Unfallchirurgie (Heidelberg, Germany)最新文献

This case report presents the clinical findings and management of a 32-year-old male recreational athlete who presented with ongoing knee pain for 4 months, without a history of trauma. The patient experienced intermittent pain during walking, particularly after prolonged periods of sitting, and exhibited positive findings on meniscus tests. However, he was able to participate in sports activities without pain. Magnetic resonance imaging (MRI) revealed a partial tear of the medial gastrocnemius head, confirming the diagnosis. Conservative treatment, including rest, physical therapy, and a gradual return to sports activities, led to significant symptom improvement. This case highlights the importance of considering rare injuries, such as isolated tears of the medial gastrocnemius head, in patients with persistent knee pain and meniscal symptoms, even in the absence of traumatic events. Previous reports on this specific injury are sparse, indicating its rarity and underscoring the need for further understanding and documentation.

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.

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.

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.

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.

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.

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.

Background: Climate change is a central issue for our future. The increase in the amount of greenhouse gases in the atmosphere promotes the so-called greenhouse effect, resulting in climate change. Worldwide, the amount of plastic waste amounts to approximately 8 billion tons. The healthcare sector is responsible for around 4.4% of global net emissions contributing to the greenhouse effect. Measures to reduce CO₂ emissions within the healthcare sector should be implemented accordingly. To make the issue of plastic waste in the operational sector more visible, in the present study we examined and calculated the packaging waste generated in the treatment of distal radius fractures.

Material and methods: The clinic stocks two different implants (sterile packaging = group I vs. implant tray = group II) for the treatment of distal radius fractures. Over a period of 12 months (July 2022-July 2023), the packaging waste from all surgically treated distal radius fractures was collected and weighed. The time required to retrieve, unpack and provide the implants in both groups (referred to as preparation time) was measured. Patient data were recorded in a dedicated register and statistical significances were calculated.

Results: A total of 124 distal radius fractures were treated. The average age of the cohort was 67.9 years with 74.2% being female. The system with sterile individual packaging (group I) was used for fracture treatment 29 times, while the system with the screw tray (group II) was used 94 times. For treatment with sterile packaging 104.5g of plastic waste and 67.4g of plastic-free packaging waste were generated per operation, while treatment with the implant tray resulted in 21.6g of plastic waste and 12.8g of plastic-free packaging waste (p = 0.0001). The average time for providing the screws in group I was significantly higher at 527.8 s compared to treatment with the implant tray in group II at 138 s (p = 0.0001).

Discussion: In the present study we found a significant increase in plastic waste when using individually packaged implants. To reduce the production of plastic waste, mandatory guidelines for waste separation in the operating room appear to be sensible. Measures such as the return and recycling of recyclable plastic waste as well as improvements in packaging design and the use of bio-based biodegradable and compostable plastics, represent further possibilities for waste reduction.