Implant-associated orthopaedic infections require prolonged inpatient treatment, repeated surgery and multidisciplinary care, yet nationwide evidence on how hospital resources are distributed across clinically distinct treatment pathways is limited. This study characterised hospital-side case costs, resource utilisation and aggregate expenditure across representative German diagnosis-related groups (DRGs) relevant to complex orthopaedic infection care. Publicly available 2024 data from the German Institute for the Hospital Remuneration System (InEK) were analysed. Twelve representative DRGs were selected a priori from official definitions and diagnostic/procedural profiles and grouped into six treatment pathways. The InEK cost matrix reflects standardised hospital-side resource costs from participating calculation hospitals and does not represent actual DRG reimbursement. National case frequencies, length of stay and mean case costs were analysed using frequency-weighted pathway estimates, while pathway-level cost composition was calculated from aggregate component expenditure. The included DRGs represented 36,212 hospitalisations and €305.2 million in aggregate annual hospital-side expenditure represented by the selected DRGs. Mean hospital-side costs ranged from €5,859 to €22,495 per case. Ward care accounted for approximately 34–69
Bioabsorbable implants offer a promising alternative to metallic fixation for patellar fractures, potentially avoiding hardware-related complications. In 2023, a new generation of bioabsorbable hydroxyapatite/poly-L-lactide (HA/PLLA) cannulated screws was introduced, featuring a low-profile (2 mm) trident-shaped head and increased root diameter for enhanced strength. This study evaluates the clinical outcomes of a surgical technique combining these redesigned screws with subperiosteal nonabsorbable sutures. Between April 2023 and May 2025, 19 consecutive patients with transverse patellar fractures (AO/OTA 34-C1/C2) underwent open reduction and internal fixation. Two bioabsorbable cannulated screws were used. High-strength nonabsorbable sutures were passed through the screw channels and a central bone tunnel using a double-loop sliding knot for compression. The sutures were systematically routed subperiosteally to minimize tissue irritation. Full weight-bearing with a brace began on postoperative day one. Clinical and radiographic outcomes were assessed. This study was approved by the institutional review board of Kainan Hospital. The mean maximum articular surface gap was 8.7 ± 5.2 mm. The mean follow-up was 8.6 ± 3.0 months. Bone union was achieved in all cases. At the final follow-up, the mean knee flexion was 138.7° ± 13.0° and extension was − 1.6° ± 3.4°. No postoperative complications, including infection, loss of reduction, screw breakage, or symptomatic hardware irritation, were observed during the follow-up period. No reoperations were required during the follow-up period. All patients achieved bone union. No major complications or reoperations were observed during the follow-up period. These preliminary findings suggest that this technique may be feasible for transverse patellar fractures.
Traumatic brain injury (TBI) remains a major global public health problem. This study aimed to evaluate the association between pre-existing bleeding disorders and clinical outcomes among patients with TBI. We hypothesized that pre-existing bleeding disorders would be associated with worse outcomes following TBI. We conducted a retrospective cohort study using the 2021–2023 National Inpatient Sample (NIS) to evaluate the association between pre-existing bleeding disorders and clinical outcomes among patients aged 15 years or older hospitalized with TBI. Mortality was significantly higher in the bleeding disorder group (13.9
Conventional trauma prognostic models rely primarily on admission data and cannot account for subsequent physiological response to treatment. We evaluated whether routinely collected physiological information available at 24 h provides incremental prognostic information for major intensive care unit (ICU) complications in severely injured patients. We conducted a prospective cohort of adults with severe trauma (Injury Severity Score [ISS] ≥ 15) admitted to the ICU between January 2024 and April 2025. The primary outcome was a composite of major respiratory, hemodynamic, renal, or septic complications during the ICU course. TRISS was compared with an admission ridge model incorporating ISS, Glasgow Coma Scale, hemoglobin, lactate, and international normalized ratio, and a 24-h updated ridge model additionally incorporating 24-h lactate and change in creatinine. Performance was internally validated with 1,000 bootstrap resamples. Among 109 patients, median ISS was 29 (IQR 20–38), and 73 (67.0
To investigate whether the addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures provides improved biomechanical construct stability and reduced interfragmentary displacement. A distal patellar pole fracture was simulated in sixteen fresh-frozen human cadaveric knees by a horizontal osteotomy in the distal third of the patella. Subsequently, locking plate fixation was performed. In a randomized half of the specimens, an additional McLaughlin wire cerclage was applied. The specimens were then subjected to 3000 cycles of extension starting at 90° of flexion under a maximum tensile load of 320 N. Using a Digital Image Correlation (DIC) system, the interfragmentary displacement between the proximal and distal fragments was measured at 1, 10, 20, 30, 50, 100, 500, 1000, 2000, and 3000 cycles. Statistical analysis was performed using repeated-measures ANOVA and Welch’s unpaired t-t test at 3000 cycles. An additional McLaughlin cerclage significantly reduced interfragmentary displacement under cyclic loading in comparison to locking plate fixation alone. After 3000 cycles, displacement was 2.27 ± 1.84 mm with plate fixation alone and 0.36 ± 0.22 mm with additional McLaughlin cerclage (mean difference 1.91 mm; 95
