Unfallchirurgie (Heidelberg, Germany)最新文献

The indications for tibial nailing are increasingly extending into periarticular regions, often under critical and challenging soft tissue conditions. Furthermore, due to the demographic development fractures of compromised osteoporotic bone must increasingly be surgically treated.Suprapatellar and parapatellar approaches have emerged as effective alternatives to the traditional infrapatellar approach, which simplify the operative technique of reduction and nail insertion, reduce the duration of intraoperative fluoroscopy time and yield improved reduction outcomes particularly in complex periarticular fractures.The insertion of the intramedullary locking nail into the medullary canal does not automatically guarantee an adequate reduction outcome. This article outlines key operative tips and tricks aimed at supporting the orthopedic surgeon in obtaining reproducible optimal surgical outcomes especially in borderline indications.Technological advancements in nail design and fixation methods enable more reliable and precise reduction even in complex cases, especially with fractures involving short metaphyseal fracture fragments. This article also addresses the specific requirements for achieving stable intramedullary fixation.

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.

Thoracoabdominal impalement injuries involving the aorta represent an extremely rare but highly life-threatening trauma scenario. We report the case of a 50-year-old construction worker who sustained an impalement injury after falling approximately 8m onto an upright standing wooden hammer handle, resulting in thoracoabdominal penetration. The injury resulted in multiple trauma, including damage to the lungs, diaphragm, spleen and kidneys as well as a contained dissection of the thoracic aorta. The patient was treated within the framework of an interdisciplinary, time-critical management approach involving emergency surgical interventions and thoracic endovascular aortic repair (TEVAR). Despite initial hemorrhagic shock and respiratory complications, the patient was successfully stabilized and transferred to inpatient rehabilitation after 6 weeks. This case highlights the importance of structured emergency response systems, advanced endovascular techniques and early psychological trauma care to improve long-term outcomes and prevent posttraumatic stress disorders.

An overseas assignment in a rural hospital in Tanzania provides surgeons with extraordinary insights into clinical practice under completely different conditions. The injury patterns are largely determined by motorcycle accidents: open fractures, traumatic brain injuries and polytrauma dominate the spectrum. Limited resources make simple and robust techniques, such as external fixation, lag screw osteosynthesis and plaster cast treatment central to patient care. Diagnostic options and intensive care are restricted, requiring a renewed focus on clinical examination, prioritization and pragmatic solutions. In addition to clinical work, the training of young colleagues plays a key role in sustainably strengthening local structures. Such an assignment broadens professional horizons, sharpens clinical judgment and fosters a deep appreciation of the possibilities offered by modern surgery in Europe.

Periprosthetic distal femoral fractures (PPDFF) following knee arthroplasty represent an increasing challenge for trauma surgery and orthopedics, particularly for older multimorbid patients. Treatment concepts vary depending on the fracture type, prosthesis stability, bone quality and patient factors [1, 6-10, 13]. Depending on the fracture type and bone quality, modern locking angle plates, retrograde intramedullary nails with angulated stems, double plate and nail-plate constructs provide a high primary stability and usually enable early functional mobilization [5, 6, 11, 13, 30-33]. In very distal, osteoporotic or complex fractures, double plating is often biomechanically superior and reduce complications such as nonunion and implant failure [2, 10, 11, 13, 14, 22, 29], although there is also a risk that the bone behind the femoral shield will not properly consolidate. Distal femoral replacement is indicated in cases of extensive bone loss or primary loosening of the prosthesis [8]. Early mobilization, especially in the mostly older patient population, improves the functional outcome and reduces mortality [1, 5, 11, 13, 16, 27, 30-33]. The aim of this review article is to systematically present and evaluate current treatment options, their evidence, specific complications and functional outcomes.

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: 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.

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.

Extra-articular fractures of the distal femur are gaining relevance as a typical injury in geriatric traumatology. While conservative treatment is reserved for exceptional cases, minimally invasive angular stable plate osteosynthesis and retrograde intramedullary nailing are established options for surgical treatment. Depending on the type of fracture and patient-specific factors double plate osteosynthesis using additional medial helical plates or combinations of different types of osteosynthesis are used.