Trauma surgery

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Temporary treatment of a thigh fracture

The trauma is concerned with the physical trauma and is often associated with trauma equated. In the narrower and proper sense trauma is (as injury surgery but (also) some of which go beyond the surgical aspects of traumatology traumatology or trauma medicine called). Trauma surgery and reconstructive surgery form the basis of trauma medicine and accident medicine.


Detail from Grützke's mural

A turning point in modern surgical history was the Crimean War . All European states recognized fundamental deficits in the care of wounds . Systematically and with unprecedented consistency, Prussia improved its medical service. Hygiene and surgery in particular "benefited" from this . The Kaiser-Wilhelms-Akademie for military medical education , the Charité and the surgical chairs in Berlin established the top position of German surgery. The first accident hospital was built in 1925 at the instigation of Lorenz Böhler in Vienna, who founded the further development of injury surgery with a special hospital for bones during the First World War and is considered the "father of accident surgery". The terrible facial injuries gave rise to maxillofacial surgery . Its pioneers were the surgeon Christian Bruhn in Düsseldorf and the dentist Georg Axhausen at the Charité. A "trauma" no one spoke - not even in the Second World War , when the leading medical officers and Advisory surgeons 1942 in Krasnodar on the introduction of the intramedullary nail of Gerhard Kiintscher agreed. The German Society for Accident Medicine, Insurance and Supply Medicine was founded in Leipzig in 1922 under Erwin Payr ; but trauma surgery is a civil child of the prosperous 1950s. In view of the many accidents at work and on the way to and from work, the statutory accident insurance in Germany pushed for optimal (not “appropriate”) care for its insured persons . The accident hospitals were expanded and the first chairs for accident surgery were established. Trauma surgery received a significant boost in development in 1958 through the merger of Swiss surgeons to form the Working Group on Osteosynthesis Questions (AO), which paved the way for the standardization of methods and instruments for operative bone fracture treatment. The subject did not become a surgical branch until 1968. In the 1980s, Munich was given a third, trauma surgery chair on Nussbaumstrasse in addition to the two surgical chairs (Großhadern and TU). The first department for orthopedic, trauma and hand surgery in Germany was established in 1995 in Mecklenburg. Like pediatric surgery , trauma surgery had to recognize that emancipation from surgery does not only bring benefits. The amalgamation with orthopedics , which after the First World War was the (non-surgical) care for cripples , which was considered necessary and desirable by all , did nothing to change this and made the training of the offspring even more difficult. At the suggestion of Dietmar Wolter - himself a notable painter - Johannes Grützke painted an incomparable “monument” for the subject full of subtle meaning and humor. The mural decorates the entire front wall of the lecture hall of the BG Klinikum Hamburg .


The main field of activity of trauma surgeons is injuries to the musculoskeletal system , i. H. of bones , muscles , ligaments and tendons . Broken bones determine everyday life and successful osteosynthesis are visible successes; But “trauma surgery” encompasses much more than “plate and screw surgery ”, the surgery of the musculoskeletal system called orthopedic surgery. Injuries to the large body cavities ( thorax , abdomen ) and skin (caused by accidents) must also be treated . The hand , which has its own specialty with hand surgery, is exposed and endangered . Trauma surgery also includes pediatric traumatology , sports traumatology and rehabilitation in trauma surgery . Even a large communal building can hardly have the capacity for burns , radiation damage and plastic surgery . This is reserved for special departments of accident hospitals .


Anyone who wants to do trauma surgery as a medical doctor must first meet the conditions for further medical training and be a specialist in surgery or specialist in orthopedics and trauma surgery . If he wants to be approved by the regional associations of the German Social Accident Insurance as a transit doctor, he must have acquired a specialization in trauma surgery or the additional qualification in special trauma surgery.

Establishing and operating an accident surgery department in a hospital is linked to structural, equipment and personnel requirements. They are specified by the German Social Accident Insurance as part of the Seventh Book of the Social Code and monitored by the six regional associations of the professional associations. Essential requirements are a helicopter landing pad , emergency room (with spiral CT ), blood bank and intensive care medicine .

In Germany, Switzerland and Austria, the professional associations , the Swiss Accident Insurance Institution and the General Accident Insurance Institution are the most important partners (and providers) of trauma surgery. Neither statutory health insurance nor private health insurance would be able to guarantee comparable standards in the acute care and rehabilitation of the injured.

Regional associations of the professional associations

  • Northwest (Hanover / Hamburg): Lower Saxony, Bremen, Hamburg, Schleswig-Holstein, Saxony-Anhalt
  • Northeast (Berlin): Berlin, Brandenburg, Mecklenburg-Western Pomerania
  • West (Düsseldorf): North Rhine-Westphalia
  • Middle (Mainz): Hesse, Thuringia, Rhineland-Palatinate
  • Southwest (Heidelberg): Baden-Württemberg, Saarland
  • Southeast (Munich): Bavaria, Saxony

Injury type proceedings

Injuries have been defined as the basis for approval for inpatient treatment of occupational accidents for decades. Only a few hospitals were ever allowed to treat seriously injured persons in accordance with Section 6 of the provisions of the Reich Insurance Office of June 19, 1936 (so-called injury type proceedings). An admission requirement was the care of a minimum number of seriously injured patients (multiple trauma). When the list of types of injuries was last updated in January 2013, three treatment levels were introduced:

  • In-patient transit doctor procedure (DAV)
  • Injury type proceedings (VAV)
  • Most serious injury type proceedings (SAV)

Trauma network

At the instigation of the German Society for Trauma Surgery , 520 clinics have joined together in 40 certified “ trauma networks ”. All BG clinics belong to the supra-regional trauma centers at the highest level of care . Your doctors use telemedicine for their patients and doctors from other clinics.


In the 19th century Carl Thiem , Carl Hansmann , Fritz König , Albin Lambotte and Robert Danis pioneered trauma surgery. Henning Brütt , who ran “Hamburg's best trauma surgery” in the port hospital, is wrongly forgotten . In 1957 Gerhard Küntscher came to the house as medical director for eight years. Küntscher's contemporaries were Heinrich Bürkle de la Camp and Werner Wachsmuth . As a student of Erwin Payr, Endre Hedri brought trauma surgery to Hungary . In the German Democratic Republic , Helmtraut Arzinger-Jonasch was an important representative of traumatology and burn medicine . Maurice Edmond Müller was the patron of the working group for osteosynthesis issues . The first professor of trauma surgery in Germany was Harald Tscherne . He made (like Hans Georg Borst and Rudolf Pichlmayr ) the Hannover Medical School world famous. Only a few doctors agreed on "hot and cold orthopedics" - trauma surgery and orthopedics - in their career and occupation, e. B. Robert Merle d'Aubigné , Peter Friedrich Matzen , Robert Judet and Alfred Nikolaus Witt . The orthopedist Gawriil Abramowitsch Ilisarow “ruled” over 1000 beds and 168 subordinate doctors in Siberia. Dietmar Wolter made the figure of the century known in Germany and devoted himself to the further development of the ingenious ring fixator. Siegfried Weller , Leonhard Schweiberer , Otmar Trentz , Norbert Haas and the politically ambitious Axel Ekkernkamp will work into the 21st century .

Neurologists and surgeons are dedicated to the complex field of paraplegia . In exile in England, the German, Jewish neurologist and neurosurgeon Ludwig Guttmann , who came from Breslau, built the first rehabilitation clinic for paraplegics. He founded the Stoke Mandeville Games as the forerunner of the Paralympic Games . In the 1960s he advised the professional association accident clinic Murnau on the establishment of Germany's first center for paraplegics. His example was followed by Friedrich-Wilhelm Meinecke and Gerhard Exner in Hamburg, Hans Jürgen Gerner in Bad Wildungen and Heidelberg and Jürgen Harms in Langensteinbach. At Robert Judet in Paris, Raymond Roy-Camille inaugurated the transpedicular screw in 1963, which opened up new avenues in the treatment of injuries (and deformations) of the spine.


There are numerous journals for bone and joint surgery.


  • Lorenz Böhler : The technique of bone fracture treatment. 3 volumes. Reprint of the 12th – 13th centuries Edition 1953/1963; Reprinted by Maudrich 1996, ISBN 3-85175-666-5 .
  • Siegfried Weller : Accident medicine, its social and economic significance , in: Main Association of Commercial Employers' Liability Insurance Associations (ed.): 100 Years of Statutory Accident Insurance (1985), pp. 172–181.
  • Axel Ekkernkamp , Jürgen Probst : From trauma medicine to trauma surgery . Journal for Medical Training and Quality in Health Care 98 (2004), pp. 31–36.
  • Hartmut Siebert: The future of trauma surgery - challenges, risks and opportunities with regard to the specialist trauma surgery / orthopedics . Trauma and occupational disease, special issue 2/2004.
  • Martin L. Hansis: Trauma Surgery , in: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (Eds.): Encyclopedia Medical History. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1430 f.
  • Christoph Weißer: Traumatology , in: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil, Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin New York 2005, ISBN 3-11-015714-4 , pp. 1409-1411.
  • Eberhard Markgraf (Ed.): Contributions to the history of trauma surgery in the GDR . Thieme, Stuttgart 2008.
  • Jürgen Probst, Hartmut Siebert, Hans Zwipp: 60 years of the German Society for Trauma Surgery after re-establishment. Milestones on the way from trauma medicine to orthopedics and trauma surgery . Berlin 2010. Summary, with a link to the full text
  • Bernhard Weigel, Michael L. Nerlich: Practice book accident surgery . Springer, Berlin Heidelberg 2011, ISBN 978-3-642-10788-7 .
  • Joachim Rüdiger Döhler : Lexicon Orthopedic Surgery. Standard terminology for orthopedists and trauma surgeons . Springer, Berlin Heidelberg 2003, reprint 2013, ISBN 978-3-642-62529-9 .
  • Ingo Marzi, Tim Pohlemann, Diana Aicher: Special trauma surgery . Urban & Fischer / Elsevier, Munich 2016. ISBN 978-3-437-23226-8 .

See also

Web links

Commons : Trauma surgery  - collection of pictures, videos and audio files

Individual evidence

  1. G. Böttger u. a .: Traumatology in surgical practice. Springer, Berlin / Heidelberg / New York 1965, ISBN 978-3-642-88524-2 , pp. 2-11.
  2. ^ Rüdiger Döhler, Peter Kolmsee: Prussia's medical service in the wars of unification . Military Medical Monthly 8/2016, pp. 254–258.
  3. Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 32.
  4. Ernst Kern: Seeing - Thinking - Acting of a surgeon in the 20th century. 2000, p. 32.
  5. See template: navigation bar for surgery ordinaries of Munich universities .
  6. ^ German surgery: Plau am See (2001) .
  7. Sandra Bergler: The young doctors in orthopedics and trauma surgery Analysis of the development of offers and requirements in job advertisements from 2003 to 2010 . Diss. Univ. Greifswald 2015.
  8. ^ Johannes Grützke: The mural for the professional association accident hospital Hamburg "From the history of trauma surgery" . Merlin-Verlag, Gifkendorf 2002.
  9. Ernst Kern: Seeing - Thinking - Acting of a surgeon in the 20th century. 2000, p. 247.
  10. In the 1980s, the radiation damage ward of the Berufsgenossenschaftliche Unfallklinik Ludwigshafen was always occupied with patients from French nuclear power plants.
  11. Regional associations of the German statutory accident insurance
  12. Requirements of the statutory accident insurance institutions according to § 34 SGB VII for hospitals to participate in injury type proceedings (VAV)
  13. Requirements of the statutory accident insurance institutions according to § 34 SGB VII for hospitals to participate in the most serious injury type proceedings (SAV)
  14. Requirements of the statutory accident insurance institutions according to § 34 SGB VII for child trauma-oriented specialist departments for participation in the special inpatient treatment of seriously injured children (injury type procedure - VAV child)
  15. Regional associations of the DGUV
  16. ↑ List of types of injury (DGUV)
  17. Injury type proceedings (VAV)
  18. DGU trauma networks