Unfallchirurg最新文献

Background: Medical education has always been challenging for students and teachers. Of growing importance is the promotion of knowledge of correlations and knowledge transfer from theoretical aspects into clinical practice. In order to achieve this aim, student-centered teaching concepts are increasingly being employed in the literature.

Objective: Can a trauma surgery practical seminar be improved by a case-based teaching concept?

Material and methods: For this purpose, standardized case studies and corresponding teaching materials, such as classification aids and treatment strategies, were made available to the students and lecturers. Using a two-staged evaluation the effects of the modified teaching design could be recorded and statistically analyzed.

Results: The seminar was considered to be relevant for the examinations. The teaching by the lecturers was found to be more competent and appeared more motivated. Overall, the seminar was rated better by the students.

Conclusion: A case-based teaching concept can significantly improve the education in trauma surgery, when correctly and specifically implemented.

In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. The topical use of nonsteroidal anti-inflammatory drugs (NSAID) should always be considered in the clinical routine. If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..

The gold standard in operative treatment of end-stage ankle osteoarthritis remains controversial even now. Endoprosthetic treatment, which has undergone significant improvements in recent years competes with arthrodesis, which can achieve excellent results particularly in the arthroscopically assisted technique. Both procedures offer specific advantages and disadvantages so that the decision about indications for treatment should always be made individually, taking specific needs and the individual constellation of findings of the patient into consideration.

A young man suffered the fatal combination of burn injuries and acute kidney failure caused by substantial rhabdomyolysis after lying on the floor in a somnolent condition for 12 h. This symptom constellation should always make physicians aware of a potential compartment syndrome.

Critically injured patients pose great challenges for medical personnel in emergency room treatment. How can such a high workload due to a lack of personnel be reduced? Telemedicine can offer solutions here. With the help of external medical expertise, diagnoses and treatment processes are already significantly accelerated and optimized in other specialist areas. This possibility should now also be introduced into the care of critical trauma surgery patients. In this article, current emergency room treatment is reflected, problems are shown and future-oriented solutions are suggested.

The aim of supramalleolar conversion osteotomy is to reduce the pain of the patient and stop or at least slow down joint degeneration. The indication for supramalleolar osteotomy is asymmetric osteoarthritis of the ankle joint with varus or valgus deformity. Good clinical results for arthritis can be achieved in the early or middle stages. Besides closing and opening wedge osteotomies dome osteotomy is sometimes indicated, especially for larger deformities. The preoperative preparation of individual patient-specific section blocks facilitates the intraoperative implementation and seems to increase the precision. Further studies are necessary to support this. The indications for additional procedures, such as fibular osteotomy are still being discussed. Inframalleolar osteotomy and soft tissue interventions are frequently necessary for balancing the foot.

Explosions can cause severe injuries, which affect multiple organ systems and leave extensive soft tissue defects. In unstable patients, damage control surgery initially focuses exclusively on controlling bleeding and contamination with the aim of preserving life and limbs. The excision of all necrotic tissue, extensive wound irrigation with antiseptic solutions and a calculated antibiotic prophylaxis, which is subsequently adapted to the microbiological findings, are the basis for sufficient infection control. As the tissue damage caused by the pressure surge can regenerate over time as well as become secondarily necrotic (developing wounds), several revision operations are often necessary to assess the viability of tissue in the sense of serial debridement. In the case of extensive soft tissue injuries temporary vacuum-assisted closure (VAC) techniques can bridge the time to the earliest possible definitive plastic surgical wound closure; however, this must not delay the closure of the defect.

Background: Effective interprofessional teamwork and stress are important factors for quality of care and patient safety in the operating room (OR); however, there are just a few systematic investigations into the relationship of OR teamwork and occupational stress.

Objective: Determination of the relationship between interdisciplinary OR teamwork and stress in routine procedures, for the whole OR team as well as individual professions.

Methods: Multimethod study with expert observations using a standardized observation tool (OTAS-D) and systematic self-reports of the entire OR team. A total of 64 elective interventions across different surgical departments were observed. Relationships were calculated using mixed-effects regression models with control of procedural and provider characteristics.

Results: The quality of the intraoperative teamwork was at a medium level. Reported stress during interventions was at comparatively low levels, with significant differences between the professions of surgery, nursing and anesthesiology. Members of the surgical team reported the highest stress levels. An association between teamwork and perceived stress could not be determined for the entire OR team; however, within the surgical sub-team there were significant positive correlations for the quality of teamwork and stress (as well as for the teamwork dimensions of collaboration and leadership). For the nursing sub-team, we observed significant negative correlations with overall teamwork as well as with the dimension team monitoring.

Conclusion: The findings suggest a profession-specific relationship between OR teamwork and occupational stress. Further research is necessary to investigate to what extent successful OR teamwork during routine procedures contributes to intraoperative stress.

Background: In many cases the treatment of humeral shaft fractures is challenging and despite the large diversity of available approaches, no standard treatment exists. In addition to conservative treatment, intramedullary nails and plate osteosynthesis are competing methods for healing humeral shaft fractures. Furthermore, cerclage is considered to be an additive treatment for spiral fractures; however, this also increases the risk of radial nerve neuropathy and is said to compromise the perfusion of bone fragments. The goal of this study was to investigate secondary radial nerve neuropathy using additive and limited invasive cerclages for nail osteosynthesis of humeral shaft fractures.

Methods: In the present study a total of 102 patients with humeral shaft fractures were clinically and neurologically re-examined after having been treated with nail osteosynthesis and additive cerclage via a limited invasive access over the past 5 years. In total 193 cerclages with limited invasive access were inserted during this time period.

Results and conclusion: Of the patients four (3.9%) showed a secondary radial neuropathy during operative stabilization. Neurophysiological and neurosonographic examinations revealed that this had not been caused by compromising, embedding or severance of the radial nerve due to the cerclage. Two out of these nerve lesions recovered spontaneously within 3 and 6 months, respectively. The other two cases could not be documented over a period of 12 months due to death of the patient. With 3.9% of iatrogenic radial nerve lesions the rate of nerve lesions falls into the lower range of that which has previously been described in the literature for nerve lesions due to operative treatment of humeral shaft fractures (3-12%). We thus conclude that there is no increased risk for iatrogenic injury of the radial nerve using additive and limited invasive cerclage.

Interventional sonography describes the step from pure sonographic imaging diagnostics to sonographically controlled treatment that can be connected directly to sonographic imaging diagnostics instead of postponing it over a longer time interval with possibly further (X-ray, computed tomography, magnetic resonance imaging) diagnostics. The sonographically controlled interventional measures range from a simple puncture of fluid-filled spaces to infiltration of deeper lying areas, such as the labrum acetabulare, the dorsal knee joint capsule and facet joints up to infiltration of the sciatic nerve. The safety is guaranteed by adhering to clearly defined hygiene standards as well as by qualified training as part of the 3‑stage model of certification of the surgery section of the German Society of Ultrasound in Medicine (DEGUM). By using modern sonography devices, structures in the submillimeter range are visible even at close range, so that nowadays even splitting of the annular ligament of the finger has become possible under ultrasound control.