Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

Femoral shaft fractures in childhood and adolescence are rare but serious injuries. The aim of the present study is to investigate the incidence and care structure of femoral shaft fractures in childhood and adolescence based on the complete hospital case data in Germany.For this retrospective, controlled registry study, the hospital case data of the Institute for the Hospital Remuneration System (InEK) for all patients treated as inpatients in Germany from 01/2019 to 09/2024 were evaluated. In addition to demographic data, the principal diagnoses, all secondary diagnoses, all billed procedures and the structural data of the treating hospital were analysed. Inclusion criteria were a femoral shaft fracture as the principal diagnosis and age between 3 and 17 years. Patients were assigned to the age groups 3-9 years (I), 10-15 years (II) and 16-17 years (III).The study analyses the inpatient treatment data of 7234 patients with the principal diagnosis femoral shaft fracture (S72.3). The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000. The group of 3-9-year-olds was treated predominantly with elastic stable intramedullary nailing (ESIN). In patients older than 15 years, ESIN was no longer used; these patients were predominantly treated with rigid intramedullary nail osteosynthesis. Length of stay increased with age from 3.8 days in group I to 5.8 days in group II and 8.3 days in group III. The majority of patients were treated in hospitals with more than 600 beds. Only 4% of the fractures were open fractures. In 2.7% of cases there was a mechanical complication of the osteosynthesis. 27% of the surgical procedures were implant removals.The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000 and shows an age- and sex-dependent pattern. ESIN intramedullary nailing is the most common operative method up to the age of 15 years and is no longer used beyond 16 years.

With the aging population in Germany, the incidence of fragility fractures is increasing significantly. To improve the care of these patients, geriatric trauma centres (ATZ-DGU) have been established by the German Society for Trauma Surgery (DGU). These centres differ from pure orthogeriatric co-management (OGCM) by more comprehensive requirements regarding process quality, outcome quality, prevention, and continuity of care.The evidence is strongest for hip fractures: studies demonstrate significantly reduced mortality, improved mobility, and increased prescription rates of osteoporosis medication in ATZs. For other fracture types-such as distal radius, pelvic ring, spinal, and proximal humerus fractures-the evidence base is weaker and more heterogeneous. Although improvements in process indicators, including early mobilisation, complication detection, and osteoporosis treatment, have been observed, a clear mortality benefit has generally not been confirmed.Health insurance claims data suggest advantages of both OGCM and ATZs, such as lower rates of nursing home admission, longer fracture-free intervals, and reduced rehospitalisation rates. At the same time, higher costs and longer hospital stays are reported. Overall, ATZs demonstrate clear qualitative improvements in care, although there are no robust prospective multicentre studies to confirm patient-relevant outcomes beyond hip fractures.Geriatric trauma centres improve quality of care primarily through structured processes, prevention, and interdisciplinary collaboration. A proven mortality benefit has so far been demonstrated unequivocally only for hip fractures. Further research is needed for other fracture types, particularly to delineate the differences between OGCM and certified ATZs.

Postoperative epidural fibrosis (PEF) is a significant complication following lumbar disc herniation surgery. It is characterised by the formation of non-physiological scar tissue that may lead to recurrent radicular pain and contribute to failed back surgery syndrome (FBSS). Despite its clinical relevance, the exact incidence and effective management strategies for LPEF have not been adequately quantified in the existing literature.This study analyses a cohort of 2673 patients who underwent surgical intervention for herniated lumbar discs between September 2010 and August 2023, focusing on 1974 patients monitored for up to one year post surgery.The study reports on the incidence of postoperative fibrosis, with 97 patients diagnosed with this condition. Over 61% of these patients experienced inadequate relief following various treatment modalities, including epidural steroid injections and anti-neuropathic medications.The findings indicate that while corticosteroid injections provided relief for a minority (23.61%) of patients, a substantial proportion continued to experience pain, necessitating referral to pain management centres. This research contributes to the understanding of LPEF's impact on patient outcomes and underscores the need for further investigation into effective preventive and therapeutic strategies during postoperative care.

The adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity of unknown etiology and onset between 10 and 18 years of life. The current AWMF S2k guideline was elaborated with participation of the specialty associations in Germany aiming at improving and unifying the standard of care in AIS patients. The purpose of this review is to present a compact synopsis of the results of the expert consensus.

Knee osteoarthritis (OA) is a widespread joint disease with no disease-modifying treatments. Chondrocyte damage is a key process in knee OA and ferroptosis is lipid peroxidation-induced iron-dependent cell death that exacerbates the process of knee OA and aggravates an imbalance in the synthesis as well as degradation of matrix metallopeptidase 13 (MMP13) and type II collagen. The clinical diagnosis of knee OA mainly depends on imaging. Whether ferroptosis-related genes could be used as new biomarkers for the diagnosis of OA remains to be explored.A dataset was used to build a diagnostic model used to diagnose and differentiate patients with end-stage knee OA. Normalization and quality control of the three profiles was carried out using R 4.1.0.Analysis of a dataset (GSE114007) of differentially expressed genes (DEGs) found that the expression of 15 ferroptosis-related genes, including activating transcription factor 3 (ATF3), cyclin-dependent kinase inhibitor 1A (CDKN1A), and cytochrome b-245 beta chain (CYBB), showed significant changes in osteoarthritic chondrocytes relative to normal subjects. Based on 15 ferroptosis-related genes, we developed and compared diagnostic models using different supervised learning algorithms.The diagnostic model based on the support vector machine gave a convincing diagnostic performance for both verifications (Area Under Curve [AUC] = 0.9601) and testing (AUC = 0.8725). The results collectively indicate that ferroptosis-related genes may play an indispensable role in knee OA and could be specific diagnostic biomarkers for knee OA.

Pelvic injuries have increased in frequency over the last few decades, whether due to high-impact trauma or minor trauma in geriatric patients. Treatment ranges from conservative measures to surgical interventions. With the use of minimally invasive surgical procedures, the importance of navigated pelvic surgery also increases.In the case shown, an anterior and posterior pelvic ring fracture is surgically treated using O-Arm. Navigation helps with complex anatomy and facilitates intraoperative verification of the correct implant position, from which less experienced teams in particular can benefit. Increased precision reduces the revision rate. However, it requires a longer operation time and good interdisciplinary training, as well as special coordination with the surgical and anesthesia staff.This video demonstrates our step-by-step procedure for navigated screw osteosynthesis of a pelvic ring fracture.

Diabetic foot syndrome (DFS) occurs in 15-25% of diabetic patients. Identification of risk factors for malnutrition and prevention is valuable for patients with DFS. The aim of this study was to investigate the association between blood parameters and nutritional indices obtained from simple blood parameters and diabetic foot amputations.A single-center cross-sectional observational study was conducted between March 2024 and March 2025. According to whether they underwent amputation, including amputations of minor and major lower extremities, patients were divided into two groups: amputated (Group A) and non-amputated (Group NA). Patients older than 18 years with a DFD diagnosis were included. Data was analyzed statistically.A total of 237 DFS patients were included in the study, with 92 patients in Group A and 145 patients in Group NA. CRP/albumin ratio (p < 0.001), albumin/globulin ratio (p = 0.003), PNI (p < 0.001), and CONUT score (p < 0.001) results revealed statistically significant differences between groups. CONUT score demonstrated significant associations in univariate and multivariate analyses. Patients with a CONUT score ≥ 5 had a 2.28 times higher risk of amputation compared to patients with a CONUT score < 5.Our results showed significant correlations between CONUT score and amputation as well as a significant association between both CONUT scores and CONUT severity, and diabetic foot amputations. This study also demonstrates that the CONUT score is a significant predictor of amputation risk in patients with diabetic foot disease, with those having a CONUT score ≥ 5 showing a 2.28-fold increased risk of amputation.

Non-specific back pain is of great importance in health economics, due to its high impact on the ability to work and the need for rehabilitation. The effectiveness of orthoses in patients with low back pain is unclear, as these studies have heterogenous designs and methodological weaknesses.The aim of this work is to formulate evidence-based recommendations for the use of orthoses in patients with low back pain.The literature search was conducted according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) at PubMed, ScienceDirect, Cochrane and Google Scholar. The risk of bias in the studies was assessed using the Cochrane risk of bias tool, version 2 (RoB2), for randomised studies and risk of bias in non-randomised studies of interventions tool (ROBINS-I) for non-randomised studies. The level of evidence was determined according to the Agency for Health Care Policy and Research (AHCPR).21 studies were included. The study design and level of evidence were distributed as follows: 20 RCTs and 1 non-RCT, as well as 14 Ib, 6 IIb, and 1 III according to the AHCPR. As regards the risk of bias, 9 studies showed a severe risk, 8 moderate risk, and 4 low risk in at least one subdomain. Treatment with orthoses was investigated in 3 studies for acute non-specific back pain and in 12 studies for chronic back pain. The recorded endpoints were pain reduction, effects on balance, compliance, daily and workplace activities, and imaging. A comparative analysis of orthosis types was conducted in 5 studies.Treatment of non-specific low back pain with thoracolumbar orthoses results in a significant reduction in pain, although the exact effect size remains unclear. However, based on the available and analysed studies, no general evidence-based recommendation for the use of thoracolumbar orthoses for non-specific low back pain can be formulated.