Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

Cage subsidence is one of the most common complications after transforaminal lumbar interbody fusion (TLIF) and correlates with inferior bone quality. Studies have reported L1 vertebral bone quality score (VBQ) based on MRI to be a promising alternative to evaluating preoperative bone quality. However, to the knowledge of the authors, no study has examined the correlation between L1 VBQ scores and cage subsidence after TLIF.The purpose of the study was (1) to assess the interrelation between the L1 VBQ score and cage subsidence after TLIF; and (2) to compare L1 VBQ and L1 CT Hounsfield Unit (HU) values in predicting cage subsidence after TLIF.We reviewed patients who had undergone TLIF at one institution between 2012 to 2021. Cage subsidence was measured using postoperative lumbar CT based on cage protrusion through the endplates at more than 2 mm. The L1 VBQ score was calculated by dividing mean L1 signal intensity (SI) by mean SI of the cerebrospinal fluid (CSF) at L1. The L1 HU value representing bone mineral density (BMD) was measured using computed tomography. We then performed Student's t-test for independent samples and logistic regression analyses for statistical analysis. We also conducted receiver operating characteristic (ROC) analysis to assess the predictive ability of the L1 VBQ score and L1 CT HU.Of 233 participants, cage subsidence was observed in 41 patients (17.6%). Comparison between the characteristics of patients between the group with subsidence and the group without subsidence revealed significant differences in the age, VBQ score, and L1 CT HU. Multivariate logistic regression showed that higher L1 VBQ score (OR = 2.499, 95% CI: 1.205-5.180, p = 0.014) and lower L1 CT HU (OR = 0.960, 95% CI: 0.933-0.987, p = 0.005) were associated with an increased rate of cage subsidence. Area under the curve (AUC) analysis of the L1 VBQ score returned 0.735 (95% CI: 0.620-0.850) and the suitable threshold was 3.424 (sensitivity: 82.9%, specificity: 70.7%). The AUC of L1 CT HU was 0.747 (95% CI: 0.642-0.852) and the suitable threshold was 136.5 (sensitivity: 85.4%, specificity: 56.1%).The present study demonstrates that L1 VBQ score and L1 CT HU are reliable predictors with similar performance for cage subsidence after TLIF.

Sufficient follow-up of fractures is often difficult, due to age-related, health-related or geographical reasons. Self-assessment of the patient's functional outcome could be an alternative to a personal medical examination. There is a lack of validated questionnaires to record these parameters for elbow injuries. The aim of the study was to validate the patient's self-assessment of the range of motion following surgical treatment of complex radial head fractures.50 patients (42% women) with a mean age of 49.7 ± 13.8 years (range 25-82 years) with a surgically treated radial head fracture (Mason III or IV) were examined, 39.6 ± 23.3 months postoperatively. The fracture was treated with radial head reconstruction (60%) or radial head prosthesis (40%). The follow-up examination included the assessment of elbow mobility using a questionnaire (Elbow Motion Assessment Score) and physical examination using a goniometer. In addition, quality of life was assessed using the SF-36 Health Survey. The agreement of the mobility was recorded as a percentage using Spearman's correlation.Exact agreement between examiner and patient was achieved at 54% in flexion, 40% in extension, 86% in pronation and 54% in supination. The median deviations in agreement were 10° in extension and flexion and 20° in pronation and supination. The correlations were r = 0.550 (flexion), r = 0.841 (extension), r = 0.808 (pronation) and r = 0.754 (supination). Patients who agreed with the examiner on the movements achieved a higher score in the SF-36 Health Survey than patients who did not agree with the examiner (50.5 to 54.1 vs. 40.0 to 45.5).The survey of the range of motion by the patient using a questionnaire showed a high level of agreement with the measurement by an objective examiner. Such self-assessment can therefore be seen as a suitable, cost-effective alternative in the follow-up examination of surgically treated radial head fractures.

Erfahrungen medizinischer Kompetenzzentren für Menschen mit Thalidomid-Embryopathie legen nahe, dass sturzbedingte Verletzungen vergleichsweise häufig vorkommen. Da Stürze im Alter Morbidität und Autonomieverluste begünstigen, wurden Sturz- und Frakturrisiken bei Thalidomid-Geschädigten untersucht.Onlinebefragung (Survey Monkey) zu funktionellen Einschränkungen sowie Sturzereignissen von Personen mit Thalidomid-Embryopathie (TE-Gruppe) und Nichtbetroffenen (Kontrollgruppe).206 Personen der TE-Gruppe und 183 der Kontrollgruppe wurden befragt. Einschränkungen des Hörens, des Gleichgewichtssinns, des Sehens, der Sensibilität und der Kraft waren in der TE-Gruppe signifikant häufiger als in der Kontrollgruppe. Personen der TE-Gruppe gaben signifikant häufiger Stürze und Verletzungen an als in der Kontrollgruppe.Menschen mit Thalidomid-Embryopathie haben im Vergleich zu Nichtbetroffenen häufiger Stürze mit schwerwiegenderen Verletzungen. Die Ergebnisse der vorliegenden Untersuchung verdeutlichen die Notwendigkeit einer individuellen Risikobewertung und präventiver Maßnahmen zur Sturzvermeidung in dieser Patientengruppe.

The placement of chest tubes in Bülau position is an established method for treating pneumothorax resulting from thoracic trauma. While complications involving nerve structures are rare, they can be clinically relevant. This case report describes a complication not previously mentioned in the literature: recurrent laryngeal nerve palsy caused by the position of the tube tip near the recurrent laryngeal nerve at the upper lung apex.A 47-year-old patient with right-sided traumatic pneumothorax and rib fractures developed progressive hoarseness following initial chest tube placement. Clinical examination revealed recurrent laryngeal nerve palsy. CT imaging showed the tube tip located at the junction of the lung apex and mediastinum in close proximity to the recurrent laryngeal nerve, which was considered the likely cause.After partial retraction of the chest tube, administration of systemic prednisolone, and initiation of speech therapy, the patient showed rapid clinical improvement. Following the full resolution of the pneumothorax, the patient was discharged. At follow-up, the recurrent laryngeal nerve palsy had completely resolved.This case emphasizes the importance of precise chest tube positioning, particularly in the region of the lung apex and mediastinum, to prevent rare neurological complications such as recurrent laryngeal nerve palsy. In the event of new neurological symptoms, immediate radiological assessment is essential to identify potential complications and initiate appropriate measures.

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.

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.

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.

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.