The Integrated Neurological Change Score (INCS) combines changes in sensory and motor subscores from the International Standards for Spinal Cord Injury Classification (ISNCSCI) into a composite measure. We evaluated the INCS sensitivity to therapeutic outcomes, robustness against ceiling effects, and association to functional improvement in patients with acute cervical spinal cord injury (SCI). To this end, we conducted a retrospective analysis of data from the Nogo Inhibition in Spinal Cord Injury (NISCI) clinical trial alongside a matched cohort from the European Multicenter Study about Spinal Cord Injury (EMSCI). The NISCI trial assessed the safety and efficacy of the anti-Nogo-A antibody (NG-101) in acute cervical SCI, reporting a potential therapeutic effect in motor incomplete patients. Our findings show that the sensitivity of INCS to the effect of NG-101 is comparable to that obtained employing the changes in the Upper Extremity Motor Score (the primary outcome in the NISCI trial). Moreover, the INCS is less susceptible to ceiling effects compared to measures of upper and lower extremity or total motor scores, as observed in the NISCI trial and in the matched EMSCI cohort. This robustness may facilitate the design of more inclusive clinical trials without compromising statistical power. Finally, INCS correlates strongly with functional outcomes in self-care and walking ability, outperforming ISNCSCI motor scores. In conclusion, the INCS represents a sensitive measure of neurological change corroborating the value of ISNCSCI standards for use in SCI trials.
Osteoporotic pelvic ring fractures (OPRFs) are common in ageing populations and challenging due to multimorbidity and immobility-related complications. The OF-Pelvis classification and score support therapeutic decision-making, yet their relationship with in-hospital complications remains unclear. We conducted a prospective multicentre study of 390 patients treated at 14 German centres. Fractures were classified using the OF-Pelvis system; treatment recommendations were derived from the OF-Pelvis Score and compared with the therapy performed. Complications during hospitalisation were recorded, and predictors were assessed by logistic regression. Functional outcomes between treatment decision and discharge were analysed with repeated-measures general linear models. Overall, 258 patients (66%) underwent surgery and 132 (34%) received conservative care. Complications occurred in 26%, most commonly urinary tract infections and wound-related events. The OF-Pelvis Score showed high concordance with real-world treatment decisions, while age was the only independent predictor of complications; neither treatment modality nor the score independently predicted adverse events. Functional outcomes improved significantly across groups despite complications when managed within structured multidisciplinary care. These findings support the score’s utility for decision-making but indicate that complication risk is driven primarily by patient-related factors, emphasising the need for targeted geriatric co-management and prevention strategies.
Künstliche Intelligenz (KI) hat in der Orthopädie und Unfallchirurgie den Weg vom Schlagwort zur klinischen Anwendung angetreten – einem je nach Anwendungsbereich unterschiedlichen Entwicklungsstand. KI-gestützte Systeme zur Frakturerkennung sowie zur automatisierten Messung von Winkeln und anderen knöchern referenzierten Parametern auf Röntgenaufnahmen erreichen mittlerweile eine Genauigkeit, die mit jener erfahrener Expert:innen vergleichbar ist. Entsprechende Anwendungen sind heute als regulierte Medizinprodukte zugelassen und haben bereits Einzug in die klinische Praxis gehalten. Prädiktive Modelle zur Vorhersage von Verweildauer, Mobilität bei Entlassung und Komplikationsraten nach orthopädisch-unfallchirurgischen Eingriffen zeigen Potenzial, befinden sich jedoch noch im Prozess der externen Validierung. Digital Twins, computerbasierte, patientenindividuelle Simulationsmodelle, eröffnen vielversprechende Möglichkeiten für Therapieplanung und Entscheidungsfindung, befinden sich klinisch jedoch noch überwiegend im Entwicklungsstadium. Vollautonome Operationssysteme bleiben aufgrund ungelöster rechtlicher, ethischer und technischer Hürden zumindest mittelfristig noch Zukunftsmusik. Eine kritische, evidenzbasierte Auseinandersetzung mit KI-Technologien ist heute Teil der professionellen Verantwortung in der Orthopädie und Unfallchirurgie.
Locked plate osteosynthesis functions as an internal fixator, yet load-induced plate–bone and fragment–fragment contacts – key transitions from load-bearing to load-sharing – remain poorly characterized. This study quantified their effects on construct stiffness, plate strain, and interfragmentary motion under axial loading. Twenty-seven configurations were tested using epoxy-glass surrogate bone fixed with titanium LCP plates, varying fracture gap (3–9 mm), working length (49–121 mm), and plate–bone distance (0–3 mm). Digital image correlation measured strain and motion. Contact events were identified manually from characteristic transitions in the force–displacement response, supported by corresponding changes in plate-surface strain progression. Geometric parameters dominated initial stiffness (125–442 N/mm), decreasing with plate elevation and working length in elevated setups. Within the investigated load range up to 600 N, 16/27 configurations showed non-linear transitions associated with contact events: fragment–fragment contact caused pronounced stiffness increases and strain stagnation at the fracture gap, whereas plate–bone contact was associated with local plate-surface strain stagnation at the location overlying the contact while strain at the fracture gap continued to increase. Interfragmentary motion stagnated after contact, confirming contact-dependent shifts in load transfer. Response surface regression explained 81.9
INTRODUCTION:Portal hypertension characterizes decompensated cirrhosis and its complications. It may trigger acute-on-chronic liver failure (ACLF), which carries a high mortality. Transjugular intrahepatic portosystemic shunt (TIPS) is the most efficient therapy for most portal hypertension-related complications including fluid overload (FO) defined as refractory or recurrent ascites, hepatorenal syndrome, and/or hydrothorax. However, TIPS for FO in ACLF is questioned. METHODS:In this case-control study, patients from the prospective cohorts CANONIC (n = 1,324) and German TIPS-Registry (n = 724) were screened for cases of FO and matched 1:1 by sex, age, Model for End-Stage Liver Disease (MELD) score, and presence and grade of ACLF. Clinical outcomes, ACLF status, and mortality were assessed. RESULTS:The total population was 118 patients with ACLF of whom 59 received TIPS and 59 did not. The main indication for TIPS was hepatorenal syndrome (61.0%). Patients with ACLF who did not receive TIPS had a higher 28-day cumulative mortality rate (22.0% vs 5.1%, P = 0.009). At 28 days, TIPS insertion in ACLF was associated with a 78% mortality reduction (hazard ratio 0.22 [0.06-0.77]). It further led to improvement of hepatic encephalopathy and the MELD score. In addition, ACLF resolution occurred in 61% of TIPS patients with ACLF. The presence of coagulation and circulatory organ failures, and increased bilirubin, INR, MELD score, and CLIF-C OF were associated with 28-day mortality. The survival benefit of TIPS was no longer observed after 90 days. DISCUSSION:TIPS decreased the 28-day mortality of patients with FO and ACLF. Thus, TIPS should be regarded as a bridging strategy-ideally for liver transplantation.
