Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

The aim of this study was to develop a simple and reliable score which supports decision making between non-operative and operative treatment in patients with osteoporotic pelvic fractures.Between 2018 to 2020, the OF Pelvis Score was developed during a total of 5 meetings of the Working Group on Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma. The OF Pelvis Score as a decision aid between non-surgical and surgical treatment was developed by expert consensus after analysis of numerous geriatric sacral and pelvic ring fractures from several hospitals. Subsequently, retrospective evaluation of the score was performed on consecutive patients from three hospitals.The following parameters were considered relevant to decision making between non-surgical and surgical treatment and were incorporated into the score: fracture morphology using the OF Pelvis Classification, pain status, level of mobilisation, fracture-related neurological deficits, health status, and the modifiers already integrated into the OF Pelvis classification. If the score is < 8, non-surgical therapy is recommended; if the score is > 8, surgical therapy is recommended; if the score is 8, there is a relative indication for surgery. The OF Pelvis Score was then evaluated retrospectively in a total of 107 patients, according to records. The OF Pelvis Score was 8 points in 4 patients (3.7%), all of whom received surgical treatment. Of the remaining 103 patients, 93 received score-compliant therapy (90.3%). Among these, 4 of the patients who did not receive score-compliant care refused the recommended surgery, so the actual therapy recommendation was score-compliant in 94.2%.The OF Pelvis Score can be used to derive a therapy recommendation in many patients in clinical practice. Because of the possible change of clinical parameters during the course of the disease, the score has a dynamic character. In the retrospective evaluation, the recommendations from the OF Pelvis Score were in close accordance with the therapy actually performed.

Formation of biofilms by bacteria is a major challenge in a clinical setting. The importance of these biofilms increases in specialties where foreign bodies and prosthetic material are used. Orthopaedics is such a speciality and phage therapy could offer additional therapeutic options when dealing with biofilm infections.We conducted a systematic literature review using the PubMed database. We searched for phage activity against biofilms of the most common pathogens found in orthopaedics.The results of the systematic review were broken down into different categories and discussed accordingly. We concentrated on the time the biofilms were allowed to mature, and the surface they were grown on. In addition, we checked the efficacy of bacteriophages compared to antibiotics and when applied simultaneously with antibiotics. We also investigated the source of the phages, how they were tested for sensibility against the biofilms, as well the conditions (pH, temperature) under which they remained active and stable.The data suggests that the in vitro efficacy of phages does not change under a wide spectrum of temperature and pH. To further explore the use of bacteriophages in orthopaedics, we need further studies that test biofilms which matured for several weeks on surfaces that are common in arthroplasty and traumatology.

Monteggia-(like)-lesions are a combination injury of the forearm characterised by a proximal ulnar fracture with concomitant dislocation of the radial head in the proximal radioulnar joint (PRUG). If there are also fractures of the radial head and/or the coronoid, these are referred to as Monteggia-like injuries. Monteggia(-like) injuries are serious lesions which, without adequate treatment, carry a high risk of permanent damage such as persistent movement restrictions, progressive osteoarthritis and pain. Adequate diagnosis and treatment are essential for a satisfactory postoperative outcome. CT imaging with 3D reconstruction is the gold standard for preoperative diagnosis and planning. Generally, anatomical reduction with osteosynthesis is the treatment of choice for Monteggia(-like) injuries. In the vast majority of cases, the surgical approach can be dorsal. Anatomical fixation of the ulnar fracture is crucial for surgical success and is usually achieved using (locking) plate osteosynthesis. Concomitant fractures of the radial head and/or coronoid as well as ligamentous injuries require special attention and should usually also be addressed.

A 51-year-old patient presented with a painful swelling palmar to the metacarpophalangeal joint of the ring finger. A round tumor was detected using X-rays and MRI. After excision, tumoral calcinosis could be verified histologically.

The treatment of acetabular defects in revision arthroplasty is an increasing challenge. Different classifications have been introduced for preoperative planning to achieve the best possible result. 3D printing is a way to better visualize and understand these defects. The aim of this study was to facilitate classification, provide young doctors with a better understanding of complex defects, and ultimately improve preoperative planning and patient safety.The study was conducted at the 2022 BOUT congress, where health care professionals were provided with X-rays, a computed tomography (CT) scan, and a 3D print to classify acetabulums according to Paprosky and ADC. A questionnaire was administered to gather information on their familiarity with the classification systems and perception of 3D models in the clinic.The study involved 14 participants, mostly resident physicians, with some familiarity with the Paprosky and ADC classifications. The 3D printing method resulted in the highest rate of correct classifications for acetabular defects compared to X-ray and CT imaging. Participants found the 3D model useful for clinical applications and rated it higher than X-ray and CT imaging for classifying acetabular defects.Acetabular defects present a challenge in assessment, preoperative planning, and surgical management due to their complex anatomy. Overall, we were able to show that the use of a 3D model increases the accuracy in the classification of acetabular defects. The use of 3D printing in orthopedics and trauma surgery is showing more and more advantages and has opened up new methods for the education of medical students and young surgeons.

This article describes the technique of a multidimensional, V-shaped, and self-centering osteotomy of the tibial tuberosity with cortical bone block support, which enables combined distoanteromedialisation of the tibial tubercule.

We report on an 18-year-old female who sustained complete loss of her knee extensor mechanism (patella, quadriceps and patellar tendon) due to a motorbike injury with severe soft tissue loss of the ventral aspect of the knee and subsequent infection. After infection control and successful latissimus dorsi free flap surgery, reconstruction of the knee extensor mechanism was performed using a fresh frozen extensor mechanism allograft with patella, quadriceps- and patellar tendon and integrated tibia tuberosity fragment. After a follow-up of 18 months, there was infection free integration of the allograft with a range of motion 0-0-90° (extension/flexion) and pain free gait.