Introduction:Osteoporotic medication (oTh) is essential for secondary prevention but is often not prescribed after vertebral fractures. Research question:The aim of this analysis was to assess the status of oTh in inpatients with osteoporotic thoracolumbar fractures and to analyze possible supply gaps. Materials and methods:Data were collected as part of the multicenter, prospective EOFTT (Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations) study. A total of 518 patients with osteoporotic thoracolumbar fractures in 17 clinics were included. The presence, type, and changes over time of oTh were recorded and evaluated using the Cochrane Q test. Results:Hospitalisation increased oTh with 36% at admission significantly in women to 83%, and in men to 71% (p < 0.001). At admission women received more frequently oTh than men (p = 0.017). At the follow-up after 7 ± 5 months, there was no significant differences between the sexes (p = 0.330). However, the proportion in both groups decreased significantly to 41% (women) and 34% (men), respectively (p < 0.001). In-hospital treatment led to a significant increase in the initiation of anti-osteoporotic medication, with calcium and vitamin D supplementation rising from 13% at admission to 35% at discharge (p < 0.001). However, a substantial and significant decline was observed during follow-up (18%, p < 0.001). Discussion and conclusion:In the inpatient setting, there is a clear improvement in oTh, which is particularly pronounced in female patients. However, the significant decline in therapy rates at follow-up highlights deficits in long-term care. Despite existing recommendations, evidence-based agents such as bisphosphonates or osteoanabolic are still rarely used. This indicates a relevant gap in care in secondary prevention and underscores the need for structured, post-hospitalisation concepts for sustainable osteoporosis therapy.

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.

Abstract Purpose To evaluate the feasibility of using the recently developed OF-Pelvis-Score (OFP-Score) for treatment decisions in patients with osteoporotic fractures of the pelvis (OFP) based on standard clinical diagnostics. Methods A multicenter prospective cohort study was conducted at 14 trauma centers including 375 consecutive patients who were treated for an OFP over a period of 19 months. All fractures were classified according to the OF-Pelvis-Classification (OFP-Classification). The decision for either conservative or surgical therapy was made independently of the OFP-Score recommendation. Final decisions were compared to the recommendations given by the OFP-Score. Results 375 patients with an average age of 81.0 years (± 7.6) were included, mainly female (85.6%). According to the OFP-Score, surgery was recommended in 60.5%, and conservative treatment was recommended in 21.9%. In 66 patients (17.6%) the score was undetermined with no treatment recommendation. In daily practice, 33.6% of the patients were treated conservatively and the remaining 66.4% operatively. Overall, the agreement between the OFP-Score and the performed treatment was 91%. The score was obtained in a mean of 3.1 min (± 2.9). All patients improved significantly with respect of VAS (p < 0.001) and ODI (p < 0.001) during their hospital stay. Conclusion Patients with osteoporotic sacral fractures improved clinically both after surgical and conservative treatment. The OFP-Score-based therapy recommendations showed a promisingly high rate of agreement with the therapy of daily practice. The scoring method provides a structured framework that supports clinical decision-making, complementing clinical judgment and other evidence-based tools in guiding treatment choices.

Osteoporotic vertebral fractures (OVF) present varying treatment challenges depending on fracture severity, stability, and patient characteristics. While the OF classification system guides treatment decisions, gender differences in OVF management and outcomes remain underexplored. How do treatment strategies and clinical outcomes differ between genders? This secondary analysis utilized prospective data from the German multicenter EOFTT study, including 518 patients (390 females, 128 males) treated for thoracolumbar OVF. Outcomes assessed included adherence to OF score recommendations, pain levels, functional performance (Timed Up Go test, Barthel Index, Oswestry Disability Index), and rates of anti-osteoporotic therapy (aoTh). Statistical analyses included generalized linear mixed models and repeated-measures general linear models, with therapy type as a covariate. Gender did not influence overall treatment choice; however, men more frequently underwent instrumentation, while women received augmentation procedures. AoTh administration was significantly lower in men at discharge (72

Osteoporotic vertebral fractures (OWFs) represent a growing medical and socioeconomic challenge due to the aging population. Approximately 400,000 cases are diagnosed annually in Europe, although the actual number is likely significantly higher due to clinically inapparent presentations. This paper summarizes the current state of research based on the S2k guideline for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures. In addition to diagnostics, the focus is on the OF classification (Osteoporotic Fracture Classification), the OF score as a decision-making tool between conservative and surgical treatment, and the various conservative and surgical treatment methods.

Background: Elderly patients with unstable ankle fractures face a high risk of wound and implant-related complications after open reduction and internal fixation (ORIF). Less invasive intramedullary fibular nail (FN) fixation may reduce soft-tissue trauma and enable earlier mobilization. Methods: In this prospective multicenter trial with pseudorandomized allocation and protocol-permitted crossover, 55 geriatric multimorbid patients (Charlson Comorbidity Index ≥ 4; mean age FN 79 ± 8 vs. ORIF 74 ± 8 years; p = 0.053) were treated with FN (n = 39) or ORIF (n = 16). Primary outcomes were operative time, fluoroscopy time, hospital stay, weight-bearing at discharge, complications, and functional scores (AOFAS, OMAS, Weber) at six weeks and twelve months. Results: FN required more fluoroscopy time (p = 0.011), while operative duration and hospital stay were comparable (p = 0.176, p = 0.520). Full weight-bearing at discharge was more frequent after FN (62% vs. 0%; p < 0.001). At six weeks, FN patients achieved higher functional scores (AOFAS p = 0.041; OMAS p = 0.027), but at twelve months no differences remained (AOFAS p = 0.404; OMAS p = 0.288; Weber p = 0.585). Radiographic malalignment was more common after FN (46% vs. 13%; p = 0.031). Distal screw loosening at twelve months occurred more often after FN (80% vs. 11%; p = 0.005) but was mostly asymptomatic. Conclusion: Fibular nailing enables earlier mobilization and faster recovery in geriatric ankle fractures, with one-year outcomes equivalent to ORIF. The higher rate of early malreduction and screw-related changes underscores the need for surgical precision, while immediate postoperative weight-bearing remains a key advantage in elderly, multimorbid patients.

Zusammenfassung Sakruminsuffizienzfrakturen zeigen eine kontinuierlich ansteigende Inzidenz. Ihre Behandlung ist in der Mehrzahl der Fälle konservativ, jedoch können anhaltende Schmerzen und Mobilitätseinschränkungen eine Indikation zur Operation darstellen. Mit Hilfe der OF-Pelvis Klassifikation lassen sich die Frakturen relativ einfach nach ihrem Schweregrad einteilen. Der OF-Pelvis Score dient zur Therapieentscheidung und kann auch zur Verlaufsbeobachtung eingesetzt werden. Die chirurgische Therapie ist regelhaft minimal-invasiv und reicht von der Sakroplastie, über iliosakrale Verschraubungen bis hin zur lumbopelvinen Stabilisation.

Osteoporosebedingte Wirbelkörperfrakturen gehören zu den häufigsten Frakturentitäten im geriatrischen Patientenkollektiv. Sie gehen einher mit weitreichenden individuellen und auch sozioökonomischen Konsequenzen. Eine suffiziente Diagnostik und Behandlung sind unerlässlich. Zentrales Element in der Therapiefindung ist der Osteoporotic Fracture (OF) Score. Obwohl der überwiegende Teil der Frakturen unter konservativer Therapie zur Ausheilung gebracht werden kann, sollte bei deren Versagen rechtzeitig eine Therapiewechsel erwogen werden. Isolierte Zementaugmentationsverfahren eignen sich v. a. zur Schmerzreduktion bei primär stabilen osteoporotischen Wirbelkörperfrakturen mit erhaltener Rahmenstruktur (OF-Typen 1–3) und weitgehend intakter Hinterkante. Eine dorsale zementaugmentierte Stabilisierung mit Zementierung des frakturierten Wirbelkörpers führt bei instabilen Frakturen der Typen OF3 und OF4 zu guten Ergebnissen. Dorsoventrale Verfahren mit zementaugmentiertem Fixateur interne von dorsal und Wirbelköperersatz von ventral spielen eine eher untergeordnete Rollen. Rein ventrale Verfahren sollten in diesem Patientenkollektiv vermieden werden.

Osteoporosis-related vertebral fractures are among the most frequent fracture entities in geriatric patients. They are associated with far-reaching individual and socioeconomic consequences. Adequate diagnostics and treatment are therefore essential. The osteoporotic fracture (OF) score is a central element in determining the right treatment. Although the majority of fractures can be healed with conservative treatment, a change of treatment should be considered in good time in cases of failure. Isolated cement augmentation procedures are particularly suitable for reducing pain in primarily stable osteoporotic vertebral fractures with a preserved framework structure (OF types 1-3) and a largely intact posterior edge. Dorsal cement-augmented stabilization with cementing of the fractured vertebral body leads to good results in unstable OF types 3 and 4 fractures. Dorsoventral procedures with cement-augmented internal fixator from the dorsal side and vertebral body replacement from the ventral side play a more subordinate role. Purely ventral procedures should be avoided in this patient group.

Purpose 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. Methods 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. Results 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%. Conclusion 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.

Introduction The assessment of bone density has gained significance in recent years due to the aging population. Accurate assessment of bone density is crucial when deciding on the appropriate treatment plan for spinal stabilization surgery. The objective of this work was to determine the trabecular bone density values of the subaxial cervical, thoracic and lumbar spine using Hounsfield units. Material and methods Data from 200 patients who underwent contrast-enhanced polytrauma computed tomography at a maximum care hospital over a two-year period were retrospectively analyzed. HUs were measured with an elliptical measurement field in three different locations within the vertebral body: below the upper plate, in the middle of the vertebral body, and above the base plate. The measured Hounsfield units were converted into bone density values using a validated formula. Results The mean age of the patient collective was 47.05 years. Mean spinal bone density values decreased from cranial to caudal (C3: 231.79 mg/cm 3 ; L5: 155.13 mg/cm 3 ; p < 0.001), with the highest values in the upper cervical spine. Bone density values generally decreased with age in all spinal segments. There was a clear decrease in values after age 50 years ( p < 0.001). Conclusions In our study, bone density decreased from cranial to caudal with higher values in the cervical spine. These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation.

Introduction: Primary dedifferentiated liposarcomas of the spine mark a rare tumor entity. Research question and case description: We present a rare case of a primary dedifferentiated liposarcoma of the thoracic spine. A 36-year-old previously completely healthy woman presented with a sudden ascending paresthesia of both legs, persistently increasing over the course of two days before initial presentation. Case report: Computed tomography and magnetic resonance imaging revealed an expansively growing tumor mass extending from T5 to T6 and absolutely compressing the dural sac and spinal cord. The patient's neurological function completely recovered after emergency posterior decompression via laminectomy with intralesional tumor debulking. The tumor was histologically classified as primary grade 2 dedifferentiated liposarcoma (DDLPS) of the spine and after referral to a sarcoma center, the patient was treated with three courses of polychemotherapy (doxorubicin plus ifosfamide). Chemotherapy was followed by aggressive resection by en-bloc spondylectomy in cooperation with a spine tumor center. Subsequently, the patient also underwent radiation therapy. Results: The patient still undergoes structured tumor aftercare and is tumor- and metastasis-free 53 months after tumor resection. Discussion and conclusion: DDLPS rarely occur in the spine, with definitive resection of the tumor being the treatment of choice. Surgery should be accompanied by other (radio-) oncological treatment options in cases where only subtotal resection is possible. Also, referral of patients with primary sarcomas of the spine to specialized sarcoma centers is essential, so they can be provided with individual treatment options and structured interdisciplinary aftercare, that ensure the best possible outcome.

When treating ankle fractures, the question of syndesmosis complex involvement often arises. So far, there is no standardized method to reliably detect syndesmosis injuries in the surgical treatment of ankle fractures. For this reason, an intraoperative syndesmosis-test-tool (STT) was developed and compared to the recommended and established hook-test (HT). Tests were performed on cadaveric lower legs (n = 20) and the diastasis was visualized by 3D camera. Tests were performed at 50, 80, and 100 N in native conditions and four instability levels. Instability was induced from anterior to posterior and the reverse on the opposite side. The impact on diastasis regarding the direction, the force level, the instability level, and the device used was checked using a general linear model for repeated measurement. The direction of the induced instability showed no influence on the diastasis during the stability tests. The diastasis measured with the STT increased from 0.5 to 3.0 mm depending on the instability, while the range was lower with the HT (1.1 to 2.3 mm). The results showed that the differentiation between the instability levels was statistically significantly better for the developed STT. The last level of maximum instability was significantly better differentiable with the STT compared to the HT. An average visualizable diastasis of more than 2 mm could only be achieved at maximum instability. In conclusion, the newly developed STT was superior to the commonly used HT to detect instability.

Introduction: Predicting the pre-morbid sagittal profile of the spine or segmental angles could enhance the process of planning the extent of fracture reduction. There is evidence that spinopelvic parameters may be suitable for this purpose. Research question: Is it possible to determine the inflection point and the mono- and bi-segmental endplate angles (EPA) in the thoracolumbar transition (from Th9 to L2) based on age, gender, spinopelvic parameters, and the adjacent EPA in the supine position? Material and methods: Based on Polytrauma CT scans in the supine position, the following spinopelvic parameters were measured using non-fractured spines: pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and the apex of the LL. Results: In this study, a total of 287 patients with a mean age of 42±16 years were included. Age-related changes were observed, where LL, thoracic kyphosis (TK), and PI increase with age. Gender-related comparisons showed that females had a more pronounced LL and reduced TK. Significant correlations between IP and spinopelvic parameters, with the apex of LL providing the best prediction, were found. However, the overall model quality remained low. Predicting mEPA and bEPA showed positive correlations. The prediction for mEPA L2/3 demonstrated the highest correlation. For bisegmental angles, the most caudal bEPA (L2) exhibited the highest correlation, albeit with some notable absolute differences in the values between measured and predicted values. Discussion and conclusion: While this study highlights the complexity of the relationship between the pelvis and thoracolumbar parameters, finding a predictive tool for thoracolumbar reduction and stabilization was not possible.

ZusammenfassungZiel dieser Studie war die Entwicklung und klinische Evaluation eines Scores, der bei der Entscheidung für eine konservative oder operative Therapie bei osteoporotischen Beckenfrakturen unterstützen soll.In den Jahren 2018 bis 2020 erfolgte die Entwicklung des OF-Pelvis-Scores im Rahmen von insgesamt 5 Treffen der AG Osteoporotische Frakturen der Sektion Wirbelsäule der DGOU. Der OF-Pelvis-Score als Entscheidungshilfe zwischen konservativer und operativer Therapie wurde im Expertenkonsens nach Analyse zahlreicher geriatrischer Sakrum- und Beckenringfrakturen aus mehreren Kliniken entwickelt. Anschließend erfolgte die retrospektive Evaluation des Scores an konsekutiven Patienten aus 3 Kliniken.Folgende Parameter wurden für die Entscheidung zwischen operativem und konservativem Vorgehen als relevant angesehen und flossen in den Score ein: Frakturmorphologie anhand der OF-Pelvis-Klassifikation, Schmerzsituation, Mobilisation, frakturbedingte neurologische Defizite, Gesundheitszustand sowie die Modifier, die bereits in die OF-Pelvis-Klassifikation integriert sind. Bei einem Punktwert < 8 wird eine konservative Therapie empfohlen, bei einem Punktwert > 8 eine operative und bei einem Punktwert von 8 besteht eine relative Operationsindikation. Der OF-Pelvis-Score wurde dann bei insgesamt 107 Patienten retrospektiv nach Aktenlage berechnet. Der OF-Pelvis-Score betrug 8 Punkte bei 4 Patienten (3,7%), die alle operativ versorgt wurden. Von den restlichen 103 Patienten wurden 93 Score-konform therapiert (90,3%). Dabei lehnten 4 der nicht Score-konform versorgten Patienten die empfohlene Operation ab, sodass die tatsächliche Therapieempfehlung in 94,2% Score-konform war.Der OF-Pelvis-Score basiert auf der Frakturmorphologie und klinischen Parametern und ermöglicht die Ableitung einer Therapieempfehlung. Aufgrund der verwendeten klinischen Parameter ist der Score dynamisch und spiegelt die sich ändernde klinische Situation auch im Verlauf wider. In der retrospektiven Evaluation zeigten die OF-Pelvis-Score-basierten Therapieempfehlungen eine sehr hohe Übereinstimmungsrate mit der tatsächlich durchgeführten Therapie.

Background: Patients affected by lumbar spinal stenosis (LSS) suffer from a multifactorial degeneration of the lumbar spine resulting in narrowing of the neuroforamina and spinal canal, leading to various functional limitations. It remains unclear whether LSS patients after surgery would benefit from early post-operative rehabilitation, or if a delayed rehabilitation would be more advantageous. The purpose of this partially randomized patient preference trial is to evaluate the impact of post-operative rehabilitation timing as well as surgical intervention type on psychometric properties and functional outcomes in patients with LSS. Methods: Data for this patient preference trial are collected before and after surgical (decompression only or decompression and fusion) and rehabilitative interventions as well as six, 12 and 24 months after completing rehabilitation. The study participants are patients diagnosed with LSS who are at least 18 years old. After a medical check-up, participants will complete patient-reported outcome measures (PAREMO-20, SIBAR, FREM-8, SF-12, SFI, ODI) and different functional assessments (functional reach test, loaded reach test, handgrip strength, standing balance control, 6-min walk test). Ethics and dissemination: The results of this study will be published through peer-reviewed publications and scientific contributions at national and international conferences. This research has been approved by the Institutional Review Board of Martin Luther University Halle-Wittenberg (reference number: 2022-128).

Introduction: Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question: Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods: 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results: Both systems achieved equally good reduction (9 degrees mean, 95% -CI: 8 degrees -11 degrees , p < 0.001). Anterior fused patients showed not significant (p = 0.057) less loss of reduction over time. Fracture severity had neither an influence on reduction or loss of reduction. Bone quality was positively correlated with greater amount of reduction and less loss of reduction. Early reduction within two days correlated with a greater amount of reduction (p = 0.006). Screw diameters and the patient 's weight had no influence on loss of reduction. Complications occurred only in "V2 " group. Discussion and conclusion: Both systems are equivalent in reduction ability. The additional anterior fusion did not result in significantly lower reduction losses. The subsample being small, is a limitation. Good bone quality correlates with better initial reduction and less reduction loss. A preoperative bone density measurement can lead to optimization of surgical techniques.

Background/Objectives: Fragility fractures of the pelvis (FFP) are characterized by inadequate trauma to a structurally compromised bone, primarily in osteoporosis. Conventional CT studies can be inadequate in identifying FFPs. An MRI of the pelvis is considered the gold standard in diagnosing FFPs. Spectral CT or Dual-Energy CT may have comparable diagnostic accuracy. It provides additional insights into associated bone marrow edema. The aim of this prospective monocentric study is to evaluate the diagnostic accuracy of Spectral CT compared to the gold standard MRI in diagnosing FFP. Methods: Over a 2-year period, patients presenting in the emergency department with clinical suspicion of an FFP were consecutively included. They underwent Spectral CT (GE Revolution 16 cm GSI) upon admission, followed by an MRI. The gold standard for diagnosing FFP is pelvic MRI, showing sensitivity and specificity ranging from 97% to 100%. The acquired images were evaluated and classified using the osteoporotic fractures of the pelvis (OFP) classification. Results: Compared to the reference test, which was the MRI pelvis, the sensitivity of the CT pelvis was determined to be 86.8 (95% confidence interval (CI) 71.9–95.6%) with a specificity of 84.6% (95% CI: 54.6–98.1%, p = 0.453). Spectral CT could identify an additional FFP correctly, exhibiting a sensitivity of 89.5% (95% CI: 75.2–97.1%, p = 0.688), while maintaining the same specificity as the conventional CT. The inter-rater reliability assessment for Spectral CT, conducted by four independent raters, resulted in a Fleiss’ Kappa value of 0.516 (95% CI: 0.450–0.582, p < 0.001). Conclusion: The sensitivity of Spectral CT in the detection of pelvic ring fragility fractures shows a slightly lower sensitivity compared to MRI. There were no statistically significant differences observed when compared to conventional CT or MRI. In conclusion, Spectral CT may be beneficial in distinguishing FFP, particularly in cases where a definitive diagnosis is uncertain. Level of Evidence: II.

Einleitung: Die spinopelvine Fixation wird häufig zur kaudalen Verankerung langstreckiger Spondylodesen durchgeführt. Aufgrund hoher Hebellasten und der komplexen Kinematik der transfixierten Sakroiliakalgelenke (SIG) resultiert häufig ein Implantatversagen. Die physiologische Kinematik des spinopelvinen Übergangs und der SIG wird jedoch in aktuellen Prüfmodellen für den Zulassungsprozess nicht beurteilt. Daher war das Ziel dieser Arbeit, ein Testmodell zu entwickeln, welches die grundsätzliche Kinematik des SIG abbildet und auf deren Basis eine Bewertung der spinopelvinen Verankerung, nahe der physiologischen Belastungssituation, erfolgen kann.