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
    0.64
  • 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

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors own final version only can be archived
    • Publisher's version/PDF cannot be used
    • On author's website or institutional repository
    • On funders designated website/repository after 12 months at the funders request or as a result of legal obligation
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (The original publication is available at www.springerlink.com)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [show abstract] [hide abstract]
    ABSTRACT: Complex pelvic traumas, i.e., pelvic fractures accompanied by pelvic soft tissue injuries, still have an unacceptably high mortality rate of about 18 %. We retrospectively evaluated an intersection set of data from the TraumaRegister DGU® and the German Pelvic Injury Register from 2004-2009. Patients with complex and noncomplex pelvic traumas were compared regarding their vital parameters, emergency management, stay in the ICU, and outcome. From a total of 344 patients with pelvic injuries, 21 % of patients had a complex and 79 % a noncomplex trauma. Complex traumas were significantly less likely to survive (16.7 % vs. 5.9 %). Whereas vital parameters and emergency treatment in the preclinical setting did not differ substantially, patients with complex traumas were more often in shock and showed acute traumatic coagulopathy on hospital arrival, which resulted in more fluid volumes and transfusions when compared to patients with noncomplex traumas. Furthermore, patients with complex traumas had more complications and longer ICU stays. Prevention of exsanguination and complications like multiple organ dysfunction syndrome still pose a major challenge in the management of complex pelvic traumas.
    Der Unfallchirurg 04/2014;
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    ABSTRACT: In the late 1960s, helicopter emergency medical services (HEMS) were established because of the increasing number of severely injured in road traffic accidents. It was initially thought to bring the doctor to the patient quickly. Today, the rescue helicopter covers the entire field of emergency medicine. By analyzing the databases of the TraumaRegister DGU® (2005-2011), the importance of the HEMS for the treatment of the severely injured was examined. The results showed that around 30 % of severely injured are allocated to hospitals by HEMS. In addition to regional differences, the level of the hospital also plays a particularly important role. The combination of the transfer by HEMS and treatment in a level I trauma center has a significantly positive effect on the survival rate of the patient, especially in patients with traumatic brain injury (TBI).
    Der Unfallchirurg 04/2014;
  • [show abstract] [hide abstract]
    ABSTRACT: Various treatment options exist for displaced proximal humeral fractures. The impact of the level of hospital care and frequency of treatment on current treatment regimens in Germany was analyzed. A total of 576 hospitals were included. The survey covered questions on frequency, diagnostics, classification, therapy, complications, and clinical scenarios. In all, 48% of the hospitals returned the questionnaire: 73% treat more than 60% of the fractures surgically, mainly with angle-stable implants. The angle-stable plate is the treatment of choice for young patients, but older patients are treated using other treatment options. Problems and complications included malreduction, secondary displacement, screw perforation, avascular necrosis, and impingement. According to treatment indication, implant choice, and common complications, no significant differences between the level of hospital care and frequency of treatment were observed. Independent of the level of hospital care and frequency of treatment, there is a trend for head-preserving angular-stable surgery with a homogenous level of treatment in Germany.
    Der Unfallchirurg 03/2014;
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    ABSTRACT: Posterior dislocations of the shoulder represent a rare injury with frequently occurring soft tissue and/or bony concomitant lesions such as the reverse Hill-Sachs lesion and the dorsal labrum tear. For the combination of these injuries, no evidence-based therapeutic recommendations exist. Reflecting on two clinical cases and the current literature data, options for the treatment of combined osseous and soft tissue injuries due to posterior dislocation of the shoulder are presented. We report two cases of fresh traumatic first-time posterior dislocations that were each explored arthroscopically and subsequently operated using an open technique. In the first case, we performed refixation of the labrum, followed by open osteosynthesis with bone substitution. Treatment of the second case included diagnostic arthroscopy and - after a frustrating attempt to elevate the defect in an arthroscopically assisted retrograde technique - open reconstruction of the humeral head with an allograft. In both cases good clinical outcomes with Constant scores of 79 and 86 points at the 16- and 12-month follow-ups, respectively, were achieved. Radiologically complete integration of the used materials was found. These cases show that for the operative treatment of fresh, traumatic posterior shoulder dislocation, it is useful to explore the joint arthroscopically to identify concomitant injuries of the labrum and if necessary treat them. The bony pathology of the humeral head can subsequently be addressed in an open technique, whereby the appropriate treatment should be chosen based on the size of the defect.
    Der Unfallchirurg 03/2014;
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    ABSTRACT: The steady rise in life expectancy of our population leads to an exponential increase in proximal femoral fractures. The growing increase of comorbidities in these patients requires continuous development of modern implant systems for internal fixation of proximal femoral fractures. In this study we enrolled 116 patients with pertrochanteric femoral fractures who were treated with a proximal femoral nail (Targon PF, Aesculap) over a period of 1 year. The indications for this implant system were set at unstable fracture types. Data of the operative and postoperative course were collected prospectively. The average age of the 116 predominantly female subjects was 77±14 years and the most commonly observed fracture subtype was 31-A1.2. The follow-up rate was 55 %. We observed a decrease in the postoperative modified Harris hip score of 22.7 %. The 1-year mortality was 21.6 %. The results of this study showed a low rate of perioperative complications and implant loss anda decline in patient mobility was typically observed within 1 year.
    Der Unfallchirurg 03/2014;
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    ABSTRACT: Falling on the outstretched hand is a common trauma mechanism. In contrast to fractures of the distal radius, which usually are diagnosed on plain film radiographs, identifying wrist injuries requires further diagnostic methods, e.g., MRI or CT. This article provides a review of the use of MRI in the most common traumatic wrist injuries, including scaphoid fractures, TFCC lesions, and tears of the scapholunate ligament. Early and selective use of MRI as a further diagnostic method in cases of adequate clinical suspicion helps to initiate the correct treatment and, thus, prevents long-term arthrotic injuries and reduces unnecessary absence due to illness. MRI shows a high reliability in the diagnosis of scaphoid fractures and the America College of Radiology recommends MRI as method of choice after X-ray images have been made. In the diagnosis of ligament and discoid lesions, MR arthrography (MRA) using intraarticular contrast agent has considerably higher accuracy than i.v.-enhanced and especially unenhanced MRI.
    Der Unfallchirurg 03/2014; 117(3):221-6.
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    ABSTRACT: Magnetic resonance imaging (MRI) plays a very important role in the diagnosis of musculoskeletal conditions; its importance in orthopedic trauma continues to grow. To ensure optimal imaging and to be able to answer all clinically relevant questions, some prerequisites must be taken into account. Of uttermost importance is a functioning communication between surgeons and radiologists. To adapt the best sequences, the radiologist needs to know all suspected injuries and the mechanism of trauma. Second, the surgeon must have basic knowledge regarding this technology to optimally use all its possibilities. The aim of this article is to familiarize the reader with basic MRI in traumatology focusing on weightings and sequences.
    Der Unfallchirurg 03/2014; 117(3):197-205.
  • Der Unfallchirurg 03/2014; 117(3):188-9.
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    ABSTRACT: Abdominal trauma represents the leading cause of haemorrhagic shock in the severely injured patient and is associated with high mortality and morbidity rates. The trauma surgeon has a central role in the multidisciplinary team addressing the specific diagnostic and therapeutic needs of patients with abdominal trauma. The management of blunt and penetrating abdominal trauma has undergone substantial changes in recent decades. Major innovations have been established in the field of diagnostic imaging and of nonoperative interventions such as angioembolization and endoscopic procedures. Another key development is the introduction of the damage control concept for the care of patients with abdominal trauma. The present manuscript comprises a review of the current management of abdominal trauma with an emphasis on diagnostic and therapeutic innovations.
    Der Unfallchirurg 03/2014; 117(3):249-61.
  • [show abstract] [hide abstract]
    ABSTRACT: The tendency in surgical fields to subspecialize continues. Diagnostic possibilities and surgical indications are becoming more and more sophisticated. As a consequence, surgeons in Germany have the possibility to acquire qualifications in magnetic resonance imaging (MRI) and are allowed to employ MRI scanners without consulting radiologists. This article aims to describe the requirements to achieve this special qualification and to give a summary on the legal issues in this matter.
    Der Unfallchirurg 03/2014; 117(3):206-10.
  • [show abstract] [hide abstract]
    ABSTRACT: Muscle injuries are the most frequent sport injuries in athletes. In addition to a thorough clinical examination and the history of the trauma mechanism, imaging modalities are required to correctly classify the injury and plan the future treatment and rehabilitation. The two major modalities are ultrasound and magnet resonance imaging (MRI). This article aims to give a comprehensive overview on the possibilities and limitations of MRI imaging in musculoskeletal injuries as well as insight into current development, classifications and technologies.
    Der Unfallchirurg 03/2014; 117(3):227-34.
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    ABSTRACT: Magnetic resonance imaging (MRI) plays a very important role in traumatology; however, clear guidelines and standard operating procedures do not exist on a large scale. The aim of this worldwide needs analysis was to gather detailed information on this imaging modality in the daily work of trauma and orthopedic surgeons and trainees, and to identify ways to optimize its application. Using the network of the"Arbeitsgemeinschaft für Osteosynthesefragen - Association for the Study of Internal Fixation" (AO/ASIF), participants who registered for a webinar on this topic were asked to complete a structured set of questions and simulated cases online. A total of 442 participants from 69 countries registered for the webinar and 361 (81.6%) completed all or the main parts of the survey. The main reported barriers to the optimal use of MRI were high cost, long waiting time, a lack of communication between surgeons and radiologists, and a lack of experience and training in this technology. To address these barriers, a more structured curriculum in the training period of orthopedic and trauma surgeons may be required as well as the development of resources for continuing and self-directed learning.
    Der Unfallchirurg 03/2014; 117(3):190-6.
  • [show abstract] [hide abstract]
    ABSTRACT: In addition to ultrasound and conventional x-ray, magnetic resonance imaging (MRI) plays an important role in the visualization of lesions of the knee. It allows the orthopaedic surgeon to safely detect ruptures of the cruciate ligaments, the meniscus, osteochondral lesions and other ligamentary structures such as the collateral ligaments and the medial patellofemoral ligament (MPFL). In patellar dislocations, risk factors for recurrent dislocations can be determined and the therapy can be adjusted accordingly.This articles aims to give the reader a comprehensive overview on current concepts and techniques in the use of MRI for lesions of the knee. It focuses on patellar dislocations, where MRI plays a dominant role in supporting decision making for the best therapeutic strategy.
    Der Unfallchirurg 02/2014;
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    ABSTRACT: Considering the controversially discussed issue of whiplash injury a pragmatic approach based on our own experience in the area of forensic expert opinion is presented. Findings of accident analysis and biomechanics are correlated with the individual situation after the accident (initial clinical appearance), the course of the ailment and the indispensable physical examination. The latter leads to determination of the individual vulnerability (not increased/increased) which is important for the evaluation of the physical condition and estimation of the physical stress limit. These limits vary widely between individuals and must be considered carefully when relating dose and effect of accident severity to a possible physical injury. Determination of the accident severity is especially important when there are no objective signs of injury and the existence of a minor whiplash injury (Quebec Task Force degree 1 or 2) is in question.
    Der Unfallchirurg 02/2014;
  • [show abstract] [hide abstract]
    ABSTRACT: Exsanguination represents the most common and potentially preventable cause of death in major trauma patients. Rapid surgical intervention coupled with an early and aggressive hemostatic therapy not only results in survival benefits of coagulopathic trauma patients, but also reduces the incidence of complications and costs. Standard coagulation tests are not suitable to adequately characterize the complexity of trauma-induced coagulopathy (TIC). This fact has led to a renaissance of viscoelastic tests, such as rotational thromboelastometry (ROTEM®) and thrombelastography (TEG®), which can be used as point-of-care monitors. In some trauma centers treatment algorithms have been developed, where hemostatic therapy is based on viscoelastic test results. Shock and tissue trauma activate profibrinolytic pathways which in turn result in premature dissolution of formed clots. Tranexamic acid rapidly and inexpensively blocks hyperfibrinolysis. ROTEM®/TEG® measurements revealed that diminished clot strength is associated with an increased bleeding tendency. Depending on the underlying cause, administration of fibrinogen concentrate and/or platelet concentrate administration improves clot firmness. Thrombin generation is initially less compromised and can be improved by the administration of plasma, prothrombin complex concentrate, or with restrictiveness by recombinant activated factor VII.
    Der Unfallchirurg 02/2014;
  • [show abstract] [hide abstract]
    ABSTRACT: Pelvic injuries are often associated with multiple injuries of other body regions, neurovascular and visceral lesions, as well as hemodynamic instability. The use of a standardized classification characterizing the severity and stability of pelvic fractures and the early stabilization of pelvic ring injuries in appreciation of damage control principles has helped to improve the number of survivors. This is particularly necessary due to the higher number of older patients. Complex pelvic trauma still represents a life-threatening situation for the patient, particularly in multiple traumatized patients. Standardized clinical investigations and modern concepts even in the preclinical therapy of complex pelvic fractures make a contribution to enhancement of treatment options. Because of the still problematic long-term results after surgery of instable pelvic fractures, the need for modern treatment concepts has to be adapted to the requirements.
    Der Unfallchirurg 02/2014; 117(2):145-61.
  • Der Unfallchirurg 02/2014; 117(2):94.

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