Unfallchirurgie (Heidelberg, Germany)最新文献

This article presents my career path, which combines trauma surgery with space medical research. I was asked to describe for young colleagues both my career path and my work as a research university professor, which combines clinical experimental trauma surgery research with human physiological research in the context of space travel. In addition to specializing in orthopedics and trauma surgery, I completed the residency in physiology at the Charité in Berlin and at the German Aerospace Center in Cologne, before completing my postdoctoral thesis on the musculoskeletal system in space flight. Together with international collaboration partners, I have been involved in experiments in international space projects for many years, for example in bed rest studies, in research in Antarctica and on the International Space Station. In this article I also reflect the advantages and disadvantages of my work and what inspires me about it.

The field of orthopedics and trauma surgery is more than just scalpels and screws: it combines craftsmanship, thinking and attitude. My path led me from university traumatology to elective orthopedics and rehabilitation to a field that is often overlooked: medical assessment. Where medicine, law and economics converge, new perspectives emerged for me and the idea of rethinking medical assessment. My model, which combines efficiency, quality and collegiality, developed from my clinical and assessment experience, curiosity and entrepreneurial spirit. My career path is an invitation to experience medicine and cooperation beyond traditional paths and to courageously forge your own path.

The discipline of orthopedics and trauma surgery is very broad and offers a wide range of options. In the area of conservative treatment it also includes methods of physical medicine. Therefore, it is also possible to work in this large field of physical and rehabilitative medicine (PRM) and there is a great deal of overlap between the two. The outcome of good surgical treatment often depends on high-quality follow-up care. Conservative treatment also offers a wide range of treatment options that present a professional challenge. Experience of orthopedics and trauma surgery is a great advantage for both. Knowledge of surgery and rehabilitative care is particularly useful at the interfaces of rehabilitation. Career pathways for interested individuals can therefore vary greatly between the different fields and offer an exciting range of tasks and opportunities, especially in interprofessional collaboration and interdisciplinary cooperation.

Pertrochanteric femoral fractures account for approximately half of all hip-related fractures and are associated with a significant loss of mobility and quality of life as well as a high mortality risk within the first year. The increasing incidence of these fractures is primarily attributed to demographic changes in our aging society. The majority of these injuries, also referred to as fragility fractures, result from low-energy trauma and are often facilitated by reduced bone quality due to osteoporosis. Globally, the incidence of proximal femoral fractures is projected to quadruple from 1.7 million cases per year in 1990 to 6.3 million cases per year by 2050. For pertrochanteric femoral fractures the gender distribution is 69% female and 31% male and the age distribution is 13% under 70 years and 87% over 70 years. This article provides a short overview on the most important surgical and interdisciplinary treatment aspects for the care of older patients with pertrochanteric femoral fractures.

Background: There is an almost unique certification structure in Germany in which clinics can be certified either as trauma center DGU® (TraumaZentrum DGU®), geriatric trauma center DGU® (AltrsTraumaZentrum DGU®) or arthroplasty center (endoCert), among others. Geriatric patients with displaced femoral neck fractures represent a highly relevant entity. The structural and process quality are validated within the framework of certification as both an AltersTraumaZentrum DGU® (ATZ) and arthroplasty center (EPZ), which represents a methodologically challenging approach to the analysis of treatment reality.

Objective: Is there a treatment variation between certified geriatric trauma centers (ATZ) and dual certified geriatric and arthroplasty centers (ATZ+EPZ) with respect to joint-preserving or joint replacement surgical procedures for geriatric displaced femoral neck fractures and short-term complications?

Material and methods: Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) from 46 clinics with ATZ and 52 clinics with ATZ + EPZ were analyzed. The follow-up period included both the in-hospital stay and a 120-day follow-up interval. The primary outcome was mortality, secondary endpoints included mobility, reoperations and health status. Univariate and multivariate analyses were performed to calculate odds ratios (OR) after adjustment for age, gender, ASA score and concomitant injuries.

Results: The median age of the collective (n = 7389) was 84 years, 29.6% and 29.8% respectively were male, the median time until surgery was 20.9 h (ATZ) vs. 20.5 h (ATZ + EPZ) and the median length of stay was 15.1 days for both types of center. The number of joint-preserving interventions was significantly increased in ATZ compared to clinics with dual certification (ATZ: 8.6% vs. ATZ + EPZ: 2.6%; OR = 3.63). The reoperation rate was comparable in the primary stay (3.7% vs. 3.9%) but was significantly increased over the 120-day course in clinics with dual certification (4.1% vs. 6.0%; p = 0.022). Revisions due to periprosthetic fractures occurred more frequently in ATZ without EPZ (8.2% vs. 3.5%). The multivariate analysis showed an increased mortality in the acute phase (OR 1.26; 1.02-1.56; p = 0.031), an increased rate of reoperations in the 120-day course (OR 1.45; 1.06-2.02; p = 0.024) and inpatient readmissions (OR 1.42, 1.02-2.00; p = 0.043) for centers with dual certification.

Conclusion: In Germany an institutional treatment variation for geriatric displaced femoral neck fractures exists. In certified geriatric trauma centers without certified arthroplasty center there is a significantly increased rate of joint-preserving treatment with differences in terms of morbidity and mortality in the acute phase.

Background: Necrotizing fasciitis is a life-threatening soft tissue infection characterized by rapid spread along fascial planes that can lead to systemic toxicity and death if left untreated.

Case: In the present case a 57-year-old male patient developed fulminant necrotizing fasciitis following a motorcycle accident with severe abrasion injuries to the left lower leg. Despite aggressive surgical intervention and antimicrobial treatment, the patient had a complicated course of intensive care. The case underlines the importance of early diagnosis and immediate interdisciplinary treatment in this surgical emergency.

Acetabular fractures with displaced fragments represent a complex intraoperative challenge. This case report describes the successful treatment of an acetabular fracture with native hip dislocation in a 56-year-old man following high-energy trauma. Open reduction and internal fixation using the Kocher-Langenbeck approach was initially unsuccessful due to a posterior wall fragment, necessitating a trochanteric flip osteotomy. The patient developed an avascular necrosis of the femoral head, which is a frequent complication of acetabular fractures associated with hip dislocation. This emphasizes the importance of regular control follow-up. Despite the high-energy mechanism of injury, the patient showed excellent results based on the Harris hip score (HHS).

Polyaxial screw systems are the state of the art in the field of fracture fixation. In contrast to conventional monoaxial systems, the polyaxial constructs enable variable screw angulation, enhancing the adaptability of plate-screw configurations in different surgical scenarios and different anatomical circumstances. This article provides a comprehensive overview of the functional principles, clinical applications and inherent limitations of polyaxial stability. The conventional monaxial technology restricts screw positioning, potentially compromising fixation in some fracture situations or anatomical regions. In contrast, polyaxial systems enable adapted screw placement, addressing specific requirements arising during surgery. Various locking mechanisms based on friction, deformation, thread forms and engagement techniques, play crucial roles in achieving stability. The article discusses the key currently used technologies, their mechanical characteristics and comparative behavior as the biomechanical interaction between screws and plates is crucial for achieving maximum stability and preventing failure modes that could compromise fracture healing. This article emphasizes that while polyaxial systems offer enhanced fragment-specific screw positioning, their successful application relies on careful surgical technique and an understanding of the mechanics involved. By integrating insights from clinical experiences, biomechanics, and the literature, we aim to raise awareness and support decision-making in fracture management using polyaxial systems. Ultimately, the article advocates a balanced understanding of both the benefits and challenges associated with polyaxial fracture fixation in modern orthopedic trauma surgery.