Unfallchirurgie (Heidelberg, Germany)最新文献

The use of 3D printing offers numerous application possibilities in traumatology, including anatomic models, repositioning and drilling guides as well as patient-specific implants. The greatest challenge lies in the rapid availability as many procedures require an immediate intervention. Anatomic models support surgical planning by complementing visual impressions with tactile ones. Printed models not only help in the establishment of surgical strategies but also enhance patient clarification. Studies demonstrate that these models significantly reduce the operating time, duration of fluoroscopy and blood loss, particularly for joint fractures. Repositioning and drilling guides simplify complex procedures and improve outcomes; however, they require precise planning and critical evaluation by the surgeon. Intraoperative guides are helpful, for instance, in accurately placing screws, especially in difficult to access areas or in metaphyseal fractures lacking clear references. Individualized implants play a lesser role in acute care but are useful for posttraumatic defects or corrective osteotomy. In the conservative segment, such as customized splints, 3D printing is being tested but with mixed results. Key requirements for 3D printing in traumatology include high-resolution computed tomography (CT), precise data processing and swift production. Regulatory hurdles and lack of reimbursement currently limit the widespread use. An optimized collaboration between technology and medicine, along with standardized processes, are essential for effectively integrating this technology into practice.

Missed injuries (MI) in children and adolescents with multiple injuries represent a major challenge in pediatric trauma care despite the availability of standard examination protocols and imaging procedures. In the initial phase of care the primary survey is essentially important for the detection and treatment of life-threatening injuries and is well established. After stabilization of the patient in the trauma room and the first phase of treatment, a secondary survey and a tertiary survey should be carried out in order to detect initially MI in the further course and avoid longer term consequences. The majority of MI involve head, thoracic and extremity injuries. Risk factors for MI are younger patient age, the presence of multiple trauma, a higher injury severity score (ISS), a lower value on the Glasgow coma scale (GCS) and a prolonged stay in the intensive care unit. While MI are frequently described in severely or multiply injured children, a high proportion of MIs are also found in children transferred from other institutions. Therefore, two case studies from a pediatric trauma center at a maximum care hospital and a literature analysis are used to analyze typical MIs. These case examples underline the importance of adhering to a standardized treatment regimen for this patient group. It is advisable to develop a standard operating procedure (SOP) with a corresponding risk score, which regulates the tertiary survey, the times of the follow-up examinations and the corresponding (specialist) specific responsibilities.

Background: Following the Russian war of aggression the number of people in Ukraine with amputated arms and legs rose sharply, overwhelming a fledgling rehabilitation system.

Aim: This article describes the development and implementation of an e‑learning tool aimed at medical professionals, amputees and their relatives, which contains a wide range of information on rehabilitation after limb amputation and is easily accessible. It is designed to provide practical support for the rehabilitation process of affected individuals and is available free of charge in the Ukrainian and German languages.

Material and methods: An interdisciplinary team of doctors, therapists, orthopedic technicians and a scientist developed the structure and outline of the learning module in a consensus process. The content was developed in small teams and, after an internal content review by two team members, linguistically synchronized and implemented on the open-source learning platform Integrated Learning, Information and Work Cooperation System (Integriertes Lern‑, Informations- und Arbeitskooperations-System, ILIAS).

Results and discussion: The e‑learning tool was fully developed and implemented within 10 months. It is available free of charge in two languages at https://digitale-lehre-mhh.de . It distinguishes between rehabilitation after arm or leg amputation, after which three consecutive rehabilitation phases (postacute, intermediate and maintenance phases) can be selected. The next level gives access to the specific content, which consists of a pathway, explanatory texts, images, video sequences and audio files on treatment, self-exercises and practical tips.

Injuries of the hand especially during gardening can entail profound consequences, particularly when the injuries are underestimated and adequate treatment is postponed.

The agonist-antagonist myoneural interface (AMI) is an innovative approach to restoring proprioception and achieving more intuitive motor control following limb loss. This cutting-edge technique replicates the natural biomechanical relationship between agonist and antagonist muscles, enabling bidirectional communication between a prosthesis and the user's peripheral nervous system. Through the transposition of neurovascularly pedicled agonist-antagonist muscle pairs, which are reconnected via an adapted tendon suture and positioned within a gliding mechanism, AMI generates proprioceptive feedback during movement. Changes in tension within these muscle pairs produce signals that are transmitted to the central nervous system via afferent nerve pathways, enabling users to perceive the joint position of the limb that was originally governed by the muscle pair. This enhanced sensory input significantly facilitates control of the prosthesis. The AMI appears to enable an integration of the prosthesis into the body's existing neural networks and improve motor control of the prosthesis and the sensory discrimination. Compared to traditional surgical techniques (myodesis or myoplasty) with a purely mechanical transposition of residual stump muscles, AMI reduces the cognitive burden during the use of the prosthesis and delivers a more natural sense of movement, fostering a profound sense of embodiment. In summary, AMI represents a significant leap forward in human-machine integration. By enhancing both the functionality and user experience of prosthetic devices, it provides a very promising transformative solution for sustainable improvement of the quality of life for individuals living with limb loss.

Glenoid bone defects are frequent and the etiology is multifactorial. To prevent increased loosening rates of the glenoid component in total shoulder arthroplasty (TSA), various techniques are available to address the loss of glenoid bone. When corrective reaming and bone grafting techniques are no longer sufficient, patient-specific instrumentation (PSI) and custom-made implants have become core strategies for managing these defects. Following precise planning based on computed tomography (CT) imaging and three-dimensional reconstruction of the bony surface, an individualized guide can be used to accurately position the implant. When the limits of bone reconstruction have been reached, specially prepared (custom-made) implants can be used to compensate for the bony defect. Patients often require minimal postoperative immobilization of the shoulder joint. The currently limited literature describes favorable clinical outcomes, although these findings are almost exclusively limited to reverse shoulder arthroplasty.

Instrumented motion analysis plays a pivotal role in orthopedic technology, offering unique opportunities to analyze and optimize biomechanical, musculoskeletal and neurological processes. This article highlights several recent studies leveraging motion analysis to explore various aspects of prosthetic development, control, loading and safety. The compiled studies highlight the essential potential of instrumented motion analysis in the field of exoskeletal prosthetics. Beyond improving the quality of life for prosthesis users, this technology plays an indispensable role for advancing the functionality and safety of current and future orthopedic devices.

The process of 3D printing has found its way into orthopedics and trauma surgery, particularly for complex interventions on the elbow and forearm. By producing patient-specific implants and surgical templates misalignments, fractures and deformities can be precisely corrected. It could be shown that this technology increases the surgical accuracy, shortens recovery times and reduces postoperative complications. Compared to conventional implants 3D-printed implants provide the advantage of individual adaptation to the anatomical situation of the patient. This is particularly relevant in complex cases, such as malunions, congenital malformations (e.g., Madelung's deformity) and tumor-related deformities. The preoperative planning with 3D models enables a detailed simulation of the procedure and optimizes the placement of the implants. Despite these advantages challenges still remain: the production of patient-specific implants is time-consuming and cost-intensive. In addition, the technology requires expertise and special resources, which limit its application in less specialized centers. Future developments, such as 4D printing with shape-changing implants, promise further progress. By combining precision, individualization and dynamic adaptability, 3D-printed implants could sustainably improve patient care in orthopedics and trauma surgery.

Background: With the Internet as the main source of information for health content, the quality of websites with medical information is of high importance.

Objective: This study analysed 250 websites on acute ankle sprain (ASD), one of the most common musculoskeletal disorders, for their quality and readability. Based on the results, a guide for patients was created.

Method: The quality of the websites was assessed using a 25-item content score and the EQIP36 score for medical information material. The reading level could be determined using the Flesch-Kincaid index and the calculated readability. The best three websites were evaluated in a user survey.

Results: Of the 250 websites recorded 77 were included in the study. The quality of these varied significantly, with none achieving the maximum score. Sources in the healthcare system showed higher quality, while commercially influenced sites were below average in terms of completeness of content. Only 14% of the websites reached the recommended reading level. A significant negative correlation was found between completeness of content and readability. The user survey showed a mixed level of satisfaction and participants with previous medical knowledge were more critical than laypersons.

Conclusion: Online resources about ASD are suboptimal and differ considerably. Deficiencies in content, readability and structure were identified, which limit the effective use by patients. Health information publishers should work harder to improve the comprehensibility and quality of the information provided.