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.

Low-dose radiotherapy is an established treatment option for non-malignant skeletal disorders. It is used in the treatment of Heberden's osteoarthritis (HA), but the evidence of efficacy does not seem to be certain. This paper reviews current literature for scientific evidence of efficacy in the treatment of HA.The PubMed and Cochrane Library databases were searched for relevant publications.9 publications were identified that published data from 7 studies. Only one study was randomised, placebo-controlled and double-blinded. None of the studies exclusively investigated HA. The studies were all inhomogenous with regard to inclusion criteria, follow-up criteria, radiation mode and interpretation or treatment success. In the RCT, no difference was found between the verum and control groups.The study situation is currently weak. The researched publications are not sufficiently focused on the collective of Heberden's osteoarthritis and are generally too inhomogenous with regard to the criteria applied. Future targeted studies are therefore required to prove efficacy.

Transient hip synovitis is one of the most common paediatric orthopaedic diseases. This non-controlled interventional study investigated the origin, clinical findings, imaging and the duration of symptoms. 146 affected patients out of the total of 27659 patients under 18 years result in an incidence of 0.53%. 76.7% boys outweighed 23.3% girls (1.8-12.9 years [Ø 6.3 y, boys Ø 6.5 y, girls Ø 6.2 y]). Diagnoses were defined by ultrasound and the absence of concurrent diseases. In 60.5% of patients, the right hip was affected, in 39.5% the left. A single patient had CF on both sides but not at the same time. No simultaneous incidence was recorded. There were two singular recurrences. Within the study period, we counted 11 cases of Perthes' disease, 2 juvenile hip arthritis and one septic hip. Patients' history showed 41.0% viral infections, 21.6% physical exertion and 15.1% singular trauma. In 22.3% no origin could be named. Clinical aspects included pain in inward rotation (51.5%), in hip flexion (49.3%) and limping (37.5%). Ultrasound depicted medium joint effusion in 53.4%, marked effusion in 46.6% and synovial thickening in 17.1% of patients. 119 patients could be followed up weekly. Joint effusion vanished after 3-36 days (Ø 13.3 d), clinical symptoms Ø 1.6 days earlier. Total duration in terms of sonographic appearance of effusion was 3 to 37 days (Ø 19.1 d).

With the new licensing regulations and the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM), the learning objectives and certificates of achievement are no longer assigned to specific subjects. In addition to the opportunity for the subject of orthopaedics and trauma surgery to present itself more prominently and at an earlier stage, there is also a need to identify the relevant subject-related learning objectives in order to integrate them into the curricula and prepare for internal faculty discussions on teaching assignments. At present, it remains unclear whether the new licensing regulations will be accompanied by the initially planned complete restructuring in the form of the so-called Z-curriculum, but the new learning objectives of the NKLM will become part of the training for future doctors.The learning objectives contained in the current draft of the NKLM from December 2023 were screened and evaluated by two teaching coordinators using the dual control principle. The learning objectives that should and can be meaningfully taught by the O & U were selected from the 2646 formulated contents. A total of 276 (10.32%) learning objectives were detected for the teaching of O & U and 2399 (89.68%) were excluded. The selected learning objectives were then assigned to the existing courses and the institute's own teaching was optimised accordingly in preparation.In this study, the learning objectives of the NKLM were compared with the current learning objectives of O & U at Leipzig University and the learning objectives of the NKLM were integrated into the curricula. Of the NKLM, 10.32% of the learning objectives relate to the subject O & U, which underlines its importance. In addition, the approach presented here shows that the learning objectives of the NKLM can be quickly implemented in an existing curriculum.