PURPOSE:The aim of this study was to investigate the clinical and radiological outcomes of anterior open-wedge high tibial osteotomy (AOW-HTO) performed to increase the posterior tibial slope (PTS) in patients with chronic posterior cruciate ligament (PCL) insufficiency and persistent posterior instability. METHODS:Eleven patients treated between November 2018 and February 2024 were included in this study. All patients presented with chronic symptomatic PCL insufficiency in combination with a reduced PTS, reflected by an increased posterior proximal tibial angle (PPTA), and underwent AOW-HTO for slope correction. Clinical outcomes were assessed using the validated Lysholm Knee Score and Tegner Activity Scale. Scores were recorded retrospectively for the patients' best pre-injury condition, preoperatively at the time of greatest functional impairment and post-operatively at final follow-up. Radiographic evaluation included preoperative, intraoperative and post-operative assessment of the PTS using standardized lateral knee radiographs. Subjective knee stability, patient satisfaction and functional outcomes at follow-up were evaluated using a standardized questionnaire incorporating the Lysholm and Tegner scores. RESULTS:Eleven patients (9 male, 2 female) were included. Mean follow-up was 3.6 ± 1.7 years. The mean preoperative PPTA was 92.2 ± 7.6° (87-111°), which decreased to 83.0 ± 3.9° (80-93°) post-operatively, corresponding to a mean slope correction of 9.2°. AOW-HTO resulted in significant improvements in patient-reported functional outcomes compared with the preoperative condition. The mean Lysholm score improved from 59.0 ± 6.1 points (range, 34-95) preoperatively to 83.0 ± 18.0 points (range, 46-100) at final follow-up (p = 0.0002). Similarly, the mean Tegner activity score increased from 3.0 ± 1.8 (range, 0-7) to 5.3 ± 1.8 (range, 3-8) (p = 0.0004). However, post-operative outcomes remained below the historical pre-injury baseline values. At final follow-up, eight patients reported satisfactory knee stability without episodes of giving way. No patient required secondary PCL reconstruction or additional posterolateral stabilization following osteotomy. Statistical significance was defined as p < 0.05. CONCLUSION:AOW-HTO resulted in satisfactory subjective knee stability and significant functional improvement in selected patients with chronic PCL insufficiency. Isolated tibial slope correction represents a valid therapeutic approach in the management of complex posterior knee instability. LEVEL OF EVIDENCE:Level IV, therapeutic studies (case series with no comparison group).

Clinical RelevanceIn recent years, an increased posterior tibial slope has been identified as a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury and increased failure rates after ACL reconstruction (ACLR). To date, the literature consists of clinical case series on slope reducing high tibial osteotomies and reports promising clinical results. However, higher case numbers are still lacking. The goal of the present series of anterior-closed-wedge high tibial osteotomies (ACW-HTO) was to analyze patient-reported outcome measures (PROMs) at a minimum of 2 years. It was hypothesized that an ACW-HTO with secondary ACLR after failed ACL surgery improves clinical outcome as compared with the pre-osteotomy state or can even give sufficient stability to avoid the need for revision ACLR.Material and methodsOne hundred consecutive cases with an ACW-HTO operated between February 2019 and December 2022 were included in 2 surgical centers (57 cases radiographic/51 cases with PROMs Sozialstiftung Bamberg and 43 cases radiographic/35 cases with PROMs Sporthopaedicum Berlin, Germany). The pre-injury (before first injury), the preoperative (before ACW-HTO), and the final postoperative conditions were documented using PROMs.ResultsThe mean follow-up was 36 months (SD ±11, range 24-82), the follow-up rate for the PROMs was 85%. The mean preoperative slope of 14.6° (SD ±2.4°; range 11°-28°), measured according to the method of Dejour and Bonnin, was corrected to a mean of 6.8° (SD ±2.0°; range 0°-12°), P < 0.0001. No relevant complications were noted and no recurrent ACL graft failure was reported within the full follow-up period. Twenty-one patients had not received a revision ACLR after ACW-HTO at final follow-up due to sufficient stability. Prior to the first ACL injury, the mean Tegner activity scale was 7.3 points (SD ±1.7; 3-10) and mean Lysholm score revealed 98 points (SD ±4; range 79-100). Prior to ACW-HTO Tegner Scale was significantly reduced to 3.3 points (SD ±1.8; range 0-9) (P < 0.0001) and Lysholm score revealed 57 points (SD ±28; range 14-94) (P < 0.0001) as compared with the pre-injury level. At final follow-up, mean Tegner activity scale changed to 4.8 points (SD ±1.9; range 0-9), which significantly improved as compared with the pre-osteotomy stage (P < 0.0001). Of 85 patients, 18 achieved their pre-injury Tegner activity level, 2 even reached a level higher than the preoperative level. So the return to pre-injury activity level is 21%. The Lysholm score significantly improved to 83 points. (SD ±18; range 24-100) (P < 0.0001) as compared with the pre-osteotomy stage.ConclusionThe present case series presents the largest published series after ACW-HTO and secondary ACLR. Clinical and radiographic results underline that this procedure is safe and significantly increases the patient's ability to participate in light sports and activities of daily living due to an improved stability. An important fact is that 21% of patients after ACW-HTO have not needed a revision ACLR due to an improvement of stability after the osteotomy.

Introduction Although head injuries are one of the most common causes of emergency room admissions in childhood and adolescence, severe traumatic brain injuries are rare. For acute diagnosis in the emergency department, (cranial) computed tomography (CT or cCT) is the gold standard, but magnetic resonance imaging (MRI) has become an increasingly valid alternative recently due to optimized protocols. This also applies to the recommendations in the current guidelines. The aim of this study was to use the national database of the TraumaRegister DGU ® to determine the current status of MRI diagnostics for pediatric traumatic brain injury (TBI) in European trauma centers. Material and method The TraumaRegister DGU ® (TR-DGU) data sets were analyzed from 2015 to 2022. All children up to the age of 15 with a relevant injury (AIS 2+) and primary admission to a European trauma center who were registered in the TraumaRegister DGU ® between 2015 and 2022 were included. In a further step, relevant predictors were determined by multivariate analysis. Results A total of 5000 children were included, 205 MRI images (4.1%) and 4002 CT images (79.8%) were documented. MRI diagnosis was performed more frequently in the 0-to-1-year age group (5.2%) than in the 14-to-17-year age group (3.5%). In conjunction with initial CT imaging, the median total time in the emergency room was 59 min, with a median time to CT of 19 min. When carrying out MRI imaging, the average total time in the emergency room was 85 min, with a median time to MRI of 49 min. Of the prehospital-intubated children (mean ISS 26.3), 91.6% had a CT scan in the acute diagnostic phase and 2.4% an MRI scan. The strongest positive predictor for MRI imaging was a concomitant cervical spine injury (OR=3.63, p<0.001) and the strongest negative predictor was prehospital intubation (OR = 0.54, p=0.007). Discussion CT imaging remains the gold standard in national comparison especially for severely injured children, partly due to its faster and wider availability after the patient arrives in the emergency room. However, in addition to radiation hygiene, the superior assessibility of the cervical spine in case of concomitant (ligamentous/soft tissue) injuries also speaks in favor of MRI imaging, particularly in young patients. If the necessary structural procedures and accessibility are at hand and when the patient's condition permits, MRI diagnostics should be considered as an alternative to CT imaging for childhood head injuries. The two procedures are nearly equivalent in terms of sensitivity.

Osteotomies have played an important role in joint preservation surgery of the knee joint for many years. A double level osteotomy is performed for severe varus or valgus deformities. There are numerous publications on double level osteotomies for severe varus deformities, whereas there are no publications on valgus deformities. The hypothesis of this study was to compare the clinical outcome after varus DLO with that after valgus DLO. In this retrospective study, 40 DLOs were followed up in 34 patients. In group one (13 cases, age 45.6 (16–61) years) a varization DLO was performed, in group two (24 cases, age 48.3 (20–61) years) a valgization DLO was performed. The pre- and postoperative clinical scores were recorded: Tegner Activity score, Japanese knee society Score and Lysholm Score. The leg axis and knee joint angles were recorded and compared pre- and postoperatively. The follow-up period was 24 (6–81) months. The follow-up rate was 73

PURPOSE:Different techniques of slope-decreasing anterior closed-wedge proximal tibial osteotomy (ACW-PTO) have been described. To determine the peri- and post-operative complication rate and obtain data on bone healing in ACW-PTO with an infratuberositary approach. METHODS:A total of 170 consecutive ACW-PTO of two sports-orthopaedic centres were retrospectively evaluated (97 and 73, respectively). Routine follow-up was performed after 6 weeks and was available in 166 cases (97.7%). Medical charts and x-rays of these cases were reviewed with regard to technique-specific complications. Lateral x-rays (n = 155) at 6 weeks post-operatively were evaluated with regard to bone healing (completely healed, partially healed or with no or delayed signs of bone healing). A multivariate binary logistic regression was performed to detect factors that influence bone healing. RESULTS:There was one case with haematoma and superficial wound-healing problems after 5 weeks with progression to a deep wound infection and revision surgery (plate exchange) at 11 weeks after the index surgery. One case with delayed bone healing was treated with plate exchange combined with revision anterior cruciate ligament reconstruction after 4 months. The further course of both cases was uneventful. No other complications were observed. Therefore, the overall complication rate was 1.2% (2 out of 166). Radiologic evaluation at 6 weeks showed complete healing in 104 cases (67.1%), partial healing in 50 cases (32.3%) and delayed healing only in the aforementioned case (0.6%), respectively. All cases of partial healing showed complete healing at 12 weeks. In regression analysis, a completely closed osteotomy (odds ratio [OR] = 3.5, p = 0.003) and compression of the osteotomy (OR = 2.5, p = 0.026) were significantly associated with complete bone healing at 6 weeks. CONCLUSIONS:ACW-PTO using an infratuberositary approach is very safe with regard to complication rate and shows rapid bone healing. The osteotomy should be completely closed and compression should be applied for optimal bone healing. STUDY DESIGN:Case series with pooled data of two centres. LEVEL OF EVIDENCE:Level 4.

Die menschliche Beinachse verändert sich im Laufe des Lebens. Für die Diagnose von Pathologien und deren Behandlung sind altersspezifische Normwerte von Relevanz. Jedoch nicht nur das Alter hat Einfluss auf die Beinachse. So ist auch das Geschlecht maßgebend. Haben Frauen wirklich häufiger X‑ und Männer häufiger O‑Beine? Es wurde eine Übersicht über die Literatur erstellt sowie eine Analyse von 713 gesunden Beinen anhand von Röntgenganzbeinaufnahmen aus dem eigenen Kollektiv der Autoren, hiervon 336 Männer- und 337 Frauenbeine. Die Auswertung der gemessenen Winkel erfolgte via Microsoft Excel (Microsoft, Redmond, WA, USA) und PSPP-Software (Gnu Project, Supported by the Free Software Foundation, Boston, MA, USA). Die Literatur bestätigt eine Tendenz zu Genua valga bei kaukasischen Frauen und die vermehrte Häufigkeit von Genua vara bei Männern, wobei Differenzen bez. der Signifikanz der Unterschiede herrschen. Das vorliegende eigene Patientenkollektiv zeigte eine durchschnittliche Gesamtachse von 0,6° Varus, hierbei waren die Achsen signifikant unterschiedlich: Frauen mit 0,3° im Valgus und Männer mit 1,7° im Varus. Der mittlere mechanische laterale distale Femurwinkel (mLDFW) lag bei 88° (85–91°) und der mechanische mediale proximale Tibiawinkel (mMPTW) bei 88° (86–90°), hier zeigte sich lediglich ein genderspezifischer signifikanter Unterschied beim mMPTW. Der Mythos des Genu valgum bei der Frau scheint eher eine leichte Tendenz zu sein, bei meist gerader Achse. Ein signifikanter Unterscheid besteht zwischen den Geschlechtern vornehmlich aufgrund der erhöhten Varusachse des Mannes.

Osteosynthesis refers to various surgical procedures, closed or open, for the treatment of fractures of any age. To document and control the osteosynthesis and the healing process X-ray controls of the affected skeletal segment are performed during the operation and at regular intervals. To assess the quality of an osteosynthesis or to identify a complication, a comprehensive and systematic image review is useful. This includes the assessment of the restoration of the functional anatomy, the position of the material in relation to the surrounding structures, an evaluation of the stability as far as this is possible, and a control of the bone healing in a functionally correct position.

Unter Osteosynthesen versteht man verschiedenste Operationsverfahren, geschlossen oder offen, zur Versorgung von Frakturen in jedwedem Alter. Zur Dokumentation und Kontrolle der Osteosynthese und des Heilverlaufs werden im Operationssaal und im Verlauf in regelmäßigen Zeitabständen Röntgenkontrollen des betroffenen Skelettabschnitts angefertigt. Zur Beurteilung der Güte einer Osteosynthese oder zur Feststellung einer Komplikation ist eine umfassende und systematische Bildbetrachtung sinnvoll. Hierzu gehören die Beurteilung der Wiederherstellung der funktionellen Anatomie und der Lage des Materials in Relation zu den umgebenden Strukturen sowie, falls möglich, der Stabilität sowie eine Kontrolle der Knochenheilung in funktionsgerechter Stellung.

Introduction: Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist. Material and methods: Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion. Results: Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by > 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment. Conclusion: In addition to X-rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.

BACKGROUND:The aim of this study was to determine whether traumatic dislocation of the patella is provoked by the presence of predisposing factors and examine the role of the mechanism of injury.METHODS:Cases diagnosed with dislocation of the patella and covered by the workers' compensation program were identified and classified as traumatic based on insurance regulations. We examined predisposing factors (e.g., frontal axis, torsional deviation, trochlear dysplasia, patella alta) in case groups based on age at dislocation and trauma mechanism. Retrospective cohort study, level of evidence III.RESULTS:Our sample size comprised 104 cases, consisting of 54 children and 50 adults. The most common mechanism of injury in children and adults was rotational trauma. Only 20% of the children and 21% of the adults exhibited no relevant predisposing factors. Group specifically, falls accounted for the highest number of cases exhibiting none of the defined anatomical predisposing factors. Children are more frequently affected by predisposition-related dislocations than adults.CONCLUSION:The proportion of predispositions is high. A fall, direct impact, or rotational trauma can be viewed as an adequate mechanism of trauma. For successful treatment, it is paramount to analyze the exact mechanism of the trauma and address any underlying predispositions.

Purpose In childhood and adolescence, cross-sectional imaging, most commonly computed tomography (CT), is often performed for advanced diagnosis of joint injuries of the distal lower leg and upper ankle. Due to radiation exposure, the need for CT remains controversial, as these injuries follow stereotypies and usually have a similar course. Alternatively, the performance of magnetic resonance imaging (MRI) is also discussed. Since radiation sensitivity at this young age is much higher than in adults, an effort must be to minimize radiation exposure according to as low as reasonably achievable (ALARA) principles. The aim of this survey is to evaluate the current procedure in Germany in the diagnosis of pediatric injuries of the distal lower leg and upper ankle. Methods For data collection, a survey entitled “CT in fractures of the ankle joint in childhood and adolescence: subject of the survey are injuries between 8 and 15 years of age” of the Section of Pediatric Traumatology in the German Association of Trauma Surgery was sent to all members via the distribution list of the German Society of Orthopedics and Traumatology and the distribution list of the German Society of Pediatric Surgery in a period from September 20, 2022–December 21, 2022. The survey included a total of 21 questions. Target groups were trauma and pediatric surgeons and orthopedic surgeons working in the hospital and in practice. Results A total of 525 participants took part in the survey: ultrasound diagnostics are used by almost 25% and the Ottawa Ankle Rules by over 50% always or in most cases. A conventional x-ray is always or most often used by over 90%. CT imaging is rarely used by 88.57%, mainly for surgical planning or analysis of fracture progression. 69.9% report that their radiology department uses a pediatric protocol for CT exams; 25.71% do not know if this is the case. MRI imaging is also used infrequently by 89.33%, mostly to identify associated injuries. Overall, CT imaging is chosen by 55.62% and MRI imaging by 35.24% as the sectional imaging modality for suspected fractures; 95.05% consider sectional imaging useful for a triplane fracture, 59.24% for a two-plane fracture, 41.71% for a Salter-Harris type III/IV injury, and 8% for a Salter-Harris type I/II injury. Conclusion The survey showed that the conventional X-ray is still the gold standard. Interestingly, more than half of the respondents regularly use the Ottawa Ankle Rules, and diagnostics using ultrasound are also used by almost a quarter. Awareness of radiation protection in children exists, although a quarter of all participants do not know the extent to which their radiology department has a specific pediatric protocol for CT imaging. Cross-sectional imaging is performed on a regular basis. Regarding the actual extent of imaging, there is a clear divergence between theory and practice.

Claviculaschaftfrakturen gehören zu den häufigsten Frakturen im Kindes- und Jugendalter. Früher wurden diese fast ausschließlich konservativ therapiert, in den letzten Jahren zeigte sich jedoch eine Zunahme der operativen Versorgungen. Klare Empfehlungen zur Diagnostik und zur Therapiewahl für diese Verletzung gibt es bisher nicht. Ziel war deshalb, im Rahmen des 7. wissenschaftlichen Arbeitstreffens der Sektion für Kindertraumatologie in der Deutschen Gesellschaft für Unfallchirurgie einen Konsens auf Basis der Expertenmeinung zu erarbeiten. Die Röntgendarstellung in einer Ebene gilt als Goldstandarddiagnostikum. Kinder unter 10 Jahren werden vornehmlich konservativ behandelt; die Art der Ruhigstellung ist zweitrangig. Bei Mädchen älter als 12 Jahre und Jungen älter als 14 Jahre sollten um mehr als Schaftbreite dislozierte und > 2 cm verkürzte Frakturen offen reponiert und osteosynthetisch stabilisiert werden, gefolgt von einer freifunktionellen Nachbehandlung. Neben dem Röntgen gilt es, die Ultraschalldiagnostik weiter zu etablieren. Die Therapie erfolgt weiterhin vornehmlich konservativ, die operative Therapie hat jedoch ebenfalls einen Stellenwert, insbesondere bei Jugendlichen. Bei korrekter Indikationsstellung ist unabhängig von der Therapiewahl von einem guten Outcome auszugehen.

Abstract Introduction: Elbow dislocation is the second most frequent joint dislocation after shoulder dislocation. They have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed. The purpose of this systematic review and meta-analysis was to review the literature and analyze the evidence of early functional rehabilitation. Methods: A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified and evaluated in a stepwise approach. Of these publications 29 met the inclusion criteria of the authors and described simple elbow dislocations in 5765 patients. Data from the studies and subgroups included were initially categorized descriptively in conservative and surgical primary therapies, in immobilizing (immobilization lasting 2 weeks or longer) and free-functional follow-up treatments, and those data were then extracted from each subgroup in absolutes. We then pooled these numbers into descriptive statistics to ensure their comparability. We determined the success rates from the numbers of excellent and good results of the specific used outcome scores. Results: The effect estimate of the conservative therapy's success rate was 84% and for surgical treatment 80% (P < .0001). The difference between the immobilizing treatment (78% success rate) and early-function therapy (83% success rate) was significant (P = .002). In a subgroup analysis the success rate of conservative and immobilizing therapy was 79%, of conservative and early-functional therapy 91%, of surgical and immobilizing groups’ was 77% and of the surgical and early-functional therapies was 93%. The difference among the 4 treatment options was significant (P < .0001), as were differences between the 2 conservative groups (P < .0001) and between the 2 surgical groups (P = .044). Discussion: Conservative therapy is the dominant therapy. Regardless of the primary therapy chosen in simple elbow dislocations: early functional follow-up care seems to be superior to immobilizing therapy with a duration more than 2 weeks.

Für Patellaluxationen sind zahlreiche prädisponierende Faktoren bekannt. Ob diese oder das Trauma die wesentliche Ursache sind, ist häufig unklar. Untersucht wurde, ob die Analyse von Unfallmechanismus und anatomischer Prädisposition bei kindlichen Patellaluxationen eine Aussage zur Ursächlichkeit erlaubt. Retrospektive Kohortenstudie, Evidenzlevel III. Betrachtet wurden hausinterne Berufsgenossenschafts(BG)-Fälle mit der Diagnose Patellaluxation bei ≤18-Jährigen, und deskriptiv bzgl. demografischer und prädisponierender Gesichtspunkte sowie Unfallinformationen ausgewertet. Die Unfallhergänge wurden in Subgruppen unterteilt: Direktanprall, Bagatelltrauma, Sturz, Verdrehtrauma. Es wurden 54 Patellaluxationen identifiziert, bei einem Patientenalter von 14 Jahren (Range 9–18 Jahre). In 39 % der Fälle fanden sich eine milde Valgusachse, im Mittel normwertige Torsionen, ein Tuberositas-tibiae-Trochleagrube(TTTG)-Wert von 17 mm (Range 8–24 mm), mit 41 % ein hoher Patella-alta-Anteil und zu 57 % eine Trochleadeformität. Lediglich 20 % der Kinder wiesen keine relevanten Prädispositionen auf. Die Bagatelltraumata zeigten den höchsten Anteil der Redizivluxationen mit 50 %, bei den übrigen Unfallkategorien betrug der Anteil der Erstluxationen >75 %. In der Sturzkohorte war die Rate der Kinder ohne relevante Prädisposition am größten. Der Prädispositionsanteil bei kindlichen Luxationen ist hoch. Stürze sind jedoch immer wesentliche Unfallereignisse, ebenso der mediale Direktanprall. Das Verdrehtrauma ist, sofern keine hochgradige Trochleadysplasie vorliegt, ebenfalls wesentlich ursächlich, Bagatelltraumen hingegen nicht.

Introduction Eight hundred and fifty-eight consecutive osteotomies around the knee joint were analyzed retrospectively to detect intra- and early postoperative complications in a period of 4 weeks postoperative. Indications for osteotomy were unilateral gonarthritis or torsional deformities resulting in femoropatellar instability or anterior knee pain. Materials and methods Etiology of deformity, technique and mode of correction and level of osteotomy were registered. Complications were detected and divided in minor complication (superficial wound infection, and deep-vein thrombosis) and major complication (compartment syndrome, deep infection, and vascular lesion). Results Fifteen major (1.7%) and 17 minor complications (2.0%) were detected: 5 vascular lesions (0.58%), 4 compartment syndromes (0.47%) and 6 deep infections (0.70%), 14 superficial wound infections (1.6%) and 3 deep-vein thrombosis (0.35%). In posttraumatic osteotomies and continuous corrections, risk for a superficial wound infection was significantly higher and with osteoclasia risk for vascular lesion was higher compared to osteotomy with oscillating saw. No difference was found for anatomical level of osteotomy and for the other complications in terms of etiology of deformity, technique of osteotomy and mode of correction. Conclusion Osteotomy around the knee is a safe procedure in the treatment of unicompartmental gonarthritis in terms of intra- and postoperative complications. Major complications are rare. Pit falls for compartment syndromes (LCW and torsional corrections) have to kept in mind. There is no difference in frequency of complications between HTO and supracondylar osteotomies. Risk for superficial wound infection is higher in posttraumatic osteotomies and with continuous corrections. Osteoclasia contains a higher risk for vascular lesion compared to oscillating saw.

INTRODUCTION:Elbow dislocation is the second most frequent joint dislocation after shoulder dislocation. They have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.The purpose of this systematic review and meta-analysis was to review the literature and analyze the evidence of early functional rehabilitation. METHODS:A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified and evaluated in a stepwise approach. Of these publications 29 met the inclusion criteria of the authors and described simple elbow dislocations in 5765 patients.Data from the studies and subgroups included were initially categorized descriptively in conservative and surgical primary therapies, in immobilizing (immobilization lasting 2 weeks or longer) and free-functional follow-up treatments, and those data were then extracted from each subgroup in absolutes. We then pooled these numbers into descriptive statistics to ensure their comparability. We determined the success rates from the numbers of excellent and good results of the specific used outcome scores. RESULTS:The effect estimate of the conservative therapy's success rate was 84% and for surgical treatment 80% (P < .0001). The difference between the immobilizing treatment (78% success rate) and early-function therapy (83% success rate) was significant (P = .002).In a subgroup analysis the success rate of conservative and immobilizing therapy was 79%, of conservative and early-functional therapy 91%, of surgical and immobilizing groups' was 77% and of the surgical and early-functional therapies was 93%. The difference among the 4 treatment options was significant (P < .0001), as were differences between the 2 conservative groups (P < .0001) and between the 2 surgical groups (P = .044). DISCUSSION:Conservative therapy is the dominant therapy. Regardless of the primary therapy chosen in simple elbow dislocations: early functional follow-up care seems to be superior to immobilizing therapy with a duration more than 2 weeks.

Background Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear. Aim This study investigated whether the analysis of the accident mechanism and anatomical predisposition in juvenile patellar dislocations enables a conclusion as to the causality. Material and methods Retrospective cohort study, evidence level III. In-house employers' liability insurance association (BG) cases with the diagnosis of patella dislocation in patients under 18 years were descriptively evaluated with respect to demographic and predisposing aspects as well as regarding accident information. The accident mechanisms were sorted into subgroups: direct impact, trivial trauma, fall, torsional trauma. Results A total of 54 patellar dislocations were identified with a patient age of 14 years (range 9-18 years). A mild valgus configuration was found in 39% of the cases, on average normal torsion, a tibial tuberosity-trochlea groove (TTTG) distance of 17 mm (range 8-24mm), with 41% a high proportion of patella alta and a trochlear deformity in 57%. Only 20% of the children had no relevant predispositions. The trivial traumas showed the highest proportion of recurrent dislocations with 50% and in the other accident categories the proportion of first dislocations was >75%. In the fall cohort the rate of children without relevant predisposition was highest. Conclusion The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.

Aims and Objectives: High tibial osteotomies (HTO) are nowadays an established method to treat unicompartmental, medial gonarthrosis. Common surgical HTO techniques include medial open wedge (MOW) and lateral closed wedge osteotomies (LCW). In addition to the intended change in the frontal plane these surgical techniques take influence on various other biomechanical issues of the knee joint e.g. the posterior tibial slope (PTS). Aim of this study was to rate and evaluate changes of the tibial slope by HTOs dependent on the used surgical technique (MOW versus LCW). Materials and Methods: 414 HTOs, that had been performed in our institution between 2004 and November 2018, were reviewed retrospectively. 135 cases were excluded. The included 279 cases from 247 patients were divided into two groups dependent on the used surgical technique (MOW/LCW). In both groups the values of PTS were defined by measuring the proximal posterior tibia angle (PPTA) on lateral x-rays of the knee from before and 4 to 6 weeks after surgery. The change of PTS was evaluated as delta-PPTA. Microsoft Excel was used for statistical analysis. Results: 279 cases were included: 190 were assigned to the group of MOW and 89 to the group of LCW osteotomies. Considering demographic data the MOW-group showed a gender distribution of 124 men/ 46 women in 93 left and 97 right knees, and the LCW-group of 46 men/43 women in 40 left and 49 right knees. The mean value of age in the MOW group was 47,6 +/- 10 years (15-70 years) and in the LCW-group 40,6+/-13,7 years (15-67 years). Before surgery there was no statistical significant difference in the PPTA-values between both groups (p=0,720): The mean PPTA in the MOW-group measured 79,9°+/-3,2° (68-88°), in the LCW-group 80,6°+/-2,6° (74-88°). The change caused by surgery showed no statistical significance in the MOW-group (delta-PPTA 0,07°+/- 2,9° [-12° bis 11°]). However, in the LCW-Gruppe we observed a significant (p<0,001) decrease of the PTS (delta-PPTA -3,09°+/- 4,5° [-12°bis 5°]). Nevertheless, the analysis of delta-PPTA in the LCW-group over the timeline of the study period showed tendencies of a decline of slope-reduction. Conclusion: As the PTS plays a relevant role in biomechanics of the knee joint a consideration of the impact of changes in PTS by HTOs is indispensable. Our results support the common thesis of a slope-reduction by LCW osteotomies but nevertheless the analysis throughout the study period showed a reduction of the slope-decrease over timeline. The common thesis of a slope-increase by MOW osteotomies was not supported by our results which showed no significant change.

Background Sacral U-shaped fractures are rare but severe injuries. Due to the resulting spinopelvic dissociation they are highly unstable. Reduction and stabilization are usually required and decompression may be necessary due to frequent concomitant neurological injuries. In the literature there is no consensus with respect to the selection of the surgical approach. Case presentations After a road traffic accident an 18-year-old woman suffered a U-fracture of the sacrum type II according to Roy-Camille and was treated with bilateral double sacroiliac screw osteosynthesis and sacral laminectomy. A 76-year-old man with a U-fracture type I according to Roy-Camille after falling down the stairs was treated by lumbopelvic fixation. A 24-year-old man with U-fracture type II according to Roy Camille after a road accident was treated with triangular vertebropelvic stabilization and sacral laminectomy. For all patients the outcome was good. Conclusion Surgical treatment is necessary, with minimally invasive techniques offering advantages over open surgery. A distinction must be made between lumbopelvic fixation and posterior pelvic ring fixation. Multiple aspects must be taken into consideration of the indications when selecting the surgical technique.