Antonio Ernstberger

Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures.

INTRODUCTION Fractures of the ankle, hind- and midfoot are amongst the five most common fractures. Besides initial operative or non-operative treatment, rehabilitation of the patients plays a crucial role for fracture union and long term functional outcome. Limited evidence is available with regard to what a rehabilitation regimen should include and what guidelines should be in place for the initial clinical course of these patients. This study therefore investigated the current rehabilitation concepts after fractures of the ankle, hind- and midfoot. METHODS Written rehabilitation protocols provided by orthopedic and trauma surgery institutions in terms of recommendations for weight bearing, range of motion (ROM), physiotherapy and choice of orthosis were screened and analysed. All protocols for lateral ankle fractures type AO 44A1, AO 44B1 and AO 44C1, for calcaneal fractures and fractures of the metatarsal as well as other not specific were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. RESULTS 209 rehabilitation protocols for ankle fractures type AO 44B1 and AO 44C1, 98 for AO 44A1, 193 for metatarsal fractures, 142 for calcaneal fractures, 107 for 5(th) metatarsal base fractures and 70 for 5(th) metatarsal Jones fractures were evaluated. The mean time recommended for orthosis treatment was 6.04 (SD 0.04) weeks. While the majority of protocols showed a trend towards increased weight bearing and increased ROM over time, the best consensus was noted for weight bearing recommendations. CONCLUSION Our study shows that there exists a huge variability in rehabilitation of fractures of the ankle-, hind- and midfoot. This may be contributed to a lack of consensus (e.g. missing publication of guidelines), individualized patient care (e.g. in fragility fractures) or lack of specialization. This study might serve as basis for prospective randomized controlled trials in order to optimize rehabilitation for these common fractures.

Social capital in a regional inter-hospital network among trauma centers (trauma network): results of a qualitative study in Germany

BackgroundAs inter-hospital alliances have become increasingly popular in the healthcare sector, it is important to understand the challenges and benefits that the interaction between representatives of different hospitals entail. A prominent example of inter-hospital alliances are certified ‘trauma networks’, which consist of 5-30 trauma departments in a given region. Trauma networks are designed to improve trauma care by providing a coordinated response to injury, and have developed across the USA and multiple European countries since the 1960s. Their members need to interact regularly, e.g. develop joint protocols for patient transfer, or discuss patient safety. Social capital is a concept focusing on the development and benefits of relations and interactions within a network. The aim of our study was to explore how social capital is generated and used in a regional German trauma network.MethodsIn this qualitative study, we performed semi-standardized face-to-face interviews with 23 senior trauma surgeons (2013-14). They were the official representatives of 23 out of 26 member hospitals of the Trauma Network Eastern Bavaria. The interviews covered the structure and functioning of the network, climate and reciprocity within the network, the development of social identity, and different resources and benefits derived from the network (e.g. facilitation of interactions, advocacy, work satisfaction). Transcripts were coded using thematic content analysis.ResultsAccording to the interviews, the studied trauma network became a group of surgeons with substantial bonding social capital. The surgeons perceived that the network’s culture of interaction was flat, and they identified with the network due to a climate of mutual respect. They felt that the inclusive leadership helped establish a norm of reciprocity. Among the interviewed surgeons, the gain of technical information was seen as less important than the exchange of information on political aspects. The perceived resources derived from this social capital were smoother interactions, a higher medical credibility, and joint advocacy securing certain privileges.ConclusionApart from addressing quality of care, a trauma network may, by way of strengthening social capital among its members, serve as a valuable resource for the participating surgeons. Some member hospitals could exploit the social capital for strategic benefits.

Verbesserung der Prozessqualität bei Traumapatienten durch digitale Bild- und Dokumentenübermittlung

Nach der Publikation des ersten „Weisbuch Schwerstverletzten-Versorgung“ der Deutschen Gesellschaft fur Unfallchirurgie (DGU) im Jahr 2006 kam es zu einer umfassenden Umstrukturierung der medizinischen Versorgungslandschaft. Zertifizierte regionale Traumanetzwerke zu schaffen und darin eine funktionierende Kommunikationsstruktur zu implementieren war das erklarte Ziel der DGU. Arzte und Kliniken erkannten, dass elektronische Datenubermittlung im Gesundheitswesen als Basis von Kommunikation, Bild- und Dokumententransfer unumganglich geworden ist. Dies galt und gilt insbesondere fur die zeitkritischen Notfallverlegungen, die zunehmenden Zweitmeinungen und fur die starkere Anbindung von Niedergelassenen im Fach Traumatologie. Die Ideallosung war ein System, das seit 2012 verfugbar ist und mittlerweile bundesweit, flachendeckend und sektorenubergreifend von allen medizinischen Dienstleistern genutzt werden kann. Durch eine gemeinsame und sichere digitale Netzwerkstruktur kann die Behandlungsqualitat beim Unfallverletzten gesteigert und Prozesse in und zwischen den medizinischen Dienstleistern konnen optimiert werden.

Humeral shaft cerclage wiring: a safe technique to prevent radial nerve injury

Humeral periprosthetic fractures are a challenging problem and their occurrence has increased, particularly over the last decade. The role of cerclage wires or cables in these fractures includes revisions with longer stems, and augmentation of a plate osteosynthesis in which the stem does not allow additional screw placement or structural bone grafts as supplementary fixation. These procedures are demanding because of the proximity of the radial nerve within the operating field. Placing a cerclage wire or cable around the fractured fragments offers a simple and safe procedure to avoid radial nerve injury or palsy in the treatment of complex humeral shaft fractures. This new technique is a simple and safe procedure to place a cerclage wire or cable around the humeral shaft.