Digitale Gesundheitsanwendungen (DiGA) und videobasierte Therapieplattformen gewinnen in der Orthopädie und Unfallchirurgie zunehmend an Bedeutung. Sie ermöglichen strukturierte Heimübungsprogramme, Telekonsultationen sowie objektivierbare Funktionsmessungen und werden damit zu relevanten Ergänzungen etablierter Versorgungsmodelle. Die Evidenz zeigt, dass videobasierte Rehabilitationsprogramme bei ausgewählten Indikationen vergleichbare klinische Ergebnisse erzielen wie Präsenzprogramme. Gleichzeitig bestehen Limitationen bei Langzeitergebnissen, Nutzerakzeptanz, Interoperabilität und Datenschutz. Für die Schulter- und Ellenbogenchirurgie eröffnen sich durch videobasierte Ansätze neue Möglichkeiten, insbesondere in der postoperativen Rehabilitation und im strukturierten Monitoring von „patient-reported outcomes“.

Background and Objective: This study aimed to evaluate the impact of early functional rehabilitation on clinical outcomes and tuberosity healing in older patients undergoing reverse shoulder arthroplasty for proximal humeral fractures. We hypothesized that early functional rehabilitation would not compromise tuberosity healing and would result in comparable or improved outcomes versus postoperative immobilization. Methods: This retrospective matched-pair analysis included patients aged 70 years or older who underwent reverse shoulder arthroplasty for proximal humeral fractures, with 12 to 24 months of follow-up. Group allocation was time-based: earlier patients received immobilization and later patients underwent early rehabilitation. Matching was based on sex, age, body mass index, fracture classification (Neer), and glenosphere size. Outcomes included patient-reported scores, range of motion, and radiographic assessment of tuberosity healing using standardized imaging. Results: Forty patients (20 per group) with a mean age of 80.7 years and a mean follow-up of 16.1 months were included. The early rehabilitation group demonstrated significantly higher Constant scores (p = 0.044), age- and sex-adjusted Constant scores (p = 0.033), and greater active external rotation (p = 0.002). Anatomical tuberosity healing was seen in 28 of 40 patients (70%). Greater tuberosity healing occurred in 75% and lesser tuberosity healing in 85% of patients with available axial imaging. One deep infection occurred in the early rehabilitation group and was successfully managed. Conclusions: Early functional rehabilitation after reverse shoulder arthroplasty in older adults with proximal humerus fractures improved functional outcomes without compromising tuberosity healing.

Abstract Background Arthroscopy of the elbow joint is usually performed with a 30° view. Stability tests, structural assessments and pathologies are described with this scope. Due to the anatomy of the distal humerus and the arthroscopic accessibility, the assessment of the capitellum, particularly with regard to cartilage damage, is limited in terms of dimension and depth. Arthroscopy with flexible optics in the range of 15° to 90° has not been routinely performed. The aim of the study was to investigate whether the use of flexible optics offers advantages in the assessment of the capitellum. Methods Eleven fresh-frozen human cadaveric elbows were examined in a standardized free-hanging position with the elbow flexed to 90°. Arthroscopy was performed through the proximal posterolateral portal using a rigid 30° arthroscope and a flexible 15°–90° arthroscope. The most anterior visible margin of the capitellar articular surface was identified and marked arthroscopically for each optic. Following open surgical dislocation of the elbow, the distance between the two markings was measured in millimeters. Paired comparisons were performed using a paired t-test, and effect size was calculated using Cohen’s d. Results In all specimens, the flexible 15°–90° arthroscope provided greater anterior visualization of the capitellum compared with the 30° arthroscope. The mean additional visible distance was 7.0 ± 2.5 mm (95% CI 5.3–8.7 mm). This difference was statistically significant (p < 0.001) with a large effect size (Cohen’s d = 2.654). Conclusions A flexible 15°–90° arthroscope significantly increased anterior visualization of the capitellum compared with a conventional 30° arthroscope in this cadaveric model. Whether this anatomical visualization gain translates into clinical diagnostic or therapeutic benefit requires further investigation.

Dysfunctional elbow osteoarthritis poses a therapeutic dilemma in young patients with high activity levels and corresponding demands on elbow mobility. In selected cases, interposition arthroplasty of the elbow remains a viable salvage option and alternative to primary prosthetic replacement. The primary objective of this study was to evaluate the effects of interposition arthroplasty on elbow joint contact mechanics, comparing Achilles tendon (AT) and fascia lata (FL) grafts. Ten fresh-frozen human elbow specimens underwent static axial loading (50-400 N) at 20° flexion in native state and following AT and FL graft interposition. Contact pressure distributions were analyzed using intraarticular digital pressure mapping sensors. The interposition of AT and FL grafts resulted in a significant reduction of the peak joint pressure (p = 0.003) and the high-pressure area with a contact pressure > 1 MPa (p = 0.002). Following interposition of the AT graft, a significantly increased contact area compared to the native joint was observed at high axial loads (p = 0.045). The relative radiocapitellar force transmission (p = 0.089) did not differ significantly between the conditions. A direct comparison of the grafts revealed no significant differences in any of the parameters examined. This study provides the first direct biomechanical comparison of AT and FL grafts for interposition arthroplasty under physiological joint loading, revealing comparable, significant reductions in peak contact pressure and novel evidence for increased load distribution independent of graft type.

Knochenmetastasen sind die häufigsten malignen Knochentumoren und oft das erste klinische Zeichen einer malignen Erkrankung. Obwohl das Auftreten von Knochenmetastasen bei einer malignen Erkrankung in der Regel eine palliative Situation für die Patientinnen bedeutet, kann eine adäquate Behandlung der Metastasen die Prognose der Patientinnen deutlich verbessern und den Erhalt der Lebensqualität sichern. Neben den onkologischen und strahlentherapeutischen Therapieoptionen stehen viele chirurgische Therapieoptionen zur Verfügung. Die Metastasenchirurgie stellt aus diesem Grund die häufigste onkologische Operation in der muskuloskeletalen Chirurgie dar. Die Indikationsstellung in der Metastasenchirurgie sollte immer in einem interdisziplinären Setting und unter Berücksichtigung der Lebenserwartung, der körperlichen Einschränkung und der Wünsche der Patientinnen gestellt werden. In diesem Übersichtsartikel werden die verschiedenen chirurgischen Therapieoptionen für die Behandlung von Knochenmetastasen je nach Körperregion zusammengefasst.

With the increasing use of elbow arthroscopy, there is a growing concern about the risk of injury to neural structures, particularly the median nerve, when the anteromedial portal is created. This risk, which was previously underestimated, underscores the need for a guide to safe access that can significantly impact surgical practices and patient outcomes. We retrospectively evaluated 83 computer tomographies of the elbow without a higher grade of osteoarthritis and surgical treatment. In a 3D reconstruction, the median nerve was located, and a circle was set around it with a radius of 1.5 cm. This was supposed to represent a safety distance. Now, a tangent line was drawn from the tip of the processus coronoideus along the created circle, and the angle to the trans epicondylar plane was measured. The two legs of the angle crossed the skin. Therefore, the distance between these two intersections was also measured. Using IBM SPSS, we tested the data for normal distribution. The mean angle was 57.38°, and the mean distance between the skin intersections was 4.77 cm. The results suggest that the anteromedial portal, approximately 4.77 cm ventrally, measured from the medial epicondyle and at an angle of 57.38° in the trans epicondylar axis, can be suggested as a safe portal placed with reduced risk of damage to the median nerve based on imagining, with a safety distance of 1.5 cm. This can be helpful during elbow arthroscopy; clinical validation is yet to be performed.

BACKGROUND:Using modern implants, even complex radial head and neck fractures can often be reconstructed. However, metaphyseal comminution is associated with delayed bone healing and an increased risk for loss of reduction. Hence, this biomechanical in-vitro study intended to evaluate the mechanical stability of a bone graft from the ipsilateral proximal ulna in plate fixation of comminuted radial neck fractures. METHODS:Osteotomies at the level of the radial neck with a 3 mm defect were created on 20 fresh-frozen proximal radius specimens to simulate metaphyseal comminution. Fixation was performed with a locking radial head plate in group A and with an additional structural bone graft from the ipsilateral ulna in group B. Cyclic loading from 5-100 N was performed and axial displacement and stiffness were evaluated. RESULTS:The axial displacement was larger in group A (0.81 ± 0.24 mm) than in group B (0.52 ± 0.27 mm) (P = .02). Group B had a higher axial stiffness compared to group A (300 (127-958) N/mm vs. 163 (82-209) N/mm, P = .015). CONCLUSION:In the case of metaphyseal comminution of radial head/neck fractures, additional bone graft augmentation from the proximal ulna results in significantly increased stability of locking plate fixation. Future clinical research should focus on whether this leads to improved union rates of these challenging fractures.

Background:Numerous single- and double-row repair techniques with simple and modified stitches have been described for subscapularis tendon tears. Purpose/Hypothesis:This study aimed to uniformly evaluate the influence of 4 different repair techniques on the biomechanical performance of fixation for full-thickness subscapularis tendon tears. It was hypothesized that (1) the 2 modified single-row repair techniques would require more cycles to result in 3- and 5-mm gap formation and have a higher load to failure after cyclic loading than the simple single-row repair technique and (2) the double-row repair technique would also require more cycles to result in 3- and 5-mm gap formation and have a significantly higher load to failure after cyclic loading compared to the simple single-row repair technique. Study Design:Controlled laboratory study. Methods:Full-thickness subscapularis tendon tears were created in 32 fresh-frozen cadaveric shoulders, and the tears were treated in 1 of 4 ways: (1) single-row repair with the mattress stitch, (2) single-row repair with the modified lasso-loop stitch, (3) single-row repair with the modified Mason-Allen stitch, or (4) double-row repair. After repair, specimens were progressively cyclically loaded to 200 N, and the number of cycles to obtain a 3- and 5-mm gap was recorded. After cyclic loading, the specimens were loaded to failure at 500 mm/min, and ultimate failure loads were measured. Results:There were no significant differences between either of the modified single-row repair techniques and the simple single-row repair technique. Double-row repair withstood significantly more cycles until 3-mm (P < .001) and 5-mm (P = .004) gap formation and had a higher ultimate failure load (P = .015) compared to the simple single-row repair technique, and double-row repair withstood more cycles until 3-mm gap formation (P = .003) compared with single-row repair with the modified lasso-loop stitch. No significant differences were found between double-row repair and single-row repair with the modified Mason-Allen stitch. Conclusion:Findings indicated that (1) there was no significant biomechanical advantage of the modified single-row repair techniques over the simple single-row repair technique and (2) while the double-row repair technique was biomechanically superior to the simple single-row repair technique, there was no significant difference between single-row repair with the modified Mason-Allen stitch and double-row repair. Clinical Relevance:Considering that double-row repair might not be useful in some tears because of the risk of overtensioning, modified single-row repair techniques appear to be an adequate refixation alternative.

Background: Coronal shear fractures of the capitellum are rare injuries which can be challenging to treat. The aim of this study was to compare the biomechanical properties of different internal screw fixation techniques for Dubberley type IA fractures of the capitellum. Methods: In this biomechanical study, Dubberley type IA fractures of the capitellum were created in 30 human fresh-frozen humeri. The specimens were then divided into 3 groups: fixation was either performed with 3 x 3.0 mm headless cannulated compression screws (HCCSs) in anteroposterior (AP) orientation (AP group), 3 x 3.0 mm HCCSs in posteroanterior (PA) orientation (PA group) or with 2 x 3.0 mm HCCSs in PA orientation and 1 x 3.0 mm HCCS in lateral orientation (LAT) group. Displacement under cyclic loading and ultimate load-to-failure were evaluated in all specimens. Results: There was no significant difference in fragment displacement after 2000 cycles between AP and PA groups (0.8 +/- 0.5 mm vs. 0.8 +/- 0.6 mm; P = .987) or PA and LAT groups (0.8 +/- 0.6 mm vs. 0.8 +/- 0.3 mm; P = .966). LAT group showed the highest load-to- failure (548 +/- 250 N) without reaching statistically significant difference to AP group (388 +/- 173 N; P = .101). There was also no significant difference between AP and PA groups (388 +/- 173 N vs. 422 +/- 114 N; P = .649). Conclusions: Variations in screw placement had no statistically significant influence on cyclic displacement or load-to-failure in Dubberley Type IA fractures. However, fracture fixation in 2 planes-both the coronal and the sagittal plane-by adding a screw in a lateral to medial direction may be beneficial to increase primary stability.

Osteoarthritis (OA) is the most prevalent disorder of the Sternoclavicular Joint (SCJ), with a reported lifetime prevalence of approximately 50

Background This in-vitro biomechanical study aimed to assess whether using a wedge as a gap filler in anterior open wedge osteotomy of the proximal tibia reduces load on the screw-plate construct and to evaluate if a 3D-printed polylactic acid wedge offers similar biomechanical stability like a bone wedge. Methods Twenty-four cadaveric proximal tibiae were randomly assigned to one of three groups: TomoFix plate alone as control group, TomoFix plate with a bone wedge, and TomoFix plate with a 3D-printed polylactic acid wedge. The specimens were subjected to axial loads of 400 N, 800 N, and 1200 N for 1000 cycles. Compression depth and axial stiffness were measured to assess stability. Findings There were no significant differences in overall compression depth or axial stiffness between the groups (p > 0.05). At 1200 N, hinge fractures occurred in 6 of 8 specimens in the control group, compared to 0 of 8 in the wedge groups. Both bone and polylactic acid wedges improved construct stability, with the polylactic acid wedge performing comparably to the bone wedge. Interpretation Gap fillers, whether bone or polylactic acid wedges, may contribute construct stability in anterior open wedge osteotomy of the proximal tibia. The 3D-printed polylactic acid wedge may be biomechanically comparable to the bone wedge, suggesting its potential as an alternative in clinical applications.

BACKGROUND:Tendon tears of the pectoralis major (PM) are uncommon and can be challenging to manage. The lack of consensus on optimal repair methods for PM tendon tears prompts further investigation. METHODS:Twenty four fresh-frozen shoulder specimens were used for this biomechanical in-vitro investigation. After simulating complete tears of the PM at its insertion, repair was performed with 3 suture anchors using a locking whipstitch technique of the PM tendon over a length of 2 (group 2), 4 (group 4), or 6 cm (group 6), 8 specimens per group. Incremental cyclic loading of the specimens was performed from 10 to 200 N and the number of cycles and the force until failure (5-mm gap formation at the tendon-bone interface) occurred were analyzed. RESULTS:The mean number of cycles until failure was 89 for group 2, 81 for group 4, and 175 for group 6. Group 6 withstood significantly more loading cycles than groups 2 and 4 (P = .019). The mean force until failure was 63.8 N for group 2, 67.5 N for group 4, and 110.0 N for group 6. Group 6 reached significantly higher failure loads when compared to groups 2 and 4 (P ≤ .014). CONCLUSIONS:This study contributes valuable insights into the optimal suture technique for repair of PM tendon tears, highlighting the biomechanical stability associated with varying lengths of locking whipstitches. The results of this investigation show that a locking whipstitch of the PM tendon over a length of 6 cm provides superior biomechanical properties at time zero. Clinical data are necessary to evaluate its relevance on the functional patient outcome.

Bone metastases are the most common malignant bone tumors and are often the first clinical sign of a malignant disease. Although the occurrence of bone metastases in a malignant disease usually means a palliative situation for patients, adequate treatment of the metastases can greatly improve the patient's prognosis and ensure that the quality of life is maintained. In addition to oncological and radiotherapeutic treatment options, there are many surgical treatment options available. For this reason, metastasis surgery is the most common oncological operation in musculoskeletal surgery. The indications for metastasis surgery should always be assessed in an interdisciplinary setting, taking the patient's life expectancy, physical limitations and wishes into account. This review article summarizes the various surgical treatment options for bone metastases depending on the region of the body.

Background: Peripheral nerve block (PNB) is effective for pain management after shoulder arthroplasty. Our study investigated the impact of regional anesthesia on perioperative pain management following total elbow arthroplasty (TEA). We aimed to determine whether single shot anesthesia (SSA) or continuous peripheral nerve block (CPNB) reduces opioid usage and improves postoperative pain levels compared to general anesthesia alone. Methods: A retrospective analysis evaluated 78 patients who underwent TEA for perioperative pain management, including nonopioid, opioid medications, and on-demand opioid use. Postoperative pain was assessed using the Numeric Rating Scale (NRS). Patients were divided into 3 groups based on anesthesia type: Group 1 received a PNB intraoperatively and a CPNB; Group 2 received SSA; and Group 3 underwent general anesthesia alone. Pain management and perception were compared over 5 days postoperatively using the Mann-Whitney U test. Results: Group 1 had significantly lower intraoperative opioid usage compared to group 3 (P = .0423) and required fewer opioids postoperatively (P = .0114). Group 1 also reported lower NRS scores, indicating better pain relief (P < .0001). Group 2 showed a trend toward reduced intraoperative (P = .4372) and postoperative opioid (P = .1107) use compared to group 3, although with no statistical significance. Group 2 had significantly lower NRS scores than group 3 (P = .0023). Conclusion: In this first study on PNB and CPNB in TEA, we showed that CPNB reduces perioperative opioid use and improves postoperative pain. SSA offers no significant advantage over CPNB in reducing opioid usage. Avoiding systemic opioids and their adverse effects is particularly beneficial for elderly patients.

Ligamentous elbow dislocations often affect young patients with high functional and athletic demands. After reduction and clinical examination of joint stability, further treatment options are, therefore, the subject of controversial debate. In order to be able to advise patients adequately, an assessment of the possible return-to-sport based on experience is necessary. This study examines the medium to long-term return-to-sports after conservative treatment of a ligamentous elbow dislocation. In this clinical study, 42 patients (47.6

PurposeThis biomechanical study aimed to investigate the effectiveness of a hinged elbow orthosis in reducing passive valgus forces following medial ulnar collateral ligament (UCL) injuries of the elbow joint. The hypothesis tested was that a hinged elbow orthosis reduces these passive valgus forces.MethodsEight fresh frozen cadaveric elbow specimens were prepared and tested under three scenarios: intact ligaments, simulated UCL rupture and application of a hinged elbow brace after simulated UCL rupture. Valgus instability was assessed using a custom testing set-up and the Optotrak motion capture system. Statistical analysis was conducted to compare the results across scenarios.ResultsIntraclass correlation (ICC) calculation showed that the testing set-up was reliable in investigating valgus deflection across all levels of applied force. The hinged elbow brace reduced passive valgus forces after UCL rupture. The reduction in valgus instability was consistent with close approximation to the native state, although not reaching its level.ConclusionThe hypothesis-that a hinged elbow orthosis significantly reduces passive valgus forces in the elbow following UCL injuries-is not supported by the data and therefore has to be rejected. Nevertheless, the study demonstrates a tendency that a hinged elbow brace could mitigate these forces, at least in an experimental cadaveric model with static study conditions.Level of EvidenceThe level of evidence of this study is level IV.

INTRODUCTION:Fractures of the distal humerus are common in older patients with osteoporotic bone, often presenting as complex, multi-fragmentary injuries involving the articular surface. This complexity complicates the decision between open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA), as both procedures carry specific risks. Hemiarthroplasty (HA) may be a viable alternative, yet few studies have compared its outcomes with those of ORIF. In this retrospective matched-pair study, we aimed to compare primary HA versus ORIF for complex distal humerus fractures. Our hypothesis was that HA could achieve functional outcomes equivalent to ORIF when joint reconstruction is not feasible. MATERIALS AND METHODS:We matched 10 pairs of patients who underwent HA or ORIF between 2018 and 2022. Matching criteria included age, gender, and fracture classification (Orthopaedic Trauma Association (OTA) or Dubberley classification for coronal shear fractures). Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score and the Mayo Elbow Performance Score (MEPS). The mean follow-up was 29 months for the HA group and 33 months for the ORIF group. RESULTS:Both treatment groups exhibited satisfactory functional outcomes. In the HA group, the median MEPS was 89.5 and a qDASH score of 21.6. Mean range of motion in extension/flexion was 105.9°. The ORIF group had a median MEPS of 81.5, a qDASH of 17 and a mean range of motion of 116.5°. No significant differences in functional outcomes were observed between the two groups CONCLUSIONS: HA can yield functional results comparable to ORIF in managing complex distal humerus fractures. When ORIF is not feasible, HA is an effective alternative, particularly for physically active patients over 60 years, as it avoids the limitations associated with linked total elbow arthroplasty, such as weight restrictions and the risk of ulnar component loosening. LEVEL OF EVIDENCE:Level III.