Unfallchirurgie (Heidelberg, Germany)最新文献

{"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":"[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":"[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":"[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}

{"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}