Einleitung Die Verletzung der großen femoralen Gefäße bei Operationen am Hüftgelenk gehört zu den seltenen aber gefürchteten Komplikationen.

In orthopaedic surgery, as in many other surgical fields, there is a clear tendency towards the use of minimally invasive procedures. These techniques are increasingly being implemented almost routinely for procedures such as spine and pelvis surgery. However, for fracture treatment and for applications involving small bones, such as hand and foot surgery, these systems are hardly ever used. We introduce a new system for image based guidance in traumatology.We included 20 patients with a fracture of the fifth metatarsal. They were randomised on admission into two groups. Ten patients in the metatarsal group were operated conventionally and ten were operated with the assistance of a new image guidance system. This system is based on 2D-fluoro images which are acquired with a conventional c-arm and are transferred to the system workstation. After detecting marked tools, it can be used to display trajectories for K-wire guidance in the c-arm shot.The average duration of surgery (time from incision to suture)...

It is known that implantation of hip endoprosthesis, especially when cemented, is accompanied by the risk of fat embolism to the pulmonary circulation. We here report the case of a paradox embolism in a patient with a persistent foramen ovale in the heart. A 77-year old man with a known multiple myeloma fell on his hip and suffered a femoral neck trochanteric fracture (AO 31.B3). A cemented total hip arthroplasty was performed and the greater trochanter was stabilised by cerclage. After surgery, slurred speech and a deviation of the eyes were observed. Magnetic resonance imaging (MRI) of the brain showed ischemia in the dorsal flow area of the cerebellum on both sides, especially in the pica flow area, the left thalamus, left temporal and occipital due to multiple embolisms. Trans esophageal echocardiography showed a persistent foramen ovale (pfo) with free flow. Intensive specialized physio and ergotherapy was initiated with good results. Upon control three and a half years later the patient showed no neurologic sequelae and a stable hip prosthesis.

Kernaussagen Wirbelsäulenverletzungen müssen weder sofort noch eindeutig erkennbar sein Die korrekte technische Rettung verhindert sekundäre Schäden Die Therapieoptionen am Unfallort konzentrieren sich im wesentlichen auf kreislaufsichernde Maßnahmen Mit Komplikationen durch Myelonverletzungen muss jederzeit gerechnet werden Die Anfahrt eines Traumazentrums mit Wirbelsäulenchirurgie muss gewährleistet werden.

BACKGROUND:Injuries to the spinal cord are not only dreaded because of the high risks existing during the acute phase, but also because of their potential long-term sequelae. Horseback riding also poses a high risk of spinal injuries. We therefore evaluated the most frequent characteristics of accidents leading to long-term sequelae, the primary long-term discomfort resulting from such injuries caused by horseback riding accidents and the way injured persons changed their behaviour after the accidents.PATIENTS:Our study included all cases of horseback riding injuries registered in the Department of Trauma, Hand, Plastic and Restorative Surgery at the University Hospital of Ulm between May 2005 and October 2012. Sequelae of the accidents were examined via follow-up interviews by phone. These included questions about protective gear worn during the accident as well as behavioural changes after the injury. In addition, a spine-specific questionnaire based on the Visual Analogue Scale (VAS) was used to assess long-term complications.RESULTS:Overall, we recorded 50 cases of spinal injuries caused by horseback riding accidents over a time span of 7 years and 5 months. 41 (82 %) of the patients were female and 9 (18 %) were male. The average patient age was 32.0 ± 15.2 years. All in all, the 50 patients sustained 84 injuries: 59 fractures and 25 other injuries such as distorsions or discoligamentous injuries. Most injuries were located in the lumbar spine (n = 43), corresponding to 51 % of all recorded injuries, followed by 32 % in the thoracic spine (n = 27) and 17 % in the cervical spine (n = 14). After sustaining a fracture to the spine, 9 out of 24 patients quit horseback riding. All patients used a helmet after the accident, but only 7 out of 15 used back protection. 11 out of 24 patients suffer from back pain while resting with a mean VAS score of 3.4 ± 1.9. More than half (17 out of 24) have back pain while working with a VAS score of 4.8 ± 2.2.CONCLUSION:The frequency and severity of back injuries sustained by horseback riders increases with age. This can be due to various reasons such as biomechanical factors. The low acceptance of back protection is remarkable.

Fragestellung: Zur Zertifizierung als überregionales Traumazentrum im TraumaNetzwerkD (DGU) wurde ein neuer Schockraum (SR) mit integriertem CT eingerichtet. Der alte SR befand sich räumlich vom CT getrennt. Ziel dieser Arbeit war es, zu eruieren, ob sich die integrierte CT-Einheit auf die Zeitintervalle der SR-Versorgung im Sinne einer Reduzierung auswirkt. Methodik: Es wurde eine Analyse durchgeführt, bei der Daten des alten SR (2005–2007) mit denen des neuen (2009) verglichen wurden. Eingeschlossen wurden alle Traumapatienten, die an das Traumaregister der DGU gemeldet wurden. Als statistisches Verfahren wurde der Mann-Whitney-U-Test angewendet. Ergebnisse: Insgesamt wurden 457 Patienten erfasst. Das Intervall zwischen Aufnahme und CT-Scan betrug im alten SR durchschnittlich 35 ± 27 min (4–240 min), im neuen 13 ± 10 min (1–67 min) (p < 0,001). Ebenso reduzierte sich die SR-Gesamtzeit von 86 ± 42 min (10–240) im alten auf 61 ± 33 min (5–190; p < 0,001) im neuen SR. Schlussfolgerung: Es zeigten sich signifikant kürzere Versorgungszeiten im neuen SR. Diese scheinen insbesondere durch die vor Ort integrierte CT-Einheit ermöglicht zu werden. So besteht die Möglichkeit, Zeitabläufe im Rahmen der Frühphase nach Trauma zu reduzieren und Patienten früher der weiteren Versorgung zuzuführen.

BACKGROUND:A new emergency room (ER) has been established in our trauma centre including an integrated CT scanner. The former ER was located at a long distance from the CT. The aim of this study was to evaluate the influence of the integrated CT in the new ER on the time period from hospital admission to CT diagnostics as well as on the total ER time period. MATERIAL AND METHODS:Data from the old ER (2005-2007) have been compared with those from the new ER (2009). All patients whose data have been transmitted to the German Trauma Registry (DGU) have been included. For statistics the Mann-Whitney U test has been used. RESULTS:Data of 457 patients could be included. Time from admission to CT scan in the old ER had an average of 35 ± 27 min (4-240 min), in the new ER 13 ± 10 min (1-67 min; p < 0.001). The total ER time could be reduced from 86 ± 42 min (10-240) in the old ER to 61 ± 33 min (5-190; p < 0.001) in the new ER. CONCLUSIONS:Time from hospital admission to CT scan as well as the total ER time period can be reduced by using an integrated CT scanner.

Pelvic injuries result from blunt trauma-like traffic accidents or falls. Up to 12% of all trauma patients suffer from pelvic injury; this has to be taken into consideration in patients after high-impact trauma. Fractures of the pelvic ring may cause injury to intrapelvic vessels, organs and soft tissue which rapidly leads to hemorrhagic shock and thus pelvic injury remains one of the most common causes of death after trauma. Early suspicion, identification and management of pelvic fractures may reduce the hemorrhagic shock after pelvic injury. The external compression provided by a splint (PelvicBinder Inc.; T-Pod (R); SAM PelvicSling (TM)) represents a well established method to reduce the intra-pelvic volume and bleeding. The application is done within a few seconds and does not cause any delay in the necessary early hospital transfer.

Beckenverletzungen treten hauptsächlich im Rahmen stumpfer Hochrasanztraumata bei Verkehrsunfällen und Sturzereignissen auf. Eine Verletzung der Beckenregion kommt bei Traumapatienten in bis zu 12 % der Fälle vor und muss in Betracht gezogen werden. Die traumatische Unterbrechung des knöchernen Beckenrings kann durch die Verletzung intrapelviner Gefäße, Leitungsstrukturen und Organe zum hämorrhagischen Schock führen und ist nach wie vor eine der führenden Todesursachen nach Trauma. Eine Beckenverletzung frühzeitig zu erkennen und zu behandeln sind wesentliche Bestandteile der präklinischen Maßnahmen, um einem hämorrhagischen Schock vorzubeugen. Mittlerweile stellt die externe Kompression des Beckens durch Anlegen einer Kompressionsschlinge (z. B. PelvicBinder, Inc.; T-Pod®; SAM PelvicSlingTM) ein etabliertes Verfahren zur Blutungskontrolle durch Reduktion des Beckenvolumens dar und ist innerhalb von Sekunden anzulegen. Unter bedarfsadaptierter Analgesie und Volumentherapie sollte dann der zeitnahe Transport in eine Einrichtung mit Polytraumaversorgung erfolgen.

Fractures of the femoral head are a challenging problem. The most often performed head preserving procedure worldwide is closed reduction and insertion of cannulated screws under fluoroscopic control. The use of navigation is still experimental in general trauma since rigid reference markers must be attached to all fragments. The examined system (Surgix®, Tel Aviv, Israel) is a fluoroscopy based image analysing system. It consists of a workstation and X-ray opaque markers in surgical tools. When the tool is visible in a C-arm shot a trajectory is displayed as additional layer in the image to serve as guidance for the surgeon. Forty synthetic femurs (Synbone®, Malans, Switzerland) were used and placed inside foam to simulate the soft tissue of the thigh. The models were equipped with 4.5mm radio-opaque markers at the fovea capitis femoris as target point. The aim was to bring the tip of a K-wire as close as possible to the target point entering the bone at the lateral base of the greater trochanter in a center-center position. Twenty were done under image guidance and 20 were operated the conventional way. Outcome measures included the accuracy (the distance between the tip of the wire and the target in a CT), the number of guide wire insertions, procedure duration, radiation exposure and learning curve. In the image guided group optimal guide wire placement was accomplished on first pass in 65% of the cases as compared to 5% in the conventional group (p = Image based guidance significantly shortened the procedure, reduced the radiation exposure and the number of trials without changing the surgeons workflow and can be used in trauma cases were reference marker based navigation is not applicable.

Der Hybridoperationssaal (-OP) erfüllt Anforderungen, die verschiedenen hoch spezialisierten Fachbereichen gerecht werden müssen. Neben kardiochirurgischen Eingriffen und interventionellen Gefäßoperationen können in ihm offene Eingriffe aus dem Bereich der Orthopädie und Unfallchirurgie, der Neurochirurgie und der Mund-, Kiefer- und Gesichtschirurgie durchgeführt werden. Dies gelingt durch die Verbindung modernster technischer Vorrichtungen, die perfekt aufeinander abgestimmt sind. Von der Planung eines Eingriffs über die Dokumentation bis hin zur Umsetzung des Planes auch mit computernavigierter Unterstützung greift alles ineinander und schont somit Zeit und personelle Ressourcen. Neue Technologien können einfacher integriert und auf ihren klinischen Nutzen hin untersucht werden. Modernste intraoperative Bildgebungsverfahren eröffnen neue Möglichkeiten der minimal-invasiven Chirurgie und der postoperativen Kontrolle mit unmittelbarer Revisionsmöglichkeit. Der Hybrid-OP stellt ein wirtschaftlich sinnvolles Konzept neuer Bildgebung im OP dar.

Computer-assisted systems are used frequently in pelvis and spine surgery but are still rare in general trauma and hardly ever used in shoulder surgery. The major limitation is the use of rigid markers and the problem of obtaining navigable images in the complex shoulder region. The aim of this study was to evaluate the use of a new image-based guidance system in shoulder traumatology. The system was used to implant a tightrope system in Tossy III lesions of the AC joint (n=7) and compared to the conventional method (n=8). Outcome parameters were duration of surgery, number of trials for perfect positioning of the guide wire, C-arm shots used till K-wire position is accepted, duration of radiation and surgeon's comment on usability and benefit. The new system did not shorten the surgical procedure significantly (45 vs 49 min, p=0.6) but reduced the average overall radiation time from 152 to 90 s (p=0.3). The number of shots to implant the guide-wire could be reduced significantly from 8 to 5 (p=0.01). The number of trials to implant the guide wire was less in the image-guided group compared to the conventional group (1 vs 2, p=0.02). For the first time image-based guidance was used in shoulder traumatology. The system holds high potential to assist surgeons without disturbing the workflow in assuring guide wire positioning, reduce the number of dangerous mistrials and reduce the emission of radiation.

A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.

Navigationssysteme werden in der Orthopädie und Traumatologie zunehmend im Bereich des Beckens und der Wirbelsäule eingesetzt. Ihr Einsatz in der allgemeinen Traumatologie ist nach wie vor selten, in der Schultertraumatologie finden sich praktisch keine Berichte in der Literatur. Limitierend ist die Notwendigkeit fixer Referenzen an allen beweglichen interessierenden Anteilen des Zielobjekts. Ziel dieser Studie war die Untersuchung erster klinischer Erfahrungen mit einem System zur bildbasierten Zielführung auf der Basis zweidimensionaler C-Bogen-Bilder.

Trotz intensiver Rehabilitation leiden Patienten nach Überrollverletzungen häufig an psychosozialen und beruflichen Residuen. Da das Ausmaß dieser posttraumatischen Residuen bislang unzureichend untersucht ist, war das Ziel dieser Studie die Erhebung des Langzeitverlaufs.

Background. The rate of long-term disability following run-over injuries has not been investigated so far. Therefore the aim of this study was to evaluate the long-term outcome following run-over injuries.Material and methods. A total of 71 patients were enrolled in the study. Data were collected regarding the injury pattern, surgical treatment and clinical outcome. The quality of life was measured with the POLO chartResults. The median ISS was 15. Eight patients died. The injuries were predominantly located at the lower extremities (39%) with severe soft tissue injuries in 68% of the cases. Patients were operated on a median of four times. In the follow-up evaluation with the SF36 7 years post-trauma, 57% of the patients had reduced physical functioning and 46% reduced psychological health.Conclusions. The long-term disability following run-over injuries is severe and requires a multidisciplinary approach. Treatment should therefore be conducted in appropriate trauma centres.