Background/Objectives: Artificial intelligence (AI) tools for fracture detection in radiographs are increasingly approved for clinical use but remain underutilized. Understanding physician attitudes before implementation is essential for successful integration into emergency care workflows. This study investigates the acceptance of an AI-based fracture detection tool among physicians in emergency care settings, using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Methods: A cross-sectional, pre-implementation survey was conducted among 92 physicians across three hospitals participating in the SMART Fracture Trial (ClinicalTrials.gov: NCT06754137). The questionnaire assessed the four core UTAUT constructs—performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC)—and additional constructs such as attitude toward technology (AT), diagnostic confidence (DC), and workflow efficiency (WE). Responses were collected on a five-point Likert scale. Structural equation modeling (SEM) and confirmatory factor analysis (CFA) were performed to assess predictors of behavioral intention (BI). Results: PE was the strongest predictor of BI (β = 0.5882, p < 0.001), followed by SI (β = 0.391, p < 0.001), FC (β = 0.263, p < 0.001), and EE (β = 0.202, p = 0.001). These constructs explained a substantial proportion of variance in BI. WE received the lowest ratings, while internal consistency for SI and BI was weak. Moderator analyses showed prior AI experience improved EE, whereas more experienced physicians were more skeptical regarding WE and DC. However, none of the moderators significantly influenced BI. Conclusions: Physicians’ intention to use AI fracture detection is primarily influenced by perceived usefulness and ease of use. Implementation strategies should focus on intuitive design, targeted training, and clear communication of clinical benefits. Further research should evaluate post-implementation usage and user satisfaction.

(1) Background: Accessory liver lobes are a rare finding and only a few case reports of accessory liver lobes in abdominal wall defects have been reported so far. In the case of a congenital wall defect including liver parenchyma, there is still an ongoing debate on the definition of the abdominal wall defect and best care practice. Even though congenital abdominal wall defects are frequently diagnosed in prenatal screenings, controversy on the underlying etiology, embryology and underlying anatomy remains. Prenatal distinction between omphalocele and hernia into the cord cannot always be obtained; however, due to its clinical relevance for postnatal management and counseling of parents, accurate diagnosis is essential. (2) Case Presentation: We describe the uncommon postnatal finding of a pediculated accessory liver lobe with gallbladder in a preterm with umbilical cord hernia, which was prenatally diagnosed as omphalocele. Postnatal examination revealed an amniotic sac with a diameter of six and a small abdominal wall defect of three centimeters in diameter. Postnatal management included resection of the accessory liver lobe and gallbladder and closure of the defect. (3) Results and (4) Conclusions: Throughout the literature, the distinction between umbilical cord hernia and omphalocele has been variable. This has led to confusion and difficulties regarding postnatal treatment options. In order to achieve an accurate prenatal and/or postnatal diagnosis, the morphological differences and clinical manifestation of umbilical cord hernia and omphalocele need to be assessed. Further embryological studies are warranted to understand the underlying embryological pathology of omphalocele and umbilical cord hernia and offer appropriate treatment. In consideration of possibly severe complications in the case of the torsion of a pedunculated accessory liver lobe, we strongly recommend primary removal once pre- or intraoperative identification has been made.

Pancreatic trauma in children is rare; therefore, both scientific knowledge and clinical experience regarding its management are limited. Abdominal sonography and subsequent computed tomography (CT) imaging are the diagnostic mainstay after severe abdominal trauma in many pediatric trauma centers. However, the diagnosis of pancreatic injury is missed on the initial imaging in approximately one third of cases, with even higher numbers in young children. While conservative treatment is preferred in low-grade injuries, surgical interventions may be indicated in more severe injuries. We present a case series including four patients with high-grade pancreatic injury. Two patients were treated surgically with open laparotomy and primary suture of the head of the pancreas and pancreatico-enterostomy, one patient underwent endoscopic stenting of the pancreatic duct and one received conservative management including observation and secondary endoscopic treatment. We want to emphasize the fact that using a minimally invasive approach can be a feasible option in high-grade pancreatic injury in selected cases. Therefore, we advocate the necessity of fully staffed and equipped high-level pediatric trauma centers.

Zusammenfassung Der Morbus Hirschsprung (MH) ist eine kongenitale Aganglionose, die die distalen Darmabschnitte in variabler Ausdehnung ab ano betrifft. Die pathogenetische Entwicklung des MH ist eine gestörte Migration von Zellen aus der Neuralleiste in die distalen Darmabschnitte. Der MH zählt damit zu den Neurokristopathien. Genetische Faktoren wurden bei etwa der Hälfte der familiären Fälle und bei 15–35% der sporadischen Fälle identifiziert. Mutationen im RET-Protoonkogen scheinen bei den meisten sporadischen Fällen gemeinsam mit anderen genetischen Defekten vorzuliegen. Bei einer kleinen Zahl der Fälle (< 5%) liegt eine multiple endokrine Neoplasie Typ 2a (MEN 2a) vor, mit einem erhöhten Risiko für ein medulläres Schilddrüsenkarzinom und für ein Phäochromozytom. Zu den assoziierten Syndromen gehören auch das Down-Syndrom, das Waardenburg-Syndrom und das Smith-Lemli-Opitz-Syndrom. Die Diagnose beruht auf dem histologischen Nachweis des kompletten Fehlens enterischer Ganglienzellen in tiefen Biopsien, die ausreichend Submukosa erfassen, gemeinsam mit dem Vorliegen hypertrophierter Azetylcholinesterase-positiver Nervenfasern im distalen Rektum, die offenbar Folge extrinsischer Innervation sind. Diagnostisch und therapeutisch wichtig ist die molekulargenetische Identifikation der Patienten mit Prädisposition für ein medulläres Schilddrüsenkarzinom und Phäochromozytom. Therapeutisches Ziel beim MH ist die einzeitige Resektion des aganglionären Segmentes mit Durchzug des euganglionären Darms und Anastomose im Bereich des Anus. Der MH ist nach wie vor ein hochinteressantes Krankheitsbild mit Modellcharakter für entwicklungsbiologische, genetische, onkologische, endokrinologische und epidemiologische Fragestellungen.

Purpose: To describe a minimally invasive technique with primary closure and strong suture connection that is feasible in cases of larger, most common type B defects of congenital diaphragmatic hernia (CDH). Background: The thoracoscopic approach (TA) is a favorable technique for the repair of CDH and is still evolving globally. A common issue is finding the optimal suture technique for secure closure in order to prevent recurrences. Whether a defect can be closed only by sutures or by using a patch depends on the size of CDH, the presence of a muscular rim along the inner thoracic surface and finally on the surgeon’s experience. From a geometrical point of view, the challenge is to transform the circular defect into a line, without tension, with a strong compound and preferably without additional material. To address this, we apply a setting of the sutures in a “T-shape” and a way to lead the sutures around the rib bones in order to increase stability. This method allows for the primary closure of CDHs and also applies to larger defects. Cases: We present seven newborns with posterolateral CDH on the left side. The defects were solely repaired by TA and by the suturing technique described in detail.