Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

Functional lack of knee extension is an important limitation for patients. Whereas in younger patients the limitation of activity usually dominates, in older patients there is also the risk of secondary injuries due to an increased risk of falls due to instability and unsteady gait. Depending on the cause, an improvement in quality of life can be achieved for most patients through various methods of knee extension reconstruction. There are no general restrictions for reconstruction due to comorbidities or age. The present study offers a comprehensive overview of the potential options for reconstruction, as well as a decision-making aid for operative indication, that considers the underlying lesion and patient-specific characteristics. Local reconstructions, functional tendon- and nerve-transfers and free functional muscle transfers are presented. Further information on the postoperative procedure is given, as well as an overview of the expected result. The therapeutic aim should not end with controlling a tumour disease or treating the initial trauma, rather therapy planning should also include functional reconstruction as part of an interdisciplinary therapeutic approach to improve quality of life and participation as well as preventing secondary consequences of disease or trauma.

Habilitation is a procedure by which one of the highest university degrees is achieved in the field of medicine in Germany. We hypothesize that this academic milestone represents an incentive for scientific productivity that drops off once a scientist has reached this career steep. This study aims to compare scientific performance of German scientists before and after completing this milestone with special focus on orthopedic surgeons and traumatologists (O&T).Scientists who had completed their habilitation in human medicine were researched from public announcements in the period Jan-Dec 2018. The periods Jan 2016 to Dec 2018 and Jan 2020 to Dec 2022 were defined as pre- and post-habilitation phases, respectively. Scientific performance was calculated using normalized citation percentiles (NCPs) from author records in Web of Science. Association between sex, subject area, and change in performance were analyzed.NCP values of 742 scientists were analyzed showing a significant decrease after completing habilitation (p < 0.001). This applied to men and women (p = 0.015, p = 0.003) and non-surgical disciplines (p = 0.001), while surgical disciplines such as O&T only demonstrated a statistically non-significant decrease. Interestingly, women showed an increase in performance after habilitation in this male-dominated discipline at only 4.5% (2) females compared to males. Most scientists in the population experienced a decline in performance (53.9% [400]). This drop amounted to over 50% in 35.5% (142) of these cases. No association was found regarding gender or subject area.Scientific performance seems to be incentive-dependent and significantly decreases after completing a career milestone in Germany. This decline is not statistically significant in O&T; women, who are strongly underrepresented, even show an increase in performance.

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.

The aim of the study was to compare closed and open reduction of displaced paediatric supracondylar humerus fractures with regard to long-term functional outcome and quality of life.In this retrospective study, 30 patients were examined with a displaced supracondylar humerus fracture (14 boys and 16 girls with a median age of 7 years [5-12 years]). The right elbow was affected in 8 cases (27%) and the left elbow in 22 cases (73%). According to the Gartland/Wilkins classification, there were 3× type IIA (10%), 8 × type IIB (27%), 18 × type III (60%) fractures (missing data n = 1 [3%]). All fractures were fixed with a crossed K-wire osteosynthesis. In the 1st group (n = 12), the fractures were reduced closed. In the 2nd group (n = 18), an open reduction was performed. The Quick Disabilities of the Arm, Shoulder and Hand Score (Quick-DASH) and the Paediatric Quality of Life Score (PedsQL) were recorded as outcome parameters after a mean follow-up of 53 months. The two groups were compared in terms of patient- and treatment-related factors and outcome parameters.The proportion of right elbow fractures was significantly higher in group 1 than in group 2 (50% vs. 11%). In group 2, the proportion of more severely displaced fractures was significantly higher than in group 1 (Gartland/Wilkins type III: 98% vs. 17%) and the median operating time was significantly longer (93 min vs. 26 min). There were no significant differences between the two groups in the Quick-DASH (0 [0-39] vs. 0 [0-11], p = 0.219), in the additional module "Sports and Music" of the Quick-DASH (0 [0-37.5], missing data n = 2, vs. 0 [0-50], p = 0.284) and in the PedsQL (95 [63-100] vs. 96 [86-100], p = 0.328).Open reduction of displaced paediatric supracondylar humerus fractures does not lead to a reduction in long-term functional outcome and quality of life compared to closed reduction.

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.