Unfallchirurgie (Heidelberg, Germany)最新文献

There is an increasing focus on preparation for disasters, crises and wars. The ability to react to such exceptional situations affects many pillars of a society. A key component of crisis response is the maintenance of medical care. This, in turn, has a significant impact on care in the outpatient and inpatient settings. Accordingly, hospitals must be prepared for such situations. An important element of such preparation is the hospital emergency and contingency planning (HECP). This requires detailed organization, structuring, planning, training and practice. Important elements of HECP are leadership, communication, zoning and the management of personnel, space and resources. The establishment of a leader of the HECP who coordinates and implements the planning is important and must be accompanied by an appropriate indemnification. Funding must be considered but cannot be an argument for failing to make serious and effective planning. Disasters that hit us unprepared will seriously jeopardize the healthcare system and thus the health of the population. Robust healthcare systems and robust hospitals can play their part in reducing the medical and social impact of disasters.

In order to prepare hospitals better for the necessary crisis care in a shortage situation, the Clinical Disaster Medicine Germany (LeiKliKatMeD) guidelines are currently being developed. They are funded by a research and development project of the Federal Office of Civil Protection and Disaster Assistance (BBK) and are being developed by the section assignment, disaster and tactical surgery (EKTC) of the German Society for Trauma Surgery (DGU) in collaboration with 38 specialist societies. This article describes the framework conditions and basic assumptions that were taken into account. In addition to recommendations for the treatment of typical injury and illness patterns in disasters, crises and war, the guidelines describe, for example, the requirements of hospital alert and operational planning as well as general points. After successful preparation and implementation these can lead to a reduction in the workload of medical treatment facilities in a crisis, so that the stage of compensated crisis care can be maintained for as long as possible in the exceptional situation of an extensive or prolonged damage position. For the prioritization and disposition of medical treatment measures in this situation, the categorization according to the urgency of treatment as part of the initial triage is an important point for the successful management of a damage situation. As a preview of the content of the guidelines, which are expected to be completed by the end of this year, these points are summarized and explained in order to facilitate the successful consideration and implementation of the expected recommendations even now.

Background: In the authors' opinion the prevalence of equinus foot deformities is an underestimated medical and socioeconomic problem that has not yet been adequately investigated. A  dorsiflexion in the ankle joint of < 10° can lead to limitations in gait.

Objective: The aim of the present study was to determine the prevalence of equinus foot deformities based on the degree of restriction of dorsiflexion in the ankle joint in hospitalized patients.

Material and methods: In this cross-sectional study the active range of motion of the ankle joint in 205 patients at Münster University Hospital was prospectively examined with a goniometer. Included in the study were 136 trauma surgery and 69 neurology patients. The association of restricted dorsiflexion with other clinical parameters was investigated using the χ²-test or Fischer's exact test. The significance level was set at p < 0.05.

Results: In total, 205 patients with mean age of 59 years were included. There was a slight predominance of males (55.1%) in the gender distribution. The average dorsal extension of the ankle joint was 7.03°on the right side and 8.92° on the left side. Of the patients 72.2% had a dorsiflexion in the ankle joint of < 10°, 38.1% a dorsiflexion < 5° and 16.1% a dorsiflexion < 0° on at least one side. A relevant association between age, gender, duration of hospitalization and the reason for treatment with a restriction of dorsiflexion could not be observed.

Conclusion: The results suggest that restriction of dorsiflexion is a frequent problem in our group of trauma surgery and neurology patients. In particular, the presence of a manifest equinus deformity of the foot of > 10% that could not achieve the neutral position is a relevant finding.

In-hospital disaster medicine demands a structured, pragmatic and resource-efficient approach in the surgical treatment of patients under extreme conditions. The Surgical Working Group for Military and Emergency Surgery (CAMIN) of the German Society of General and Visceral Surgery (DGAV) has developed guideline-based recommendations for making decisions, prioritization and management in disaster scenarios. The guidelines address the special challenges of atypical trauma patterns, as can be found in terrorist attacks or situations with mass casualties, such as gunshot or blast injuries. They highlight the use of damage control surgery (DCS), the differentiated application of laparotomy, open abdominal management and the triage of general and oncological procedures. The clinical assessment, focused diagnostics (e.g., extended focussed assessment with sonography in trauma, eFAST) and staged surgical algorithms are at the heart of this concept, aiming to ensure the highest level of patient safety and effectiveness despite critical resource limitations. The overriding principle is: "do the most for the most."

Hoffa fractures are coronal plane fractures of the femoral condyle and overall represent a rare fracture entity. These fractures are predominantly caused by high-energy trauma und usually involve the lateral femoral condyle. An axial load to the femoral condyle with the knee in 90° or more of flexion produces the typical fracture pattern. In the initial radiological diagnostics the fracture is often overlooked, therefore, a computed tomography (CT) examination is indicated for the diagnostics and planning of surgery (selection of the access and the implant). The operative treatment with an equivalent of the Herbert screw achieves a good functional result, which corresponds to the preferred osteosynthesis implant for simple Hoffa fractures without a debris zone. Meniscal, chondral and ligamentous lesions are frequent collateral injuries of Hoffa fractures and can impact on the functional outcome. Therefore, additional magnetic resonance imaging (MRI) diagnostics and intraoperative stability tests are recommended. Despite differentiated diagnostics and management the trajectory of Hoffa fractures is often associated with complications and therefore require a structured rehabilitation protocol and follow-up with radiological controls.

An emergency doctor became infected with group A streptococci during resuscitation and developed necrotizing fasciitis (NF) on his arm and thorax. The patient could be cured by antibiotic treatment and several operations. This case aims to increase the awareness for the risk of NF for medical personnel and makes an appeal to personnel involved in emergencies to consider the relevance of personal protective equipment.

Background: Although patellar fractures are one of the rarer entities in the routine clinical practice, the biomechanical functioning of the knee joint must be correctly addressed. The numerous biomechanical data are often not considered in routine clinical practice, which is reflected in avoidable follow-up interventions.

Aim of the work: The subject of this review article is the concise explanation of the recording of fracture morphology, the resulting conclusions about the fracture character, a summary of the international biomechanical key results and the resulting meaningful treatment procedures.

Conclusion: With this review article the Fracture Committee of the German Knee Society would like to propose a treatment recommendation for the surgical treatment of patellar fractures.

Simulators and immersive technologies, such as virtual reality and augmented reality are becoming increasingly more important for training in orthopedic and trauma surgery. They enable safe and standardized training of surgical skills and contribute to improving patient safety. This article provides an overview of various simulation techniques, their evaluation methods and the challenges of their integration into orthopedic and trauma surgery further education.

Background: The current guidelines of the German Federal Joint Committee on the treatment of proximal femoral fractures require that patients with a proximal femoral fracture receive surgical treatment as soon as possible and within 24 h of admission. This is intended to reduce perioperative complication rate and mortality.

Objective: The aim of this study was to analyze the hospital mortality as well as complication rates and types in relation to the preoperative waiting time.

Methodology: From 2010 to 2020, a total of 575 patients with femoral neck fractures treated with a bipolar prosthesis were retrospectively analyzed with respect to hospital mortality and the occurrence of complications. Patients with pathological fractures, femoral neck fractures more than 4 weeks old and those treated with osteosynthesis were excluded. Patient-specific data, hospital mortality and complication rates and types were recorded.

Results: During the study period, the implementation of the given guidelines resulted in a reduction in the preoperative waiting time from a median of 38 h in 2010 to 19 h in 2020. Surgical treatment was performed on average after 14.2 h in patients who had surgery within 24 h after admission and on average after 40.2 h for those who had surgery after 24 h. The average American Society of Anesthesiologists (ASA) score for all 575 patients was 2.76. The group of patients who had surgery after more than 24 h had a significantly higher ASA classification (p = 0.024). A total of 12 (4.2%) patients in the group surgically treated within 24 h died, compared to 24 (8.5%) deaths in the group surgically treated after 24 h (p = 0.035). The complication rate for the entire cohort was 15% (88 patients). There was no difference in the occurrence of complications and the overall complication rate with respect to the timing of surgery.

Conclusion: During the study period the preoperative waiting time was halved from 39h to 19 h. Patients who were surgically treated within 24 h had a significantly lower hospital mortality than those surgically treated after 24 h; however, the group surgically treated after 24 h simultaneously showed higher baseline comorbidities and in the adjusted analysis for age and ASA score, the 24‑h threshold no longer emerged as an independent risk factor for hospital mortality. Regarding complication rates, no significant differences were found between the groups based on the timing of surgery.