Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

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.

The individual and socio-economic burden of delayed rehabilitation after a fracture is high. Early identification of patients with critical healing processes and timely intervention are key factors for successful treatment management. The aim of this study was to demonstrate how step counts, collected via patient-owned wearables, can assist in identifying critical recovery trajectories.The study included 56 patients who already had a wearable device. Data on age, gender, injury type, PROMIS - Global Health 10 score at 3 months, and work ability at 3 months were collected. Step counts were recorded both before and after the injury.Data from 56 patients were analysed. Postoperative healing was reliably monitored using the patients' own wearables for both upper and lower extremities. Significant differences in daily step counts were observed between patients with normal healing and those with delayed rehabilitation. Significant differences were also found in step counts between patients who regained work ability within 3 months and those who did not. PROMIS surveys conducted after 3 months revealed significant differences between daily step counts in patients above the 80th percentile compared to those below the 20th percentile.The analysis demonstrates that monitoring healing progress with patient-owned wearables can effectively estimate the risk of delayed recovery and prolonged work disability, as based on easily accessible personal activity data. Further refinement of the technology and inclusion of additional patients with defined injury types could help identify trauma patients in need of additional care during treatment. Early and targeted interventions could enable a return to pre-injury activity levels and reduce the duration of work disability.

Arthroscopy has emerged as a crucial technique in modern orthopedic surgery, offering significant advantages over traditional open procedures. However, the steep learning curve and the need for advanced psychomotor skills presents challenges in training residents effectively. This study aimed to assess the development of arthroscopic skills, research involvement, and the impact of the COVID-19 pandemic arthroscopic training among residents in Germany.A prospective cross-sectional survey was conducted among members of the German-speaking Society for Arthroscopy and Joint Surgery (AGA) in two periods: March-April 2020 and March-April 2024. A total of 730 residents were invited to participate with response rates of 38.5% (n = 281) in 2020 and 30.5% (n = 223) in 2024. The survey included questions on demographic data, arthroscopic experience, research activities, participation in cadaver workshops and courses, and subjective perceptions of training.The study revealed significant arthroscopic experience variability (p < 0.001) with no significant differences in independently performed procedures between the 2020 and 2024 cohorts. However, there was a significant association between training year and the number of independently performed arthroscopies (p = 0.002). The COVID-19 pandemic led to a partial shift towards digital learning formats with a reduction in hands-on training opportunities. Despite these challenges, the volume of arthroscopies performed and the amount of research involvement remained stable. The data also indicated a trend towards outsourcing surgical training to external courses and organizations.Despite a subjective worsening of training conditions in the medium term, the volume of arthroscopies, course participation, and research activity of German-speaking residents in orthopedic and trauma surgery remains unchanged, although there is still a substantial variability in arthroscopy case volume. To compensate for this, training is increasingly being outsourced and improved in-house training concepts should be established.

For the osteosynthetic treatment of fractures of the femur and optimal exposure of the fractured region including radiological fluoroscopy, it is often recommended to carry out positioning on an extension table, with positioning of the contralateral lower limb on a leg holder. It is not uncommon for this to result in peri- and postoperative damage of varying severity as a result of patient positioning. Some cases of damage due to improper positioning can be found in the literature in the context of urological, general and gynaecological surgery. This is often associated with the responsible surgical speciality, which often requires a lithotomy position and thus the bilateral positioning of the healthy lower extremities. The aim of this article is to draw attention to the well leg compartment syndrome (WLCS) of the unaffected side in orthopaedic surgery, by presenting a case of our own and to point out particular risks on the basis of a current literature review, as well as to discuss procedural suggestions for prevention.A literature search was carried out using the online medical database "PubMed" (search date 20.02.2025). After entering the search terms "Well leg compartment syndrome AND orthopaedic surgery", "Well leg compartment syndrome AND orthopaedics" and "Well leg compartment syndrome AND hemilithotomy positioning", a total of 175 search hits were found. After removal of duplicates and an extended full-text search, a total of 14 case reports were selected and included in the current publication.This report describes a compartment syndrome of the lower leg of the positioned uninjured limb (well leg compartment syndrome, WLCS) in a 63-year-old patient following prolonged emergency intramedullary nail osteosynthesis of a complex femur fracture, with an operating time of 8:12 h.In the literature, WLCS of the lower leg in orthopaedic surgery is found in most cases after intramedullary nail osteosynthesis of the femur in patients positioned in modified lithotomy. The operating time was over 2 h in most cases. The diagnosis of compartment syndrome was made in a wide time window between immediately postoperatively and up to 3 days after the operation. The treatment of choice in the majority of cases was fasciectomy of all 4 compartments of the lower leg. No statement can be made about other risk factors in the cases presented in the research - due to missing or limited data.Position-associated acute compartment syndrome in orthopaedic surgery is a rarely described complication. Risk factors include a long operating time, increased BMI, increased blood loss, low intraoperative blood pressure and peripheral vascular disease. The uninjured leg should be correctly positioned in the lithotomy position intraoperatively (90° flexion in hip and knee) and be as little as possible in the case of known risk factors. Regional procedures can also be used safely in high-risk patients, but often obscure the initial diagnosis.

Delirium is a common complication in elderly patients after total hip arthroplasty (THA). Malnutrition is common in the elderly and is closely associated with developing postoperative delirium (POD). Therefore, preoperative assessment of the patient's nutritional status is necessary. The geriatric nutritional risk index (GNRI) is a reliable indicator of nutritional status in the elderly population, but the relationship with postoperative delirium is not clear.The aim of this study was to determine the effect of preoperative GNRI on postoperative delirium.We reviewed 688 elderly patients who underwent primary elective THA at our medical center between 2013 and 2023. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, using diagnostic criteria from the Diagnostic and Statistical Manual IV and the Confusion Assessment Method. Propensity matching was used to match patients in the delirium and non-delirium groups. Multiple logistic regression analysis was used to determine the association between GNRI and postoperative delirium. The validity of the GNRI for predicting POD was assessed by the area under the receiver operating characteristic curve (AUC) and the optimal prediction threshold was calculated.When matched, the GNRI was significantly higher for the delirium group than the non-delirium group (89.0 ± 8.0 vs. 99.8 ± 8.1, p < 0.001). In multivariate logistic regression analysis, GNRI was an independent risk factor for POD, and the incidence of POD increased with lower GNRI (OR 0.846, 95% CI 0.792-0.904, p < 0.001). The results of the ROC analysis showed an AUC of 0.827 and a prediction cut-off of 95.7 for the GNRI (sensitivity: 85.7%, specificity: 68.6%).In elderly patients, a lower GNRI was significantly associated with the occurrence of POD after THA. Assessing GNRI prior to THA in elderly patients may be effective in predicting the risk of POD.

A 25-year-old female patient complained of intermittent pseudoradicular, ulnar-accentuated tingling paraesthesias of the right arm, accompanied by swelling and cyanotic skin discolouration of the forearm 9 days following plate osteosynthesis of a clavicle shaft fracture in the middle third (OTA classification type B). CT angiography revealed almost complete obstruction of the lumen of the subclavian vein at the junction between the clavicle and the first rib, which was consistent with a thoracic inlet syndrome. This was triggered by a haematoma of the concomitantly fractured first rib and a cortical screw protrusion in the area of the constriction between the clavicle and the first rib. Revascularisation was achieved by evacuating the fracture haematoma, partial resection of the first rib, and replacement of the two protruding screws. This case demonstrates that screw protrusion must be avoided during plate osteosynthesis of clavicle shaft fractures, particularly in the medial third of the clavicle - due to its proximity to the first rib. Injuries to the subclavicular neurovascular bundle can be comprehensively detected and treated by resection of the first rib.

We aimed to evaluate the effectiveness of compression by assessing finite element analysis with clinical and radiological evaluation of patients undergoing compressive and conventional intramedullary nailing for femur shaft fractures.We retrospectively examined a total of 162 patients from November 2012 to August 2019. The patients were divided into Group 1 (n = 79) in which the conventional intramedullary nailing was used, Group 2 (n = 42) in which 1.0-mm compressive nails were used, and Group 3 (n = 41) in which 1.5-mm compressive nails were used. Group 2 (n = 42) with 1.0-mm compressive nails, and Group 3 (n = 41) with 1.5-mm compressive nails used. The mean follow-up period was 14.3 ± 4.2 (12-22) months for Group 1, 15.4 ± 5.2 (13-26) months for Group 2, and 14.2 ± 5.2 (13-24) months for Group 3.The mean union period and functional score were calculated as 13.6 ± 2.6 months (12-17 months) and 79.4, respectively, in Group 1, which is a good degree result. The mean union period and functional score were calculated as 12.2 ± 2.8 months (11-17 months) and 85, respectively, in Group 2, which is excellent. Lastly, the mean union period and functional score were calculated as 11.1 ± 2.5 months (10-19 months) and 86, respectively, in Group 3, (p < 0.001) which is also excellent. In Group 1, union was observed in three cases. In Group 2, union delay was observed in one case, whereas in Group 3, union was observed in all cases.Compression of femur shaft fractures speeds up bone healing and improves functional scores in adult femur shaft fractures, and compression can the fracture union period. Finite element analysis showed that there was no statistically significant difference between the compression amounts of 1.5 mm and 1.0 mm, but the effect of compression on bone union.

Pilon tibial fractures are intra-articular fractures of the distal tibial metaphysis, typically resulting from high-energy axial trauma. Accurate classification using AO/OTA type 43-C and advanced imaging, including CT with 3D reconstruction, is essential for preoperative planning. Initial management of displaced fractures includes prompt reduction and temporary immobilization, often with a spanning external fixator. Definitive treatment follows a staged protocol based on soft tissue status and involves open reduction and internal fixation via approach-specific surgical access. Conservative management is reserved for stable, non-displaced fractures. Anatomical reduction is critical for favorable long-term outcomes. Postoperative care includes early physiotherapy, individualized weight-bearing, and close radiological monitoring.

Osteoporosis is a systemic skeletal disease of multi-aetiological origin and is a major factor in health economics. The reduction in bone mass and disruption of the microarchitecture lead to an increased risk of fracture. The therapy is versatile, with orthoses being used in the treatment of acute vertebral fractures as well as chronic pain.The aim of this work is to formulate evidence-based recommendations for the use of orthoses in osteoporotic vertebral fractures and chronic symptoms.The literature search was conducted according to the PRISMA protocol at PubMed, ScienceDirect, Cochrane and Google Scholar. The risk of bias of the studies was assessed using RoB2 for randomised studies and ROBINS-I for non-randomised studies. The level of evidence was determined according to AHCPR.A total of 18 studies were identified, with 11 studies focussing on the treatment of chronic back pain in osteoporosis and 7 studies on pain therapy for acute osteoporotic vertebral fractures. The non-RCTs matched 5× to evidence levels IIa. The risk of bias was 10× moderate, 4× severe and 3× critical. The RCTs could be divided by the following evidence levels: 10× Ib, 1× IIb, 1× III and 1× IV. The risk of bias was 10× moderate and 3× critical.In the case of chronic back pain, the use of orthoses leads to a reduction in pain and has a positive effect on back extensor strength, but a significant reduction in pain cannot be achieved in osteoporosis-associated vertebral body fractures. The currently available literature do not support the superiority of a specific type of orthosis.