Unfallchirurgie (Heidelberg, Germany)最新文献

{"title":"[Traumatic splenic injury with unexpected rupture of an echinococcal cyst : A very rare differential diagnosis in the emergency room].","authors":"P Schöttes, J Richter, S M Schmidt-Dresely, P Mertens, T Strohmann, J-P Stahl","doi":"10.1007/s00113-026-01707-w","DOIUrl":"10.1007/s00113-026-01707-w","url":null,"abstract":"<p><p>We report a rare case of traumatic splenic rupture with concomitant rupture of an intraparenchymal echinococcal cyst in a 48-year-old male patient following a fall from a ladder from a height of approximately 3 m. The initial advance trauma life support (ATLS)-based emergency room diagnostics revealed perisplenic free fluid on ultrasound examination as well as an atypical, partially calcified lesion within the splenic parenchyma. Contrast-enhanced computed tomography (CT) demonstrated a high-grade splenic laceration with massive intra-abdominal hemorrhage and a ruptured, calcified cyst located at the inferior splenic pole with a volume of approximately 265 ml. Despite initially stable hemodynamic parameters, immediate surgical intervention was indicated due to the extent of the injury. The CT findings were confirmed intraoperatively and splenectomy with abdominal lavage was performed. Histopathological examination verified a ruptured intraparenchymal echinococcal cyst. Postoperatively, antiparasitic treatment with albendazole was initiated and standard postsplenectomy vaccination was administered. The patient was discharged after 8 days. This case highlights that even in nonendemic regions, rare parasitic diseases should be considered in the differential diagnosis of splenic injuries with atypical cystic or calcified findings. In acute trauma settings, therapeutic decision-making should be guided not only by the hemodynamic status but also by the overall extent of injury.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"495-499"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058530","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":"[Orthopedics and trauma surgery in German emergency departments : Evaluation from the AKTIN emergency department registry].","authors":"Helena Düsing, Ronny Otto, Michael Raschke, Felix Walcher, Susanne Drynda, Christian Waydhas, Simon Oeckenpöhler","doi":"10.1007/s00113-026-01685-z","DOIUrl":"10.1007/s00113-026-01685-z","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments are a central component of emergency care in Germany. The decision by the Federal Joint Committee (G-BA) to establish central emergency departments and the required qualifications for medical personnel are changing emergency care throughout Germany; however, so far not much is known about the various patient groups treated in emergency departments.</p><p><strong>Material and methods: </strong>For the present analysis a retrospective evaluation of treatment data for adult patients for the years 2019-2022 from 25 emergency departments in the AKTIN emergency department register was carried out. The reasons for presentation were classified in accordance with the Canadian Emergency Department Information System Presenting Complaint List 3.0 (CEDIS-PCL) and the emergency department diagnoses and inpatient treatment diagnoses based on the 10th edition of the International Statistical Classification of Diseases and Related Health Problems, German modification (ICD-10-GM) codes.</p><p><strong>Results: </strong>Of the total of 2,102,029 treatment cases 795,904 (38%) patients can were assigned to the disciplines of orthopedics and trauma surgery. The majority of patients from the field of orthopedics and trauma surgery attended independently (51.5%) and remained outpatients (68.8%).</p><p><strong>Conclusion: </strong>Even though many patients remained outpatients, expertise in the field of orthopedics and trauma surgery is needed to recognize potentially dangerous developments and indications for inpatient admission (\"red flags\"). At the same time there is the high potential to treat patients who remain outpatients at other levels of care.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"358-365"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273546","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":"[Finger joint arthrodesis with the cup and cone technique : A simple and safe procedure].","authors":"Adrian Sebald, Andreas Arkudas, Raymund E Horch","doi":"10.1007/s00113-026-01698-8","DOIUrl":"10.1007/s00113-026-01698-8","url":null,"abstract":"<p><strong>Background: </strong>Finger joint arthrosis frequently results from trauma, degenerative or inflammatory causes. When conservative treatment and joint-preserving procedures fail, arthrodesis remains a reliable surgical option to relieve pain and restore hand function. Among the various techniques, the cup and cone method has proven particularly effective due to its large cartilage-free surface area and ease of intraoperative axis correction. The aim of this study is to evaluate this based on the patient cohort of a supramaximum care provider.</p><p><strong>Material and methods: </strong>A retrospective analysis of 201 finger joint arthrodeses in 168 patients was conducted between 2015 and 2025. Data collected included demographics, joint location, surgical indications and postoperative complications. A subgroup analysis of arthrodesis performed for degenerative osteoarthritis included comparison of preoperative and postoperative axis deviation and flexion angles per joint type.</p><p><strong>Results: </strong>Patients had a mean age of 60 years and 71% were male. The right hand was affected in 54% of cases. Most arthrodeses involved proximal interphalangeal (PIP) joints (104), followed by distal interphalangeal (DIP, 65) and thumb IP joints (16). The leading indication was posttraumatic arthritis (48%), followed by degeneration (20%). Complication rates were low, with infection being the most common. In degenerative osteoarthritis cases, significant postoperative reductions in axis deviation were observed (up to 25°).</p><p><strong>Conclusion: </strong>Arthrodesis of the finger joints is an effective measure for improving function and relieving symptoms in treatment-refractory cases. The cup and cone technique has proven to be a procedure with a high success rate and a low complication rate. Individual planning of joint positioning and careful selection of the surgical technique are crucial for the functional outcome. Future prospective studies should further investigate long-term effects and patient satisfaction.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"394-401"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476682","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":"[Role of trauma surgery in the emergency department from the perspective of the occupational accident insurance physician procedure].","authors":"Andreas Gather, Philipp Faul, Paul Alfred Grützner, Matthias Münzberg","doi":"10.1007/s00113-026-01682-2","DOIUrl":"10.1007/s00113-026-01682-2","url":null,"abstract":"<p><p>The emergency department (ED) represents the central point of entry for trauma surgical care of occupational, school and commuting accidents within the German hospital system. In addition to providing acute medical treatment, the ED plays a crucial role as an interface to the occupational accident insurance health system. In particular, the transition physician (D-physician) system entails specific structural, procedural and documentation-related requirements that are largely shaped by trauma surgery. This article analyzes the role of trauma surgery in the ED from the perspective of the D‑physician. It outlines the legal framework and care structures of the D‑physician system, the distinction from general emergency care and the importance of interdisciplinary interfaces and standardized decision-making processes. Special emphasis is placed on the management of complex injury patterns in the context of the injury type and severe injury type procedures as well as on the integration of trauma surgery into modern concepts of clinical acute and emergency medicine. The aim of this article is to highlight the key role of trauma surgery in the ED and to identify practice-relevant aspects for ensuring high-quality, legally compliant and efficient care of patients covered by the occupational accident insurance.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"373-376"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183719","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":"[Trauma team activation following motor vehicle accidents-impact of changes in criteria in the S3 guideline on polytrauma/severely injured patient care].","authors":"Bastian Brune, Max Bittner, Fabian Haut, Maximilian Wolf, Sascha Keil, André Nohl, Frank Herbstreit, Christian Waydhas, Lars Becker, Marcel Dudda","doi":"10.1007/s00113-025-01636-0","DOIUrl":"10.1007/s00113-025-01636-0","url":null,"abstract":"<p><strong>Background: </strong>With the 2023 revision of the German S3 guideline \"Polytrauma/severely injured patient care\" the criteria for trauma team activation (TTA) were revised. Accident mechanism-based criteria were largely eliminated. The impact of these changes on emergency department (ED) management, over- and undertriage following traffic accidents, and hospital length of stay has not yet been systematically evaluated.</p><p><strong>Objective: </strong>The aim of this study was to assess the effects of the guideline update on patient treatment in the emergency department of a level I trauma center.</p><p><strong>Methods: </strong>In a prospective, single-center observational study, all patients presenting after motor vehicle accidents were recorded over a 2-year period (pre- vs. postguideline update). Primary endpoints were the frequency and appropriateness of TTA as well as the distribution of treatment locations. Secondary endpoint was hospital length of stay.</p><p><strong>Results: </strong>A total of 1438 cases were analyzed. The number of red-triaged patients decreased significantly (257 vs. 157; p < 0.001). The overtriage rate among TTA patients declined (27.6% vs. 21%, p < 0.01) without a significant increase in undertriage. Mortality and hospital length of stay did not differ significantly between groups.</p><p><strong>Conclusion: </strong>The revision of TTA criteria led to a marked reduction in trauma team activations while maintaining quality of care. No significant increase in undertriage was observed. The updated TTA criteria may support resource-efficient patient care without compromising safety.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"377-385"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194054","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":"[Calcaneal fractures-Current status and treatment approaches].","authors":"Sebastian Schilde, Christian Fischer, Phillipp Kobbe, Thomas Mendel","doi":"10.1007/s00113-026-01699-7","DOIUrl":"10.1007/s00113-026-01699-7","url":null,"abstract":"<p><p>Calcaneal fractures primarily affect patients aged 40-59 years, with an incidence rate of 17.5 per 100,000 inhabitants. They are typically caused by axial forces resulting from falls from a height or traffic accidents. In 75% of cases the posterior facet of the subtalar joint is affected, which can result in substantial functional limitations. The aim of treatment is to anatomically reconstruct the joint surfaces and the shape of the foot and to prevent long-term damage, such as osteoarthritis. Surgical treatment typically involves open reduction and internal fixation (ORIF), although minimally invasive procedures are increasingly being adopted to minimize soft tissue complications. The long-term results vary, with the initial severity of the fracture and the quality of the reduction being decisive factors. Complications, such as wound healing disorders, infections and posttraumatic osteoarthritis are common, particularly in complex fractures. Advances in minimally invasive surgery offer promising approaches to improve outcomes. Overall, treating calcaneal fractures remains challenging and requires a tailored strategy for each type of fracture to achieve optimal functional results.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"402-418"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629487","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":"[The role of trauma surgery in the emergency department].","authors":"Frank Hildebrand","doi":"10.1007/s00113-026-01701-2","DOIUrl":"https://doi.org/10.1007/s00113-026-01701-2","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":"129 6","pages":"355-357"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045157","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":"[How much trauma surgery occurs in the emergency department and how is the quality of treatment assured?]","authors":"Wolfgang Lehmann, Christine Höfer","doi":"10.1007/s00113-026-01690-2","DOIUrl":"10.1007/s00113-026-01690-2","url":null,"abstract":"<p><strong>Background: </strong>Since the 2018 decision of the Federal Joint Committee (G-BA) inpatient emergency care in Germany has undergone a profound structural change. Although musculoskeletal injuries account for around 40-45% of the emergency department (ED) caseload, current regulations lack binding requirements for primary trauma/orthopedic surgical treatment. This raises questions regarding quality of care, legal certainty and postgraduate training.</p><p><strong>Objective: </strong>This study investigated to what extent injured patients in German trauma centers receive primary care from physicians with trauma surgery qualifications and which structural consequences result from this.</p><p><strong>Methods: </strong>In a nationwide online survey all 626 trauma centers listed in the German Society for Trauma Surgery (DGU) TraumaNetwork were contacted. Data were collected on ED structures, the qualifications of physicians involved in primary care and responsibilities for setting the indications for trauma/orthopedic surgery. In addition, a qualitative content analysis of voluntary free-text comments was performed.</p><p><strong>Results: </strong>Responses from 225 trauma centers were analyzed (response rate 36%). The primary care of non-polytraumatized trauma/orthopedic surgery patients was provided predominantly by trauma surgery residents (53% local trauma centers, 56% regional trauma centers, 59% supraregional trauma centers). The on-site presence of board-certified trauma surgeons was lower (16-28%). In 78 hospitals emergency physicians from other disciplines provided initial care in fewer than 10% of cases. The free-text comments emphasized deficits in quality of care and postgraduate training.</p><p><strong>Discussion: </strong>The results demonstrate a relevant discrepancy between the epidemiological importance of trauma/orthopedic clinical conditions and their structural anchoring in the emergency department. The G‑BA requirements ensure organizational standards but do not guarantee specialty-specific depth. To ensure quality of care, legal certainty and postgraduate training, binding regulations for trauma/orthopedic surgical competence in the ED are necessary.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"366-372"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358022","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":"[Surgical treatment of calcaneal fractures : Surgical technique, tips and tricks].","authors":"Thomas Mendel, Christian Fischer, Philipp Kobbe, Sebastian Schilde","doi":"10.1007/s00113-026-01700-3","DOIUrl":"10.1007/s00113-026-01700-3","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"419-426"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482766","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":"[Management and outcome of patients with stab injuries treated at a German level I trauma center : A retrospective analysis over a 3-year period].","authors":"Ludwig Jägerhuber, Georg Siebenbürger, Jan Bruder, Pascal Martin, Felix Maßen, Wolfgang Böcker, Markus Wörnle, Mareen Braunstein","doi":"10.1007/s00113-026-01693-z","DOIUrl":"10.1007/s00113-026-01693-z","url":null,"abstract":"<p><strong>Background: </strong>Stab wounds inflicted by a third party represent an increasingly relevant form of penetrating trauma in Germany, gaining attention both in the public sphere and in clinical emergency care.</p><p><strong>Objective: </strong>This retrospective study investigated the incidence, injury severity, anatomical distribution, and clinical outcomes of stab wound cases treated at a German level I trauma center over a 3-year period.</p><p><strong>Material and methods: </strong>All patients presenting with stab injuries to the inner city emergency department of LMU University Hospital between September 2021 and August 2024 were included. A structured analysis of demographic data, injury characteristics, therapeutic interventions and clinical outcomes was conducted.</p><p><strong>Results: </strong>A total of 48 cases were identified (47 male, 1 female; mean age 36.6 years, median 27 years). The most frequently affected anatomical regions were the upper extremities (25%) and thorax (20.3%). Hospital admission was required in 41.7% of cases, 14.6% sustained major trauma (abbreviated injury scale, AIS ≥ 3) and 1 patient died.</p><p><strong>Discussion: </strong>Stab wounds continue to pose a rare yet clinically significant challenge. The findings underline the necessity for structured interdisciplinary management and targeted emergency preparedness protocols in trauma systems.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":" ","pages":"386-393"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438310","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}