Fragestellung Die Inzidenz von Beckenfrakturen nimmt im geriatrischen Kollektiv bedingt durch die demographische Entwicklung zu. Das Therapiespektrum reicht von der konservativen Therapie bis zu verschiedenen operativen Therapieverfahren. Gerade im häufig multimorbiden geriatrischen Kollektiv werden minimal- invasive Therapieformen wie die perkutane ISG Verschraubung bevorzugt. Vergleichende Studien zum Nutzen der ISG Verschraubung gegenüber der konservativen Therapie sind hingegen bis dato rar.

Introduction: Osteoporosis-related fragility fractures of the pelvic ring (FFP) differ fundamentally from pelvic fractures in younger patients. However, very little is known about biomechanical stability of different osteosynthesis procedures addressing the anterior pelvic ring in these fractures. The aim of this study was to compare standard external fixation with internal fixation using a novel screw-and-rod system in osteoporotic fractures of the pelvic ring in terms of stiffness, plastic deformation and maximum load under cyclic loading in a human cadaveric model. Materials and Methods: A total of 18 embalmed osteoporotic cadaver pelvis specimens were randomized based on the T-score into a group for external fixation and a group for internal fixation. FFP typeIIB fractures were created. In addition to the external or internal fixator, a cement-augmented sacroiliac screw was implanted. Afterwards, axial cyclic loading was performed in a testing setup simulating one-leg stand. Results: Mean plastic deformation and stiffness both were significantly better in the internal fixation group than in the external fixation group (plastic deformation: 0.37 mm (SD: 0.23) versus 0.71 mm (SD: 0.26), p = 0.011; stiffness: 43.69 N/mm (SD: 18.39) versus 26.52 N/mm (SD: 9.76), p = 0.029). Maximum load did not differ significantly between internal fixator (506.3 N; SD: 129.4) and external fixator (461.1 N; SD: 147.4) (p = 0.515). Conclusions: Submuscular internal fixation might be an interesting alternative to external fixation in clinical practice because of better biomechanical properties as well as several advantages in clinical use. (C) 2020 Elsevier Ltd. All rights reserved.

Background and objective. Malnutrition in geriatric trauma patients is associated with an increased risk of complications and mortality and is therefore a key risk factor. The assessment of the affected patients plays an important role in improving the outcome of this growing patient group. Material and methods. In 2016 a questionnaire was sent to 571 departments specialized in traumatology and orthopedics throughout Germany. The following were recorded: level of care, expertise in geriatric trauma, nutrition-based screening procedures and nutritional ward round procedures. Results. The response rate was 57% (n= 325) and closely reflected the treatment reality in Germany with respect to the level of care (superregional, regional or local trauma center and those without special qualifications). In 14% (n= 45) the participants were German Society for Trauma Surgery(DGU)-certified centers for age-related traumatology, while a further 5%(n= 15) were in the process of certification. The nutritional status was assessed in 56% (n= 181) of the clinics. Most frequently used was the body mass index (74%) followed by the mini nutritional assessment (30%), laboratory parameters (29%) and nutritional risk screening 2002 (19%). Some additional methods were specified. In approximately half of the departments nutritional ward rounds took place in regular wards (50%) and intensive care units (57%). Discussion. The high response rate of this study seems to show the particular interest for malnutrition in geriatric trauma patients. This is reflected in an increase in the participating clinics compared to past surveys and also the more regularly performed assessment of nutritional status and implementation of nutritional visits. Conclusion. The establishment of suitable and time-effective screening instruments and their implementationare still a challenge.

Im klinischen Alltag entstehen immer wieder Situationen, in denen das Behandlungsteam und die Angehörigen mit der Frage der Therapieausweitung bzw. -begrenzung bei schwer kranken Patienten konfrontiert werden. In solchen Fällen kann eine Patientenverfügung oder eine Vorsorgevollmacht eine wichtige Hilfestellung zur Entscheidungsfindung im Sinne der Patienten leisten. Jedoch liegt einerseits nicht für jeden Patienten eine Patientenverfügung oder eine Vorsorgevollmacht vor; andererseits besteht unserer Erfahrung nach sowohl von ärztlicher Seite als auch von Patientenseite häufig Unsicherheit im Umgang mit diesen Dokumenten. Im vorliegenden Beitrag werden daher die aktuell verfügbaren Dokumente (Patientenverfügung, Vorsorgevollmacht, Betreuungsverfügung) vorgestellt sowie ihre (juristischen) Anwendungsmöglichkeiten und -grenzen im klinischen Alltag aufgezeigt.

Introduction: Cement-augmentation is a well-established way to improve the stability of sacroiliac screw fixation in osteoporosis-associated fragility fractures of the posterior pelvic ring. However, to date little is known about the influence of different techniques of cement augmentation on construct stability. The aim of this study was to evaluate the primary stability of cement-augmented sacroiliac screw fixation with cannulated versus perforated screws under cyclic loading. Materials and Methods: A total of eight fresh-frozen human cadaveric hemipelvis specimens with osteoporosis were used. After generating ventral osteotomies on both sides of the sacrum, each specimen was treated using a cement-augmented cannulated screw on one side and a cement-augmented perforated screw on the other side. Afterwards, axial cyclic loading was performed. Results: No statistically significant difference was found between cannulated and perforated screws concerning maximum load (356.25 N versus 368.75 N, p = 0.749), plastic deformation (1.95 mm versus 1.43 mm, p = 0.798) and stiffness (27.04 N/mm versus 40.40 N/mm, p = 0.645). Conclusions: Considering the at least equivalent results for perforated screws, cement augmentation via perforated screws might be an interesting option in clinical practice because of potential advantages, e.g. radiological control before cement application, reduced risk of cement displacement and time saving. (C) 2018 Elsevier Ltd. All rights reserved.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

Schenkelhalsfrakturen sind typische Frakturen des älteren Menschen, deren Häufigkeit aufgrund des zunehmenden Anteils älterer Menschen an der Bevölkerung in Zukunft weiter steigen wird. Sowohl bei der operativen Behandlung als auch beim perioperativen Management sind aufgrund des größtenteils geriatrischen Patientenguts einige Besonderheiten zu beachten.

INTRODUCTION:The frequency of urological traumata and the need for interventions in severely injured patients in Germany are unknown. The aim of this study was to determine the frequency of urological traumata in about 90,000 severely injured patients (Injury Severity Score, ISS ≥ 16). MATERIALS AND METHODS:Data of 90,000 patients from the TraumaRegister DGU® were retrospectively analyzed. All patients with an ISS of ≥ 16 were included. The kind of urological traumata and the need for urological intervention within 24 hours were assessed, as well as the kind of accident, additional traumata and the clinical course. RESULTS:48,797 patients fulfilled the inclusion criteria. Urological trauma was existent in 7.1 %, especially in men (78 %). Kidneys were affected most frequently (4.8 %) compared to ureters (0.2 %), urinary bladder (1.2 %), urethra (0.5 %) and genitals (0.4 %). Traffic accidents and falls from higher levels represented the main cause for urological traumata (> 90 %). It was associated with additional pelvis, thorax and abdomen traumata (each 7.1 %) and showed a distinct increase dependent on the abbreviated injury scale (AIS). Ureter (10.6%) and urethra (6.3%) trauma was deferred diagnosed most, this was associated with a higher rate of urological operations. The general duration of hospital stay and that in the intensive care unit were prolonged by urological traumata. DISCUSSION:The data showed the prevalence of urological trauma in severely injured patients analyzed in a huge patient cohort of the TraumaRegister DGU®. For the first time the number, degree and medical care in the reality of urological traumata in severely injured patients were available.

Die Unfallchirurgie mit ihrem hohen Anteil geriatrischer Patienten ist oftmals mit der Problematik der Therapieausweitung bei schwer kranken Patienten konfrontiert. Hierbei stellen Patientenverfügung, Vorsorgevollmacht oder gesetzliche Betreuung eine wichtige Unterstützung der ärztlichen Entscheidung dar.

The aim of the present study was to identify patient factors associated with higher costs in hip fracture patients. The mean costs of a prospectively observed sample of 402 patients were 8853 €. The ASA score, Charlson comorbidity index, and fracture location were associated with increased costs.

Weitgehend unbekannt ist die tatsächliche Häufigkeit urologischer Verletzungen in Deutschland beim Polytrauma wie auch die tatsächliche operative Interventionshäufigkeit. In der vorliegenden Arbeit wurde die Häufigkeit der unterschiedlichen urogenitalen Verletzungen im Rahmen eines Traumas bei fast 90.000 schwer verletzten Patienten (Injury Severity Score, ISS ≥ 16) untersucht. Zusätzlich wurden andere Parameter wie der Unfallhergang, Begleitverletzungen und Auswirkungen auf den Verlauf analysiert.

Due to the increasing number of elderly patients, trauma surgeons are often confronted with end-of-life treatment decisions. Advance directives can help reduce the lack of clarity in those situations.The aim of this study was to identify the presence of living wills, durable power of attorney, legal guardianship and appointment of guardianship in the geriatric trauma center of a university hospital.The data of all patients treated in our geriatric trauma center from 01/01/2013 to 03/31/2014 were analyzed regarding the presence of a living will, durable power of attorney, legal guardianship and appointment of guardianship as well as the procedure of documenting those items.Out of 181 patients, 63 % (n = 114) had one or more of these documents. Most frequently used was the durable power of attorney in 33 % (n = 59), followed by a living will in 27 % (n = 48), legal guardianship in 20 % (n = 37) and appointment of guardianship in 7 % (n = 12).The existence of those documents was recorded in 88 % (n = 100) of patients within 24 h after admission; documentation in the medical records was found in 58 % (n = 66).A large proportion of patients had one or more of the documents named above. In this respect, standardized documentation of advance directives in the medical record is an important issue for all persons involved.

Background: The purpose of this study was to evaluate long-term clinical and radiological results as well as survival rates of the NexGen (R) CR posterior cruciate retaining prosthesis. Patients andMethods: We evaluated a consecutive series of 761 total knee replacements performed on 716 patients from 1999 to 2001 at our institution. All patients had been recorded prospectively in our in-house arthroplasty register. Follow-up data were available for 379 patients at 10 years postoperatively. Functional outcome was evaluated using the Knee Society score. An additional radiographic evaluation was performed on 224 patients at 10 years. The mean age of the patients at the time of surgery was 71 years. 75% of the patients were female, 25% were male. Mean BMI of the patients was 29.2 kg/m(2). The preoperative diagnosis was osteoarthritis in 91%, rheumatoid arthritis in 5,5% and posttraumatic osteoarthritis in 2%. Patella resurfacing was performed in 4%. All components were cemented.Results and Discussion: Mean Knee Society clinical score improved from 26.7 points preoperatively to 88.5 points at the time of the latest follow-up, and mean Knee Society function score improved from 48.3 to 55.2 points. Flexion improved from a mean of 106.7 degrees preoperatively to 111.4 degrees at 10 years. Patellofemoral pain was indicated by 66% of the patients before surgery and 4% at the latest follow-up. 96% were satisfied with the result of the surgery at 10 years. Radiographic evaluation was performed on 224 patients at the time of the latest follow-up. 203 patients (91%) had normal radiographic findings, 21 patients (9%) showed pathological findings. Radiolucencies were seen in 18 patients on the AP view of the tibia, 1 patient had an additional femoral radiolucency. There was an osteolysis located in the lateral tibia seen in 1 patient and an occurrence of heterotopic ossification in another patient. One knee showed a patella subluxation. No patient had radiographic evidence of loosening. 17 knees had required revision surgery with exchange of at least one of the components up to 10 years after the index procedure. 5 of the patients had revision for a deep infection, 2 for periprosthetic fractures of the distal femur with loosening of the prosthesis, 1 for fracture of the proximal tibia due to osteoporosis, 4 for aseptic loosening, 3 for instability and 2 for severe pain. Kaplan-Meier survival of all components using revision for any reason as the end point was 97.8% at 10 years.Conclusion: The good clinical and radiological long-term results as well as the satisfactory survival rate after total knee replacement with the NexGen CR (R) prosthesis are comparable with the results of other long-term studies using the NexGen CR (R) and assimilable prosthesis. Our results demonstrate that quality of life was improved by the implantation of the NexGen CR (R) prosthesis even a long time after the index procedure despite old age and comorbidity of the patients.