Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Value of retrograde femoral nailing : Pros and cons].","authors":"E Liodakis, S Schreiber, M Müller, M Orth","doi":"10.1007/s00113-025-01605-7","DOIUrl":"https://doi.org/10.1007/s00113-025-01605-7","url":null,"abstract":"<p><strong>Background: </strong>Femoral intramedullary nailing is the gold standard in the surgical treatment of femoral shaft fractures and can generally be performed using an antegrade or retrograde technique. As an intramedullary load-sharing device this type of osteosynthesis has biomechanical advantages. Retrograde intramedullary nailing is becoming increasingly more important in the treatment of periprosthetic, metaphyseal and intra-articular distal femoral fractures.</p><p><strong>Objective: </strong>This article aims to demonstrate the value of retrograde femoral nailing and to discuss the clinically relevant advantages and disadvantages that need to be considered.</p><p><strong>Material and methods: </strong>Systematic literature search using PubMed, Google Scholar and Cochrane Library using the keywords \"femoral fracture, retrograde nailing, periprosthetic fracture, intramedullary nailing and locking plate osteosynthesis\".</p><p><strong>Results: </strong>In distal femur fractures retrograde nailing shows significantly less nonunions and infections than lateral locking plate osteosynthesis. In the treatment of intra-articular comminuted distal femur fractures, the rates of complications and revisions were lower with retrograde nailing than with plate osteosynthesis. Counterintuitively, there was no increased risk of septic arthritis of the knee joint after primary treatment of open fractures with a retrograde femoral nail. There is an increased risk of postoperative knee complaints.</p><p><strong>Discussion/conclusion: </strong>Retrograde intramedullary femoral nailing provides many advantages with a comparatively low risk profile and can be used in a variety of forms for femoral fractures. The risk of postoperative knee complaints should be considered when determining the indications.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746441","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":"[Importance of emergency temporary external fixation for bicondylar tibial plateau fractures : A 10-year retrospective analysis from a university level 1 trauma center].","authors":"Claas Neidlein, Daniel P Berthold, Felix Winden, Boris Michael Holzapfel, Wolfgang Böcker, Julian Fürmetz, Markus Bormann","doi":"10.1007/s00113-025-01604-8","DOIUrl":"https://doi.org/10.1007/s00113-025-01604-8","url":null,"abstract":"<p><strong>Background: </strong>Tibial plateau fractures (TPF) have significantly increased over the last decade, with a notable proportion being bicondylar fractures. The necessity of a temporary external fixator (tEF) as an initial treatment for bicondylar TPF remains controversial, with limited data available regarding associated complications.</p><p><strong>Aim of the study: </strong>The aim of this study is to investigate the complication rates between patients with and without initial treatment using tEF in patients with bicondylar TPF.</p><p><strong>Material and methods: </strong>This monocentric retrospective study analyzed the complication rates of bicondylar TPF from January 2011 to December 2020 at a university national trauma center. The bicondylar TPFs were divided into two groups based on the respective initial treatment: temporary external fixator (tEF, n = 67) and primary immobilization in brace/cast (iBC, n = 82). The complication rate was determined using univariate regression analysis.</p><p><strong>Results: </strong>Overall, there was no significantly increased relative risk of complications between tEF and iBC (odds ratio, OR 1.97, 95% confidence interval, CI 0.90-4.37, p = 0.069). The specific complication of a postinterventional infection, however, was significantly more frequent with the use of tEF (OR 5.11, 95% CI 1.27-29.88, p = 0.01) but the use of tEF was not associated with an impaired range of motion (ROM).</p><p><strong>Discussion: </strong>The overall postoperative complication rate for tibial plateau fractures is not influenced by the initial treatment with a temporary external fixator or a brace/cast. The decision for a tEF should be made individually and based on clear indications. The higher infection rate in patients with tEF represents a risk that must be considered in the context of potential bias related to more complex soft tissue and bone injuries as well as multiple injuries. Further studies are needed to validate these findings and provide further analysis to improve clinical decision making.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710147","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":"[Peri-implant shaft fractures of the femur and tibia : Classification, diagnostics, treatment and geriatric trauma aspects].","authors":"Christopher Lampert, Boris Michael Holzapfel, Wolfgang Böcker, Maximilian Lerchenberger","doi":"10.1007/s00113-025-01606-6","DOIUrl":"https://doi.org/10.1007/s00113-025-01606-6","url":null,"abstract":"<p><p>Peri-implant fractures of the femur and tibia shaft represent an increasing challenge in the clinical routine due to rising incidence, an aging and multimorbid patient population and often unfavorable postoperative outcomes. This article provides an overview of classification systems, diagnostic approaches and therapeutic strategies, with particular emphasis on aspects relevant to geriatric trauma care. The Vancouver, Lewis-Rorabeck, and Felix classifications form the basis for making treatment decisions in periprosthetic fractures of the femur and tibia. The management is primarily guided by the fracture location, implant stability, and bone quality. In cases of stable implants, locking plate osteosynthesis or intramedullary nailing is commonly used. When prosthetic loosening is present (e.g., Vancouver B2/B3 or Lewis-Rorabeck type III classification), revision arthroplasty is generally required. Interprosthetic fractures represent a distinct biomechanical challenge due to the presence of the implant and necessitate lengthy, locking bridging constructs or, in selected cases, the use of a megaprosthesis. In the context of geriatric trauma care, early mobilization that enables immediate full weight-bearing and interdisciplinary treatment within a certified geriatric trauma center are essential to reduce morbidity, mortality and the level of long-term care needed. Furthermore, the use of cemented stems can reduce the risk of periprosthetic proximal femoral fractures. These aspects should be incorporated into the management of geriatric trauma patients to contribute to an improvement in long-term outcomes.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621455","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":"[Centers for geriatric trauma DGU® : Distribution and development in Germany].","authors":"Josef Stolberg-Stolberg, Charlotte Ramadan, Jeanette Köppe, Janette Iking, Karen Fischhuber, Markus Blätzinger, Michael J Raschke, J Christoph Katthagen","doi":"10.1007/s00113-025-01568-9","DOIUrl":"10.1007/s00113-025-01568-9","url":null,"abstract":"<p><strong>Background: </strong>Due to the demographic changes, including the need for more orthogeriatric co-management, addressing the healthcare of geriatric patients is an important issue.</p><p><strong>Objective: </strong>The aim of this study was to create an overview of the fundamental characteristics of centers for geriatric trauma ATZ-DGU including the distribution of departments and cooperations as well as the level of trauma care. The distribution of sites across Germany was compared to hospital and population data.</p><p><strong>Methods: </strong>Certified German ATZ-DGU were assigned to Trauma Center DGU^® (TC) certification data (levels III-I) via institutional numbers. They were evaluated descriptively and correlations with several parameters at the federal states level were added.</p><p><strong>Results: </strong>Due to cooperations 188 institutions formed 147 ATZ-DGU and 152 provided orthogeriatric co-management in domo. Of the facilities with trauma surgery departments 86% (n = 168) were certified as TCs (level II = 33% > III = 30% > I = 22%). The number of ATZ-DGU per German state was correlated with the number of hospitals (r_s = 0.88), inhabitants (r_s = 0.92) and cases in total (r_s = 0.92, p < 0.001 each) but not with the proportion of people older than 65 years (p > 0.05). With only 14 facilities, the new federal states of Germany seemed to be disadvantaged and also showed great disparities compared to each other.</p><p><strong>Conclusion: </strong>The levels of trauma care revealed a distribution referring to the different focus of the two certificates: treatment of the severely injured vs. geriatric co-treatment. On average, the population in the new German states was older, while there were less ATZ-DGU; however, there seemed to be a slight tendency towards improvement.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"525-532"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058892","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":"[Osteosynthesis for proximal humeral fractures : Plating, double plating and more].","authors":"Karl J Sander, Julia Sußiek, Mats Jonas Wiethölter, Michael J Raschke, J Christoph Katthagen","doi":"10.1007/s00113-025-01574-x","DOIUrl":"10.1007/s00113-025-01574-x","url":null,"abstract":"<p><p>Due to demographic changes, proximal humeral fractures (PHF) are becoming increasingly more frequent in routine clinical practice. At the same time, surgical treatment is more frequently indicated and more demanding due to increasingly more complex fracture morphology and declining bone quality. Osteosynthesis using locking plate fixation remains the mainstay of surgical treatment alongside reverse fracture arthroplasty. The treatment concept is individually dependent on the characteristics of the fracture morphology, the patient-specific risk profile and the expertise of the surgeon. In younger patients fracture fixation is preferable, when feasible. In recent years, combinations of different surgical techniques have been increasingly used to achieve humeral head preservation and sufficient stability. The risk of complications, such as secondary dislocation and screw cut-out has significantly decreased in recent years due to improved evaluation of the indications and surgical techniques. As one of these combined procedures, double plate fixation offers promising options for complex fractures due to an additional plate applied ventrally. This technique is increasingly becoming established in routine clinical practice. Cement augmentation of screws and different bone grafts are additional options to supplement locking plate osteosynthesis so that a good reconstruction result can also be achieved in osteoporotic bone.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"501-507"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045548","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":"[Wrist arthroscopy remains the reference standard for the diagnostics of lesions of the triangular fibrocartilage complex].","authors":"Christian Karl Spies","doi":"10.1007/s00113-025-01586-7","DOIUrl":"10.1007/s00113-025-01586-7","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"565-566"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144902","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":"[Prolonged immobilization with an external fixator for subtalar dislocation without fracture : A case report].","authors":"Yasmin Youssef, Volker Schöffl, Gordian Weber, Steffen Röttel, Christian Willy, Falko Patzsch","doi":"10.1007/s00113-025-01583-w","DOIUrl":"10.1007/s00113-025-01583-w","url":null,"abstract":"<p><strong>Background: </strong>Subtalar dislocations (simultaneous dislocations of the talocalcaneal and talonavicular joints) without concomitant fracture are rare and account for 1-2% of all dislocations. The treatment has been described in several case reports and consists primarily of closed reduction with the patient under anesthesia followed by immobilization.</p><p><strong>Case: </strong>A 30-year-old male patient sustained a multidimensional nonfractured dislocation of the ankle joint with a predominantly subtalar component (luxatio subtalolateralis) while climbing. As it turned out later, a closed reduction was not possible due to interposition of the tendons of the posterior tibialis muscle and the flexor digitorum pedis longus muscle, so that an open reduction had to be performed. The full extent of the injury could only be assessed during the surgical exploration. The patient was treated in an external fixator for 12 weeks. Subsequently, physiotherapy was initiated. After only 6 months postoperatively the patient showed good mobility, functionality and resilience in the affected ankle joint. After 30 months the patient was free of symptoms. The prolonged immobilization after subtalar dislocation using an external fixator over a total period of 12 weeks, as performed in this case report, demonstrated good long-term functional outcomes.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"545-551"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201036","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":"[Robotically assisted placement of a pubic ramus screw and an SI-S1 screw].","authors":"Dominik M Haida, Iris Wagenblast, Stefan Huber-Wagner","doi":"10.1007/s00113-025-01580-z","DOIUrl":"10.1007/s00113-025-01580-z","url":null,"abstract":"<p><strong>Objective of surgery: </strong>The aim of this operation is to stabilize the anterior pelvic ring fractures on both sides and the sacral fracture on the right using robotically assisted screw osteosynthesis and to restore the mobility of the patient.</p><p><strong>Indications: </strong>The indications arise from the patient's very severe pain, resulting immobility under conservative treatment measures and a fragility fracture of the pelvis grade II (FFP II).</p><p><strong>Contraindications: </strong>Typical contraindications for this type of operation are the same as for conventional techniques (mainly infection and swelling).</p><p><strong>Surgical technique: </strong>Performed in the 3D navigation hybrid operating theatre Robotic Suite with the following components: navigation unit \"Curve Navigation System\", movable robotic 3D cone beam computed tomography (CBCT) \"Loop‑X\", robotic arm \"Cirq Arm System\" and wall monitor \"BUZZ\" (Brainlab, Munich, Germany). The individual surgical steps are explained in the video online (English).</p><p><strong>Follow-up treatment: </strong>Full weight bearing, pain medication according to the World Health Organization (WHO) stage scheme, physiotherapy after the first postoperative day.</p><p><strong>Evidence: </strong>Navigated and robotically assisted techniques are mainly used on the spine. These techniques are also increasingly being used on the pelvis, whereby very high levels of accuracy can also be achieved.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"560-564"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060711","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":"[Old and young-Differences in the treatment of proximal humeral fractures?]","authors":"Jan N Riesselmann, Freya M Reeh, Helmut Lill, Alexander Ellwein","doi":"10.1007/s00113-025-01587-6","DOIUrl":"10.1007/s00113-025-01587-6","url":null,"abstract":"<p><p>The rising incidence of proximal humeral fractures has made this an important topic in the treatment reality of trauma surgery. Given the variety of treatment options available, the question arises as to what extent patient age influences the choice of treatment and, consequently, the functional outcome. In our approach the morphological features of the fracture and individual patient characteristics form the foundation for determining whether surgical or conservative treatment should be pursued. Whenever possible, joint-preserving reconstruction should be the goal in younger patients. In older patients, the implantation of reverse shoulder arthroplasty is the treatment of choice. Joint replacement enables early mobilization of older patients, facilitating a swift return to daily life. Looking ahead, a further increase in the fracture incidence and a corresponding rise in the rate of necessary surgical interventions are anticipated.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"492-500"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113036","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":"[Focus on the shoulder : Precise diagnostics for complex pathological alterations].","authors":"S Albers, M Zyskowski, P Zehnder, C Kirchhoff, P Biberthaler, Markus Schwarz","doi":"10.1007/s00113-025-01585-8","DOIUrl":"10.1007/s00113-025-01585-8","url":null,"abstract":"<p><p>The shoulder joint combines three main joints and two auxiliary joints, which enable a unique freedom of movement. Stability is primarily ensured by muscles and ligaments, making injuries, overuse or degenerative processes common causes of complaints. A systematic examination includes the anamnesis, inspection, palpation, range of motion assessment and functional tests. During the inspection the pattern of movement, muscle atrophy and malalignments are assessed. Bone and soft tissue structures are tested by palpation. Functional tests help to differentiate pathological alterations. A structured examination enables an accurate diagnosis with the option of supplementary imaging examinations.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"533-544"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144901","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}