Unfallchirurgie – leicht gemacht

Die richtige Einschätzung und Einteilung von unfallchirurgischen Verletzungen ermöglichen eine passgenaue Therapie und Nachbehandlung. Mit einfachen Regeln lassen sich fast alle Frakturen korrekt nachbehandeln und in einem Arztbrief leicht an die Weiterbehandler vermitteln.

Abstract

Trauma surgery is simple, and provided a few principles are followed, a treatment plan can be developed for almost any injury, even with limited experience. Fractures should be classified according to the AO classification and thus, divided into articular and shaft fractures. For articular fractures, the goal is anatomical articular surface restoration, typically accomplished through plate osteosynthesis. The healing time for joint-proximal fractures is shorter because of well-perfused cancellous bone and requires 6 weeks. In shaft fractures, the goal is to restore length, axis, and rotation as biologically as possible while sparing attached soft tissues. Ideally, this is done with a locking intramedullary nail. Axial, midline clamping in the medullary canal and rotational locking with pins ideally enables immediate full weight-bearing as tolerated with the implant in place, depending on the fracture. With inferior blood supply, shaft fractures require 12 weeks for bony healing. If necessary, displaced pediatric fractures are treated after reduction with Kirschner wires to protect the growth plates. This maintains stability and requires immobilization in a plaster cast, depending on age, for up to 6 weeks (the younger the patient, the less time needed). This is generally accepted by children without problems or range-of-motion deficits. Medical reports should describe fracture etiology, classification, treatment, and degree of stability achieved. The resulting follow-up care, including recommended follow-up appointments in a private outpatient practice, expected duration of disability or inability to work until risk-free full weight-bearing is achieved, and recommendations regarding implant removal, should also be mentioned.

Schlüsselwörter

Grundlagen - Weiterbildung - Unfallchirurgie

Keywords

basics - education - trauma surgery

Publikationsverlauf

Artikel online veröffentlicht:
10. April 2024

• Literatur

• 1 Kindertraumatologie. Marzi I. 3. Berlin, Heidelberg: Springer; 2016
• 2 von Laer L, Schneidmüller D, Hell A-K. Frakturen und Luxationen im Wachstumsalter. 7. Stuttgart, New York: Thieme; 2020
• 3 Internal Fixators: AO Manual of Fracture Management, Concepts and Cases using LCP and LISS. 117 Step-by-Step Case Descriptions. Wagner M. Stuttgart, New York: Thieme; 2006
• 4 Thierse H-J, Luch A. Die humane Nickelallergie – Vorkommen, Mechanismen, Produktsicherheit. UMID: Umwelt und Mensch – Informationsdienst 2014; (02) 87-95 Zugriff am 20. Februar 2024 unter: https://www.umweltbundesamt.de/sites/default/files/medien/378/publikationen/humane_nickelallergie_87–95.pdf
• 5 Baierlein SA. Frakturklassifikationen: 120 Tabellen. Stuttgart: Thieme; 2011
• 6 Nickelallergie: trotz Regulierung nach wie vor häufig. Akt Dermatol [Anonym]. 2017; 43: 444