Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

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.

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.