Unfallchirurgie (Heidelberg, Germany)最新文献

Background: Periprosthetic fractures of the knee joint are among the major complications following joint replacement surgery. The surgical treatment is challenging and therefore requires careful preoperative planning in order to select the best possible treatment strategy.

Material and methods: This review article was compiled based on a selective literature search of the PubMed database. Evidence-based treatment recommendations are provided using common classification systems and current research results.

Results: Regardless of the location of a periprosthetic fracture in the knee, at first it has to be determined whether the knee joint endoprosthesis is stable or loose. If the implant is stable, the prosthesis can be retained with osteosynthetic treatment. In the case of a loose implant, prosthesis malfunctioning, malalignment or malpositioning, ligament instability, infection or deficient bone substance, the prosthesis has to be replaced. Knowledge of the exact classification of the fracture and the implant in place is therefore essential for determining the surgical strategy. This article focuses primarily on the different strategies for prosthesis replacement.

Conclusion: Periprosthetic fractures of the knee are complex injuries that require extensive expertise in trauma and arthroplasty in order to provide the best possible surgical treatment.

Background: Despite new working time regulations, the workload in orthopedics and trauma surgery remains high. Balancing work, family and leisure is difficult and can lead to frustration, health problems, and potential risks to patient safety, which can diminish the attractiveness of this surgical specialty. A current survey analyzes the present situation and identifies the needs of clinically active colleagues in the field of orthopedics and trauma surgery.

Material and methods: An electronic questionnaire (Microsoft Forms, Microsoft Inc., Redmond, WA, USA) was distributed to collect demographic data as well as information on current and desired working time and duty models. Additional questions addressed the work-life balance, opportunities for remote work (home office) and career goals. Data analysis and graphical presentation were carried out using Excel (Microsoft Inc) and statistical analyses were performed with SPSS Version 25.0 (IBM Corp., Armonk, NY, USA).

Results: A total of 549 individuals participated. Most participants were residents in training (n = 231) or senior physicians (n = 161). The established working time models were recognized but rated as below average in terms of satisfaction. Of the respondents 84% worked full-time with an average working time of 59.5 h per week. Both full-time and part-time employees expressed a significant desire to reduce their working hours, 54% reported the presence of an objective electronic or other time-tracking system and in 47% of cases a time-tracking account was in place. Of the respondents 84% indicated that remote work was not available, although 75% would like to make use of this option and 90% were interested in a continued employment in the hospital provided that their preferences could be implemented.

Conclusion: The workload of clinically active physicians in orthopedics and trauma surgery is high. Concepts that include a reduction in working hours, an improvement in duty-related strain, greater flexibility in working time models and the possibility of partial remote work could have a sustainable impact and offer a significant competitive advantage in view of increasingly scarce human resources.

Although relatively rare patellar fractures are challenging joint injuries with relevant implications for knee function. The clinical decision-making is primarily guided by the fracture morphology, associated soft tissue damage and patient-associated factors. In addition to the commonly used tension band wiring osteosynthesis, modern biomechanically superior plate osteosyntheses are currently available. This article provides an overview of epidemiology, diagnostics, conservative and surgical treatment options of patellar fractures.

Periprosthetic acetabular fractures (PPAF) are a rare but increasingly relevant complication following total hip arthroplasty. The management is complex and requires expertise in fracture treatment and revision arthroplasty. The treatment planning is based on the morphological fracture characteristics according to the column concept (Letournel), the extent of bone defects (fracture-related or pre-existing), the stability of the acetabular component and patient-related factors. This review article presents a practice-related algorithm on how to approach PPAFs. In addition to the preoperative diagnostics, established classification systems, surgical approaches and treatment strategies for various fracture scenarios are also presented.

Interprosthetic femoral fractures (IFF) involve fractures occurring between total hip and knee arthroplasty and represent an increasing challenge, with complication rates of up to 57% and a mortality rate of 31%. The treatment is complex and requires an individual, often multidisciplinary approach. Risk factors are related to the patient, implant and surgical technique. Classification systems, such as the one proposed by Pires enable a systematic categorization based on fracture location and morphological features of the fracture. The treatment options range from angular stable plate osteosynthesis, double plate fixation and nail-plate combinations to endoprosthetic solutions, such as stem revision, proximal or distal femur replacement or total femur replacement (TFR). As an alternative to TFR, sleeves can be used providing a bone-sparing solution. Endoprosthetic procedures are primarily indicated for loose prostheses and poor bone quality but carry a higher risk of complications. The choice of treatment depends on many factors, especially fracture type, prosthesis fixation and bone vitality. The goal is always an early functional, loadbearing reconstruction to prevent secondary complications. Preventively, attention should be paid to the biomechanically adapted and stable treatment of the primary arthroplasty. Ultimately, IFFs require detailed planning and expertise in both osteosynthetic and endoprosthetic treatment strategies.

Due to the increasing numbers of implantations by total hip arthroplasty and the simultaneous aging of the population, in many countries the prevalence of periprosthetic fractures (PPF) is increasing. Older people with corresponding comorbidities are particularly affected. The frequent cause is low-energy trauma in the sense of a stumbling fall. The surgical treatment in orthopedics and trauma surgery is challenging. It cannot be compared with an elective shaft exchange or a solitary osteosynthesis. The combination of a vulnerable patient group and complex surgical procedures results in operations that are associated with high complication and mortality rates. Therefore, patients must be preoperatively prepared in the best possible way and these must also be performed with the least possible stress for the patient. The aim of this review article is to describe the risk factors of these injuries based on the current literature. The aspects of preoperative preparation, the classification of the fractures and the options for surgical treatment of Vancouver B2 and Vancouver B3 fractures are presented. The selection of implants and the form of fixation of the revision prostheses are also included. It is decisive that the approach is protective with respect to muscle tissue and results in a stable postoperative implant as patients are often cognitively not in a position to carry out partial weight bearing. Furthermore, aspects of postoperative aftercare, possible complications and prevention are described.

Background: In tropical regions traumatic myiasis has long been recognized as a surgical complication. As a result of climate change pathogenic flies are migrating to more northern climates making this condition increasingly more prevalent in Europe.

Objective: Currently, no data from Germany exist regarding the patient-related risk factors, incidence, clinical course and expected complications. This case series aims to fill that gap. Additionally, a relationship with weather data is discussed.

Material and methods: This retrospective case analysis of six patients discusses the risk factors, systemic septic complications, treatment protocols, length of hospital stay and weather data.

Results: The median patient age was 60.5 years with an average of 4 pre-existing conditions. Risk factors included male gender (67%), socioeconomic disadvantage (84%), poor personal hygiene (67%), arterial hypertension (84%), alcoholism (50%) and lower extremity injuries (100%, 67% fracture-related). The mean hospital stay was 49 ± 25.39 days. All cases showed evidence of a bacterial superinfection. Of the admitted cases 100% underwent surgery and 80% additionally received antibiotic treatment. Amputation was required in 33% of cases. No patients required intensive care treatment for septicemia. All cases occurred in late spring and summer. On the day of admission the median daytime temperature was 20.6 °C and 14.6 °C at night with a median humidity of 66.6%. Daytime temperatures were higher on the day of admission than in the preceding week and month. There were no statistically significant differences in humidity between the three time points.

Conclusion: Traumatic myiasis has arrived in Europe. Temperature spikes and possibly humidity peaks, could trigger larval hatching and thereby favor the clinical presentation.

Background and question: The challenge in the rehabilitation of polytraumatized people is the lengthy path to the best possible recovery, which requires patience on the part of the person undergoing rehabilitation as well as continuous support. The aim of this analysis is to identify specific factors and times that are important in the rehabilitation process.

Study design and investigation methods: A total of 50 documented courses of rehabilitation management with 214 course documentations were evaluated. Problems in the course and measures taken were clustered for statistical evaluation.

Results: The patient population was similar to that of the Trauma Register of the German Society of Trauma Surgery (TR-DGU). The start of care was on average 200 days after the accident. In the initial period 4-5 months after the accident, medical and technical measures, especially obtaining second opinions, predominated in 78% of cases, further hospitalizations in 42% and further medical rehabilitation measures in 54%. Problems of occupational participation became relevant 11-12 months after the accident. Social rehabilitation management came to the fore after 15-16 months.

Conclusion: In summary, rehabilitation after polytrauma requires a comprehensive, individually adapted concept that takes the physical, psychological and social aspects of recovery into account.