103 research outputs found
Treatment of diametaphyseal forearm fractures in children and adolescents
No full textZusammenfassung Operationsziel Die Osteosynthese bei dislozierten diametaphysären Unterarmfrakturen dient der Wiederherstellung von Anatomie und Funktion. Durch die Versorgung mit einer antegraden intramedullären Nagelosteosynthese im Radius sollen Länge, Rotation und Achse im Rahmen der altersspezifischen Korrekturgrenzen wiederhergestellt werden. Die ausreichende Stabilität gewährleistet eine frühfunktionelle Nachbehandlung ohne Last. Indikationen Dislozierte diametaphysäre Unterarm- oder Radiusfrakturen, die sich nicht geschlossen, stabil reponieren lassen oder außerhalb der altersspezifischen Korrekturgrenzen verbleiben. Kontraindikationen Radius- oder Unterarmfrakturen, die sich distal oder proximal des definierten Areals befinden. Im Zugangsweg befindliche Weichteildefekte, Kontaminationen oder Infekte. Operationstechnik Im Verlauf des Thompson-Zugangs wird der Soft-Spot zwischen M. extensor digitorum und M. extensor carpi radialis brevis aufgesucht und eine ca. 3–4 cm Hautinzision durchgeführt. Dann stumpfes Präparieren bis auf den Knochen unter Schonung des N. radialis profundus und superficialis. Retraktion der Muskulatur mit 2 Langenbeck-Haken. Eröffnen der Kortikalis mit einem Pfriem. Gegebenenfalls kann zuvor ein 2,5-mm-Bohrer mit Gewebeschutz bei sehr harter Kortikalis verwendet werden. Der TEN-Durchmesser (TEN = Titanium Elastic Nail) wird so gewählt, dass er etwa zwei Drittel des Markraumes ausfüllt. Es empfiehlt sich, ein Abflachen der TEN-Kufe mit einer Parallelflachzange durchzuführen. Nach geschlossener Reposition wird der TEN dann bis vor die Wachstumsfuge unter leicht rotierenden Bewegungen gebracht. Der TEN wird am proximalen Ende umgebogen und oberhalb der Muskelbäuche abgekniffen. Alternative Verfahren sind die Kirschner-Draht-Osteosynthese oder der retrograde TEN von radial oder dorsal, mit oder ohne additive Biegung. Weiterbehandlung Ziel der Osteosynthese ist die frühfunktionelle Nachbehandlung ohne Last. Sportkarenz wird für 8 Wochen empfohlen. Die Metallentfernung kann nach Konsolidierung zwischen 3 und 6 Monaten erfolgen. Ergebnisse Deutlich dislozierte bzw. außerhalb der Korrekturgrenzen liegende Radius- und Unterarmfrakturen im Kindesalter zeigen nach beschriebener Osteosynthesetechnik sehr gute Behandlungsergebnisse bei geringem Risikoprofil. Eine Pseudarthrose konnte genauso wie Nervenschäden nicht beobachtet werden. Eine sekundäre Dislokation trat nicht ein.Abstract Objective Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load. Indications Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits. Contraindications Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path. Surgical technique In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3–4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a 2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. A titanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending. Postoperative management The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8 weeks. Metal removal can be performed after consolidation between 3 and 6 months. Results Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with a low risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred.Zusammenfassung Operationsziel Die Osteosynthese bei dislozierten diametaphysären Unterarmfrakturen dient der Wiederherstellung von Anatomie und Funktion. Durch die Versorgung mit einer antegraden intramedullären Nagelosteosynthese im Radius sollen Länge, Rotation und Achse im Rahmen der altersspezifischen Korrekturgrenzen wiederhergestellt werden. Die ausreichende Stabilität gewährleistet eine frühfunktionelle Nachbehandlung ohne Last. Indikationen Dislozierte diametaphysäre Unterarm- oder Radiusfrakturen, die sich nicht geschlossen, stabil reponieren lassen oder außerhalb der altersspezifischen Korrekturgrenzen verbleiben. Kontraindikationen Radius- oder Unterarmfrakturen, die sich distal oder proximal des definierten Areals befinden. Im Zugangsweg befindliche Weichteildefekte, Kontaminationen oder Infekte. Operationstechnik Im Verlauf des Thompson-Zugangs wird der Soft-Spot zwischen M. extensor digitorum und M. extensor carpi radialis brevis aufgesucht und eine ca. 3–4 cm Hautinzision durchgeführt. Dann stumpfes Präparieren bis auf den Knochen unter Schonung des N. radialis profundus und superficialis. Retraktion der Muskulatur mit 2 Langenbeck-Haken. Eröffnen der Kortikalis mit einem Pfriem. Gegebenenfalls kann zuvor ein 2,5-mm-Bohrer mit Gewebeschutz bei sehr harter Kortikalis verwendet werden. Der TEN-Durchmesser (TEN = Titanium Elastic Nail) wird so gewählt, dass er etwa zwei Drittel des Markraumes ausfüllt. Es empfiehlt sich, ein Abflachen der TEN-Kufe mit einer Parallelflachzange durchzuführen. Nach geschlossener Reposition wird der TEN dann bis vor die Wachstumsfuge unter leicht rotierenden Bewegungen gebracht. Der TEN wird am proximalen Ende umgebogen und oberhalb der Muskelbäuche abgekniffen. Alternative Verfahren sind die Kirschner-Draht-Osteosynthese oder der retrograde TEN von radial oder dorsal, mit oder ohne additive Biegung. Weiterbehandlung Ziel der Osteosynthese ist die frühfunktionelle Nachbehandlung ohne Last. Sportkarenz wird für 8 Wochen empfohlen. Die Metallentfernung kann nach Konsolidierung zwischen 3 und 6 Monaten erfolgen. Ergebnisse Deutlich dislozierte bzw. außerhalb der Korrekturgrenzen liegende Radius- und Unterarmfrakturen im Kindesalter zeigen nach beschriebener Osteosynthesetechnik sehr gute Behandlungsergebnisse bei geringem Risikoprofil. Eine Pseudarthrose konnte genauso wie Nervenschäden nicht beobachtet werden. Eine sekundäre Dislokation trat nicht ein.Abstract Objective Osteosynthesis in dislocated diametaphyseal forearm fractures is intended to restore anatomy and function. Antegrade intramedullary nailing in the radius is used to restore length, rotation, and axis within the age-specific correction limits. Sufficient stability ensures early functional postoperative treatment without load. Indications Dislocated diametaphyseal forearm or radius fractures that cannot be closed, stably reduced, or remain outside the age-specific correction limits. Contraindications Radius or forearm fractures located distal or proximal to the defined area. Soft tissue defects, contamination or infections located in the access path. Surgical technique In the course of the Thompson approach, the soft spot between the extensor digitorum and extensor carpi radialis brevis muscles is located and an approx. 3–4 cm skin incision is made. Then blunt preparation down to the bone, sparing the profundus and superficial radial nerve. Retraction of the musculature with two Langenbeck hooks. Opening of the cortex with an awl. If necessary, a 2.5 mm drill with tissue protection can be used beforehand if the cortex is very hard. A titanium elastic nail (TEN) diameter is selected so that it fills approximately 2/3 of the medullary canal. It is recommended to flatten the TEN runner with parallel flattening forceps. After closed reduction, the TEN is then brought up in front of the growth plate with slightly rotating movements. The TEN is bent over at the proximal end and pinched off above the muscle bellies. Alternative procedures include Kirschner wire osteosynthesis or retrograde TEN from radial or dorsal, with or without bending. Postoperative management The aim of osteosynthesis is early functional follow-up without load. Sports abstinence is recommended for 8 weeks. Metal removal can be performed after consolidation between 3 and 6 months. Results Clearly dislocated or outside the correction limits infantile radius and forearm fractures show very good treatment results with a low risk profile after the described osteosynthesis technique. Pseudarthrosis and nerve damage were not observed. Secondary dislocation has not occurred
Developing a core outcome set for acetabular fractures: a systematic review (part I)
No full textAbstract Background There are indications that clinical studies investigating the surgical treatment of acetabular fractures assess different outcomes. This heterogeneity reduces the comparability of study results and, thus, limits the knowledge generated from research. Core outcome sets (COS) contain a minimum set of outcomes that should be measured in studies investigating a specific disease or injury. A COS for surgically treated acetabular fractures does not yet exist. Therefore, the aim of this study is to identify the reported outcomes in studies investigating the surgical treatment of acetabular fractures. Methods Studies including skeletally mature individuals (≥ 16 years) with isolated acetabular fractures treated surgically were included. Studies with polytrauma patients, pathological fractures, additional pelvic fractures, exclusively non-surgical treatment, or juvenile individuals were excluded. Three databases and two clinical trial registries were searched on 15 November 2022. The identified outcomes were grouped and subsequently categorized according to the Core Outcome Measures in Effectiveness Trials Guidelines. Results A total of 193 studies were included, which reported a cumulative total of 2581 outcomes. After grouping, 266 unique outcomes were identified. No outcome was examined in all studies. Pain , ability to walk independently , range of motion , quality of reduction , and heterotopic ossification were the most reported unique outcomes and assessed in at least 60% of included studies. A total of 105 outcomes were only assessed in one of the included studies. Outcomes of all five core areas and 25 outcome domains of the Core Outcome Measures in Effectiveness Trials taxonomy were examined. Furthermore, outcomes were named and defined differently, measured at different time points, and assessed using a variety of measurement instruments. Conclusion Overall, this systematic review shows that a wide range of outcomes are measured in studies examining surgical treatment of acetabular fractures. The results of this systematic review will be used in a subsequent study to develop the COS for surgically treated acetabular fractures by using the Delphi method. Systematic review registration PROSPERO: CRD42022357644; COMET: 2123
Preventing the disaster: severe abdominal injury in child passengers of motor vehicle accidents often indicate even more serious trauma
No full textAbstract Purpose The purpose of this study was to assess severe abdominal injury in child passengers of different ages of motor vehicle accidents and analyze the concomitant pattern of injury regarding injury severity, trauma management and outcome. Method Data acquisition from Trauma Register DGU ® (TR-DGU) in a 10-years period (2010–2020) of seriously injured children (max. AIS 2+ / intensive care) 0–15 years of age, as motor vehicle passengers (cMVP) ( n = 1,035). Primarily treated in or transferred to a German Trauma Center. Matched pairs analysis with adult severely injured motor vehicle passengers (aMVP) (age 20–50 years, n = 26,218), matching 1:4 (child: adult), was performed to identify causes of mortality. Results The study group (cMVP) included 1,035 children. The mean age was 9.5 years, 50.5% were male and the mean Injury Severity Score (ISS) was 18.7 points. 93.0% were transported from scene directly to the final trauma center. Transferred patients showed a higher ISS (26 vs. 18 points), higher rate of severe traumatic brain injury (TBI), a higher rate of serious abdominal injury and a higher mortality rate (12.5% vs. 7.4%). Most of the severe abdominal injuries occurred after the third year of age (first peak between 8 and 9 years; second peak 14–15 years). Serious injuries to the pelvis show a similar distribution but less often, the same applies to thoracical injuries. Severe brain and head injuries show an antiproportional distribution to the age groups with the highest rate in the 0–1 year old (78%) and the lowest in the 14–15 year old (40%). The highest mortality rate was shown in the youngest age groups, related to TBI (AIS TBI ≥ 3; 62% in 0–1 years). The matched pairs analysis shows a higher mortality rate of cMVP compared to aMVP within the first 24 h after hospital admission and a significantly higher rate of shock and unconsciousness, while the intubation rate is significantly lower. Conclusion Child passengers of motor vehicle accidents are in need of a specific and age-related attention towards security systems. Severe injuries in children are rare, yet life threatening. The highest mortality rate is related to severe TBI, especially in the youngest children. But also severe abdominal as well as thoracic injuries their concomitant trauma need to be prevented and are indicators for even more severe injuries. It seems to be favorable for cMVP to be directly transported to designated special centers with sufficient capacity and competency to treat and manage severely injured children
Optimierte Ressourcenmobilisation und Versorgungsqualität Schwerstverletzter durch eine strukturierte Schockraumalarmierung
No full textEinfluss des Zeitpunktes einer operativen Rippenstabilisierung auf das Outcome bei polytraumatisierten Patienten – eine matched-pairs Analyse aus dem TraumaRegister DGU®
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