Der Unfallchirurg (Unfallchirurg)

Publisher: Deutsche Gesellschaft für Unfallheilkunde, Springer Verlag

Journal 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.

Current impact factor: 0.65

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 0.649
2013 Impact Factor 0.608
2012 Impact Factor 0.64
2011 Impact Factor 0.61
2010 Impact Factor 0.675
2009 Impact Factor 0.592
2008 Impact Factor 0.686
2007 Impact Factor 0.56
2006 Impact Factor 0.645
2005 Impact Factor 0.647
2004 Impact Factor 0.452
2003 Impact Factor 0.521
2002 Impact Factor 0.548
2001 Impact Factor 0.413
2000 Impact Factor 0.496
1999 Impact Factor 0.602
1998 Impact Factor 0.626
1997 Impact Factor 0.824
1996 Impact Factor 0.733
1995 Impact Factor 0.169
1994 Impact Factor 0.141
1993 Impact Factor 0.174
1992 Impact Factor 0.198

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.67
Cited half-life 9.30
Immediacy index 0.15
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
    • 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

  • Source

    Preview · Article · Jan 2016 · Der Unfallchirurg
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    ABSTRACT: Background: Prehospital assessment of injury type and severity by emergency medical services physicians impacts treatment including appropriate destination hospital selection, especially in (potentially) life-threatening cases. Injuries which are underestimated or overlooked by the emergency physician can delay adequate therapy and thus significantly influence the overall outcome. The current study used data from the TraumaRegister DGU® to evaluate the reliability of prehospital injury assessments made by emergency physicians. Material and methods: Data of 30,777 patients from the TraumaRegister DGU® between 1993 and 2009 were retrospectively evaluated. Using the abbreviated injury scale (AIS), subjective prehospital assessments of injury severity by emergency physicians were correlated with objectively identified injuries diagnosed after admission to hospital. For this evaluation, prehospital injury assessments rated moderate or severe by the emergency physician as well as injuries diagnosed in hospital with an AIS score ≥3 points were deemed relevant. Results: The 30,777 patients with an injury severity score (ISS) ≥ 9 suffered a total of 202,496 injuries and of these 26 % (51,839 out of 202,496) were considered relevant with an AIS ≥3 points. The most frequent relevant injuries were to the head (47 %) and chest (46 %). Of the 51,839 relevant injuries, the prehospital assessment by the emergency physician was accurate for 71 % and in 29 % of the cases relevant injuries were underestimated. Relevant injuries were unrecognized or underestimated in prehospital assessments for almost 1 out of every 7 cases of head trauma, almost 1 out of every 3 thoracic trauma and almost 1 out of every 2 abdominal and pelvic trauma. Conclusion: The assessment of injury severity by emergency medical services physicians based on physical examination at the scene of the trauma is not very reliable. Thus, mechanisms of injury and overall presentation as well as identifiable injuries and vital parameters should be recognized by the emergency physician when considering treatment strategies and choice of appropriate destination hospital. The patient should be re-evaluated in a priority-oriented manner at the latest on arrival in the trauma room to avoid the consequences of unrecognized or underestimated injuries.
    No preview · Article · Jan 2016 · Der Unfallchirurg
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    ABSTRACT: Impaired hemostasis represents a major risk factor for increased morbidity and mortality in patients with traumatic intracranial hemorrhage. In cases of polytrauma with major bleeding, hyperfibrinolysis may develop and this may result in excessive coagulopathy. Patients receiving antithrombotic medication and suffering from intracranial hemorrhage are at particular risk for the development of neurological sequelae due to the increased tendency to bleeding. This article outlines the principles of hemostatic therapy of traumatic intracranial hemorrhage during antithrombotic treatment. The basic principles of the pathophysiology and effects of coagulation impairment in this patient population are reviewed. Furthermore, the use of specific coagulation tests and the administration of hemostatic substances are discussed.
    No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: Background: In the treatment of complex pelvic fractures hemorrhage control is of primary importance; however, studies regarding the localization of bleeding are contradictory so that various treatment approaches are recommended. The primary aim of external pelvic compression applied in the trauma room is to reduce the pelvic volume and counteract blood loss through self-induced tamponade. This study examined the influence of external pelvic compression on mortality and outcome in cases of hemodynamically unstable pelvic fractures in a larger number of cases. Material and methods: The current study used the TraumaRegister DGU® (TR-DGU) to retrospectively evaluate the records of 104 patients treated between 2002 and 2011. All patients suffered severe injury with an injury severity score (ISS) of at least 16 points. In addition, the patients were hemodynamically unstable with confirmed relevant isolated pelvic injuries. To evaluate the effectiveness of external pelvic compression, patients with and without external pelvic stabilization were compared. Results: Of the investigated patients 26.9 % died of their injuries and of these the mortality was 78.6 % within the first 6 h of admission to the trauma room. External pelvic stabilization was performed in 45.2 % of patients. The mortality was 19.1 % in patients with external pelvic stabilization and in contrast, the mortality in the group of patients without external pelvic stabilization was 33.3 %. During the course of hospitalization, surviving patients with external pelvic stabilization were significantly more likely to develop sepsis or multiple organ failure and required longer periods of intensive care. Conclusion: External pelvic stabilization seems to be an important instrument for the initial treatment of hemodynamically unstable pelvic fractures and showed a positive effect on patient mortality.
    No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: The increasing importance of preventive measures in the field of orthopedics and trauma surgery becomes apparent because of the demographic changes and the high risk for secondary fractures following osteoporotic fractures. Within the fracture treatment chain, orthopedics and trauma surgery are in the “pole position” to initiate these measures in geriatric patients. In the past orthopedists and trauma surgeons have constantly accused of neglecting secondary fracture prevention in fragility fracture patients. There are several reasons that speak in favor of us undertaking a role in secondary fracture prevention: osteoporosis medication is highly effective in fracture prevention when correctly indicated, the positive effects of osteoporosis therapy on fracture healing and legal issues. Arguments that have been used to justify neglect of secondary fracture prevention are undesired side effects related to osteoporosis medications, such as atypical femoral fractures and osteonecrosis of the jaws, interference of some specific drugs with fracture healing and the working conditions in emergency departments. These run contrary to the consideration of chronic diseases such as osteoporosis, secondary osteoporosis and the underlying disease could be overlooked and the increasing complexity of medicinal osteoporosis therapy. In the first part of the article these arguments are weighed against each other. In the second part the concept of a fracture liaison service (FLS) is discussed. The FLS framework now allows an active role to be taken with respect to secondary fracture prevention despite the busy daily routine schedule. Implementation of an FLS is facilitated by dedicated instruction protocols and programs. Self-financing of an FLS is currently possible only in some specific healthcare systems. In healthcare systems in German-speaking areas a cross-financing must be available and the value of an FLS indirectly presented. Apart from the financial aspects, implementation of a FLS is also worthwhile because it can be looked on as the future driving force of innovation.
    No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: Backgrounds and objectives: As part of the expansion of the site-specific education profile of the medical curriculum MED@ULM of the University of Ulm, a new track "trauma care and trauma research" was established in the winter semester 2012/2013. The acceptance of the track was evaluated during the winter semester 2013/2014. Material and methods: The 6-semester track extends the existing curriculum by offering subjects in trauma management and trauma research to students of human medicine. A central aim of the track is to promote medical professional competence, expertise in emergency care and competence in trauma-related scientific work and research. Central learning contents could be intensified in newly established emergency simulation training. Additionally, participating students have to perform a doctoral thesis on an obligatory trauma-related experimental subject. A first analysis study focusing on the learning style of the participating students (n = 17) and a control group consisting of members of the same semester (n = 20) was performed using the Kolb learning style inventory. In a validated evaluation in the winter semesters 2013/2014 and 2014/2015, the students were asked about their expectations and experience with the track, criticisms, suggestions and satisfaction with the study conditions. The data were analyzed using descriptive statistics. Results: The analysis of the students' preferred learning styles revealed no differences between track students and the control group. Most of the students considered the track as a form of personal further education. The students had high expectations of practical skills with relevance to the clinical daily routine, learning scientific methods and preparing their thesis. The track students were more critical with regard to the study conditions than the control group students, although the track students of the third semester still judged their studies to be more interesting than the track students of the first semester and the control group. Conclusion: With the introduction of the new trauma track into the curriculum of the medical curriculum MED@ULM of the University of Ulm, a further possibility for medical students to focus on their own individual options was established. At least half of the track students wanted to be later active in the triad of patient care, teaching and research. Further investigations are necessary to determine whether the establishment of the trauma track has a positive influence on the number of new recruits in trauma surgery and anesthesiology.
    No preview · Article · Dec 2015 · Der Unfallchirurg

  • No preview · Article · Dec 2015 · Der Unfallchirurg
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    ABSTRACT: The geriatric trauma working party, a subgroup of the German Society of Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU), focuses on the challenges of geriatric fractures, which are steadily increasing due to demographic changes. Inherent comorbidities implicate perioperative complications leading to loss of mobility and endangered independence followed by an increased burden on the social services. An interdisciplinary approach is required. The geriatric trauma working party defined criteria for interdisciplinary treatment and comprehensive care as well as early rehabilitation in interdisciplinary geriatric fracture centers. By passing an independent audit process these centers can achieve certification as a geriatric trauma center DGU (AltersTraumaZentrum DGU). Certified centers can participate in a recently established geriatric fracture registry which includes an internationally consented data set. Audit and registry enable centers to acquire an international benchmark, ensure permanent improvement in quality and allow participation in health services research.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Mechanical stimuli are known to significantly influence bone metabolism and fracture healing. Various studies have demonstrated the involvement of complex molecular mechanotransduction pathways, such as the Wnt/beta-catenin, bone morphogenetic protein (BMP) and estrogen receptor signaling pathways in mechanotransduction. Mechanotransduction is influenced by aging and the comorbidities of the patient. Pharmacological modulation of signal transduction influences bone formation and the mechanosensitivity of skeletal tissue. The combination of pharmacological and biomechanical therapies may be useful for the treatment of fractures with impaired healing.
    No preview · Article · Nov 2015 · Der Unfallchirurg
  • Article: [Preface]

    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: In ancient times as well as in the Middle Ages treatment options for discogenic nerve compression syndrome were limited and usually not very specific because of low anatomical and pathophysiological knowledge. The stretch rack (scamnum Hippocratis) was particularly prominent but was widely used as a therapeutic device for very different spinal disorders. Since the beginning of the nineteenth century anatomical knowledge increased and the advances in the fields of asepsis, anesthesia and surgery resulted in an increase in surgical interventions on the spine. In 1908 the first successful lumbar discectomy was initiated and performed by the German neurologist Heinrich O. Oppenheim (1858-1919) and the surgeon Fedor Krause (1857-1937); however, neither recognized the true pathological condition of discogenic nerve compression syndrome. With the landmark report in the New England Journal of Medicine in 1934, the two American surgeons William Jason Mixter (1880-1958) and Joseph Seaton Barr (1901-1963) finally clarified the pathomechanism of lumbar disc herniation and furthermore, propagated discectomy as the standard therapy. Since then interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. The surgical procedures changed over time and were continuously being refined. In the late 1960s the surgical microscope was introduced for spinal surgery by the work of the famous neurosurgeon Mahmut Gazi Yasargil and his colleague Wolfhard Caspar and so-called microdiscectomy was introduced. Besides open discectomy other interventional techniques were developed to overcome the side effects of surgical procedures. In 1964 the American orthopedic surgeon Lyman Smith (1912-1991) introduced chemonucleolysis, a minimally invasive technique consisting only of a cannula and the proteolytic enzyme chymopapain, which is injected into the disc compartment to dissolve the displaced disc material. In 1975 the Japanese orthopedic surgeon Sadahisa Hijikata described percutaneous discectomy for the first time, which was a further minimally invasive surgical technique. Further variants of minimally invasive surgical procedures, such as percutaneous laser discectomy in 1986 and percutaneous endoscopic microdiscectomy in 1997, were also introduced; however, open discectomy, especially microdiscectomy remains the therapeutic gold standard for lumbar disc herniation.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Introduction The improvement and acceleration of fracture healing has been a component of medical practice since fractures have been treated. The aim is not only to fulfill the basic principles of fracture healing, such as reduction, retention, soft tissue coverage and infection prevention but also to reduce negative influences on fracture healing and promote positive factors. Nicotine, alcohol, diabetes and malnutrition can negatively affect fracture healing and should be appropriately controlled during fracture treatment; however, it is far more difficult to develop medicinal treatment strategies that lead to improvement and acceleration of fracture healing. Aim This article provides an overview of pharmacological factors influencing fracture healing. In addition, substances frequently used in clinical practice will be evaluated in terms of the effects on fracture healing processes. Material and methods An extensive literature search was conducted in PubMed based on thematic keywords. The selection of studies and scientific publications focused mainly on results from clinical trials in order to provide practically relevant information. Results In this context, preclinical studies have identified several drugs that lead to the acceleration of fracture healing; however, only a very limited number of clinical trials have confirmed this positive effect. Most of these studies dealt with drugs developed for the treatment of osteoporosis, as osteoporotic fractures are common and a positive or negative influence of such drugs are of particular interest in this field. In the field of osteoporosis medication a certain degree of positive effect of parathyroid hormone 1–34 (PTH) on fracture healing has been shown in clinical trials. For other osteoporosis medications no negative influence on fracture healing in clinical settings has been reported; however, there seems to be a positive effect in terms of better implant fixation for patients receiving oral bisphosphonate therapy. Discussion Systemic medication to improve fracture healing will not be part of the clinical routine in the foreseeable future as the available data for already approved drugs and drugs under development do not currently justify routine administration. However, the currently known data should encourage the potential of known medications to be completely exhausted in fracture healing studies as well as novel therapy options in the sense of positive effects on fracture healing in order to improve patient care.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Hippocrates was the first to intensively describe and document the principles for the treatment of injuries and diseases of the spine. His principles for abrupt treatment of the "hunchback" were followed by physicians even up to the end of the nineteenth century. The non-operative treatment of scoliosis was improved in the beginning of the sixteenth century by the introduction of mechanical devices that started the development of corsets which are still in use in modern scoliosis treatment. Stretching beds were only in temporary use. With the beginning of the nineteenth century gymnastics and physiotherapy became more and more important. Manual therapy was exercised by physicians until the late Middle Ages. After a long period of time in which bonesetters and other laymen performed manual therapy it was professionalized at the end of the nineteenth century again by the introduction of osteopathy and chiropractic. In Germany the development and introduction of manual treatment started relatively late in the twentieth century, predominantly as manual medicine.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Computed tomography (CT) is the method of choice in the diagnosis and classification of odontoid fractures with a sensitivity of more than 99 % and a specificity almost equally as high. In this article we report on four cases where CT-generated motion artefacts exactly mimicked an Anderson type II fracture of the dens axis, initially leading to a wrong diagnosis. Although this seems to be a very rare event, these cases indicate that overlooked CT motion artefacts can lead to severe consequences and attention must be paid to the radiological signs outlined in this report.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. It is due to these factors that the concept of an elderly trauma center was developed. These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Scoliosis can be considered as one of the classical orthopedic diseases of the spine. The history of orthopedics is closely connected to the development of the therapy of scoliosis. In the eighteenth and the beginning of the nineteenth centuries the therapy of scoliosis was mainly a conservative corrective orthopedic treatment with a variety of corset forms and extension bed treatment. In the middle of the nineteenth century physiotherapy (movement therapy) became established as an supplementary active treatment. The first operations for treatment of scoliosis were carried out in 1839. The real success with surgical procedures for improvement in corrective options was connected to the introduction of metal spinal implants in the early 1960s.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: A balanced calcium homeostasis is of critical importance not only for bone remodeling, the physiological process of bone resorption and bone formation that constantly renews bone throughout life but also for normal fracture healing. Given that disturbances of calcium homeostasis are present in 50 % of the German population and that this might result in delayed fracture healing after correct surgical treatment, this paper focusses on calcium and vitamin D in the daily practice in orthopedics and trauma surgery. To ensure the required enteral calcium uptake the following three conditions are required: (1) sufficient calcium intake via the nutrition, (2) a 25-hydroxyvitamin D serum level > 30 µg/l and (3) the presence of sufficient gastric acidification. Given the endemic vitamin D deficiency in Germany as well as the constantly increasing number of people using proton pump inhibitors on a regular basis, it is necessary to closely connect trauma orthopedic surgery and osteological treatment. The first issue to be dealt with is to control and if needed normalize calcium homeostasis in order to allow a normal undisturbed fracture healing process after both conservative as well as operative treatment of fractures.
    No preview · Article · Nov 2015 · Der Unfallchirurg
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    ABSTRACT: Background This article presents a retrospective look at spinal implants of the 1970s and 1980s. Objective The historical development of internal fixators as the successor to external fixators. Mechanical principle Pedicled screws are stably anchored in vertebral bodies of the thoracic or lumbar spine or the sacrum using a dorsal approach. They are joined by a rod as a longitudinal support, separated by freely selectable distances and in any desirable and initially modifiable angle. After locking this results in an angular and rotationally stable completely sunken bilateral construction for fixing two or more vertebrae together and the position can be manually adjusted using long lever arms on the pedicled screws. Results The first in vivo application in humans was on 22 December 1982 in Basel. The initial indications were unstable spinal fractures. The expectations placed on the new working principle of internal fixation and its realization were confirmed and short stretch fixation exclusively of the neighboring vertebra and immediate mobilization of patients could be routinely achieved. The indications were extended to include instability of the spine for conditions outside the field of traumatology. Further developments of implants and other technical solutions in the coupling system using the same basic principle in the direction of multisegmental applications, ease of operation and titanium-based materials became internationally established and were developed into universal spinal stabilization systems for spinal degeneration, deformities, tumors and olisthesis. Conclusion The basic principle of spinal fixators (internal and external) is contained in the complete product range of dorsal stabilizing implants from practically all manufacturers worldwide and has become taken for granted.
    No preview · Article · Nov 2015 · Der Unfallchirurg