Tibial plateau fractures (TPF) are often associated with non-bony injuries that may impair knee stability and long-term outcomes. However, it remains unclear in which patients preoperative MRI is indicated to detect these injuries, and clear recommendations for surgical decision making are lacking. This study aimed to develop a CT-based predictor of surgically relevant non-bony injuries. This retrospective single-center study included all intra-articular TPF treated between January 2022 and May 2025 at a Level I trauma center. Fractures were classified according to the 10-segment and three-column classifications. Operative reports were reviewed to identify non-bony injuries requiring surgical treatment. Descriptive statistics and multivariate logistic regression were performed to determine predictors of surgically relevant non-bony injuries. Among 243 patients (mean age 49,3 ± 14,9 years), 34,6
BackgroundMedical directors of emergency medical services (& Auml;LRD) are responsible for the overall professional conception of prehospital patient care as well as for medical quality management. Treatment quality and patient safety depend on their effectiveness and on how they are structurally integrated.MethodsAn online survey of approximately 240 medical directors of emergency medical services in Germany yielded 107 usable data sets from 12 federal states.ResultsParticipants are predominantly responsible for a single district. The integration of these medical directors into administrative bodies is highly heterogeneous, as are their employment status, scope of work, and responsibilities.ConclusionMedical directors are insufficiently involved in central processes such as personnel management, budget responsibility, and dispatch center control. Overall, the results reveal structural weaknesses and inconsistent responsibilities.
Smartphonebasierte Ersthelferalarmierungssysteme sind ein zentraler Bestandteil der Überlebenskette beim außerklinischen Herz-Kreislauf-Stillstand. In Deutschland bestehen erhebliche regionale Unterschiede hinsichtlich Qualifikationsanforderungen sowie Registrierungs- und Freigabeprozessen. Der Einfluss dieser Zugangshürden auf die Anzahl registrierter Ersthelfender ist bislang nicht systematisch untersucht. Es wurde eine retrospektive Sekundärdatenanalyse auf Basis frei verfügbarer Daten durchgeführt. Eingeschlossen wurden 99 Regionen mit vollständigen Angaben zu Registrierungsverfahren, Qualifikationsanforderungen und der Anzahl registrierter Ersthelfender. Zusätzlich wurde im Rheinisch-Bergischen Kreis der Effekt freiwilliger 2‑stündiger Kurzschulungen zur Herzdruckmassage auf die subjektive Sicherheit der Teilnehmenden mittels einer Befragung untersucht. Zum Zeitpunkt der Datenerhebung war in 45
BACKGROUND:Smartphone-based first responder alert systems are a key component of the chain of survival in out-of-hospital cardiac arrest. In Germany, there are considerable regional differences in terms of qualification requirements and registration and approval processes. The impact of these barriers to access on the number of registered first responders has not yet been systematically investigated. METHODS:A retrospective secondary data analysis was performed based on freely available data. Ninety-nine regions with complete information on registration procedures, qualification requirements, and the number of registered first responders were included. In addition, the effect of voluntary 2 h short training courses on chest compressions on the subjective confidence of participants was examined in the Rheinisch-Bergisch district using a survey. RESULTS:At the time of data collection, a smartphone-based first responder alert system had been implemented in 45% of emergency medical service areas. The average registration rate was 0.246% of the population. Regions with self-registration procedures had significantly higher registration rates than regions with formal registration (0.267% vs. 0.152%; p < 0.001). In two regions with self-declaration only and no verification of proof, rates of up to 0.489% were achieved. In the local case study, 2217 first responders were registered, 40% of whom had first aid qualifications only. The short training course was associated with a significant increase in subjective safety. CONCLUSION:Low-threshold registration procedures are associated with higher registration rates in smartphone-based first responder alert systems. Accompanying short training courses can apparently increase the subjective confidence of first responders. Reducing formal barriers to access could help improve the availability of volunteer first responders. However, the effects of lower barriers to access on the psychological stress of first responders and on patient outcomes are unclear.
Objectives: Tibial plateau fractures (TPF) are increasingly regarded as complex knee joint injuries rather than isolated fractures. However, standardized recommendations for the diagnosis and management of concomitant soft-tissue injuries are still lacking. Post-traumatic instability has a significant impact on both clinical outcomes and the development of post-traumatic osteoarthritis. The present study was therefore designed to analyze the rate of subjective instability and its potential causes following TPF in a large, multicenter patient cohort. Methods: This multicentric, retrospective study included patients who underwent surgical treatment for TPF between 2011 and 2021. Fractures were classified according to the Schatzker and ten-segment classification. Trauma mechanisms and treatment strategies as well as pre- and postoperative imaging were analyzed. Patient-reported outcome measures (PROMs) were collected using standardized questionnaires (KOOS, Lysholm, Tegner, IKDC). Subjective instability was defined as a positive response to an instability-related question in those questionnaires. Statistical analysis was performed using t-tests and chi-squared tests. Results: A total of 348 patients were included in the study. The mean age was 51 years (standard deviation ±14.3 years); 61% were female and 39% male. Preoperative MRI was performed in 22.5% of cases. Surgical treatment of concomitant soft-tissue injuries (meniscal repair or ligament reconstruction) was performed in 18% of cases. Overall, 42% (n = 146) of patients reported subjective instability. No significant difference was found between Schatzker type I–III and Schatzker type IV–VI fractures. Concerning the ten-segment classification, the postero-medio-central and antero-medio-medial segments were most frequently associated with instability (53% and 52%, respectively). Postoperative tibial slope and medial proximal tibial angle (MPTA) did not differ significantly between stable and unstable groups 6 weeks postoperatively. Concomitant collateral ligament injuries were associated with an increased rate of postoperative instability. Significant patient-related risk factors for postoperative instability included younger age (p = 0.007), higher BMI (p = 0.001), and active nicotine abuse (p = 0.008). Conclusion: This study demonstrates a high rate of subjective instability following tibial plateau fractures. These instabilities cannot be sufficiently explained by the initial bony fracture complexity or postoperative bone deformity alone. Therefore, the diagnosis and management of concomitant soft-tissue injuries in TPF should be further investigated.
