Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

Different anatomical variants have been reported for the proximal and distal femur. Given this context, the goal of our study was to answer the following question: Can we also identify different anatomical variants of the proximal humerus?Two hundred anteroposterior (AP) radiographs of the proximal humerus with an equal gender distribution and equal laterality per gender were reviewed. The metaphyseal diameter of the proximal humerus at the level of the anatomical neck (X) and the intramedullary diameter at 10 cm from the apex of the greater tuberosity (Y) were measured. A new ratio was established, based on both measurements (Y/X). Radiographs showed different anatomical variants: type A: Y/X < 0.3, type B: Y/X = 0.3-0.4, type C: Y/X > 0.4. Two observers reviewed the AP radiographs independently and blindly in 2 different sessions.Three different anatomical groups (A, B and C) were identified based on the 25th and 75th percentiles. A higher percentage of type C was observed among females and a higher percentage of type A among males. A high inter-observer reliability was noted, with a Cronbach's alpha of 0.97 (ICC 0.96-0.98). The intra-observer reliability for observer 1 had a Cronbach's alpha of 0.98.A novel radiological classification of the proximal humerus has been established based on 3 different anatomical types (A, B and C). Further studies are needed to establish whether the novel classification system can be used as an indicator for aseptic loosening of cemented or cementless total shoulder arthroplasty.

Megaendoprosthesis offer a viable treatment in complex revision arthroplasty cases with good functional outcome. In the context of a neoplastic indication, the diagnosis-related group (DRG) I95A is usually assigned with a relative weight of 4.906 (2021). In contrast, in revision arthroplasty, the appropriate DRG is assigned, depending on the joint replacement. The additional costs compared to the invoiced DRG are to be compensated by agreeing on hospital-specific individual fees. These complex revision arthroplasties set high technical and operative demands and are mainly performed in specialised departments. We conducted a cost-benefit analysis of the use of the megaendoprosthesis in revision cases in a specialised orthopaedic clinic, as a single centre study. The question we sought to answer was: Is cost recovery possible in the modified German DRG system (aG-DRG)?A retrospective single centre analysis of treatment costs was performed. From 2018 to 2020, 113 patients treated with a megaendoprosthesis reconstruction in a referral centre due to extensive bone loss after aseptic or septic revision of a hip or knee prosthesis were included in the study. Relevant case-related cost drivers of the aG-DRG matrix (including staff and material costs of the operating theatre area and the ward) were taken into account. The actual costs were determined according to the specifications of the calculation manual published by the German institute for the remuneration system in hospitals (InEK). For each case, the contribution margin was calculated by relating the hospital's internal costs to the corresponding cost pool of the aG-DRG matrix.According to the DRG system 2021, 17 different DRGs were used for billing - in 70% based on a patient clinical complexity level (PCCL) ≥ 4. Compared with the InEK calculation, there is a deficit of -2,901 € per case in the examined parameters. The costs of physicians show a shortfall in both the operating theatre and on the ward. Implant costs, which were supposed to be compensated by hospital-specific additional charges, show a hospital-specific shortage of -2,181 €. When analysing the risk factors for cost recovery, only these showed a significant difference.Implantation of the megaendoprosthesis in revision arthroplasty is often the last option to preserve limb function. At present, despite a high degree of specialisation and process optimisation, this treatment cannot be provided cost-effectively even in tertiary care. The politically desired specialised department structure requires sufficient reimbursement for complex cases. The economic outcome of each treatment case is often unpredictable, however the surgeon is confronted with these cases and is expected to treat them. The high standard deviation indicates large differences in the cost/revenue situation of each individual case. Our results show for the first time a realistic cost analysis for megaprosthesis in revision arthroplasty and underline the importance

Falls in senior home residents are common. Individual preventive training can lower the fall risk. To detect the need for training, a systematic assessment of the individual fall risk is needed. The aim of this study was thus to assess whether a fall risk score based on free field insole measurements can distinguish between an at-risk group of senior home residents and a healthy young control group. A published fall risk score was used in senior home residents over the age of 75 and a young (< 40 years) control group to determine the individual fall risk. In addition, the fall events over 12 months were assessed. Statistical analysis including ROC analysis was performed to determine the ability of the score to detect participants at heightened fall risk. In total, 18 nursing home residents and 9 young control participants were included. Of the nursing home residents, 15 had at least one fall, with a total of 37 falls recorded over 12 months. In the control group, no falls were recorded. The fall risk score was significantly different between nursing home residents and the control group (9.2 + 3.2 vs. 5.7 ± 2.2). Furthermore, the score significantly differentiated fallers from non-fallers (10.3 ± 1.8 vs. 5.2 ± 2.5), with a cut-off > 7.5 (AUC: 0.95) and a sensitivity of 86.7% (specificity 83.3%). The fall risk score is able to detect the difference between senior nursing home residents and young, healthy controls, as well as between fallers and non-fallers. Its main proof of concept is demonstrated, as based on movement data outside special gait labs, and it can simplify the risk of fall determination in geriatric nursing home residents and can now be used in further, prospective studies.

Both surgeons and patients want to achieve a high level of satisfaction and the best possible functional results within a short time after knee TEP surgery. By using a tool that digitally records various measurement parameters of balance and motor function preoperatively and postoperatively on a mobile basis and with little time expenditure, progressive results can be compared. Individual factors can thus be determined and these can influence the progress in regeneration and training progress perioperatively.In a prospective study, 100 patients before and 66 patients after installation of a cement-retained knee TEP were evaluated for the following parameters: balance, maximum strength, and power. All measurements were performed with the KMP measurement platform from MotoSana. The second measurements were performed in each case after a standardised follow-up treatment.It was shown that there are significant relationships between personal factors such as age, height, body weight and with baseline values and performance measures: maximum strength and power. Furthermore, it was shown that postoperative improvement could be achieved for the most part around balance support. All patients who previously had to hold on with one hand or both hands no longer needed support after surgery to maintain the single-leg stance for the specified time of 15 s. For a more detailed analysis of the balance parameters, the samples were adjusted and only the patients who did not hold on for support pre- and postoperatively were counted. In patients with low and medium initial stance, the sway area increased at the second measurement session, and in patients with large sway areas, it decreased, and the stance became more stable. In the area of maximum strength and power, patients with high baseline values still had higher values after AHB compared with the other patients, but lower values compared with their own baseline values.Patients who already had very good motor skills before surgery were able to achieve a greater increase in motor skills compared to the weaker group. However, all patients failed to reach their preoperative baseline values after completion of the AHB. Deficits in balance were still detectable in all groups. By using the presented force plate, measurement-based coordinated rehabilitation procedures are possible during and after completion of the AHB. Rehabilitation with individualised improvement of balance and motor function could be expected to prevent dissatisfaction after knee arthroplasty, e.g. due to muscular imbalance in femoropatellar pain syndromes.

The clinical picture of "frozen shoulder" is still poorly understood. In order to present the current state of knowledge on aetiology, diagnosis, and treatment, and to provide recommendations for the professional groups involved, a working group was formed by the DGOU and the DVSE to create a German language, evidence-based guideline, which was published in 2022 by the AWMF. The following summarises the development and the most important results.

Purpose: In order to prevent implant failure and secondary fracture dislocation, it is often recommended that patients perform partial weight-bearing after surgery of the lower extremity. Previous examinations showed that patients are often not able to follow these instructions. In this study, patients who had undergone surgery of the lower extremity were studied in order to analyze whether incorrect loading influenced the number and severity of complications.

Methods: Fifty-one patients were equipped with electronic shoe insoles, which measure loading and other parameters. The measurement period was 24 to 102 hours. Median duration of follow-up was 490 days. The primary outcome parameter was postoperative complications leading to revision surgery. Statistical analysis was performed using the chi-square and Fisher exact tests with significance set at a p < 0.05.

Results: Seven out of fifty-one patients had postoperative complications. Four wound complications, one implant failure, chronic instability after fracture of the tibia, and one implant loosening of a hip prosthesis were recorded. In total, 26 of 39 patients were not able to follow the postoperative instructions. Five of the twenty-six patients with difficulties in partial weight-bearing suffered a postoperative complication. In comparison, only 2 of the other 25 patients were affected. There was no statistically significant correlation between high weight-bearing and occurrence of complications (p = 0.29).

Conclusion: Most of the patients were unable to follow the surgeon's instructions for partial weight-bearing. Excessive loading did not seem to influence the number and severity of postoperative complications, especially regarding implant failure. Therefore, we should continue with measurements and reevaluate the "partial weight-bearing doctrine".

Background: The aim of the present bibliometric study was to record the focus of publications, type of study and publication activities depending on the hierarchy level and gender of the authors of German university departments for orthopaedic surgery.

Material and methods: The publication performance of the staff surgeons, consisting of chief and senior physicians, section and division heads of 39 German university departments of orthopaedic surgery university hospitals, was recorded over a period of 10 years (January 1, 2010 to December 31, 2019). All publications were considered that were listed in PubMed and for which the staff surgeons were first or last authors. In addition, the impact factor (IF) and the h-index were determined.

Results: 1739 (39.2%) publications were compiled by 180 staff surgeons of university departments for trauma surgery and 2699 (60.8%) publications by 343 surgeons in departments of orthopaedics and trauma surgery. Most publications were related to injuries or impairments of the lower extremity including the hip (n = 1626; 38.1%), followed by the upper extremity (n = 737; 17.3%). These publications focussed on diagnostic testing (25.5%), surgical techniques (19.1%) or special osteosyntheses (16.9%). The highest average IF per publication was achieved by publications on plastics (IF 2.02), on outcome (IF 1.96) and on diagnostic testing (IF 1.93). Heads of departments were first authors in 18.8%, senior physicians with management functions in 40.7% and senior physicians without management functions in 69% of papers and last authors in 81.2%, 49.3% and 31.0% of articles, respectively. 64 of 523 staff surgeons (12.2%) were women. 306 authors (6.1%) were women, corresponding to 4.8 authorships per female surgeon - significantly for male surgeons (10.3 authorships per male surgeon).

Conclusion: In the present study, among senior physicians with a management function, the share of publishing surgeons was 59.1% for women, but 85.5% for men. In contrast, in the group of senior physicians without management function female and male surgeons were almost equally represented (57.5% vs. 60.5%). It must therefore be asked whether the work life balance is more difficult to meet for women than for men with longer careers. Mentoring programs are required to support the publication activities of the increasing number of female applicants in the future.

Background: Initial results after autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis have been promising. But long-term results have not yet been available.

Methods: In a prospective study, 42 patients with thumb carpometacarpal joint osteoarthritis were observed for a mean time of 5 years after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to numerous analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire score (DASH score) before and after treatment were analysed.

Results: The average pain preoperatively was 8.0 ± 1.6 and 4.0 ± 3.0 after 5 years overall. Force and pinch force of the treated hand improved from 71% and 60% preoperative in comparison to the non-treated hand to 100% and 96%, respectively, 5 years after fat transplantation. There were similar improvements for the parameters strength and DASH score. All improvements were statistically significant. No serious adverse events were observed.

Conclusions: Autologous fat transplantation is a real alternative to trapeziectomy even in the long term in basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in basal joint osteoarthritis of the thumb as it offers stable results and warrants a high patient satisfaction rate.