Unfallchirurgie (Heidelberg, Germany)最新文献

Background: Heterotopic ossification (HO) arising from inflammatory processes often results in bony transformation of soft tissue. While the occurrence of HO is well-documented, its biomechanical influence on clavicular fractures remains less explored. We present a case report of a patient with a clavicular fracture following a bicycle accident, accompanied by incidental findings of HO around the coracoclavicular (CC) ligaments.

Case presentation: A 59-year-old man presented with a displaced right-sided clavicular fracture and a cervical vertebral body fracture following a bicycle fall. Incidental findings revealed pronounced HO around the CC ligaments. The patient underwent surgical stabilization for the cervical vertebral body fracture and clavicular fracture using open reduction and internal fixation. The presence of ossified CC ligaments may influence the biomechanical considerations for clavicular fractures.

Conclusion: The present case report suggests that ossified CC ligaments may impact clavicular biomechanics, potentially offering increased stability at the CC attachment and acting as a protective shield during trauma. This observation may indicate a possible predisposition to fractures in the clavicular region medial to the CC ligaments. While we cannot determine causality based on this single case, pronounced ossification of the CC ligaments could increase local stiffness and alter load distribution.

Compared to ruptures of the Achilles tendon, injuries to the tibialis anterior and tibialis posterior tendons or the peroneal tendons are relatively rare, so that the literature on this subject largely consists of individual case reports and small case series. There are major differences between the individual entities in terms of the pathogenesis, possible sequelae and treatment recommendations. This article is intended to provide an overview and instruction manual for the clinical management.

Acute aortic injuries are among the most life-threatening emergencies in vascular and emergency medicine. They are mostly caused by high-velocity trauma with deceleration and shear forces in the region of the aortic isthmus. Due to the anatomical features these particularly result in tears or complete transection of the vascular wall. Without rapid diagnosis and treatment the majority of cases are fatal. Contrast-enhanced computed tomography (CT) angiography is considered the diagnostic gold standard and enables a precise classification of the injury according to the severity and immediate treatment planning. Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for lesion grades II and III. The interdisciplinary interplay of interventional radiology, cardiovascular surgery and anesthesia can achieve a significant reduction in the perioperative mortality. Although mortality rates of up to 20% have been reported after open surgery, the mortality after TEVAR is between 7% and 9%. Neurological complications, particularly spinal ischemia, are less common than after open surgical treatment. Following successful TEVAR a life-long imaging follow-up is necessary for the early detection of prosthesis migration, endoleaks or infections.

Traumatic injuries to the liver, spleen and kidneys often pose a challenge in acute care. In addition to conservative and surgical treatment, interventional radiology provides a minimally invasive option for bleeding control and organ preservation. The indications for transarterial embolization depend on the hemodynamic stability, imaging results and accompanying injuries. Special technical aspects, such as the selection of embolization material, microcatheter techniques and consideration of anatomical conditions are crucial for treatment success. Knowledge of the indications, contraindications and technical details enables targeted, patient-oriented treatment. Interventional procedures reduce the need for open surgery, lower the mortality in severely injured patients and help to preserve organ function. This article highlights the role of interventional radiology in the care of trauma patients with bleeding in the solid organs of the upper abdomen.

Background: The current European political security environment is very tense due to the return of conventional and hybrid warfare. National and collective defence have again become key political tasks. In this context, the resilience of the healthcare system, understood as critical infrastructures contributing to social cohesion, institutional trust and democratic stability, have moved to center stage. Orthopedics and trauma surgery (O&U) are central to injury care, while palliative medicine represents an essential component of humane and functional healthcare provision in crises and armed conflict scenarios.

Objective: This article describes the structural, organizational and competency requirements of O&U in the context of national and collective defence. The article outlines the preparedness for war-related and disaster-related injuries, the development of mission-relevant generalist competencies, the establishment of resilient hospital structures and the explicit integration of palliative care and ethical concepts into crises and armed conflict scenarios.

Material and methods: Narrative review based on military medical and clinical experiences, relevant national and international emergency and disaster medicine guidelines, palliative care literature and health scientific and health policy documents on resilience of healthcare systems.

Results: Key requirements for O&U facilities are: (1) a shared understanding of the political security situation and the realistic nature of defence scenarios, (2) mission-relevant generalist profiles (emergency surgeon in crisis and disaster situations) with broad damage-control surgery skills, (3) robust clinical structures with clear standard operating procedures (SOP), defined triage and leadership pathways and material as well as personnel redundancies, (4) systematic promotion of psychological resilience and ethical ability to act of the team and (5) the broad integration of core principles of palliative care to ensure symptom control and dignified dying despite resource constraints.

Conclusion: Preparing O&U for national and collective defence is not only a special military medical task but also a discipline-specific and total societal responsibility. Emergency surgery , complex reconstructions and palliative care must be regarded as complementary pillars of a resilient healthcare system. Resilient trauma surgery and palliative care structures contribute doubly by maintaining treatment capacity in times of armed conflict and stabilizing public trust and social cohesion.

Since the beginning of the Russian invasion, approximately 2000 war casualties have been treated in Western Europe and of these 324 patients were distributed to North Rhine-Westphalia (NRW) via the SPoC.NRW cloverleaf system. The types of injuries and the required medical specialties were determined as well as their distribution transferred to the structures of the German Society for Trauma Surgery (DGU local, regional, supraregional trauma centers). As expected, 94% of the injured were between 21 and 60 years old, 66% of the injuries affected the upper extremities (26.6%) and the lower extremities (39.8%). The required departments were evaluated based on the affected locations. This revealed that in addition to trauma surgery (89%), plastic surgery (61%) and general surgery (8%) were predominantly required. In interdisciplinary treatment the typical head and neck specialties (neurology, ENT, ophthalmology, maxillofacial surgery = 19%) were involved. Ukrainian war casualties treated in hospitals in NRW that were willing to accept such patients have so far received very good care. The distribution of Ukrainian war casualties treated in NRW shows a concentration in supraregional trauma centers (55%). In the event of a military intervention, it is anticipated that over 1000 patients requiring treatment will arrive in Germany every day. These first data provide insights into future needs of medical care.

Background: Embolization via interventional radiology (IR) plays a critical role in the management of trauma patients and is effective in controlling arterial hemorrhaging in the pelvis, retroperitoneum, and gastrointestinal tract.

Objective: To evaluate the role of IR in the management of traumatic arterial bleeding in the pelvic, retroperitoneal and gastrointestinal regions.

Material and methods: A comprehensive literature review was conducted to assess the current evidence regarding the indications, procedural techniques and results of embolization following trauma in the named regions.

Results: The decision to perform embolization is determined individually and interdisciplinary based on contrast-enhanced computed tomography (CT). In cases of arterial bleeding, embolization following pelvic trauma is a key pillar of treatment. Posttraumatic retroperitoneal renal embolization is indicated as the method of choice in cases of traumatic arterial bleeding without devascularization or fragmentation of the kidney. Although there is a lack of robust data and clear guidelines for embolization in traumatic gastrointestinal and other retroperitoneal hemorrhages, evidence from nontraumatic cases suggests a high therapeutic potential. The endovascular techniques used in trauma closely mirror those employed in nontraumatic vascular occlusion interventions in these regions.

Discussion: Targeted embolization effectively controls traumatic bleeding.

A mass casualty incident (MCI) poses exceptional organizational and medical challenges to healthcare systems as a large number of severely injured patients must be treated within a very short time frame using limited resources. In addition to prehospital triage, emergency surgical care and intensive care management, interventional radiology (IR) is gaining in importance. Through minimally invasive, image-guided procedures, IR enables rapid and targeted hemorrhage control, particularly in cases of pelvic fractures, parenchymal organ injuries and traumatic vascular lesions. Key techniques include transarterial embolization and endovascular vascular reconstruction. In the context of an MCI, interventional radiology provides substantial advantages in terms of organ preservation, reduction of surgical interventions and efficient resource utilization and serves as a complementary partner in emergency care. At the same time its application is subject to clear limitations as it requires a highly specialized infrastructure, experienced personnel and strict prioritization. Early integration of IR into trauma bay algorithms, disaster response plans, and interdisciplinary command structures is therefore essential. The article discusses organizational aspects and the current state of evidence as exemplified by the attack on the Magdeburg Christmas market on 20 December 2024.