Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Treatment of geriatric odontoid fractures].","authors":"Andreas Sommer, Lukas Klein, Peter Obid","doi":"10.1007/s00113-024-01522-1","DOIUrl":"10.1007/s00113-024-01522-1","url":null,"abstract":"<p><p>The treatment of odontoid fractures in geriatric patients, particularly type II fractures, remains controversial. In biologically young patients, studies suggest advantages of surgical treatment in terms of mortality; however, this advantage is not observed in geriatric patients. While the mortality appears to be higher after conservative treatment in patients aged 65-80 years, there are studies that have shown no differences in mortality for patients aged 80 years or older and even showed advantages of conservative treatment in this age group. The complication rates of both surgical and conservative approaches are comparable. Although conservative treatment is associated with a higher rate of pseudarthrosis, healing in a \"rigid\" pseudarthrosis is associated with a good clinical outcome and can therefore be considered a treatment success. The central problem with the currently available literature, including the present prospective but nonrandomized data, is selection bias, which significantly limits the comparability of the patient cohorts. So far, no clear superiority of either treatment method has been demonstrated. Therefore, conservative treatment retains its importance in the geriatric patient population and the majority of these patients achieve a very good functional outcome with conservative treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017645","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":"[Conservative treatment of injuries to the cervical spine : Mobilization or immobilization].","authors":"Christian Arras, Julian Kylies, Lennart Viezens, Leon-Gordian Leonhardt","doi":"10.1007/s00113-024-01507-0","DOIUrl":"10.1007/s00113-024-01507-0","url":null,"abstract":"<p><p>Many injuries to the cervical spine can be treated conservatively. Treatment options include early functional, mobilizing and immobilizing procedures. If a structural injury can be ruled out by morphological imaging, early functional mobilization should be performed in combination with adequate analgesia according to the World Health Organization (WHO) step by step scheme to avoid chronification. If a structural injury to the cervical spine is present, a stability test is crucial for the decision on treatment. Stable fractures include, for example, types I, II and V fractures of the atlas according to Gehweiler, types I and III fractures of the dens axis according to Anderson and D'Alonzo and type A fractures of the subaxial cervical spine according to the AO. If the results of the imaging examination are inconclusive, functional imaging should be performed. If the injury is stable, external immobilization can be used for conservative treatment. Semirigid and rigid cervical orthotic devices as well as Minerva corsets and the halo fixator are available for this purpose. The degree of immobilization increases with the invasiveness of the procedure. Immobilization should be carried out under clinical and radiological monitoring until the injury has healed. An increase or persistence of symptoms during conservative treatment indicates treatment failure and should result in follow-up imaging. Immobilizing treatment should also be accompanied by isometric physiotherapeutic exercise and adequate analgesic treatment. In adult patients the external stabilization should be gradually reduced through physiotherapeutic exercise after completion of the immobilization treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"96-102"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788076","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":"[Takotsubo cardiomyopathy during trauma resuscitation].","authors":"Sonja Wassman, Gregor Römmermann, Michael Dommasch","doi":"10.1007/s00113-024-01497-z","DOIUrl":"10.1007/s00113-024-01497-z","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"141-143"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565070","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":"[Packaging waste in the operating room].","authors":"Caroline Lopez Lopez, Marie-Jacqueline Reisener, Nikolaus Kreitz, Veit Kleine-Doepke, Sönke Landschoof, Christian A Kühne","doi":"10.1007/s00113-024-01508-z","DOIUrl":"10.1007/s00113-024-01508-z","url":null,"abstract":"<p><strong>Background: </strong>Climate change is a central issue for our future. The increase in the amount of greenhouse gases in the atmosphere promotes the so-called greenhouse effect, resulting in climate change. Worldwide, the amount of plastic waste amounts to approximately 8 billion tons. The healthcare sector is responsible for around 4.4% of global net emissions contributing to the greenhouse effect. Measures to reduce CO₂ emissions within the healthcare sector should be implemented accordingly. To make the issue of plastic waste in the operational sector more visible, in the present study we examined and calculated the packaging waste generated in the treatment of distal radius fractures.</p><p><strong>Material and methods: </strong>The clinic stocks two different implants (sterile packaging = group I vs. implant tray = group II) for the treatment of distal radius fractures. Over a period of 12 months (July 2022-July 2023), the packaging waste from all surgically treated distal radius fractures was collected and weighed. The time required to retrieve, unpack and provide the implants in both groups (referred to as preparation time) was measured. Patient data were recorded in a dedicated register and statistical significances were calculated.</p><p><strong>Results: </strong>A total of 124 distal radius fractures were treated. The average age of the cohort was 67.9 years with 74.2% being female. The system with sterile individual packaging (group I) was used for fracture treatment 29 times, while the system with the screw tray (group II) was used 94 times. For treatment with sterile packaging 104.5g of plastic waste and 67.4g of plastic-free packaging waste were generated per operation, while treatment with the implant tray resulted in 21.6g of plastic waste and 12.8g of plastic-free packaging waste (p = 0.0001). The average time for providing the screws in group I was significantly higher at 527.8 s compared to treatment with the implant tray in group II at 138 s (p = 0.0001).</p><p><strong>Discussion: </strong>In the present study we found a significant increase in plastic waste when using individually packaged implants. To reduce the production of plastic waste, mandatory guidelines for waste separation in the operating room appear to be sensible. Measures such as the return and recycling of recyclable plastic waste as well as improvements in packaging design and the use of bio-based biodegradable and compostable plastics, represent further possibilities for waste reduction.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"103-108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808334","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 of the cervical spine : Challenges in diagnostics and treatment].","authors":"Lennart Viezens","doi":"10.1007/s00113-024-01523-0","DOIUrl":"https://doi.org/10.1007/s00113-024-01523-0","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"128 2","pages":"71-74"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054605","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":"[Infection from Baltic Sea water requires extensive mesh-skin transplantation at the University Hospital Ulm].","authors":"F Kreß, P Schenk, F Gebhard, K Schütze","doi":"10.1007/s00113-024-01501-6","DOIUrl":"10.1007/s00113-024-01501-6","url":null,"abstract":"<p><p>Vibrio vulnificus (V. vulnificus) is a gram-negative bacterium that can cause severe infections after entering the human body via open wounds or consumption of shellfish. An increased occurrence of bacteria is known at water temperatures > 20 °C. In addition, a low salt content of 5-25‰ is beneficial for the reproduction of Vibrio spp. In the review by Fleischmann et. al. the direct correlation between low salinity and high water temperature with the increased occurrence of V. vulnificus on German Baltic Sea coasts was demonstrated [7]. It can cause fulminant necrotizing fasciitis which can result in amputation, septic shock and death. This case report shows the successful surgical treatment in Germany of a fulminant lower leg infection with septic shock after coming into contact with Baltic Sea water. A rapid and extensive debridement was followed by the successful transplantation of cutaneous tissue using a mesh graft.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"136-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717354","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":"[Accident pension after fracture of the pelvic ring and acetabulum : Changes in pension claims and costs following isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019-A DGUV registry analysis].","authors":"Nico Hinz, Julius Dehoust, Stefan Mangelsdorf, Arndt-Peter Schulz, Karl-Heinz Frosch, Maximilian J Hartel","doi":"10.1007/s00113-024-01516-z","DOIUrl":"10.1007/s00113-024-01516-z","url":null,"abstract":"<p><strong>Background: </strong>It is known that fractures of the pelvic ring and acetabulum in work-related accidents are associated with long periods of incapacity to work, a high rate of reduction in earning capacity (MdE) and high costs for pension/severance pay.</p><p><strong>Objective: </strong>Investigation of changes in pension claims and costs from 2013 to 2019 after isolated fractures of the pelvic ring and acetabulum in work-related accidents in Germany.</p><p><strong>Material and methods: </strong>For all patients from the German Social Accident Insurance (DGUV) registry with isolated fractures of the pelvic ring or acetabulum in work-related accidents, linear trend analyses were carried out among others for the proportion of MdE ≥20%, the proportion of cases receiving pension/severance pay and total costs for pension/severance pay from 2013 to 2019. A logistic regression analysis for the likelihood of receiving a pension was also performed.</p><p><strong>Results: </strong>The proportion of MdE ≥20% decreased for fractures of the pelvic ring and acetabulum in total from 14.3% for 2013 to 8.2% for 2019 and there was a decreasing trend for the proportion of cases receiving pension/severance pay for fractures of the pelvic ring and acetabulum in total from 23.1% for 2013 to 13.6% for 2019 as well as for both fracture types individually. There was also a decrease in the costs for pensions/severance pay for fractures of the pelvic ring and acetabulum in total from € 1,542,531 for 2013 to € 1,006,887 for 2019. The likelihood of receiving a pension decreased by 8% per subsequent accident year between 2013 and 2019.</p><p><strong>Conclusion: </strong>The proportion of pension claims and thus the costs for pensions/severance pay decreased for isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019. The DGUV seems to fulfil its guideline Rehabilitation before pension.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"109-116"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911300","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 strategy of a complex fracture entity].","authors":"Christian Michelitsch, Philipp Florian Stillhard, Christoph Sommer","doi":"10.1007/s00113-024-01514-1","DOIUrl":"10.1007/s00113-024-01514-1","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"130-135"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840544","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":"[Fatal course of a fulminant gas gangrene of the right hemithorax].","authors":"Christoph J Neumann, Matthias Unterberg, Daniel Mesbah, Mark Sandfort, Rüdiger Smektala","doi":"10.1007/s00113-024-01490-6","DOIUrl":"10.1007/s00113-024-01490-6","url":null,"abstract":"<p><p>The full clinical picture of a gas gangrene infection is an absolute rarity. The mechanism of development can be either traumatic or spontaneous (e.g., hematogenous seeding in occult colon carcinoma). In particular, the rare pathogen Clostridium septicum appears to be associated with spontaneously occurring gas gangrene. Diabetes mellitus is a significant risk factor. The mortality rate of the disease is around 50%, even with maximum therapeutic efforts, and the course of the disease is fulminant in the majority of cases. Initial symptoms are unspecific and make early diagnosis difficult. Treatment consists of high-dose antibiotics in combination with radical surgical debridement and, if necessary, supplementary hyperbaric oxygen therapy.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"59-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402306","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":"[Specialized in trauma surgery-Not a simple way].","authors":"Marie Samland","doi":"10.1007/s00113-024-01509-y","DOIUrl":"10.1007/s00113-024-01509-y","url":null,"abstract":"<p><p>The question of the need for generalists and specialists in trauma surgery is controversially discussed concerning the challenges in the healthcare system, the interdisciplinary nature of the discipline, and the consequences of increasing specialization. The hospital reform as well as the availability of personnel and financing are discussed as central points. For high-quality patient care it is essential that the balancing act between generalists and specialists is successful. Effective interdisciplinary collaboration and holistic thinking are crucial to overcome the challenges in the healthcare system and to fulfil the needs of patients.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"25-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803834","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}