Achilles tendon ruptures are among the most common ruptures of large tendons. Due to the vulnerable soft tissue there is a high risk of soft tissue defects. The combination of Achilles tendon ruptures and soft-tissue defects remains a challenge for the surgeon. Despite different treatment options there is a lack of structured treatment recommendation. By means of a systematic literature review and experience from our own clinic standard, an overview of the stepwise treatment options is presented. A treatment algorithm for reconstructive measures of Achilles tendon ruptures accompanied by soft-tissue defects according to the length of defect of the Achilles tendon, the size of the soft-tissue defect and patient-individual factors is developed. This is intended to serve the surgeon as a basis for decision making prior to application of therapy.
QR-Code scannen & Beitrag online lesen Zusammenfassung Hintergrund: Die Chirurgie als wichtiger Teil des Gesundheitssektors trägt zur Umweltverschmutzung und damit zur Klimakrise bei. Ziel dieser Arbeit ist, eine Übersicht über die aktuelle Datenlage und die Möglichkeiten für Verbesserungen zu geben. Methoden: Für diese Übersichtsarbeit wurde eine Literaturrecherche in PubMed/MEDLINE mit den Suchbegriffen "carbon footprint and surgery", "climate change and surgery", "waste and surgery" sowie "greening the operating room" durchgeführt. Schwerpunkte waren Energie, Abfall, Wasser und Anästhesie. Ergebnisse: Der größte Anteil an Emissionen in der Chirurgie wird durch die Energienutzung generiert. Operationssäle benötigen 3-bis 6-mal so viel Energie wie die restlichen Krankenhausräume. Abfall von Krankenhäusern entsteht zu 20-30 % bei Operationen, was insbesondere auf die zunehmende Nutzung von Einmalartikeln zurückzuführen ist. 50-90 % des als infektiös eingestuften Mülls werden falsch einsortiert. Die Beseitigung dieses Mülls ist nicht nur umweltschädlicher, sondern auch kostenintensiver. Die Aufbereitung chirurgischer Instrumente mittels Dampfautoklaven verbraucht viel Wasser. Modernere Sterilisationsmethoden, beispielsweise mittels Plasma, können hier Abhilfe schaffen. Inhalative, nichtmetabolisierte Narkotika gelangen bis zu 20 % in die Stratosphäre und zerstören die Ozonschicht. Die i.v. Anästhesie ist hier ein Ansatzpunkt. Die Wahl der Operationsmethode kann ebenfalls zur Verbesserung der Umweltbilanz einer Operation beitragen. Schlussfolgerung: Die chirurgischen Disziplinen sind relevante Produzenten von Umweltschadstoffen. Durch vielfältige interdisziplinäre Ansatzpunkte kann auch die Chirurgie ihren Beitrag zum Umweltschutz leisten.
Background Surgeons working in orthopedics and trauma surgery are frequently exposed to repetitive actions and non-ergonomic positions in their operative activities with the regular use of lead aprons. Musculoskeletal complaints of the neck and back among surgeons are reported in the literature as up to 80%. In this study, the effects of lead aprons on the posture of surgeons are examined using videorasterstereography, foot pressure measurement and questionnaires. Methodology All subjects (n = 31) were examined before and after exposure to wearing lead aprons during surgery using videorasterstereography and pedography. In addition, a survey with a separately created questionnaire and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was carried out. Results An average duration of lead apron use of 102.6 min showed an increase in forefoot load (p = 0.002) especially in the elderly subjects and thoracic kyphosis (p < 0.001) especially in the younger doctors with a significant lateral deviation (p = 0.006). In addition, the lateral deviation was shown to correlate with an increasing body size or a shorter period of employment (p = 0.008; r = 0.51/p = 0.026; r = − 0.44). Significantly fewer surgeons experienced back complaints on working days without lead apron use in the operating room compared to days in the OR (p = 0.011). Conclusion The impact of wearing front covered lead aprons during operations in the field of orthopaedics and trauma surgery leads to more frequent back complaints, even among young and healthy doctors. Under an average duration of surgery of 102 min a temporary postural deviation occurs that can be demonstrated by means of videorasterstereography and foot pressure measurement. The subjects showed a shifted weight distribution on the forefoot, a gain in thoracic kyphosis and an increase in lateral deviation, which also correlated with an increasing height and shorter length of employment.
Background: Surgery for humeral shaft fractures is associated with a high risk of iatrogenic radial nerve palsy (RNP).Plausible causes are difficult anatomical conditions and variants. Methods:We performed a cadaveric study with 23 specimens (13 female and 10 male Caucasian donors) to assess the course and anatomy of the radial nerve (RN) with its branches alongside the humeral shaft. The accuracy of identification of the RN in the surgical field was analyzed by measuring the location, course, diameter, and form of each nerve and vessel of interest.Results: The RN is not a single structure running alongside the humeral shaft; at least 4 parallel structures crossed the dorsal humerus in all subjects. The RN was accompanied by 2 vessels and at least 1 other nerve, which we named the musculocutaneous branch (MCB). With an oval profile and an average diameter of 3.1 mm (range, 2.6 to 3.8 mm), the MCB was thinner but, in some cases, close to the average diameter of 4.7 mm (range, 4.0 to 5.2 mm) of the RN, which had a round profile. Both accompanying vessels had similar diameters: 3.5 mm (range, 2.6 to 4.2 mm) for the radial collateral artery and 4.0 mm (range, 2.9 to 4.4 mm) for the medial collateral artery. In 20 (87%) of the cases, the RN ran proximal to and in 3 (13%) of the cases, distal to the MCB. Furthermore, a distal safe zone of at least 110 mm (range, 110 to 160 mm) was found, measured from the radial (lateral) epicondyle proximally. Conclusions:The RN does not cross the dorsal humerus alone, as often stated in anatomical textbooks, but runs parallel to vessels and at least 1 nerve branch with a similar appearance. Thus, for reliable preservation of the RN, we recommend identification and protection of all crossing structures in posterior humeral surgeries 110 mm proximal to the radial epicondyle.T his study was approved by the institutional review board (406/17).
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