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Background: MRI is commonly used to diagnose and assess prognosis for rotator cuff (RM) pathology in addition to history and clinical examination.

Aim: This study investigates the image and report quality of shoulder MRIs with regard to prognosis-relevant parameters in outpatients who subsequently underwent surgical treatment for RM rupture.

Materials and methods: Using a defined questionnaire, both the MR images and the original reports of 94 patients were evaluated by an experienced radiologist with regard to referral information, MRI technology and quality of the MRI reports.

Results: Questions or comments on RC were noted in 39% (general practitioners) and 48% (orthopaedics/UCH) of referrals. In MRI reports with the diagnosis "complete rupture of the RC", no information on the size of the defect was available in 47% of cases. In 18 and 30% of the reports, respectively, a fatty infiltration of the RM musculature or atrophy of the musculature was mentioned. When a partial RC rupture (n = 25) was diagnosed; the depth diameter (< or > 50% of the tendon thickness) was determined in only one case. The protocol recommendations valid today for MRI diagnostics of the shoulder were implemented in 60% of the examinations. According to the evaluating radiologist, 93-97% of the available MRI examinations were able to answer prognostic-relevant questions of an RC rupture.

Discussion: The questions by physicians referring to the MRI examination of a shoulder with a subsequently arthroscopically verified RC rupture were predominantly unspecific or insufficient. In the radiological reports of these MRI examinations, prognosis-relevant parameters could not be extracted in sufficient form and number, although the MRI technique would have allowed this.

Sarcopenia - the age-associated loss of muscle function and muscle mass - is of utmost importance for older patients with degenerative and traumatic diseases of the musculoskeletal system, as it closely linked to the loss of independence and quality of life in higher age. Impairments of mobility that are highly present in this patient group accelerate the age-associated decline of muscle function and muscle mass. The diagnosis of sarcopenia relies primarily on tests of strength and function like handgrip, chair-rise test and gait speed. The measurement of muscle mass is desirable, but not mandatory. In the near future the prevention and treatment of sarcopenia has to become part of the clinical routine for older orthopedic patients. Specific modifications of physical exercise like resistance training and optimal nutrition with regard to protein intake (1.0-1.2 g/kg bodyweight per day) in combination with vitamin D supplementation are key components of sarcopenia prevention and therapy.

Background: In orthogeriatric centers, postoperative, multiprofessional comprehensive treatment has proven to be an effective component in the convalescence of geriatric patients. The aim of the treatment is to minimize the perioperative risk and safely achieve individual rehabilitation goals in the acute inpatient stay. To meet the needs of geriatric patients, in addition to changes in the spatial division and design, primarily adjustments to the team composition and the procedural processes are required.

Therapeutic strategies: An interdisciplinary and multiprofessional team (orthopedics/traumatology, geriatrics, nursing, physiotherapy, occupational therapy, social services, psychology, speech therapy, …) uses geriatric assessments in regular team meetings to collect and analyze the current rehabilitation status of patients; ICF-based goals are formulated and the therapy is adapted to individual needs. Here, too, the focus is on recording the individual risk (comorbidities, mental status, polypharmacy, malnutrition, fragility) and avoiding preventable complications. Multiprofessional strategies for avoiding or treating postoperative delirium are particularly important. In addition, maintaining patients' autonomy is the top priority, so that they can be released from the acute inpatient stay strengthened for follow-up treatment or their home environment. The establishment of orthogeriatric comanagement in acute inpatient facilities is an important component in the process chain, from which many geriatric patients benefit in the context of postoperative recovery.

Background: The treatment of bone and prosthesis infections remains difficult despite modern treatment concepts. Further tools for the improvement of treatment outcome are desirable. Preclinical studies provide promising evidence of the efficacy of bacteriophages for the treatment of bone and joint infections.

Objectives: The present work provides a systematic review of the clinical application of bacteriophages for the treatment of bone and joint infections.

Materials and methods: A systematic search was performed in PubMed to identify primary clinical data on the use of phage therapy in patients with bone and joint infection.

Results: Eight case reports and three case series were included in the study. Indications for phage therapy were periprosthetic joint infection (n = 12, 52.2%), fracture-related infection (n = 9, 39.1%), osteomyelitis (n = 1, 4.4%) and sacroiliac joint infection after cement augmentation of a metastasis (n = 1, 4.4%). Interventions were heterogeneous; phages were administered intravenously, injected intraoperatively into the joint, applied locally intraoperatively, or administered via drains. In combination with antibiotic therapy, complete infection eradication was achieved in 18 patients (78.3%). No side effects were reported in 91.3% of patients.

Conclusion: Bacteriophages represent a promising treatment option for bone and prosthesis infections in combination with antibiotic therapy. Future clinical trials with a higher level of evidence are required for the successful translation of bacteriophage therapy into clinical practice.

The complex kinematics of the saddle joint has been a challenge in the development of trapeziometacarpal prostheses. The introduction of the dual-mobility design increases the range of motion and limits strains on the cup fixation. Therefore, rates of loosening and dislocation have been markedly reduced. Furthermore, several studies showed a similar relief of pain, range of movement and grip strength compared to the results of resection arthroplasty. The preservation of the length of the first ray as well as the more stable and functional joint can be favourable in younger and active patients. Further investigation is needed to determine whether or not those higher demands affect long-term survivorship. The high grade of patient satisfaction, the shorter recovery time and the safe surgical technique motivates considering the implantation of a total endoprosthesis with a dual-mobility cup as an attractive alternative to resection arthroplasty in the operative treatment for trapeziometacarpal osteoarthritis.

Background: Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation.

Objectives: Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed?

Methods: The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed.

Results: Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive.

Conclusions: Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.

Background: Back pain in the pediatric population is common. History and a thorough physical examination and a systematic work-up approach are key components to guide the physician in evaluating the possible causes of pain and providing appropriate treatment.

Objective: The main aim of this review was to develop an algorithmic approach to assist physicians in the assessment of pediatric back pain. A comprehensive review of prevalence, differential diagnoses and proper management of pediatric back pain are also presented.

Material and methods: An extensive literature search was performed in PubMed to gather articles on the prevalence, risk factors, diagnostic tools, differential diagnoses and appropriate management of pediatric back pain.

Results: Available literature revealed that pediatric back pain is a common complaint. Although most cases are non-specific and self-limiting, there is a wide differential that should be considered including inflammatory, neoplastic, infectious and mechanical causes. Sedentary lifestyle, obesity and vigorous physical activity have been shown to increase the likelihood of developing back pain. We proposed an algorithm to guide the physician's decision about the next step in the diagnostic process.

Conclusion: A well-defined strategy in the diagnostic process is needed in approaching children/adolescents with back pain. This would have the benefit of minimizing costs, unnecessary tests and child/family anxiety as well as increasing the likelihood of early diagnosis and proper treatment.

Radiosynoviorthesis (RSO) is an established therapeutic method for the local treatment of pain in aseptic joint inflammation (e.g. arthritis, activated osteoarthritis, synovitis). RSO can be used for the treatment of synovial membrane inflammation of the finger joints such as the thumb's carpometacarpal joint. The beta emitter Erbium-169 (Er-169) is injected into the joint space, which irradiates the inflamed synovialis, thereby leading to fibrosis and obliteration of the pain receptors of the synovial membrane. The chances of success in the treatment of the thumb's carpometacarpal joint by RSO are estimated to be 54-100% within 2-6 weeks after therapy.