Der Unfallchirurg
-
Fracture-related infections (FRI) are a major challenge in orthopedic trauma surgery. The problems in the treatment of such infections are manifold. Especially in cases with insufficient fracture consolidation the treatment not only focusses on the eradication of the infection but also on the restoration of the osseous continuity. ⋯ The FRIs are biofilm-associated infections, so that the current guidelines follow the previously established treatment algorithms for periprosthetic infections. Despite the analogies to periprosthetic infections there are also differences in the treatment as the aspects of fracture healing and bone defect restoration represent determining factors in the treatment of FRI. This article presents the special features of FRI and the classification and guidelines for the treatment are discussed.
-
Joint empyema, also known as septic arthritis, is a severe disease associated with considerable morbidity and mortality. Failing to initiate immediate treatment can result in irreversible joint destruction within a short time. The knee joint is most frequently involved, followed by the shoulder and hip joints. ⋯ An arthrotomy must be carried out only rarely. A pre-emptive antibiotic treatment is initially administered and is later adjusted according to the resistogram. This article gives an overview on the pathophysiology, diagnostics and general management of joint empyema.
-
The journal Der Unfallchirurg and the German Society for Trauma Surgery (DGU) are connected by a colorful story, which reaches a climax in a mutual anniversary year in 2022. Der Unfallchirurg, initially named the Monthly Journal for Trauma Medicine (Monatsschrift für Unfallheilkunde) had already endured 125 years as the specialist journal of the DGU in 2019; however, in 1944 in the 51st year the publication came to a halt due to the upheaval and serious consequences of the Second World War and only reappeared in 1949 with the 52nd year. In its 100-year history the DGU passed through 4 temporally definable phases with respect to content, politics and personnel, to which must be added its preliminary phase as the Division of Trauma Medicine (Abtheilung für Unfallheilkunde) within the Society of German Natural Scientists and Physicians (GDNÄ). In the synopsis on the history of the specialist journal, this article analyzes the more than 125-year development of the DGU.
-
Infections of the hand and forearm are a frequently seen surgical emergency of the hand. Patients of all age groups are affected and underlying systemic diseases are risk factors. Posttraumatic causes are the leading cause of infections. ⋯ Follow-up treatment includes early functional exercise under the guidance of a hand therapist to minimize postinfectious restrictions in the range of motion and to enable occupational rehabilitation. In rare cases, fulminant necrotizing infections with resulting skin and soft tissue defects can occur. In these cases, secondary plastic reconstruction is usually required after cleansing of the infection.
-
Due to its low invasive nature, arthroscopy nowadays represents the gold standard in the treatment of native joint empyema. This article gives a summary of the literature with expert recommendations, reviews and case reports on arthroscopic treatment of native joint empyema and the limitations. ⋯ In postoperative infections with enclosed foreign material, such as after cruciate ligament reconstruction, the foreign material can in most cases be left in and successful infection eradication can be carried out with several arthroscopic lavages and débridement. In cases of higher grade infections with destruction of the joint, arthroscopic treatment alone is normally insufficient.