Unfallchirurgie (Heidelberg, Germany)最新文献

The centerpiece in private accident insurance is the compensation in cases of disability, which must be determined by a physician within a certain time limit. The insurer contract specifies the compensation rate for loss or inability to function. In cases of insurance the medical expert has to refer to generally accepted revised or updated assessment recommendations in order to be able to apply the given framework to the specific individual disability situation of the insured person. This article deals with the interdisciplinary consensus benchmarks for the assessment of disability, which form the principles of a uniform medical assessment of accident-related functional disorders in the private accident insurance.With the publication of these new assessment recommendations developed under the guidance of the Specialist Society of Interdisciplinary Medical Expert Opinion (FGIMB), the recommendations published by Schröter and Ludolph in 2009 [12] are withdrawn, so that these are now replaced as the authoritative version by the assessment recommendations of the FGIMB.

The supracondylar humerus fracture is the most frequent fracture of the elbow region during the growth period. The peak age is around 5 years. Extension fractures predominate. The clinical diagnostics are supplemented by X‑ray images in two projections. Growth-associated spontaneous corrections of posttraumatic deformities rarely occur. The goal of treatment is therefore the active transformation of every displaced fracture into a nondisplaced stably fixed fracture.If this is not successful, the consequences of healing in a malalignment can be, e.g., restriction of elbow flexion due to remaining antecurvation or cubitus varus. Combinations are often present. The causes include technical problems with reduction and retention but also misjudgement of the X‑ray findings, ignorance of the growth prognosis or inadequate verification of whether the treatment goal has been achieved.Unsatisfactory treatment results should be corrected as early as possible. This can be done primarily before bony healing is completed or secondarily as a corrective osteotomy at any later point in time. The earlier the correction of the malalignment is performed, the greater the chances of a complete restoration to the original condition. Depending on the type and extent of the deformity various techniques for corrective osteotomy are suggested in the literature.

The reconstruction of long bone defects as a result of primary traumatic, secondary infection or tumor-related loss of substance continues to represent a surgical challenge. Callus distraction via segment transport, vascularized bone transfer and the induced membrane technique (IMT) are established methods of reconstruction. In recent decades IMT has experienced increasing popularity due to its practicability, reproducibility and reliability. At the same time, the original technique has undergone numerous modifications. The results are correspondingly heterogeneous. This overview is intended to explain the basic principles of IMT and to provide an overview of the various modifications and their complications.

Background: Fractures of the distal radius in childhood are frequent but rarely lead to relevant growth disturbances.

Objective: The experiences of a pediatric trauma center over 15 years are exemplarily presented and discussed.

Material and methods: Osteotomies of the distal radius were selected and the clinical and radiological findings were recorded and analyzed.

Results: Posttraumatic growth disturbances were corrected in 10 cases with a median age of 13 ½ years. In six cases an iatrogenic cause was also possible. In two cases callus distraction with secondary palmar plate osteosynthesis was used for consolidation. In eight cases primary ad hoc corrections were carried out using palmar plate osteosynthesis (six with iliac crest and two with allogeneic grafts). In five cases the distal ulnar growth plate was also addressed. During follow-up breakage of one plate was registered. After an average of 31 months postoperatively, 9 children had full range of motion (ROM) and in 1 case there was an extension deficit of 10^o.

Conclusion: It is important to evaluate the cause of the mostly partially inhibiting growth disturbances to draw preventive conclusions. From a clinical perspective the visible deformity is given priority and the pain and functional limitations are less relevant. The indications for corrective surgery must include the age of the patient, remaining growth potential, size and localization of the growth plate bridge, the deformity and the individual wishes of patients and parents. In most cases a full correction is possible with palmar plate osteosynthesis and an iliac crest graft. External fixation and callus distraction is an alternative in cases where the correction is more extensive. The distal ulnar growth plate should be controlled concerning further growth potential before hardware removal.

Background: To break or not to break-That is the question that has been asked in pediatric traumatology for many years regarding the treatment of greenstick fractures of the diaphyseal forearm shaft.

Objective: The frequency of greenstick fractures of the forearm shaft in children and adolescents; the influence of breaking the fracture on the refracture rate.

Methods: Analysis and discussion of relevant articles, analysis of the refracture rate of pediatric greenstick fractures of the forearm shaft in our own patient population.

Results: Greenstick fractures frequently occur in the area of the forearm shaft and incomplete consolidation leads to an increased refracture rate. In the patient collective of the authors of 420 children with greenstick fractures of the diaphyseal forearm, there was a refracture rate of 9.5%; however, the rate for non-completed fractures was significantly higher compared to the group with completed fractures (15.2% vs. 3%). While in the subgroup of conservatively treated fractures (n = 234), breaking the intact cortex significantly reduced the refracture rate, breaking the intact cortical bone during surgical treatment with elastic stable intramedullary nailing (ESIN) did not change the refracture rate.

Conclusion: As part of the conservative treatment of greenstick fractures of the diaphyseal forearm, completing the fracture can be recommended in order to lower the refracture rate. Completing the fracture does not appear to be necessary during surgical treatment using ESIN.

Background: Primary periphyseal stress injuries (PPSI) of the hand and fingers are a rare condition overall but are most commonly seen in adolescent rock climbers and is the most common sport-specific injury in young climbers. Early diagnosis and treatment are crucial for a good treatment outcome and to avoid chronic sport-related injury.

Objective: The aim of the study is to introduce the injury to a wider audience. Based on an analysis of the current literature, the pathophysiology is demonstrated and the diagnostic and treatment standards are analyzed. Prophylactic measures are also reported.

Material and methods: Based on a systematic multiple database analysis, the current literature on PPSI of the hand and fingers in climbers were collected and further analyzed in a narrative review. The pathophysiology, diagnostic and treatment concepts are presented.

Results: Most cases of PPSI to the hand and fingers are in young rock climbers; however, a few cases have been reported in gymnasts, baseball players and piano players. Overall, there are over 200 documented cases in the literature. Most are Salter-Harris III/Aitken II fractures but grade I, II and IV fractures have also been reported. Patients are mostly 13-15 years of age and within the main pubertal growth spurt. After diagnosis, usually by magnetic resonance imaging (MRI), treatment is often conservative, with an increasing number of cases requiring surgical revision. Surgery usually involves spot drilling of the growth plate to induce fusion.

Discussion: Early diagnosis and treatment are critical for a good outcome. This includes specific education and information for athletes, coaches, parents and treating physicians. Also, the frequent use of the crimp position has also been shown to increase the risk of PPSI. Preventive aspects should target this as well as overall load management.

This article reports on a complicated case of a soft tissue defect with challenging soft tissue coverage on the lower leg. After a lower leg fracture and treatment with a tibial nail, a 29-year-old man developed compartment syndrome due to massive secondary bleeding with a lesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with a soft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated a delayed incomplete healing over 8 months. In addition, X‑ray imaging revealed a nonunion and a resulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and a difficult local blood flow situation, the choice of reconstruction procedures was limited. A bridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1 year.

Background: Due to continuous improvements in treatment, more and more severely and seriously injured patients are surviving. The complexity of the injury patterns of these patients means that they are difficult to map in routine data.

Aim of the work: The aim of the data exploration was to identify ICD 10 diagnoses that show an association with an injury severity score (ISS) ≥ 16 and could therefore be used to operationalize severely injured patients in routine data.

Material and methods: The coded four-digit ICD 10 S diagnoses and the calculated ISS of trauma patients from the Armed Forces Central Hospital Koblenz (BwZKrhs) and the University Hospital Düsseldorf (UKD) were analyzed using statistical association measures (phi and Cramer's V), linear regressions and machine learning methods (e.g., random forest).

Results: The S diagnoses of facial, head, thoracic and pelvic injuries, associated with an ISS ≥ 16 were identified. Some S diagnoses showed an association with an ISS ≥ 16 in only 1 of the 2 datasets. Likewise, facial, head, thoracic and pelvic injuries were found in the subgroup of 18-55-year-old patients.

Discussion: The current evaluations show that it is possible to identify ICD 10 S diagnoses that have a significant association with an ISS ≥ 16. According to the annual report of the trauma register of the German Society for Trauma Surgery (TR-DGU®), injuries with an abbreviated injury scale (AIS) ≥ 3 are particularly common in the head and thoracic regions.