Experiences in the Use of Motorized Intramedullary Nails after Complex Injuries to the Extremities. / Erfahrungen bei der Anwendung motorisierter Marknägel nach komplexen Extremitätenverletzungen.

The treatment of complex injuries of the extremities after comminuted fractures or non-unions is a challenging area in the field of trauma surgery. Internal, motorized implants nowadays enable a patient-oriented and progressive treatment of these cases. The present article aims to present modern treatment strategies of complex injuries of the extremities, support the use of novel, motorized intramedullary nails and provide experiences for the handling with lengthening nails or transport nails. For this purpose, the preoperative planning including selection of patients, presentation of internal lengthening and transport systems and the most important factors during preparation of the surgery are described. Moreover, critical steps during the implantation of motorized nails and also during potential follow-up interventions are highlighted and the postoperative protocol including precise recommendations for the transport und consolidation phase are provided. Finally, the experiences are illustrated by presentation of the four different cases. The use of internal, motorized implants represents the latest step in the treatment of complex injuries of the extremities. These implants improve the quality of life and the authors recommend its use. However, these implants require a high expertise and adaption of established treatment protocols in these challenging trauma cases. Follow-up analyses with a considerably large number of cases are necessary and the research on implants to solve persisting problems in the area of complex injuries of the extremities has to be pursued intensively.

Occurrence, resistance patterns, and management of carbapenemase-producing bacteria in war-wounded refugees from Ukraine.

We analyzed consecutive clinical cases of infections due to carbapenemase-producing gram-negative bacteria detected in war-wounded patients from Ukraine who were treated at one university medical center in southwest Germany between June and December 2022. The isolates of multiresistant gram-negative bacteria were subjected to a thorough microbiological characterization and whole genome sequencing (WGS). We identified five war-wounded Ukrainian patients who developed infections with New Delhi metallo-ß-lactamase 1-positive Klebsiella pneumoniae. Two isolates also carried OXA-48 carbapenemases. The bacteria were resistant to novel antibiotics, such as ceftazidime/avibactam and cefiderocol. The used treatment strategies included combinations of ceftazidime/avibactam + aztreonam, colistin, or tigecycline. WGS suggested transmission during primary care in Ukraine. We conclude that there is an urgent need for thorough surveillance of multiresistant pathogens in patients from war zones.