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.

Osteoporosis is a chronic underdiagnosed condition that weakens bone structure with increased risk of fragility fractures. While the prevalence of osteoporosis is expected to increase due to demographic developments in many countries, there is found to be a serious treatment gap for patients. This is partly due to inadequate diagnostic procedures at healthcare facilities. Considering this, there is a need to understand factors that affect processes involving diagnosis and treatment in osteoporotic patients. This study's primary aim is to explore the management of patients with fragility fractures and osteoporosis by conducting and analyzing semi-structured interviews with healthcare professionals at a German maximum care provider. Insights from the interviews were used to map out the pathway of clinical care for patients and the results suggest a multitude of factors including disease awareness, communication, and up-to-date information to be particularly important for increased treatment quality. Future studies shall focus on improving generalizability and exploring the effectiveness of recently updated guidelines for management of osteoporosis.

Unstable distal clavicle fractures are clinically common, and there is no consensus regarding gold-standard treatment. The purpose of this study was to report on a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using a ligament augmentation and reconstruction system (LARS) of an artificial ligament, and to compare the clinical and radiographic outcomes with hook-plate fixation.Thirty patients with unstable distal clavicle fractures were treated with modified coracoclavicular (CC) stabilization using either a ligament augmentation and reconstruction system (LARS) or open reduction internal fixation with a hook plate. Indexes for evaluation included fracture healing, quality of reduction, and presence of complications. Shoulder function was evaluated using the Constant-Murley score.Patients were assessed at a mean time of 31.2 ± 10.1 months follow-up. All patients experienced radiographic union. The result at the last follow-up showed that patients treated surgically with ligament augmentation and reconstruction system had better Constant-Murley scores for shoulder function and lower complication rates than those treated with a hook plate.Treatment using LARS for unstable distal clavicle fractures resulted in excellent union rates and functional outcomes. This simple surgical technique is considered to be an efficient method for treating fractures that naturally restores stability of the distal clavicle fracture.

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.