Der Unfallchirurg
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Interventional sonography describes the step from pure sonographic imaging diagnostics to sonographically controlled treatment that can be connected directly to sonographic imaging diagnostics instead of postponing it over a longer time interval with possibly further (X-ray, computed tomography, magnetic resonance imaging) diagnostics. The sonographically controlled interventional measures range from a simple puncture of fluid-filled spaces to infiltration of deeper lying areas, such as the labrum acetabulare, the dorsal knee joint capsule and facet joints up to infiltration of the sciatic nerve. The safety is guaranteed by adhering to clearly defined hygiene standards as well as by qualified training as part of the 3‑stage model of certification of the surgery section of the German Society of Ultrasound in Medicine (DEGUM). By using modern sonography devices, structures in the submillimeter range are visible even at close range, so that nowadays even splitting of the annular ligament of the finger has become possible under ultrasound control.
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In 2020 a total of 126 patients attended the practice with distortion trauma of the ankle. Based on a thorough clinical and ultrasound examination 25 ligamentous injuries of the anterior talofibular ligament (ATFL, 9.8%), 8 osseous ligament avulsions (6.3%), 7 injuries of the lateral calcaneocuboid ligament (CC ligament, 5.6%), 5 lesions of the calcaneofibular ligament (CFL) each combined with ATFL injuries (3.9%) and 1 syndesmosis injury (0.6%) were recorded. This didactic article presents a comprehensible ultrasound examination course in an instructive manner from the clinical practice. ⋯ The talofibular advance can be measured on the monitor. Instability of the anterior syndesmosis can be visually demonstrated on the monitor using the sonographic Frick test. A final ultrasound control on the monitor confirms the structural healing and the re-establishment of ligamentous stability.
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After explosions, various injury mechanisms lead to multiple injuries that can affect the entire body. While high pressure peaks and exposure to heat, especially in the vicinity of a detonation, can cause severe injuries and organ damage, fragments also pose a considerable threat to explosion victims even over long distances. The recognition and treatment of life-threatening disorders and the assessment of the severity of the injury are just as challenging for the entire treatment team as long-term operative management, reconstruction strategies and rehabilitation of the complex injuries. Knowledge of the injury mechanics and the pathophysiology of blast injuries should help the interdisciplinary team to master this challenge.
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In many cases the treatment of humeral shaft fractures is challenging and despite the large diversity of available approaches, no standard treatment exists. In addition to conservative treatment, intramedullary nails and plate osteosynthesis are competing methods for healing humeral shaft fractures. Furthermore, cerclage is considered to be an additive treatment for spiral fractures; however, this also increases the risk of radial nerve neuropathy and is said to compromise the perfusion of bone fragments. The goal of this study was to investigate secondary radial nerve neuropathy using additive and limited invasive cerclages for nail osteosynthesis of humeral shaft fractures. ⋯ Of the patients four (3.9%) showed a secondary radial neuropathy during operative stabilization. Neurophysiological and neurosonographic examinations revealed that this had not been caused by compromising, embedding or severance of the radial nerve due to the cerclage. Two out of these nerve lesions recovered spontaneously within 3 and 6 months, respectively. The other two cases could not be documented over a period of 12 months due to death of the patient. With 3.9% of iatrogenic radial nerve lesions the rate of nerve lesions falls into the lower range of that which has previously been described in the literature for nerve lesions due to operative treatment of humeral shaft fractures (3-12%). We thus conclude that there is no increased risk for iatrogenic injury of the radial nerve using additive and limited invasive cerclage.
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Observational Study
[Teamwork and stress in routine interventions: an observational study of multiprofessional OR teams].
Effective interprofessional teamwork and stress are important factors for quality of care and patient safety in the operating room (OR); however, there are just a few systematic investigations into the relationship of OR teamwork and occupational stress. ⋯ The findings suggest a profession-specific relationship between OR teamwork and occupational stress. Further research is necessary to investigate to what extent successful OR teamwork during routine procedures contributes to intraoperative stress.