouts. The results were retrospectively compared with the data from the annual reports of the TraumaRegister (TR) DGU® from 2021 and 2022.</p><p><strong>Results: </strong>The 167 participating hospitals reported 22,479 trauma room callouts in 2021 and 24,366 in 2022 (response rate of the online survey 24.1%). Of these callouts 70% concerned level 1 supraregional trauma centers. The comparative analysis showed that the actual number of callouts is 3-5 times higher than the data documented in the TR-DGU® . Of the trauma rooms 80% were not included in the register due to low injury severity. The study confirms the discrepancy between the documented and actual workload of the trauma rooms in German trauma centers and emphasizes the necessity to adjust the financial and personnel consideration of the trauma centers to the actual utilization in order to ensure a continuing high quality of care.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461056","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":"[Transosseous lacerations in the ankylosed cervical spine].","authors":"Tobias Driesen, Lukas Weiser, Katharina Jäckle, Friederike Sophie Klockner, Maximilian Reinhold, Wolfgang Lehmann, Paul Jonathan Roch","doi":"10.1007/s00113-024-01506-1","DOIUrl":"10.1007/s00113-024-01506-1","url":null,"abstract":"<p><p>Transosseous lacerations represent a particular type of discoligamentous injury of the cervical spine and occur in ankylosing diseases of the spine, with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) being the primary entities. The altered biomechanics of the spine due to the underlying disease pose special challenges in the diagnostics and treatment. Even low-energy trauma can cause severe injuries of the cervical spine, which are often difficult to accurately diagnose due to the difficult assessability of the conventional projection radiography used in the primary diagnostics. In addition to a correct diagnosis a differentiated treatment concept is crucial as treatment courses can be complicated by pre-existing comorbidities, which are present in the majority of cases. Due to a high rate of secondary neurological deficits without adequate stabilization, surgical stabilization is generally recommended. Unlike the treatment of \"classical\" discoligamentous injuries in the mobile cervical spine, long segment dorsal instrumented spondylodesis is the standard of care for these cases, whereby ventral stabilization is also of value, either as a stand-alone or possibly additive procedure. The intraoperative site, which deviates from that of a normal patient, can present an additional challenge.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788077","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":"[Which diagnostic tests are indicated in the emergency department after trauma to the cervical spine?]","authors":"Oliver Riesenbeck, Michael J Raschke","doi":"10.1007/s00113-024-01520-3","DOIUrl":"10.1007/s00113-024-01520-3","url":null,"abstract":"<p><p>Injuries to the cervical spine are a diagnostic challenge as, although they are rare in relation to the overall population, they should not be overlooked under any circumstances. This article presents the diagnostic procedure in the emergency department, starting with the patient's medical history and subsequently clinical and neurological examinations. As a result, the clinical decision tools national emergency X‑radiography utilization study (NEXUS) criteria and the Canadian C‑spine rule (CCR) are discussed. Finally, the current literature is reviewed considering the diagnostic examination options, taking the clinically relevant key questions into account.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933842","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":"[Pilon fractures : Treatment principles and surgical therapy strategy].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Christoph Sommer","doi":"10.1007/s00113-024-01511-4","DOIUrl":"10.1007/s00113-024-01511-4","url":null,"abstract":"<p><p>Pilon fractures typically result from high-energy trauma combined with axial compression. The surrounding soft tissues are often severely compromised, complicating treatment. These fractures are best classified according to the Working Group for Osteosynthesis Issues/Orthopedic Trauma Association (AO/OTA) classification system. Even with anatomical reduction of the joint surface there remains a high risk of suboptimal outcome. Advances in implant technology, minimally invasive surgical techniques and strategic management have successfully reduced complication rates in recent years. Despite several adaptations, the principles of Rüedi and Allgöwer remain valid today: correct reconstruction of the fibula (for simple fractures) facilitates subsequent joint reduction. Autologous bone grafts are beneficial in metaphyseal bone defects. Access routes tailored to the soft tissue conditions and fracture pattern enable stabilization, usually with angle stable plates.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"117-129"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960199","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}