Pub Date : 2024-05-01Epub Date: 2024-03-05DOI: 10.1007/s00113-024-01419-z
Christoph Eckstein, Christian Wulbrand, Bernd Füchtmeier, Franz Müller
Background: Fractures of the navicular bone are rare and the number of those treated surgically is even smaller. Moreover, scientific analyses on this topic are only sporadically present in the literature, therefore this retrospective and monocentric study was initiated.
Methods: A total of 30 patients with 30 fractures were included. With the exception of one primary fusion, all patients underwent open reduction with internal osteosynthesis. Clinical and radiological follow-up was performed at least 2 years postoperatively using AOFAS-Score, SF-12 and a radiological examination. The primary objectives were the clinical and radiologic outcomes as mid-term to long-term outcomes. The secondary objective was to compare these results with two existing computed tomography (CT) fracture classifications in terms of their association with the outcome.
Results: The median follow-up was 7.8 years (range 2-16.2 years) postoperatively. One patient suffered an infection, four patients required secondary arthrodesis and eight patients had to change their occupation. The mean AOFAS-Score was 80.8/100 and the mean physical and mental SF-12 component summary scores were 47.1 and 55.7 points, respectively. Male sex and arthrodesis were associated with worse outcomes in both scores but not patient age or ipsilateral concomitant injuries. Both CT fracture classifications showed low predictive value.
Conclusion: The severity of the injury in the preoperative CT showed no connection with the clinical outcome in the AOFAS-Score and SF-12 scores. Posttraumatic osteoarthritis and secondary arthrodesis are associated with a poor outcome. In the course of the observational period the reduction results improved, which was accompanied by a better clinical outcome.
{"title":"[Postoperative outcome of 30 patients with navicular bone fractures-In connection with AOFAS-Score, SF-12 and fracture classifications].","authors":"Christoph Eckstein, Christian Wulbrand, Bernd Füchtmeier, Franz Müller","doi":"10.1007/s00113-024-01419-z","DOIUrl":"10.1007/s00113-024-01419-z","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the navicular bone are rare and the number of those treated surgically is even smaller. Moreover, scientific analyses on this topic are only sporadically present in the literature, therefore this retrospective and monocentric study was initiated.</p><p><strong>Methods: </strong>A total of 30 patients with 30 fractures were included. With the exception of one primary fusion, all patients underwent open reduction with internal osteosynthesis. Clinical and radiological follow-up was performed at least 2 years postoperatively using AOFAS-Score, SF-12 and a radiological examination. The primary objectives were the clinical and radiologic outcomes as mid-term to long-term outcomes. The secondary objective was to compare these results with two existing computed tomography (CT) fracture classifications in terms of their association with the outcome.</p><p><strong>Results: </strong>The median follow-up was 7.8 years (range 2-16.2 years) postoperatively. One patient suffered an infection, four patients required secondary arthrodesis and eight patients had to change their occupation. The mean AOFAS-Score was 80.8/100 and the mean physical and mental SF-12 component summary scores were 47.1 and 55.7 points, respectively. Male sex and arthrodesis were associated with worse outcomes in both scores but not patient age or ipsilateral concomitant injuries. Both CT fracture classifications showed low predictive value.</p><p><strong>Conclusion: </strong>The severity of the injury in the preoperative CT showed no connection with the clinical outcome in the AOFAS-Score and SF-12 scores. Posttraumatic osteoarthritis and secondary arthrodesis are associated with a poor outcome. In the course of the observational period the reduction results improved, which was accompanied by a better clinical outcome.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01Epub Date: 2024-01-15DOI: 10.1007/s00113-023-01402-0
Marie K Reumann, Hauke Hillrichs, Maximilian M Menger, Steven C Herath, Mika F R Rollmann, Fabian Stuby, Tina Histing, Benedikt J Braun
Introduction: The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite a relatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results.
Material and methods: Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed.
Results: A total of 66 patients were analyzed. The mean age was 58 years (range 25-88 years). The overall healing rate was 88% with a mean consolidation time of 8 months (range 2-29 months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of a dynamic hip screw (n = 1).
Discussion: The analysis of our treatment data as well as the current literature, revealed a trend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain a predictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in a targeted manner by a combination of mechanical and biological methods with a reamed nail change to a larger caliber implant.
{"title":"[Nonunions after intertrochanteric and subtrochanteric femoral fractures].","authors":"Marie K Reumann, Hauke Hillrichs, Maximilian M Menger, Steven C Herath, Mika F R Rollmann, Fabian Stuby, Tina Histing, Benedikt J Braun","doi":"10.1007/s00113-023-01402-0","DOIUrl":"10.1007/s00113-023-01402-0","url":null,"abstract":"<p><strong>Introduction: </strong>The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite a relatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results.</p><p><strong>Material and methods: </strong>Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed.</p><p><strong>Results: </strong>A total of 66 patients were analyzed. The mean age was 58 years (range 25-88 years). The overall healing rate was 88% with a mean consolidation time of 8 months (range 2-29 months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of a dynamic hip screw (n = 1).</p><p><strong>Discussion: </strong>The analysis of our treatment data as well as the current literature, revealed a trend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain a predictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in a targeted manner by a combination of mechanical and biological methods with a reamed nail change to a larger caliber implant.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139467429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-03-25DOI: 10.1007/s00113-024-01415-3
Ulla Stumpf, Ralf Schmidmaier
The S3 guidelines on the prophylaxis, diagnostics and treatment of osteoporosis 2023 were completely revised and updated between 2021 and 2023 in accordance with the Association of the Scientific Medical Societies of Germany (AWMF) regulations. The guideline committee consisted of delegates from the 20 specialist societies of the Umbrella Organization Osteology (Dachverband Osteologie, DVO) as well as delegates from the German Society of General Medicine and Family Medicine (DEGAM), the German Society for Nephrology (DGfN) and the Federal Self-help Association for Osteoporosis (BfO).The guidelines focus on preventive measures, diagnostic procedures and treatment approaches for osteoporosis in men aged 50 years and over and postmenopausal women. The main aim is the optimization of care processes, reduction of fracture incidences and maintenance or improvement of the quality of life and functional capacity of patients affected by fractures. A major update to the guidelines includes the introduction of a new risk calculator that can take more risk factors (n = 33) into account and that can estimate the risk of vertebral body and proximal femoral fractures for a 3-year period (previously 10 years). This results in new thresholds for diagnostics and treatment. The programmed app is currently not yet certified as a medical product and a paper version is therefore currently available for patient care with the planned integration of a web-based version of the risk calculator. From the perspective of trauma surgery, the recommendations and innovations for manifest osteoporosis are of particular clinical importance. The focus of the DVO guidelines update is therefore on the implementation of secondary fracture prevention in trauma surgery, orthopedic and geriatric traumatology in the clinical and practical daily routine.
{"title":"[Secondary fracture prevention/Update osteoporosis guidelines 2023 of the Umbrella Organization Osteology].","authors":"Ulla Stumpf, Ralf Schmidmaier","doi":"10.1007/s00113-024-01415-3","DOIUrl":"10.1007/s00113-024-01415-3","url":null,"abstract":"<p><p>The S3 guidelines on the prophylaxis, diagnostics and treatment of osteoporosis 2023 were completely revised and updated between 2021 and 2023 in accordance with the Association of the Scientific Medical Societies of Germany (AWMF) regulations. The guideline committee consisted of delegates from the 20 specialist societies of the Umbrella Organization Osteology (Dachverband Osteologie, DVO) as well as delegates from the German Society of General Medicine and Family Medicine (DEGAM), the German Society for Nephrology (DGfN) and the Federal Self-help Association for Osteoporosis (BfO).The guidelines focus on preventive measures, diagnostic procedures and treatment approaches for osteoporosis in men aged 50 years and over and postmenopausal women. The main aim is the optimization of care processes, reduction of fracture incidences and maintenance or improvement of the quality of life and functional capacity of patients affected by fractures. A major update to the guidelines includes the introduction of a new risk calculator that can take more risk factors (n = 33) into account and that can estimate the risk of vertebral body and proximal femoral fractures for a 3-year period (previously 10 years). This results in new thresholds for diagnostics and treatment. The programmed app is currently not yet certified as a medical product and a paper version is therefore currently available for patient care with the planned integration of a web-based version of the risk calculator. From the perspective of trauma surgery, the recommendations and innovations for manifest osteoporosis are of particular clinical importance. The focus of the DVO guidelines update is therefore on the implementation of secondary fracture prevention in trauma surgery, orthopedic and geriatric traumatology in the clinical and practical daily routine.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-01-26DOI: 10.1007/s00113-023-01407-9
S Roth, S Oberthür, S Sehmisch, S Decker
The frequency of osteoporotic vertebral fractures in the clinical routine is increasing due to the demographic change. They are the most frequent fractures associated with osteoporosis and affect an especially morbid and vulnerable group of patients. These fractures often occur after minor trauma or spontaneously. Pain is the predominant symptom, whereas mechanical stability is mostly sufficient, in comparison to vertebral fractures after high-energy trauma, and is not a predominant indication for surgery. These fractures can be described using the classification for fractures associated with osteoporosis and the corresponding treatment recommendations are guided by them. Besides the specific treatment of osteoporotic vertebral fractures, a holistic treatment of patients taking pre-existing comorbidities into consideration is decisive. A mobilization as quickly as possible and treatment of the underlying osteoporosis are important to prevent further fractures.
{"title":"[Osteoporotic vertebral fractures of the thoracic and lumbar spine].","authors":"S Roth, S Oberthür, S Sehmisch, S Decker","doi":"10.1007/s00113-023-01407-9","DOIUrl":"10.1007/s00113-023-01407-9","url":null,"abstract":"<p><p>The frequency of osteoporotic vertebral fractures in the clinical routine is increasing due to the demographic change. They are the most frequent fractures associated with osteoporosis and affect an especially morbid and vulnerable group of patients. These fractures often occur after minor trauma or spontaneously. Pain is the predominant symptom, whereas mechanical stability is mostly sufficient, in comparison to vertebral fractures after high-energy trauma, and is not a predominant indication for surgery. These fractures can be described using the classification for fractures associated with osteoporosis and the corresponding treatment recommendations are guided by them. Besides the specific treatment of osteoporotic vertebral fractures, a holistic treatment of patients taking pre-existing comorbidities into consideration is decisive. A mobilization as quickly as possible and treatment of the underlying osteoporosis are important to prevent further fractures.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-11-21DOI: 10.1007/s00113-023-01392-z
Silke Vißmann, Philippus Schöttes, Fatma Topcuoglu, Thorsten Strohmann, Jens-Peter Stahl, Stefan Rohde
Background: For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable.
Objective: Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. The aim was to verify that the implementation of the pedicle screws is plannable and precise by using 2D X‑ray only.
Method: This retrospective study analyzed 27 consecutive trauma patients (17-84 years, 13f/14m) with vertebral body fractures. The position and precision of 108 screws, implanted using the hand-guided aiming sleeve was investigated. To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined.
Results: Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found.
Conclusion: The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.
背景:在椎弓根螺钉的植入中,导航支持系统的应用越来越多,它可以使螺钉的方向更加可预测,从而避免螺钉错位。目的:探讨手导瞄准套置入椎弓根螺钉后的精度。目的是通过仅使用2D X光片验证椎弓根螺钉的实施是可计划的和精确的。方法:回顾性分析27例连续创伤椎体骨折患者(17-84岁,13f/14m)。研究了108颗采用手导瞄准套植入的螺钉的定位和精度。为了确定螺钉的位置,使用术后3D CT数据集(GE Optima 540, General Electric Company Boston, MA, USA;切片厚度1.25 mm)。然后将螺钉与先前定义的螺钉尖端的理想位置进行比较。除了确定与理想目标点的绝对和相对偏差外,还确定了收敛角和与盖板的平行度。结果:108枚植入椎弓根螺钉,90枚(83%)命中目标。其余18例(17%)为与临床无关的螺钉偏移:17例椎弓根螺钉发生外侧偏移(16%),1例发生内侧偏移(1%)。与椎体理想靶点的平均腹侧偏差为2.3 mm,标准差为± 2.3 mm。无螺钉错位或椎弓根穿孔。结论:手导瞄准套经皮椎弓根螺钉置入胸腰椎是一种安全、精确的手术方法。与文献报道的其他导航螺钉植入方法相比[1-6],该方法需要矫正的错位风险较低。基于ct的初步规划是不必要的。该方法经济,不需要特殊的技术设备。
{"title":"[Precision and safety of positioning pedicle screws in the thoracic and lumbar spine using a hand-guided aiming sleeve : A CT control study].","authors":"Silke Vißmann, Philippus Schöttes, Fatma Topcuoglu, Thorsten Strohmann, Jens-Peter Stahl, Stefan Rohde","doi":"10.1007/s00113-023-01392-z","DOIUrl":"10.1007/s00113-023-01392-z","url":null,"abstract":"<p><strong>Background: </strong>For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable.</p><p><strong>Objective: </strong>Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. The aim was to verify that the implementation of the pedicle screws is plannable and precise by using 2D X‑ray only.</p><p><strong>Method: </strong>This retrospective study analyzed 27 consecutive trauma patients (17-84 years, 13f/14m) with vertebral body fractures. The position and precision of 108 screws, implanted using the hand-guided aiming sleeve was investigated. To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined.</p><p><strong>Results: </strong>Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found.</p><p><strong>Conclusion: </strong>The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138292504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-13DOI: 10.1007/s00113-024-01414-4
Carlos Pankratz, Christoph Dehner, Florian Gebhard, Konrad Schuetze
The current demographic development is leading to an increasing number of cases of osteoporosis-related fractures. Affected individuals are typically part of a vulnerable, predominantly geriatric patient group with limited physical resources. Additionally, the pathophysiological characteristics of osteoporotic bones with reduced bone quality and quantity, pose a significant challenge to the osteosynthesis techniques used. Achieving rapid postoperative mobilization and stable weight-bearing osteosynthesis to prevent postoperative medical complications are the main goals of the surgical management. In recent years augmentation techniques have gained in importance in the treatment of osteoporosis-related fractures by significantly enhancing the stability of osteosyntheses and reducing mechanical complication rates. The main options available are polymethyl methacrylate (PMMA) augmentation and various bioresorbable bone substitute materials with different properties. Implant augmentations can be applied at various locations in the extremity bones and standardized procedures are now available, such as for the proximal humerus and femur. When used correctly, low complication rates and promising clinical outcomes are observed. This article aims to provide an overview of available techniques and applications based on the current literature. Guidelines and substantial scientific evidence are still limited.
{"title":"[Augmentation techniques for the treatment of osteoporosis-associated fractures of the extremities].","authors":"Carlos Pankratz, Christoph Dehner, Florian Gebhard, Konrad Schuetze","doi":"10.1007/s00113-024-01414-4","DOIUrl":"10.1007/s00113-024-01414-4","url":null,"abstract":"<p><p>The current demographic development is leading to an increasing number of cases of osteoporosis-related fractures. Affected individuals are typically part of a vulnerable, predominantly geriatric patient group with limited physical resources. Additionally, the pathophysiological characteristics of osteoporotic bones with reduced bone quality and quantity, pose a significant challenge to the osteosynthesis techniques used. Achieving rapid postoperative mobilization and stable weight-bearing osteosynthesis to prevent postoperative medical complications are the main goals of the surgical management. In recent years augmentation techniques have gained in importance in the treatment of osteoporosis-related fractures by significantly enhancing the stability of osteosyntheses and reducing mechanical complication rates. The main options available are polymethyl methacrylate (PMMA) augmentation and various bioresorbable bone substitute materials with different properties. Implant augmentations can be applied at various locations in the extremity bones and standardized procedures are now available, such as for the proximal humerus and femur. When used correctly, low complication rates and promising clinical outcomes are observed. This article aims to provide an overview of available techniques and applications based on the current literature. Guidelines and substantial scientific evidence are still limited.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-11-14DOI: 10.1007/s00113-023-01387-w
Denise Schulz, Anne Neubert, Joachim Windolf
{"title":"[Evidence from O (orthopedics) and T (trauma surgery) with TraumaEvidence : Current research in a nutshell].","authors":"Denise Schulz, Anne Neubert, Joachim Windolf","doi":"10.1007/s00113-023-01387-w","DOIUrl":"10.1007/s00113-023-01387-w","url":null,"abstract":"","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107606260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-03-05DOI: 10.1007/s00113-024-01423-3
Richarda Böttcher, Frank Dähne, Sebastian Böttcher, Ulrike Johl, Anja Tittel, Ulrike Schnick
The approach for nerve injuries in children in the context of fractures of the upper extremities is inconsistent in the literature. The underlying mostly retrospective studies do not usually consider the potential diagnostics. The frequency of nerve injuries with a clear need for reconstructive surgery is sometimes estimated so differently that precedent-setting errors in these studies must be assumed; however, as 10-20% of pediatric fractures near the elbow show primary or secondary nerve lesions, timely and appropriate further treatment is necessary. An overview concerning diagnostic tools with an explanation of potential results and an algorithm with a timeline for diagnostic and therapeutic management are presented. Good results after nerve lesions can only be achieved when timely diagnostics without delay and correct detection of axonal lesions which benefit from surgical treatment are carried out.
{"title":"[Nerve injuries due to fractures in childhood : Primarily and secondarily on the upper extremity].","authors":"Richarda Böttcher, Frank Dähne, Sebastian Böttcher, Ulrike Johl, Anja Tittel, Ulrike Schnick","doi":"10.1007/s00113-024-01423-3","DOIUrl":"10.1007/s00113-024-01423-3","url":null,"abstract":"<p><p>The approach for nerve injuries in children in the context of fractures of the upper extremities is inconsistent in the literature. The underlying mostly retrospective studies do not usually consider the potential diagnostics. The frequency of nerve injuries with a clear need for reconstructive surgery is sometimes estimated so differently that precedent-setting errors in these studies must be assumed; however, as 10-20% of pediatric fractures near the elbow show primary or secondary nerve lesions, timely and appropriate further treatment is necessary. An overview concerning diagnostic tools with an explanation of potential results and an algorithm with a timeline for diagnostic and therapeutic management are presented. Good results after nerve lesions can only be achieved when timely diagnostics without delay and correct detection of axonal lesions which benefit from surgical treatment are carried out.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-01DOI: 10.1007/s00113-023-01409-7
Wolfgang Lehmann, Recep Cagirici, Yamen Al Askar, Christopher Spering
Insufficiency fractures of the pelvis have increased in recent years, primarily due to the demographic change and the incidence will continue to rise. In addition to conventional X‑rays, the diagnostics always require slice imaging. Unlike high-energy trauma magnetic resonance imaging (MRI) plays an important role in insufficiency fractures. Once the fracture has been diagnosed, in addition to the extent of instability in the anterior and posterior pelvic rings, the pain symptoms are crucial for the decision on surgical treatment. The basic principle is to stabilize as little as possible but as much as necessary. There are currently a variety of procedures that can be applied as a minimally invasive procedure, especially for the often slightly or displaced insufficiency fractures. The decisive factor for treatment is that it enables early mobilization of the patients. All of these measures must be accompanied by thorough diagnostics of osteoporosis and the appropriate treatment.
骨盆不全骨折近年来有所增加,主要原因是人口结构的变化,而且发病率还将继续上升。除了常规的 X 射线检查外,诊断始终需要切片成像。与高能量创伤不同,磁共振成像(MRI)在损伤性骨折中发挥着重要作用。一旦确诊骨折,除了骨盆前后环的不稳定程度外,疼痛症状也是决定手术治疗的关键。基本原则是尽可能少地稳定,但在必要时稳定。目前有多种微创手术可供选择,尤其适用于轻微或移位的骨盆不全骨折。治疗的决定性因素是使患者能够尽早活动。在采取所有这些措施的同时,还必须进行彻底的骨质疏松症诊断和适当的治疗。
{"title":"[Diagnostics and treatment of insufficiency fractures of the pelvis].","authors":"Wolfgang Lehmann, Recep Cagirici, Yamen Al Askar, Christopher Spering","doi":"10.1007/s00113-023-01409-7","DOIUrl":"10.1007/s00113-023-01409-7","url":null,"abstract":"<p><p>Insufficiency fractures of the pelvis have increased in recent years, primarily due to the demographic change and the incidence will continue to rise. In addition to conventional X‑rays, the diagnostics always require slice imaging. Unlike high-energy trauma magnetic resonance imaging (MRI) plays an important role in insufficiency fractures. Once the fracture has been diagnosed, in addition to the extent of instability in the anterior and posterior pelvic rings, the pain symptoms are crucial for the decision on surgical treatment. The basic principle is to stabilize as little as possible but as much as necessary. There are currently a variety of procedures that can be applied as a minimally invasive procedure, especially for the often slightly or displaced insufficiency fractures. The decisive factor for treatment is that it enables early mobilization of the patients. All of these measures must be accompanied by thorough diagnostics of osteoporosis and the appropriate treatment.</p>","PeriodicalId":75280,"journal":{"name":"Unfallchirurgie (Heidelberg, Germany)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}