Unfallchirurgie (Heidelberg, Germany)最新文献

Vibrio vulnificus (V. vulnificus) is a gram-negative bacterium that can cause severe infections after entering the human body via open wounds or consumption of shellfish. An increased occurrence of bacteria is known at water temperatures > 20 °C. In addition, a low salt content of 5-25‰ is beneficial for the reproduction of Vibrio spp. In the review by Fleischmann et. al. the direct correlation between low salinity and high water temperature with the increased occurrence of V. vulnificus on German Baltic Sea coasts was demonstrated [7]. It can cause fulminant necrotizing fasciitis which can result in amputation, septic shock and death. This case report shows the successful surgical treatment in Germany of a fulminant lower leg infection with septic shock after coming into contact with Baltic Sea water. A rapid and extensive debridement was followed by the successful transplantation of cutaneous tissue using a mesh graft.

Background: It is known that fractures of the pelvic ring and acetabulum in work-related accidents are associated with long periods of incapacity to work, a high rate of reduction in earning capacity (MdE) and high costs for pension/severance pay.

Objective: Investigation of changes in pension claims and costs from 2013 to 2019 after isolated fractures of the pelvic ring and acetabulum in work-related accidents in Germany.

Material and methods: For all patients from the German Social Accident Insurance (DGUV) registry with isolated fractures of the pelvic ring or acetabulum in work-related accidents, linear trend analyses were carried out among others for the proportion of MdE ≥20%, the proportion of cases receiving pension/severance pay and total costs for pension/severance pay from 2013 to 2019. A logistic regression analysis for the likelihood of receiving a pension was also performed.

Results: The proportion of MdE ≥20% decreased for fractures of the pelvic ring and acetabulum in total from 14.3% for 2013 to 8.2% for 2019 and there was a decreasing trend for the proportion of cases receiving pension/severance pay for fractures of the pelvic ring and acetabulum in total from 23.1% for 2013 to 13.6% for 2019 as well as for both fracture types individually. There was also a decrease in the costs for pensions/severance pay for fractures of the pelvic ring and acetabulum in total from € 1,542,531 for 2013 to € 1,006,887 for 2019. The likelihood of receiving a pension decreased by 8% per subsequent accident year between 2013 and 2019.

Conclusion: The proportion of pension claims and thus the costs for pensions/severance pay decreased for isolated fractures of the pelvic ring and acetabulum in work-related accidents from 2013 to 2019. The DGUV seems to fulfil its guideline Rehabilitation before pension.

Background: Given that a primary osteoporotic fracture can result in subsequent fractures and that the precise etiology of the typical fracture cascade remains uncertain, it is pertinent to determine the initiating factor and the specific fracture involved in this cascade.

Method: All patients with a fracture of a long bone were consecutively screened over the 12-month study period. All participants were asked about existing risk factors (including previous fractures) in accordance with the applicable guidelines of the Umbrella Organization Osteology (DVO). The existing risk factors were employed to calculate the fracture risk and this formed the basis of the diagnosis and indications for treatment.

Results: A total of 613 patients were included in the study. Of the total number of patients 378 were deemed to require pharmacological treatment for osteoporosis. In this cohort 182 fractures were reported. Among the previous fractures distal radius fractures were the most common, occurring in 54 patients followed by fractures of the proximal femur (n = 40) and proximal humerus (n = 27). As anticipated, a breakdown of the data by gender revealed a different picture. In line with the incidences it can be seen that men have fewer distal radius fractures and more fractures close to the hip joint.

Discussion: The results indicate that women with a distal radius fracture have the potential to facilitate an early diagnosis and subsequent treatment for osteoporosis. In contrast, in men fractures in the region of the hip joint were the most common initial presentation, precluding the possibility of deriving an early indication of the presence of osteoporosis from previous fractures.

Background: In most cases osteoarthritis of the ankle is of posttraumatic origin. Younger people are more frequently affected, which makes treatment a particular challenge. In addition to conservative treatment numerous surgical procedures are available for the treatment of advanced arthrosis. The aim of this nationwide survey was to document the current status of the diagnostics and treatment of ankle arthritis in Germany.

Material and methods: Members of the German Society for Orthopedics and Trauma Surgery (DGOU) were invited to participate in an anonymous online survey on the treatment of ankle joint osteoarthritis. The survey included 69 questions on the person, on the diagnostic and treatment approaches as well as 3 clinical and radiological patient cases. The evaluation of the results of the survey included differences in the subgroups of participants based on the discipline, the location of activity, position and certification.

Results: From November 2019 to February 2020 a total of 343 members participated in the survey. For the diagnostics 96% requested conventional radiographs in a standing position and in 2 levels. Other native radiographs were considered necessary by less than half of respondents. Less than one third of participants sometimes (n = 87) or always (n = 18) use an outcome score. The therapeutic repertoire included supramalleolar osteotomy (n = 106), ankle arthroplasty (n = 100) and arthrodesis (n = 248). Open arthrodesis using screws through an anterior approach was the most frequently used surgical procedure.

Conclusion: Diagnostic standards were regularly used in the treatment of ankle arthrosis. With respect to the surgical treatment there was a wide heterogeneity due to the pathological anatomy and preferences of the participants. Open arthrodesis was the most frequently selected procedure.

Fractures of the thoracic (Th) and lumbar (L) vertebrae are among the most frequent fracture entities in Germany and particularly affect the thoracolumbar junction (TLJ; Th11-L2). Based on expert recommendations and consensus meetings, the thoracolumbar AOSpine injury score was established for patients with healthy bone and the osteoporotic fracture (OF) score for geriatric patients with the respective classifications for treatment decisions. In both cohorts, the treatment decision is based on the fracture morphology, neurological status and patient-specific contextual factors. In terms of fracture morphology, surgical treatment is generally indicated for distraction and rotation/translation injuries. The treatment decision for compression fractures is more complex as additional factors must be taken into consideration. The decision in patients with healthy bone is primarily influenced by imaging morphological criteria (deformity and destruction) whereas in osteoporotic patients the decision is influenced by individual criteria, such as the general condition, the possibility of low pain mobilization and concomitant diseases. Overall, the treatment decision for fractures of the TLJ is not dogmatic as individual factors must be considered and high-quality studies are lacking.

Osteoporosis-related vertebral fractures are among the most frequent fracture entities in geriatric patients. They are associated with far-reaching individual and socioeconomic consequences. Adequate diagnostics and treatment are therefore essential. The osteoporotic fracture (OF) score is a central element in determining the right treatment. Although the majority of fractures can be healed with conservative treatment, a change of treatment should be considered in good time in cases of failure. Isolated cement augmentation procedures are particularly suitable for reducing pain in primarily stable osteoporotic vertebral fractures with a preserved framework structure (OF types 1-3) and a largely intact posterior edge. Dorsal cement-augmented stabilization with cementing of the fractured vertebral body leads to good results in unstable OF types 3 and 4 fractures. Dorsoventral procedures with cement-augmented internal fixator from the dorsal side and vertebral body replacement from the ventral side play a more subordinate role. Purely ventral procedures should be avoided in this patient group.

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.

We report the case of a 66-year-old female patient with a treatment refractory disorder of wound healing of the knee, who had already been treated several times surgically and with antibiotics for several months. The examination revealed a skin defect with a fistula in the region of the knee joint. The X‑ray imaging showed an extensive bony defect of unclear etiology. After specific diagnostics for acid-resistant rod-shaped bacteria, it was possible to identify Mycobacterium tuberculosis as the causative pathogen. After antitubercular drug treatment complete healing of the lesions was observed. The bony defect could be filled with bone substitute. There was neither a history of primary foci nor of a potentially infectious environment.