Unfallchirurgie (Heidelberg, Germany)最新文献

Proximal humeral fractures are not only frequent injuries but also serve as an important indicator for a possibly underlying osteoporosis. Therefore, in addition to fracture management, timely diagnostics and treatment of the osteoporosis should also be prioritized. The decision between a conservative and surgical treatment approach requires a differentiated consideration of the fracture morphology, individual patient characteristics and functional expectations. Conservative treatment can be an adequate alternative in specific cases, particularly in geriatric patients with low functional demands; however, the standardization of this treatment approach remains challenging. Surgical interventions have proven effective, especially for complex fractures, with reverse shoulder arthroplasty emerging as a reliable option. Various augmentation and fixation techniques, such as the combination of locking plates with fibular grafts or double plating osteosynthesis, demonstrate biomechanical advantages and can improve the primary stability. Innovative technologies, including 3D planning, intraoperative navigation and robotics, offer new possibilities for optimizing implant placement and can contribute to improvement of long-term clinical outcomes. Economic analyses suggest that reverse arthroplasty can provide not only clinical benefits in selected cases but can also be cost-effective; however, further evaluation of the long-term impact on the healthcare system is required.

Fractures and ligamentous lesions of the thumb ray are frequent due to the exposed position of the thumb. A thorough anatomical understanding with respect to the joints and stabilizing ligaments is essential for a targeted examination, the selection of appropriate imaging diagnostics and the decision for a surgical or conservative treatment approach. Misdiagnoses or untreated injuries can lead to impaired functionality, pain and instability, which can substantially impair the function of the hand, particularly thumb opposition.

Posttraumatic femoral head necrosis after a femoral neck fracture in children and adolescents is a rare but severe complication. If this occurs in older patients a total hip arthroplasty (THA) is mostly indicated. In children and adolescents the primary goal of treatment is preservation of the hip joint. There is no standard treatment or generally applicable treatment recommendation. Various measures for treating this rare entity are discussed in the literature. In addition to conservative measures, retrograde drilling with or without cancellous bone grafting, joint distraction or grafting measures are available. As a final solution, however, a THA is also a suitable treatment option as soon as the anatomical conditions are appropriate.

Traumatic acute compartment syndrome in childhood is a rare complication following an accident but it occurs more frequently than generally assumed. The accident mechanisms and anatomical localization are very well known so that this complication must always be considered if these risk factors are present. The diagnostic confirmation is based on clinical examination findings and implies the assessment of the three A's: increasing anxiety, agitation and analgesic requirement. The measurement of compartment pressure can only be used if this examination is not possible or appears unsafe; however, there are no recognized age-adapted normal values. In the presence of manifest acute compartment syndrome, a timely dermatofasciotomy is the only treatment measure that results in a very good functional outcome. Otherwise, Volkmann's ischemic contracture cannot be avoided.

Although injuries to the triangular fibrocartilage complex (TFCC) are less common in children and adolescents than in adults, can lead to chronic pain and instability in the distal radioulnar joint (DRUJ), ultimately predisposing individuals to long-term osteoarthritis. A dislocated distal radius fracture with avulsion of the styloid process of the ulna following high-energy trauma is a risk factor for a TFCC injury. The diagnostics include a thorough clinical examination and imaging procedures, such as X‑ray and magnetic resonance imaging (MRI). If there is no instability of the DRUJ, conservative treatment can be successful in most cases. However, if there is instability of the DRUJ or if there is no improvement after 3 months of conservative treatment, diagnostic arthroscopy of the wrist is indicated for further diagnostics and concurrent treatment. Depending on the age and extent of the injury, various surgical techniques can be used, such as transcapsular or transosseous refixation. Early diagnosis and treatment are essential to achieve freedom from pain, a stable DRUJ and enable a return to sports activities. In our own patient collective 12 children and adolescents showed very good results with no major complications.

The increasing overlap between trauma surgery and orthopedics presents new challenges for medical training. However, specialized and structured training is essential, particularly in acute traumatology. With the Austrian Society for Trauma Surgery (ÖGU) diploma "Advanced Trauma Surgery | Traumatology", ÖGU offers a 3‑year training program that combines theoretical content with practice-oriented modules. The aim of the program is to optimally prepare specialists and residents for modern trauma care. The first round of the program will start in October 2025 as part of the Austrian Trauma Days.