Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

The management of shoulder injuries resulting from epileptic seizures presents a particular challenge. These injuries often present complex patterns, ranging from dislocations and fractures to damage to the rotator cuff. Recurrent seizures can significantly impact the outcome and must be considered a central risk factor when choosing the therapeutic approach. Accordingly, these injuries require close multidisciplinary cooperation between orthopaedics/trauma surgery, neurology/epileptology and physiotherapy, both in diagnosis and treatment. Despite their clinical relevance, standardised treatment algorithms are currently lacking, and the available scientific evidence remains limited. This review article addresses the specific characteristics of seizure-related shoulder injuries within a multidisciplinary approach. Epidemiological aspects, including pathomechanical principles, diagnostic challenges, and current conservative and surgical treatment options, are discussed.

Due to the distinctive heterogeneity of the functional and biomechanical effects of posttraumatic fracture sequelae subsequent to proximal humerus fractures, there are no validated therapy guidelines yet and the majority of existing studies have concentrated on endoprosthetic treatment options. This retrospective clinical study which directly compares the functional outcome of patients after corrective osteotomy and osteosynthesis with that of patients treated with reverse total shoulder arthroplasty was therefore needed to demonstrate that the functional outcome after joint-preserving treatment provides better results, as shown by the Constant score and range of motion, and identifies the specific criteria relevant for treatment decision-making with a focus on joint preservation.Clinical follow-up examinations were performed after the respective revision surgeries and information was collected about patients' postoperative status (e. g. rating scale for pain, range of motion). Postoperative function was evaluated and analyzed using standardized shoulder scores (Constant score, Simple Shoulder Test, Subjective Shoulder Value).A total of 29 patients were enrolled, with 11 receiving joint-preserving treatment (group A) and 18 treated with arthroplasty (group B). Follow-up examinations were carried out at 38.3 ± 30.2 months after revision surgery. In addition to the higher satisfaction level in group A, lower levels of pain, and a higher range of motion, the Constant score (71.4 ± 11.6 points vs. 54.1 ± 15.3 points, p = 0.008), the Simple Shoulder Test (80.3 ± 16.8 % vs. 54.6 ± 28.3 %, p = 0.011) and the Subjective Shoulder Value (75.5 ± 15.4 % vs. 58.1 ± 20.9 %, p = 0.021) each demonstrated significantly better results for group A.These findings showed better clinical outcomes after joint-preserving therapy, which suggests that it is the better treatment option. Patients < 60 years of age with good bone quality, intact rotator cuff muscles, and a respective patient individually functional entitlement benefit from a joint-preserving approach, which should consequently be the preferred treatment option. For patients > 60 years of age, however, secondary endoprosthetic treatment of fracture sequelae is still indicated, due to progressively degenerative lesions of the rotator cuff muscles and/or of the glenohumeral joint itself in this age group.

The patella is an important part of the extensor mechanism of the knee. Due to its subcutaneous location, it can be easily exposed to trauma. In this study, we aimed to clarify the effect of patella fractures on walking by examining the results of gait analysis of patients with patella fractures.Patients who were treated due to a patella fracture in the last 10 years were selected from the hospital archive. A total of 18 patients and 36 healthy control subjects were included. Clinical, radiological, and functional results were collected for the fracture group retrospectively, and gait analysis was performed for all patients and control subjects. Results were evaluated statistically.The mean follow-up time for the fracture group was 64.9 ± 47.02 months. Foot rotation (p = 0.026), step width (SW; p < 0.001), lateral symmetry (LSIM; p < 0.001,) and anterior-posterior variability (p = 0.012) were found to be statistically increased on the injured sides of the fracture group compared to the control group.In this study, it was found that patellar fractures resulted in increased foot rotation, and it was thought that this result might be related to the compensatory mechanism of knee joint arthrosis to reduce the knee adduction moment and the lateral-medial shear force. Multivariate analyses showed that LSIM and FR were associated with patella fracture. A multicenter study with a greater number of patients is needed for more accurate results.

Pain and stiffness are common symptoms that occur in many elbow pathologies. In the diagnostic algorithm for non-specific elbow pain, benign tumour lesions should be ruled out in rare cases. The following case presentations demonstrate that rare entities such as osteoid osteoma (OO) can be the cause for unclear elbow complaints.Three male patients presented with non-traumatic elbow pain over several months before seeking medical help for the first time. Their main concern was restricted Range of Motion (ROM). The plain radiographs were normal in ⅔ cases, and the CT-scans showed unspecific signs of free joint bodies in the area of the incisura trochlearis of the proximal ulna in the initial stages. Either arthroscopic or open excision was performed as based on CT and/or MRI scans. The decision on the appropriate approach of treatment depends on the localisation of the OO. In particular, the medial ulnohumeral joint section cannot be completely visualised and remains reserved for the open procedure, with the associated disadvantages. Histopathological preparation confirmed the diagnosis. Overall, both techniques seem to reduce the patient's pain immediately, restore ROM with a slight delay, and show almost no recurrence rates of the tumorous lesions.Patients presented with elbow pain and restricted ROM with no history of elbow trauma; plain radiographs as well as nocturnal pain are highly indicative of OO. Even though this is rare, we should always keep it in mind in order to protect the patient from wrong or delayed diagnosis and treatment. A surgical approach is to be preferred, particularly in the case of intra-articular localisation.

The healing of a bone fracture depends on the complex interaction between biology and mechanics. If this interaction is disrupted, a pseudarthrosis may develop. This results in significant impairments in quality of life for the affected individuals. For the selection of the appropriate therapy, which often requires surgical intervention, the frequently multifactorial underlying etiology must be accurately identified. The five pillars of pseudarthrosis treatment are: stable fixation, mechanical alignment, biological stimulation, optimization of modifiable factors, early functional rehabilitation.

This study investigated the effects of EndoCert certification on outcome quality after hip and knee replacement surgery in Germany. The analysis was based on three data sets: AOK billing data, structured hospital quality reports and EndoCert data.Certified endoprosthesis centres (EPZ) were compared with non-certified clinics with regard to the primary endpoint "overall complications". The effects of certification were investigated using hierarchical logistic regression models. A total of 1283 clinic locations were identified that performed study-relevant revision surgery during the observation period (2016-2018).The results showed significantly fewer overall complications during hip replacement surgery in certified centres compared to non-certified facilities (OR = 0.83 [95% CI: 0.75-0.92]; p = 0.0003). No significant difference was found for knee replacements (OR = 1.09 [95% CI: 0.93-1.27]; p = 0.29).This study provides important insights into quality assurance in arthroplasty. The positive effects of EndoCert certification for hip replacements underline the importance of specialized centres for complex interventions and targeted certification measures in improving the quality of care. The lack of effects for knee replacements could be due to limitations of the quality indicator used, as possible improvements in mobility and freedom from pain were not taken into account. Further studies are therefore required.

The following paper provides an overview of the procedure of extracorporeal shockwave therapy and a classification of the current literature. The PubMed, Lvivo and WebOfScience databases were searched for "Extracorporeal Shockwave Therapy" and "Fracture nonunion". A total of 45 studies were identified, 12 of which were included in the analysis after narrowing them down. Fracture healing rates after the application of extracorporeal shockwave therapy (ESWT) averaged 69.25% (52-86%). Overall, it can be seen that the studies are based on small samples (average 154 patients) with a high variance in sample sizes (17-924 patients).

Osteoarthritis is a common degenerative disease of joint cartilage that affects millions of people in the world, especially the elderly. Progression of osteoarthritis is associated with a plethora of genetic and non-genetic factors. The CRISPR/Cas9 system is emerging as a powerful tool for genome engineering and has remarkable potential for guiding further research into osteoarthritis and may be a viable means for treating the disease. This review discusses existing and potential applications of the CRISPR/Cas9 system in osteoarthritis studies and treatments. Firstly, we briefly summarize the current status and mechanism of this technology. Next, we focus on the latest advances in the application of CRISPR/Cas9 system in elucidating the contributions of various factors to the pathogenesis of osteoarthritis as demonstrated through in vitro studies and animal models. Finally, we provide our perspective on the direction and challenges of studying and treating osteoarthritis with CRISPR/Cas9.