Unfallchirurgie (Heidelberg, Germany)最新文献

Background: The majority of the total costs in German hospitals are accounted for with around two thirds for personnel costs for medical and nursing services. The aim of this study was to present a health-economic model for physician and nursing service costs for the cost-intensive areas operating room (OR), intensive care unit and peripheral ward in a university orthopedic trauma department.

Methods: Based on the remuneration per collective bargaining classification in 2024 and corresponding assumptions of the physician and nursing staffing for a university orthopedic trauma department, the staffing costs of 1min in the OR were determined. An exemplary model for the calculation of surgical staff costs was created for gamma nail osteosynthesis for proximal femoral fractures and angle-stable plate osteosynthesis for proximal humeral fractures. For the intensive care unit and peripheral ward, the staffing costs per bed were calculated for a 24‑h day.

Results: The staffing costs per minute in the OR amounted to 5.63 €. The model calculations resulted in staffing costs of 300 € for gamma nail osteosynthesis for proximal femoral fractures (Ø 53 OR minutes) and staffing costs of 567 € for angle-stable plate fixation for proximal humeral fractures (Ø 101 OR minutes). The staffing costs for a 24‑h day amounted to 807 € per bed in the intensive care unit and 192 € for the peripheral ward.

Conclusion: On the basis of the model presented, it is possible to calculate the staffing costs in the operating room as well as in the intensive care unit and peripheral ward. Taking the structural and staff basic conditions into account, the model can also be transferred to hospitals at other levels of care and can serve as a basis for a cost-effective deployment of staff.

Background: The diagnostics and treatment of blunt abdominal trauma is highly diverse and should ideally be standardized.

Objective: This article provides an overview of radiological diagnostic and treatment options.

Material and methods: An overview of the primary diagnostics and key findings in blunt abdominal trauma as well as the diagnostics and treatment of retroperitoneal bleeding is presented.

Results and discussion: Multiphase computed tomography represents the gold standard in trauma diagnostics and can guide further treatment. A variety of embolization techniques are available for the treatment of retroperitoneal bleeding, depending on the pathological alterations and goal.

Humeral shaft fractures are rare in childhood, accounting for less than 5% of all pediatric fractures. Indirect trauma predominates in younger children, whereas direct trauma is more common in older patients. To date, no uniform recommendations exist regarding diagnostic evaluation or treatment management. Therefore, during the 13th and 14th scientific meetings of the Pediatric Traumatology Section (SKT), the available evidence was reviewed, the management strategies were critically discussed within an expert panel and a consensus was formulated.The management remains predominantly conservative, although the number of surgically treated cases is increasing. Potential humeral length discrepancies are generally clinically not a problem, whereas angular deformities exceeding 10° are cosmetically relevant. Owing to the extensive range of motion of the shoulder, functional impairment is generally not expected. In conservative treatment immobilization is recommended for 3-6 weeks, depending on the fracture type and patient age. Absolute indications for operative intervention include open fractures (> type II), unstable multilevel injuries of the affected arm and severe soft tissue damage that precludes adequate immobilization. Relative indications comprise polytrauma, traumatic brain injury, multiple or bilateral injuries, simple transverse fractures due to inherent instability and prolonged healing, anticipated noncompliance and patient preference. Elastic stable intramedullary nailing (ESIN) represents the gold standard for surgical management. Typical complications include radial nerve injury, technical difficulties during fixation and nonunion.Traumatic radial nerve palsy occurs in approximately 4% of cases. The treatment approach selected based on fracture morphology should be maintained. Primary nerve exploration is not initially required. High-resolution ultrasonography of the radial nerve should be performed within 1-2 weeks in both primary and secondary palsy. Nonstructural lesions typically recover spontaneously within 3-6 months. Early physiotherapy and occupational therapy are recommended in the presence of nerve deficits. In cases of an inadequate trauma mechanism, pathological fractures or potential indicators of child abuse must be considered.

Toe injuries are common in clinical practice and cover a wide spectrum, from simple fractures and dislocations to complex tendon and soft tissue injuries. While most injuries can be conservatively treated, displaced fractures, open injuries or relevant loss of function require a differentiated surgical approach. Rare but prognostically important entities, such as décollement injuries or proximal tendon ruptures pose a particular challenge. A structured clinical examination supported, if necessary, by imaging is essential for making the correct diagnosis and deciding on the appropriate treatment. This article provides a comprehensive overview of the diagnostics, surgical and conservative treatment options as well as possible complications and their management.

Compared to ruptures of the Achilles tendon, injuries to the tibialis anterior and tibialis posterior tendons or the peroneal tendons are relatively rare, so that the literature on this subject largely consists of individual case reports and small case series. There are major differences between the individual entities in terms of the pathogenesis, possible sequelae and treatment recommendations. This article is intended to provide an overview and instruction manual for the clinical management.

Background: The treatment of fragility fractures of the pelvis (FFP) is becoming increasingly more important due to the demographic changes. Older age and the associated multimorbidity pose a challenge for the optimal treatment of pelvic fractures.

Method: A total of 36 patients were included. They were categorized according to the FFP classification with the following distribution: 44.4% FFP II, 16.7% FFP III and 38.9% FFP IV. Transiliosacral screws used unilaterally/bilaterally (cannulated 7.3 mm titanium screws with 32 mm thread, MedTech J&J, Umkirch, Germany) were compared to a continuous transiliosacral sacral rod (cannulated 7.5 mm rod, Marquardt, Spachingen, Germany) for stabilization of the posterior pelvic ring (screw vs. rod) and in combination with or without a ventral supra-acetabular external fixator (steel Schanz screws with cross-connectors classified as ⌀Fix vs. Fix). The parameters measured were the duration of surgery, complication and revision rates and functional outcomes. The quality of life on the visual analogue scale (EQ-VAS), EQ-5D-5L index and Elderly Mobility Scale (EMS) were compared 1 day, 6 weeks and 6 months postoperatively.

Results: The mean age of the overall cohort was 81.5 ± 7.7 years and the overall mortality rate was 5.6%. The higher complication (29.4% vs. 17.6%, p = 0.419) and revision rates (5.9% vs. 0.0%, p = 0.310) of the screw group were not statistically significant. The EQ-VAS, EQ-5D-5L and EMS showed no significant differences between screw vs. rod. The fix group had a longer operation time (47.2 ± 9.2 min vs. 35.2 ± 20.2 min, p = 0.005) but a lower complication rate (11.1% vs. 28.0%, p = 0.306); however, their mobility was significantly reduced postoperatively and after 6 weeks (EMS day 1: 6 ± 4 vs. 11 ± 4, p = 0.003; week 6: 12 ± 2 vs. 16 ± 3, p = 0.010).

Discussion: Osteoporosis treatment had not been performed prior to the injury in 64.7% of the injured patients, 29.4% received a basic treatment for osteoporosis and 5.9% received specific treatment for osteoporosis. Surgical treatment of FFP II-IV showed a good clinical outcome with age-appropriate values after 6 months. The clinical outcome was the same after 6 months regardless of the surgical procedure.

Since the beginning of the Russian invasion, approximately 2000 war casualties have been treated in Western Europe and of these 324 patients were distributed to North Rhine-Westphalia (NRW) via the SPoC.NRW cloverleaf system. The types of injuries and the required medical specialties were determined as well as their distribution transferred to the structures of the German Society for Trauma Surgery (DGU local, regional, supraregional trauma centers). As expected, 94% of the injured were between 21 and 60 years old, 66% of the injuries affected the upper extremities (26.6%) and the lower extremities (39.8%). The required departments were evaluated based on the affected locations. This revealed that in addition to trauma surgery (89%), plastic surgery (61%) and general surgery (8%) were predominantly required. In interdisciplinary treatment the typical head and neck specialties (neurology, ENT, ophthalmology, maxillofacial surgery = 19%) were involved. Ukrainian war casualties treated in hospitals in NRW that were willing to accept such patients have so far received very good care. The distribution of Ukrainian war casualties treated in NRW shows a concentration in supraregional trauma centers (55%). In the event of a military intervention, it is anticipated that over 1000 patients requiring treatment will arrive in Germany every day. These first data provide insights into future needs of medical care.

Traumatic injuries to the liver, spleen and kidneys often pose a challenge in acute care. In addition to conservative and surgical treatment, interventional radiology provides a minimally invasive option for bleeding control and organ preservation. The indications for transarterial embolization depend on the hemodynamic stability, imaging results and accompanying injuries. Special technical aspects, such as the selection of embolization material, microcatheter techniques and consideration of anatomical conditions are crucial for treatment success. Knowledge of the indications, contraindications and technical details enables targeted, patient-oriented treatment. Interventional procedures reduce the need for open surgery, lower the mortality in severely injured patients and help to preserve organ function. This article highlights the role of interventional radiology in the care of trauma patients with bleeding in the solid organs of the upper abdomen.

Acute aortic injuries are among the most life-threatening emergencies in vascular and emergency medicine. They are mostly caused by high-velocity trauma with deceleration and shear forces in the region of the aortic isthmus. Due to the anatomical features these particularly result in tears or complete transection of the vascular wall. Without rapid diagnosis and treatment the majority of cases are fatal. Contrast-enhanced computed tomography (CT) angiography is considered the diagnostic gold standard and enables a precise classification of the injury according to the severity and immediate treatment planning. Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for lesion grades II and III. The interdisciplinary interplay of interventional radiology, cardiovascular surgery and anesthesia can achieve a significant reduction in the perioperative mortality. Although mortality rates of up to 20% have been reported after open surgery, the mortality after TEVAR is between 7% and 9%. Neurological complications, particularly spinal ischemia, are less common than after open surgical treatment. Following successful TEVAR a life-long imaging follow-up is necessary for the early detection of prosthesis migration, endoleaks or infections.

Background: Trauma registries provide essential insights into the quality of care for severely injured patients. This study compares key epidemiological, clinical and process-related parameters from Germany, Austria and Switzerland based on the respective national trauma registry data.

Methods: A narrative descriptive analysis of the most recently available registry data was performed. For Germany (TR-DGU, 2023) and Austria (TR-ÖGU, 2023), only data from the core dataset were included [1, 2]. For Switzerland, in the absence of national annual reports, published analyses of the Swiss Trauma Registry (STR, 2015-2019; Costa et al.) were used, which exclusively include patients with an injury severity score (ISS) ≥ 16 and/or abbreviated injury scale (AIS) score of the head ≥ 3 [3, 4]. Due to differences in inclusion criteria and time periods, no inferential statistical comparisons were conducted.

Results: In 2023 Germany documented 31,217 patients in the core dataset, including 28,718 primary admissions (mean age 54.5 years, 69.6% male, mean ISS 18.5). The in-hospital mortality in the outcome cohort of 25,208 patients was 7.4% [1]. Austria reported 1060 cases in the same year (mean age 50.2 years, 73.8% male, mean ISS 22.6) with a mortality of 14.7% [2]. In Switzerland, the published STR analyses between 2015 and 2019 included a total of 13,222 patients (mean age 58 years, 68% male, mean ISS 22) with a mortality of 11.6% [3, 4]. While blunt trauma dominated in all three countries (> 90% in Germany and Austria, ≈ 94% estimated for Switzerland), prehospital structures differed: Germany and Austria rely on emergency physician-based systems, whereas Switzerland relies more on paramedics. Process parameters such as prehospital intubation, whole-body CT in the trauma room and transfusion rates vary between countries but overall indicate comparable clinical care pathways.

Conclusion: Trauma care in the DACH region is broadly comparable but differs in patient demographics, case selection, trauma mechanisms and mortality. Because the STR data used in this study are derived exclusively from publications including only severely injured patients, the Swiss cohort by definition reflects a more severely injured population than the German and Austrian core datasets. Harmonized registry structures and joint analyses could enhance transnational learning and further improve the quality of care.