Der Unfallchirurg (Unfallchirurg )

Publisher: Deutsche Gesellschaft für Unfallheilkunde, Springer Verlag


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
  • 5-year impact
  • Cited half-life
  • Immediacy index
  • Eigenfactor
  • Article influence
  • Website
    Unfallchirurg, Der website
  • Other titles
    Unfallchirurg (Online)
  • ISSN
  • OCLC
  • 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
    • 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: 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.
  • [Show abstract] [Hide abstract]
    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.
  • Der Unfallchirurg 05/2014; 117(5):390-1.
  • [Show abstract] [Hide abstract]
    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.
  • [Show abstract] [Hide abstract]
    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.
  • Der Unfallchirurg 05/2014; 117(5):461-3.
  • [Show abstract] [Hide abstract]
    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.
  • [Show abstract] [Hide abstract]
    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;
  • [Show abstract] [Hide abstract]
    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;
  • [Show abstract] [Hide abstract]
    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;
  • [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;
  • [Show abstract] [Hide abstract]
    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: Precise function of the hand is crucially characterized by opposition movement of the thumb, only possible because of the functional anatomy of the first carpometacarpal joint. High functional demands to this joint consequently lead to the highest rate of osteoarthritis of the hand joints and loss of function. Carpometacarpal (CMC) osteoarthritis of the thumb is rarely seen in posttraumatic cases. It can be caused by fractures involving the joint surfaces of both, the trapezium or the first metacarpal, whereas dislocations of the carpometacarpal joint itself only occasionly lead to osteoarthritis. Identification and compilation of current concepts in diagnosis and therapy of posttraumatic carpometacarpal osteoarthritis of the thumb. Selective PubMed and Cochrane review, data obtained from own patient investigations and author's experiences were used. Adequate treatment of the injury will minimize the risk for future malfunction. In early stages, arthroscopy is a valuable method for the diagnosis and treatment of posttraumatic rhizarthrosis. For all stages, a multitude of operative procedures are described and being used but yet not finally assessed for effectiveness. Advanced osteoarthritis of the first CMC joint is widely treated by trapeziectomy, which is suitable for most patients, and considered as gold standard. Additional procedures like suspension, interposition or k-wire transfixation do not provide any significant advantage and lead to comparable results. It is advisable to treat hyperextension of the metacarpophalangeal joint of the thumb at any stage of CMC osteoarthritis.
    Der Unfallchirurg 04/2014; 117(4):291-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Injuries of the distal interphalangeal joints mostly involve the extensor tendon. Its superficial position on the dorsal aspect of the finger often exposes the extensor tendon to closed and open injuries. Lesions of the extensor tendons are more common than those of the flexor tendons. Furthermore, injuries of the joint often occur as fractures of the dorsal base of the distal phalanx, and, less frequently, as fractures of the head of the middle phalanx. In all cases, correct diagnosis and therapy is essential. Incorrect diagnosis and neglecting of the injury by both surgeon and patient often lead to considerable complications, e.g., delayed healing and lack of function.
    Der Unfallchirurg 04/2014; 117(4):327-33.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Injuries of the metacarpophalangeal joints of the thumb and fingers are of a bony or ligamentous nature. They can heal without subsequent problems if correctly diagnosed and treated but incorrect or absent diagnostics and therapy can result in chronic instability, dislocation, fusion as well as subsequent arthritis and functional limitations. They can lead to substantial impairment of the gripping function. Fractures with inclusion of joints and with fragments sufficiently large for refixation are as a rule treated operatively just as differences in torsion and instability. Persisting instabilities are secondarily stabilized by ligamentoplasty and arthritis of the metacarpophalangeal joint of the thumb is treated by fusion. For metacarpophalangeal joints of the fingers the main concern is preserving motion. Established salvage operations for arthritis include denervation, resection arthroplasty and systematic arthrolysis for impairment of the joint and contractures with intact joint surfaces. Even in chronic conditions, with appropriate treatment good functional results for metacarpophalangeal joints of the thumb and fingers can be achieved. This article presents the current pathophysiological principles and concepts for diagnostics and therapy of acute and chronic injuries of the metacarpophalangeal joints of fingers and thumbs.
    Der Unfallchirurg 04/2014; 117(4):307-14.

Related Journals