Unfallchirurgie (Heidelberg, Germany)最新文献

In this case report we describe the case of a 24-year-old male patient with the rare diagnosis of an avulsion fracture of the peroneus longus tendon accompanied by Lisfranc instability. Due to the patient's young age we opted for osteosynthesis of the peroneus longus avulsion with simultaneous Lisfranc stabilization, which was performed as a minimally invasive procedure using a suture-button system. Through precise diagnostics and early surgical intervention, a complete functional recovery was achieved.

Thoracoabdominal impalement injuries involving the aorta represent an extremely rare but highly life-threatening trauma scenario. We report the case of a 50-year-old construction worker who sustained an impalement injury after falling approximately 8m onto an upright standing wooden hammer handle, resulting in thoracoabdominal penetration. The injury resulted in multiple trauma, including damage to the lungs, diaphragm, spleen and kidneys as well as a contained dissection of the thoracic aorta. The patient was treated within the framework of an interdisciplinary, time-critical management approach involving emergency surgical interventions and thoracic endovascular aortic repair (TEVAR). Despite initial hemorrhagic shock and respiratory complications, the patient was successfully stabilized and transferred to inpatient rehabilitation after 6 weeks. This case highlights the importance of structured emergency response systems, advanced endovascular techniques and early psychological trauma care to improve long-term outcomes and prevent posttraumatic stress disorders.

Vertebral body metastases represent one of the most frequent manifestations of skeletal tumor dissemination and must be considered in the differential diagnosis of unexplained back pain, particularly in patients with a known history of oncological diseases. The associated morbidity, including spinal instability, deformity, pathological fractures and severe pain, is substantial. Healthcare professionals are regularly confronted with this complex clinical scenario in both outpatient and inpatient settings. A thorough medical history, especially the identification of red flags (e.g., prior trauma and/or malignancy) is critical. Early initiation of appropriate imaging studies, timely evaluation of the clinical urgency and expedited referral to specialized spine centers constitute the foundation for effective interdisciplinary treatment planning. This article outlines the key diagnostic and organizational principles required for the evaluation and further management of patients with vertebral metastases.

Splenic injuries often represent severe internal injuries in cases of abdominal trauma. Contrast-enhanced computed tomography (CT) and laboratory diagnostics play a particularly important role in the diagnostics. Traumatic splenic injuries are classified according to the American Association for the Surgery of Trauma (AAST) and World Society of Emergency Surgery (WSES) criteria. The degree of injury and the hemodynamic and clinical situation of the patient are decisive factors in the choice of treatment. Nonoperative management (NOM) is used in cases of hemodynamic stability and minor splenic injuries. Close clinical monitoring, laboratory and sonographic control examinations are essential in this context. Bleeding and pseudoaneurysms can be successfully treated using angioembolization, a procedure of interventional radiology. Splenorrhaphy can be used as a surgical measure. Total splenectomy is the last life-saving measure for splenic injuries. After splenectomy vaccination prophylaxis and patient education to prevent severe infections are an integral part of the procedure.

Severe trauma is a frequent cause of death worldwide, especially among younger patients and predominantly due to blunt abdominal trauma. While the liver is often affected, pancreatic injuries are rare. The initial diagnostics include the medical history, physical examination, laboratory tests and the focused assessment with sonography for trauma (FAST). The estimation of hemodynamic stability is decisive. Emergency laparotomy is indicated for critically ill patients and those with an accumulation of free intraabdominal fluid detected by sonography. Stable or stabilizable patients should undergo triphasic contrast-enhanced computed tomography. This enables classification of the injury pattern according to the injury scoring scale of the American Association for the Surgery of Trauma (AAST) and explicit detection of active bleeding and helps to estimate the extent of the injuries. Nonoperative management (NOM) has become established as the standard treatment. In addition to pure monitoring, special interventions are also used. A surgical approach is necessary in cases of instability, extensive injuries or failure of the NOM. The surgical approach depends on the pattern of injury and is similar to that of elective surgery. In addition to local hemostasis resections are possible. Both NOM and complex surgical treatment should be performed at specialized centers.

Hollow organ and mesenteric injuries occur in up to 7% of all cases of abdominal trauma and are linked to high morbidity and mortality, especially with delayed diagnosis and treatment. The causes include blunt, penetrating or blast injuries. Hollow organ injuries are more frequent in penetrating trauma, while injuries of the parenchymatous organs dominate in blunt trauma. The clinical diagnosis is difficult as the early symptoms are often nonspecific. Important predictors include abdominal tenderness, the seatbelt sign, leukocytosis, lactatemia and abnormalities in computed tomography (CT). The use of CT is considered the gold standard in the diagnostics but has limited sensitivity despite high specificity. Therefore, close clinical monitoring and, if necessary, repeated imaging is mandatory. Scoring systems, such as the bowel injury prediction score (BIPS) help identify injuries which require surgery. The treatment depends on the injury pattern and the condition of the patient. Stable patients without radiological signs of injury can initially be managed conservatively. Specific CT signs (e.g., pneumoperitoneum, bowel wall discontinuity) indicate the need for surgical exploration. Surgical options range from simple suturing to resection with primary anastomosis or placement of a stoma. In unstable patients damage control strategies including open abdomen therapy may be required.

Background: Antibiotic prophylaxis is a key component of infection prevention in trauma and orthopedic surgery. Until 2024, no uniform nationwide guidelines existed in Germany regarding the optimal choice, dosage, and duration of perioperative antibiotic use.

Methods: A nationwide survey was conducted among 36 German trauma and orthopedic centers to assess current practices of antibiotic prophylaxis in closed and open fractures, primary arthroplasty, and posterior spinal instrumentation. The questionnaire included the choice and duration of systemic antibiotics, empirical strategies, and the use of local antibiotics such as vancomycin powder. The current practice was then compared to the recently published S3-guideline "Perioperative and periinterventional antibiotic prophylaxis" (AWMF 067-009; https://register.awmf.org/de/leitlinien/detail/067-009 ) in Germany.

Results: For closed fractures, 94.4% of hospitals used first- or second-generation cephalosporins, with single-shot administration. In Gustilo-Anderson (GA) type I open fractures, cefuroxime and ampicillin/sulbactam were each used by 13 hospitals (36.1%), with 63.9% applying a single-shot regimen. In type III open fractures, piperacillin/tazobactam was most common (33.3%), and 72 h prophylaxis was most frequently reported in both type II and III fractures (38.9%). In distal phalanx fractures, 94.4% of hospitals administered systemic antibiotics despite guideline recommendations to omit prophylaxis when no osteosynthesis is required. In arthroplasty, cefuroxime (50.0%) and cefazolin (41.7%) predominated, with single-shot use in 94.4%. In spine surgery, 38.9% additionally used local vancomycin powder.

Conclusion: While guideline adherence is high in routine indications, significant deviations remain in open fractures and distal phalanx fractures of the fingers. Extended prophylaxis beyond 72 h in GA type III fractures and the frequent use of antibiotics in distal phalanx injuries contrast with current recommendations. Stronger implementation of national standards is essential to reduce overtreatment and support antimicrobial stewardship.