Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

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.

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.

Degenerative spinal diseases may lead to multisegmental instabilities and present as de novo scoliosis. Due to frequent primary and secondary complications, their treatment is controversial among spine surgeons. The aim of this systematic review is to investigate the postoperative quality of life after multilevel fusion surgery for de novo scoliosis. Furthermore, technical aspects and complications are examined in detail.A systematic literature search was conducted, excluding systematic reviews or meta-analyses. A follow-up period of at least 24 months was required. Standardised outcome instruments on quality of life, epidemiological data and information on surgical technique and any further follow-up examinations were extracted. Studies on adolescents or neuromuscular scoliosis were excluded, as were case reports and studies on short-span fusions.Twenty studies were included in the systematic review. The Oswestry Disability Index (ODI) was reported in 15 studies. All authors reported significant improvements. Inclusion of the L5/S1 segment showed no differences in quality of life, but better radiological correction, although the rate of adjacent segment degeneration and complications was higher. The data on general postoperative complications ranged from 10.5% to 71.5%.Quality of life after multilevel fusion for de novo scoliosis shows significant improvements. There is no general recommendation on the last instrumented vertebra or the caudal anchoring of the instrumentation. Treatment in specialised centres for spine surgery is strongly recommended, also due to the high postoperative complication rates.

Congenital patellar dislocation (CPD) is a rare condition in which the patella is laterally dislocated at birth. Surgical intervention is typically required due to abnormal knee development.This case report details a successful application of medial patellofemoral ligament reconstruction using a femoral soft-tissue fixation technique (ST-MPFL-R), combined with lateral release and vastus medialis advancement in a 7-year-old boy with CPD.ST-MPFL-R combined with lateral release and vastus medialis led to satisfactory results.This approach avoided damaging growth plates and achieved patellar stability at six-year follow-up. While the application of ST-MPFL-R for CPD was reported for the first time, further research with larger patient groups is needed to definitively compare it to traditional methods.

Gender-specific differences also affect the subject of orthopaedics and trauma surgery (O&T). While the proportion of women studying medicine is steadily increasing, the proportion of female surgeons in O&T is only 18.6%. This underrepresentation affects not only clinics but also research and is reflected in participation in scientific annual meetings such as the German Congress for Orthopaedics and Trauma Surgery (DKOU).This retrospective study examined the gender differences in abstract submissions to the DKOU from 2015 to 2024. The anonymised data were subjected to examination regarding gender, role in submission and academic title.The overall participation of women in the 82,813 abstracts was 20%. The proportion of women among submitters was 23.3%, among presenters 24.5% and among co-authors 18.2%. In the analysis of the female cohort alone, women were more likely to be submitters and presenters than in the male cohort (p < 0.001). The proportion of female participation in abstract submissions increased by an average of 0.5% per year over the study period. However, women were significantly underrepresented at higher academic degrees, such as habilitations (7.4%), professorships (7.6%) and university professorships (5.2%).The results show that the proportion of women submitting abstracts to the DKOU largely corresponds to the percentage in the field of orthopaedics and trauma surgery (18.6% in 2022), reflecting the overall gender disparity in this specialty. If this trend analysis were applied to the general development of gender parity in orthopaedics and trauma surgery, gender-equitable staffing of medical positions could not be achieved before the year 2087. To accelerate this development, targeted measures to promote women in orthopaedics and trauma surgery are necessary. This includes dismantling structural barriers and implementing specific support programs for female surgeons pursuing academic careers.

After anterior cruciate ligament reconstruction (ACLR), patients have been found to have reduced plantar sensation, which may result in reduced afferent input to the central nervous system and thus contribute to motor deficits. Textured surfaces are thought to have a beneficial neurosensory effect. The aim of this cross-sectional study was to compare plantar sensation and leg muscle activity while stepping on different textured surfaces between patients after ACLR and healthy controls.Plantar cutaneous thresholds to light touch were measured in 10 patients at least 6 months after ACLR and in 10 healthy controls. Patients or controls were asked to step forward on the centre of a force plate with the affected (ACLR) or randomly assigned (healthy controls) leg and maintain the single-legged stance for 10 seconds (floor condition). They were instructed to perform the same task on a balance board with a textured surface, the same balance board with a smooth surface, and a balance pad in random order. Muscle activity of four leg muscles was recorded using surface electromyography. The significance of differences in plantar sensation and mean muscle activity within three time frames between and within ACLR patients and healthy controls was analysed using non-parametric statistical tests with Bonferroni correction (p < 0.05).There were no significant differences between patients with ACLR and healthy controls in plantar sensation and muscle activity for all unstable surface conditions (p > 0.05). Friedman tests revealed significant differences in the activities of all muscles between surface conditions at the first peak of the vertical ground reaction force (vGRF) after the rapid increase in the force-time curve (transition from early lifting phase to late lifting phase) within both groups (p < 0.01). Post-hoc Wilcoxon signed-rank tests showed significantly altered activity for most muscles between the smooth and textured balance board conditions only at the first vGRF peak (p ≤ 0.01) in both patients and healthy controls.Although plantar sensation and muscle activity did not differ between patients with ACLR and healthy controls, altered muscle activity in both groups, especially during the transition from the early to the late lifting phase of stepping on a textured unstable surface, may indicate an acute change in the afferent input of plantar mechanoreceptors in response to the surface stimulus. In addition, it may indicate an acute change in motor output caused by a beneficial neurosensory effect. This effect should be considered with caution due to the small sample size.