Der Unfallchirurg (Unfallchirurg )

Publisher: Deutsche Gesellschaft für Unfallheilkunde, Springer Verlag

Description

Die Zeitschrift Der Unfallchirurg ist ein international angesehenes Publikationsorgan das sich allen Aspekten der Unfall- und Wiederherstellungschirurgie widmet. Die Originalien ermöglichen die Präsentation relevanter klinischer Studien. Die Rubrik Kasuistik stellt interessante Fälle vor. Das Leitthema führt in jedem Heft in einem oder mehreren angeforderten Beiträgen in ein für den Unfallchirurgen wesentliches Thema seines klinischen Alltags ein und gibt einen Überblick über den State of the art''. Die Rubrik Weiterbildung bietet dem Assistenten auf dem klinischen Weg zum Facharzt didaktisch aufgearbeitetes Wissen. Die Rubrik orientiert sich an der Weiterbildungsordnung des Fachgebiets und bezieht die Interessen sowohl niedergelassener als auch klinisch tätiger Chirurgen ein. In den anderen Rubriken werden ausschließlich zu speziellen Themen erarbeitete Übersichten publiziert und spiegeln damit das multidisziplinäre Umfeld wider. Medizin aktuell informiert über Kongresse und für das Fach relevante Neuigkeiten. In Für Sie gelesen werden wichtige Arbeiten aus nationalen und internationalen Journals referiert und In der Diskussion stellt sich den Brennpunkten des Fachgebietes. Zur Publikation eingereichte Manuskripte müssen bei Untersuchungen an Probanden oder Patienten die Erklärung enthalten daß das Versuchsprotokoll von einer Ethikkommission begutachtet wurde und somit den ethischen Standards der Deklaration von Helsinki 1964 in der jeweils gültigen Fassung (Pharm. Ind. Nr. 12/1990 sowie Bundesanzeiger Nr. 243 a vom 29. 12. 1989) entspricht. Gleichzeitig ist die Einwilligung der Versuchsperson nach Aufklärung im Text des Manuskriptes zu fixieren. Hinweise die auf die Identität der Versuchsperson schließen lassen sind zu vermeiden. Tierversuchsprogramme müssen den Passus enthalten daß die Principles of laboratory animal care'' (NIH publication No. 86-23 revised 1985) eingehalten wurden soweit nicht zusätzlich besondere nationale Regelungen zu beachten sind (für die Bundesrepublik Deutschland ist dies das Tierschutzgesetz in aktueller Fassung). Die Herausgeber behalten sich deshalb das Recht vor Manuskripte abzulehnen die den o.g. Anforderungen nicht entsprechen. Der Autor haftet bei Verstoß gegen die o.g. Anforderungen oder bei falschen Angaben.

Impact factor 0.61

  • Hide impact factor history
     
    Impact factor
  • 5-year impact
    0.70
  • Cited half-life
    8.70
  • Immediacy index
    0.12
  • Eigenfactor
    0.00
  • Article influence
    0.15
  • Website
    Unfallchirurg, Der website
  • Other titles
    Unfallchirurg (Online)
  • ISSN
    1433-044X
  • OCLC
    43496873
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

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    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • S Y Vetter, K Wendl, P A Grützner, S Matschke
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    ABSTRACT: A 12-year-old boy suffered a rare occurrence of a traumatic spondylolisthesis (L5/S1) without neurological alterations after being partially buried underneath a collapsing brick wall. Additionally he sustained a third degree open fracture of the left distal fibula and epiphysiolysis of the left distal tibia. A closed reduction and percutanous dorsal instrumentation L5/S1 as well as an open reduction and osteosynthesis of the tibia and fibula were performed. After 6 months the instrumentation was completely removed and an unrestrained range of motion of the lumbar spine and the upper ankle joint was regained.
    Der Unfallchirurg 01/2015;
  • V Bogner, M Brumann, T Kusmenkov, K G Kanz, M Wierer, F Berger, W Mutschler
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    ABSTRACT: The Injury Severity Score (ISS) is a well-established anatomical scoring system for polytraumatized patients. However, any inaccuracy in the Abbreviated Injury Score (AIS) directly increases the ISS impreciseness. Using the full body computed tomography (CT) scan report, ISS computation can be associated with certain pitfalls. This study evaluates interpretation variations depending on radiological reports and indicates requirements to reliably determine the ISS. The ISS of 81 polytraumatized patients was calculated based on the full body CT scan report. If an injury could not be attributed to a precise AIS cipher, the minimal and maximal ISS was computed. Real ISS included all conducted investigations, intraoperative findings, and final medical reports. The differences in ISS min, ISS max, and ISS real were evaluated using the Kruskal-Wallis test (p<0.05) and plotted in a linear regression analysis. Mean ISS min was 24.0 (±0.7 SEM) points, mean ISS real 38.6 (±1.3 SEM) and mean ISS max was 48.3 (±1.4 SEM) points. All means were significantly different compared to one another (p<0.001). The difference between possible and real ISS showed a distinctive variation. Mean deviation was 9.7 (±0.9 SEM) points downward and 14.5 (±1.1SEM) points upward. The difference between deviation to ISS min and ISS max was highly significant (p<0.001). Objectification of injury severity in polytraumatized patients using the ISS is an internationally well-established method in clinical and scientific settings. The full body CT scan report must meet distinct criteria and has to be written in acquaintance to the AIS scale if intended to be used for correct ISS computation.
    Der Unfallchirurg 01/2015;
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    ABSTRACT: The German statutory accident insurance (DGUV) has the statutory mandate to eliminate or to prevent an aggravation of the consequences of accidents by all appropriate means and is based on the principle of rehabilitation before pension. For this, special methods have been developed in recent decades, such as employer's mutual insurance inpatient further treatment (BGSW, Berufsgenossenschaftliche Stationäre Weiterbehandlung) and extended outpatient physiotherapy (EAP, Erweiterte Ambulante Physiotherapie). In 2012 the workplace-related musculoskeletal rehabilitation (ABMR, Arbeitsplatz-bezogene muskuloskelettale Rehabilitation) was added to these complex treatments. For complex injuries and delayed healing these methods approach their limits. The accident clinics of the Association of Clinics in Statutory Accident Insurance (KUV, Klinikverbund der gesetzlichen Unfallversicherung) provide a number of specialized rehabilitation measures in order to ensure an optimal seamless rehabilitation of the severely injured. In addition to complex inpatient rehabilitation (KSR, Komplexe Stationäre Rehabilitation) integrated special rehabilitation procedures, such as neurorehabilitation for severely traumatic brain injured patients and rehabilitation after spinal cord injury and other special rehabilitation methods, such as occupation-oriented rehabilitation (TOR, Tätigkeitsorientierte Rehabilitation) and pain rehabilitation, ensure that the German Society for Trauma Surgery (DGU) phase model of trauma rehabilitation is implemented. This provides an early start in the context of acute treatment as so-called early rehabilitation. After a specialized post-acute rehabilitation, additional therapeutic options are often required. An appropriate treatment of severely injured patients is important, for example through rehabilitation managers, which must not end with discharge from the rehabilitation hospital. The aim of all efforts is the reintegration into the working and social environment in addition to the best possible quality of life.
    Der Unfallchirurg 01/2015;
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    ABSTRACT: To improve patient safety and quality in joint arthroplasty a certification of arthroplasty centers (EndoCert©) and a German arthroplasty register (EPRD) have been implemented. This should guarantee a long-term improvement in documentation of arthroplasty in the future. Although the stages of operations in elective and trauma-associated joint arthroplasty are comparable, the surgical preconditions are often quite different. As required by the German Society of Trauma Surgery (DGU) this study analyzed the current situation with respect to the proportion of fracture-associated joint arthroplasties among the total volume carried out in Germany. A uniform internet-based questionnaire was sent to all listed trauma centers in Germany by the central office of the DGU. In addition any information regarding hip joint arthroplasty in 2011 was collected from the Federal Statistical Office of Germany. The questionnaire was returned by 324 (47 %) out of 690 of the trauma centers contacted. A total of 34,135 total hip arthroplasties (THA) and 26,753 total knee arthroplasties (TKA) were carried out in 2011 by these clinics. The absolute numbers for total endoprosthesis replacement cited by the trauma centers were 5718 THAs and 3829 TKAs. According to the data from the Federal Statistical Office of Germany 131,966 hip fractures were registered in 2011, including 69,582 femoral neck fractures (patient age >19 years) and 62,384 pertrochanteric fractures. From a total number of THAs of approximately 200,000 in Germany 47,695 (approximately 25 %) of these were associated with trauma. The data analyzed in this study and the results obtained from known literature sources demonstrate that THA is the most frequently performed procedure in trauma management of femoral neck fractures. Because of the ubiquitous and high incidence and the need for emergency treatment due to correlated risks and complications of delayed treatment, a high and standardized around the clock (24 h and 7 days a week) treatment option is mandatory. Long waiting times to treatment or transfer are inacceptable due to the increased mortality and complications.
    Der Unfallchirurg 01/2015;
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    ABSTRACT: We report on a 19-year-old male patient with a rare injury: a basis fracture of the second metacarpal with avulsion of the extensor carpi radialis longus (ECRL) tendon. The patient was treated with open reduction and internal plate fixation of the fragment. The functional results after 10 months of follow-up were pronation/supination 90/0/90° (90/0/90°), extension/flexion 70/0/70° (70/0/70°) radial/ulnar duction 20/0/40° (25/0/40°), bilateral grip strength was 115 kPa. The patient suffered no pain at all. The Mayo wrist score reached 100 points. Radiologically, the fracture was consolidated.Consistent diagnostics and surgical therapy lead to functional and radiological recovery following fracture of the second metacarpal base with avulsion of the extensor carpi radialis longus tendon.
    Der Unfallchirurg 01/2015;
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    ABSTRACT: Bone tumors and especially bone sarcomas are rare lesions of the skeletal system in comparison to the much more frequently occurring bone metastases. Despite the relative rarity they are important differential diagnoses of bone lesions.
    Der Unfallchirurg 06/2014; 117(6):491-500.
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    ABSTRACT: Bone tumors are very rare. Diagnosis and treatment is an interdisciplinary task for experienced radiologists, pathologist, and surgeons that is ideally performed in specialized centers. For optimal processing of bone specimens, basic laboratory equipment and special techniques are required. The cornerstone of the histological diagnosis remains H&E staining, supplemented by special stains, immunohistochemistry, and molecular techniques. For an appropriate diagnosis, data on clinical history, age, location, topography within bone, and imaging are required. Major differences between histological and radiological diagnosis have to be clarified before starting treatment (e.g., by involving a reference registry).
    Der Unfallchirurg 06/2014; 117(6):510-6.
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    ABSTRACT: We report on a 32-year-old patient, who developed septic shock, toxic shock-like syndrome, and multiple organ failure following nectrotizing fasciitis. Amputations had to be performed on all extremities. Subsequently, she developed secondary sclerosing cholangitis. Treatment goals had to be reassessed, since long-term survival seemed doubtful and, in the best case, burdened with severe handicap. We discuss the evaluation of the treatment goals, utilizing a structured model of goal-setting. In the first step the treatment goal is identified based on the patient's wishes. This goal's realistic achievability is verified considering scientific evidence and medical experience. The benefit of the aspired goal is set in relation to risks and burden of the necessary treatment measures in a third step. The resulting benefit-risk ratio must be evaluated by the patient or her representative. Treatment goals have to be reevaluated if the assessment of achievability or the benefit-risk ratio are disadvantageous. In this case, the initial therapeutic goal was retained. After an extraordinarily prolonged and complex therapy including reconstructive surgery the patient is now living independently at home.
    Der Unfallchirurg 05/2014; 117(5):399-405.
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    ABSTRACT: Precise coding is an essential requirement in order to generate a valid DRG. The aim of our study was to evaluate the quality of the initial coding of surgical procedures, as well as to introduce our "hybrid model" of a surgical specialist supervising medical coding and a nonphysician for case auditing. The department's DRG responsible physician as a surgical specialist has profound knowledge both in surgery and in DRG coding. At a Level 1 hospital, 1000 coded cases of surgical procedures were checked. In our department, the DRG responsible physician who is both a surgeon and encoder has proven itself for many years. The initial surgical DRG coding had to be corrected by the DRG responsible physician in 42.2% of cases. On average, one hour per working day was necessary. The implementation of a DRG responsible physician is a simple, effective way to connect medical and business expertise without interface problems. Permanent feedback promotes both medical and economic sensitivity for the improvement of coding quality.
    Der Unfallchirurg 05/2014; 117(5):464-9.
  • Der Unfallchirurg 05/2014; 117(5):461-3.
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    ABSTRACT: Due to advanced medical interventions, the multitude of beliefs in our society, and increasing economic pressure, difficult ethical decisions are also part of the surgical care of patients. How can health care personnel address the ethical challenges in a structured, well-founded ethical manner? Based on the four principles of biomedical ethics beneficence, nonmaleficence, respect for autonomy, and justice, we present a model for the step-wise ethical evaluation of difficult cases. The principle-based model of ethical case discussions consists of five steps: 1) In the medical analysis of the case, the available management strategies are identified, including a detailed description of their benefits and risks. 2) The evaluation starts with the ethical obligations towards the patient: Which treatment strategy is in the patient's best interest? And: Which option does the patient prefer herself after appropriate disclosure? 3) Then it has to be examined whether obligations to third parties (family members, other patients, etc.) have to be taken into account. 4) In the synthesis, the individual evaluations are integrated into an overall assessment of the case; conflicting obligations have to be balanced based on good reasons. 5) A critical review of the case concludes the case discussion. The application of the model is exemplified based on a surgical case discussion. Difficult ethical decisions can be supported by structured case discussions, in which all medical disciplines and professional groups involved in the care of the patient should participate.
    Der Unfallchirurg 05/2014; 117(5):392-8.
  • Der Unfallchirurg 05/2014; 117(5):390-1.
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    ABSTRACT: A 24-year-old woman underwent cosmetic bilateral tibial lengthening with severe complications. In all, 15 operations, including allogeneic fibular grafting of both tibia, were required to treat unstable bilateral non-union, malalignment, and osteomyelitis of the right tibia.The present article describes the surgical strategy of revision to achieve good recovery with full consolidation and proper alignment of the lower leg. Furthermore, the indications for allogeneic bone grafting, which was described by Erich Lexer 100 years ago are discussed. For surgical revision, a T-external fixator was used on the right leg, while a customized tibial nail was used on the left leg. Using these techniques, full consolidation and proper alignment was achieved. Allogeneic bone grafts in upper extremity defects cannot be recommended.
    Der Unfallchirurg 04/2014;
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    ABSTRACT: Ruptures of the anterior cruciate ligament (ACL) lead to an anteromedial rotational instability in the knee joint and, thus, to a deterioration of the patient's ability to stand (postural control). It still remains unclear whether postural control can be restored by ACL reconstruction. The aim of this study was to investigate the effect of a unilateral ACL graft on the ability to stably stand on the injured leg using computer-aided dynamic posturography (CDP); the stability indices on standing on one leg were compared pre- and postoperatively. A total of 25 patients were studied after unilateral ACL injury and subsequent ACL reconstruction using CDP. The average time of follow-up was 608 days (range 357-821 days). The ability to stably stand on the healthy and injured leg was compared and evaluated for significant differences. There was a significant improvement of postural control after ACL reconstruction. The Overall Stability Index (OSI) for the leg with ACL rupture was 3.7° ± 1.6° preoperatively and 3.0° ± 1.1° postoperatively (p < 0.05). In the postoperative comparison with the healthy leg, the value in the operated leg was 3.0° ± 1.1° and the healthy leg was 3.0° ± 1.4° (p = 0.99). ACL replacement can be improve stability compared to the preoperative value by about 21 % and even the stability level of the contralateral healthy knee can be achieved.
    Der Unfallchirurg 04/2014;
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    ABSTRACT: Exploration for natural resources in the seabed of the Indian Ocean was undertaken by the German government institution of earth sciences and resources ("Bundesanstalt für Geowissenschaften und Rohstoffe", BGR) in November 2012. To provide for the medical safety of crew and scientists, a cooperation between the BGR and the trauma department of the Hannover Medical School was established. Research by physicians accompanying the naval expedition revealed that medical consultations mainly occur because of respiratory infections, abdominal discomfort, genitourinary discomfort and seasickness, with the rate of traumas being between 31% and 41%. Di Giovanna et al. stated that 97% of all emergencies on cruise ships are not critical and only 3% need an immediate emergency medical intervention. Consultations were already performed on the mainland prior to departure and included minor traumas due to non-appropriate footwear, otitis and respiratory infections. Seasickness was the main reason for consultation during the first days at sea. Strong seas resulted in some bruises. Minor injuries and foreign body injuries to the hands and feet also required consultation. First-degree sunburns resulted from exposure to the sun, while air-conditioning caused rhinosinusitis and conjunctivitis. A special consultation was a buccal splitting of tooth 36. An immediate emergency medical intervention was not necessary due to the relative low level of pain for the patient; however, due to the risk of further damage caused by nocturnal bruxism, a protective splint was formed using a small syringe. Other reasons for consultation were similar to those reported in the general literature.Medical activities at exotic locations may create the vision of a holiday character at first; however, intensive planning and preparation are needed. We recommend contacting police, customs, the federal institute for drugs and medical devices as well as the labour inspectorate, preferably in both the originating country and the destination, to prepare custom formalities and to obtain formal documents and approvals beforehand. It is advisable to be prepared not only for emergency situations, but also for general medical and dental problems. Improvisation in the treatment of special health problems is an unavoidable requisite.
    Der Unfallchirurg 04/2014;