Unfallchirurgie (Heidelberg, Germany)最新文献

Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only the mortality of patients. For incidents outside the daily routine care in trauma surgery, such as natural disasters, accidents with multiple casualties and nonmilitary treatment of the domestic population in defence situations, such registers can provide data-based recommendations for action. These data, mainly obtained from routine traumatological treatment, enable a targeted resource management in the abovenamed incidents, which are associated with mass casualties. Due to the utilization of registers from the military field or from international registers, the perspective is additionally extended with respect to treatment strategies and injury patterns. Whether data can also be generated in a suitable manner for the abovenamed registers in specific disaster situations and can provide a direct gain of knowledge from the incident, must be critically discussed. The maintenance of the register datasets is time-consuming and has been subjected to a more stringent regulation at least since May 2018, when the European Union General Data Protection Regulation (EU-GDPR) came into force. The future Register Act in Germany will hopefully achieve greater simplification in the documentation of routine data.

The war in Ukraine and the pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have brought the resilience of our healthcare system and the preparation for disaster medical situations into the focus of a broad and current professional discussion. All measures to improve medical care in disasters can be subsumed under the umbrella term civil health protection. Most damage events that result from the realization of the risks in our daily lives in the sense of a catastrophe or damage situation result in an acute presentation of injured people with an exceedance or a restriction of the treatment capacity of a hospital. Both lead to a shortage situation that endangers patients and that may require applying the principles and concepts of disaster medicine and activating the hospital alarm and deployment plan for structured implementation. As the clinics of the TraumaNetworks DGU® represent an essential pillar of trauma care in the event of a disaster, a prerequisite for dealing with a damage situation is to know the elements of the organization, competences and responsibilities as well as to elucidate the role of the hospitals from the perspective of trauma surgery. This article presents the principles of the nomenclature of medical care in disasters, organization and possible coping strategies and discusses the principles of risk stratification in the preparation. All of this happens with the aim of optimizing the preparation and functioning of one's own hospital in the event of damage or a disaster.

The current security situation, both in terms of domestic and foreign politics, continues to pose a major challenge for Germany and it is therefore important to prepare the healthcare system for this. In the context of catastrophes based, e.g., on violence, terror, crisis or war, it will be unavoidable to have to treat a large number of injured and wounded casualties. The need for surgical treatment will always play a central role in this context, so that it is imperative that our hospitals and clinics are prepared in this respect. In addition to the general training content in a clinical context, there is a particular need for content that addresses nonroutine aspects, such as gunshot and blast injuries and also provides organizational and strategic recommendations for action. The Academy of Trauma Surgery (AUC) of the German Society for Trauma Surgery is a central and important partner for the German healthcare system and shows how such content, also based on structural advantages such as the TraumaNetworks DGU®, can be successfully communicated.

The clinical picture and surgical treatment of implant-associated osteomyelitis of the calcaneus with soft tissue defect are presented based on this case study. Due to the fulminant infection, complete resection of the calcaneus and a two-stage complex reconstruction of the hindfoot were performed. As necrosis developed in the surgical access route, coverage with a free ALT flap became necessary.

The diagnostics and treatment of pathological fractures of the extremities differ from the approach for conventional fractures. Metastases from breast, bronchial, renal cell and prostate cancer are the predominant cause. Typically, patients present at over 50 years old present after an inadequate trauma. They often report symptoms or swelling in the affected region that already existed before the fracture. An underlying malignant disease is sometimes already known; however, occasionally this is manifested in the form of a fracture. The femur is affected in 74% of cases, followed by the humerus and the tibia. Important indications for the presence of a pathological fracture can even be obtained from conventional radiographs. The diagnostics are supplemented with further modalities depending on the treatment goal. Surgical treatment is the first choice as the fractures do not heal using conservative measures. In this context, a prognosis-stratified approach is recommended.

Background: Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice.

Objective: The aim of this study was to describe the demographic and economic indicators of a university hospital and to examine the development of inpatient and outpatient case numbers over the past decade.

Material and methods: A retrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate a correlation, a linear regression model was calculated and a p-value <0.05 was considered significant.

Results: In total, 2918 cases were included over a decade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with a patient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period.

Conclusion: The increasing case numbers in the outpatient and inpatient sectors indicate a centralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.

This paper describes the use of digital solutions to improve the care of trauma patients in Germany. The focus is on the trauma networks of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). The use of digital solutions includes quality assurance through the TraumaRegister, which enables comprehensive data analysis as well as preregistration and resource utilization through programs such as the interdisciplinary proof of treatment IVENA eHealth, Rescuetrack and Rescue-Net. In addition, Predictive Hospital Resource Planning is presented, which optimizes resource forecasting using artificial intelligence (AI). Telemedical services such as Medgate and teleradiology solutions (Nexus/Chili) offer additional support, especially in rural areas. The paper shows how the digitalization of medical care is crucial to improving the efficiency and quality of treatment of trauma patients. In addition, the paper shows possible developments in the field of clinical decision making through AI.

Background: Individual mobility in road traffic is of high importance in Germany, both individually and socioeconomically; however, diseases and injuries of the musculoskeletal system in particular can lead to temporary impairments. The aim of this prospective patient survey was to record how patients assessed their driving capability during an injury and the associated immobilization and on what basis the decision on driving capability was made on the part of the patients.

Material and methods: A systematic questionnaire was used to analyze a total of 100 patients with a diagnosis in orthopedics/trauma surgery and associated joint immobilization. In addition to personal data and the injuries/illnesses, an analysis on risk tolerance was performed and patients were asked about their knowledge regarding driving capability. Finally, it was recorded which patients drove a motor vehicle and for what reasons despite immobilization.

Results: Overall, 40.2% reported knowledge of the applicable laws regarding driving capability and 55.6% considered the treating physician to be responsible regarding the decision on driving capability. The patients who drove a motor vehicle reported higher personal and professional dependence on the motor vehicle (personal: 60.6% vs. 45.7%; professional: 48.5% vs. 36.1%). In the group of patients who drove a motor vehicle during immobilization, overall a fracture was less likely to be the reason for immobilization (33.3% vs. 51.0%).

Conclusion: Overall, the patient population rated their knowledge of the law as low and viewed the treating physician as having the majority of the decision-making responsibility regarding driving capability. The patients who drove a motor vehicle during immobilization reported a higher personal as well as professional dependence on driving a motor vehicle. At the same time the injury severity had an influence on the decision, so that patients with fractures were more likely to avoid driving a motor vehicle. Further studies, particularly at the biomechanical level, are needed to ensure a better basis for the physician in making decisions with respect to the driving capability of orthopedic and trauma surgery patients.