Zusammenfassung Der Einfluss von Vitamin D im Rahmen der Pathogenese von muskuloskeletalen Erkrankungen ist aktuell ein Thema von hohem wissenschaftlichem Interesse. Nahezu alle Altersschichten der Bevolkerung sind von einer Vitamin-D-Unterversorgung gefahrdet. Vitamin D ist ein essenzieller Faktor fur die Knochengesundheit und Muskelfunktion, beides Kernelemente der Orthopadie. Zahlreiche Studien zeigten einen moglichen Zusammenhang zwischen dem Serum Vitamin-D-Spiegel und orthopadisch/traumatologischen Krankheitsbildern. In diesen Beobachtungsstudien wurden diverse negative Auswirkungen eines Vitamin-D-Mangels auf das Ergebnis nach Endoprothesenoperationen und den Verlauf orthopadisch/traumatologischer Krankheitsbilder beschrieben. Die vorliegende Arbeit soll einen uberblick uber dieses stetig wachsende Themengebiet bieten.Summary Vitamin D is a key element in musculoskeletal development, maintenance and function. Sufficient levels of vitamin D correlate with greater bone mineral density, lower rates of osteoporotic fractures and improved neuromuscular interaction. Several epidemiologic studies have identified an increasing number of orthopaedic patients at risk for insufficient serum vitamin D levels, with a high risk for widespread consequences e.g. in bone healing, risk of fracture, periprosthetic infection or post-arthroplastic outcome.

ZusammenfassungDer Einfluss von Vitamin D im Rahmen der Pathogenese von muskuloskeletalen Erkrankungen ist aktuell ein Thema von hohem wissenschaftlichem Interesse. Nahezu alle Altersschichten der Bevölkerung sind von einer Vitamin-D-Unterversorgung gefährdet. Vitamin D ist ein essenzieller Faktor für die Knochengesundheit und Muskelfunktion, beides Kernelemente der Orthopädie. Zahlreiche Studien zeigten einen möglichen Zusammenhang zwischen dem Serum Vitamin-D-Spiegel und orthopädisch/traumatologischen Krankheitsbildern. In diesen Beobachtungsstudien wurden diverse negative Auswirkungen eines Vitamin-D-Mangels auf das Ergebnis nach Endoprothesenoperationen und den Verlauf orthopädisch/traumatologischer Krankheitsbilder beschrieben. Die vorliegende Arbeit soll einen Überblick über dieses stetig wachsende Themengebiet bieten.

Already three decades ago, the potential of medical 3D printing (3DP) or rapid prototyping for improved patient treatment began to be recognized. Since then, more and more medical indications in different surgical disciplines have been improved by using this new technique. Numerous examples have demonstrated the enormous benefit of 3DP in the medical care of patients by, for example, planning complex surgical interventions preoperatively, reducing implantation steps and anesthesia times, and helping with intraoperative orientation. At the beginning of every individual 3D model, patient-specific data on the basis of computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound data is generated, which is then digitalized and processed using computer-aided design/computer-aided manufacturing (CAD/CAM) software. Finally, the resulting data sets are used to generate 3D-printed models or even implants. There are a variety of different application areas in the various medical fields, eg, drill or positioning templates, or surgical guides in maxillofacial surgery, or patient-specific implants in orthopedics. Furthermore, in vascular surgery it is possible to visualize pathologies such as aortic aneurysms so as to improve the planning of surgical treatment. Although rapid prototyping of individual models and implants is already applied very successfully in regenerative medicine, most of the materials used for 3DP are not yet suitable for implantation in the body. Therefore, it will be necessary in future to develop novel therapy approaches and design new materials in order to completely reconstruct natural tissue.

Hypovitaminosis D has been identified as a common risk factor for fragility fractures and poor fracture healing. Epidemiological data on vitamin D deficiency have been gathered in various populations, but the association between vertebral fragility fractures and hypovitaminosis D, especially in males, remains unclear. The purpose of this study was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in patients presenting with vertebral fragility fractures and to determine whether patients with a vertebral fracture were at greater risk of hypovitaminosis D than a control population. Furthermore, we studied the seasonal variations in the serum vitamin D levels of tested patients in order to clarify the relationship between other known risk factors for osteoporosis and vitamin D levels. We measured the serum 25-OH D levels of 246 patients admitted with vertebral fractures (105 men, 141 female, mean age 69 years, sd 8.5), and in 392 orthopaedic patients with back pain and no fractures (219 men, 173 female, mean age 63 years, sd 11) to evaluate the prevalence of vitamin D insufficiency. Statistical analysis found a significant difference in vitamin D levels between patients with vertebral fragility fracture and the control group (p = 0.036). In addition, there was a significant main effect of the tested variables: obesity (p < 0.001), nicotine abuse (p = 0.002) and diabetes mellitus (p < 0.001). No statistical difference was found between vitamin D levels and gender (p = 0.34). Vitamin D insufficiency was shown to be a risk factor for vertebral fragility fractures in both men and women.

Purpose To investigate the possibility of increasing elution of fosfomycin, gentamicin, clindamycin, and vancomycin by the addition of dextran fluid during the cement-mixing phase. Methods In 12 test series, we produced standardized, antibiotic-loaded test specimens of cement, with and without addition of dextran, and determined their effectiveness against three reference pathogens in agar diffusion and elution tests. Results In the test series using combined agents, Refobacin ® -Palacos ® R plus fosfomycin continuously produced the largest zone of inhibition, both against methicillin-sensitive Staphylococcus aureus ( p = 0.009) and against methicillin-resistant Staphylococcus aureus ( p = 0.009). The addition of dextran to the various test series had no useful effect on the size of the zone of inhibition for any of the antibiotics tested. Conclusions Dextran supplementation in Refobacin ® -Palacos ® R bone cement did not have the hope for positive effect on the elution rate of bound antibiotics.

The present study investigated the incidence and risk factors of heterotopic ossification (HO) after implantation of knee prosthesis.

BACKGROUND:The study presented here investigated the short-term effectiveness of one-off lumbar caudal epidural injection (EI) in sciatica in relationship to the reported duration of pain. MATERIALS AND METHODS:This retrospective analysis involved 106 consecutive in-patients who received either conservative treatment (Group I) or an additional EI on the first day of their treatment (Group II). Both groups were divided according to the duration of symptoms at the time of admission (less than three months, or more than six months). Propensity score matching was performed for the whole collective and the resulting subgroups. This incorporated gender, age and pain intensity at the time of admission. The target parameter were changes on a visual analogue scale (VAS) of pain intensity on days D1, D3, and D10 depending on the respective treatment. A routine evaluation of the mental variables anxiety, depression and somatisation was performed as part of the examination upon admission and their relationship to the success of treatment was later assessed. RESULTS:The mean age of the patients was 61.7 (± 11.6) in Group I and 63.6 (± 13.6) in Group II. 59 % of the patients were female (n = 63). The Lasègue sign was prevalent in 45 % of Group I and 51 % of Group II. The intensity of pain on the day of admission was similar in both groups (7.0 ± 1.0 for Group I, 6.7 ± 1.8 for Group II). The length of stay on the ward was also similar in both groups (10.2 ± 3.9 and 9.4 ± 3.7 d, respectively). It was found that, independent of the duration of symptoms, injection treatment was significantly more effective than conservative treatment only in the early stages (D1 and D3, p < 0.001). No differences could be found in the expression of these mental variables between treatment groups, as these factors showed no influence on the results of therapy. CONCLUSIONS:In the context of acute treatment a once only lumbar caudal epidural injection represents at most a short-term effectiveness for the therapy of sciatica. The results presented here indicate that neither the duration of symptoms nor the measured psychometric variables show any effect on the success of therapy.

Zu sam men fas sung Die Be reit stel lung ei ner suf fi zi en ten post ope ra ti ven Schmerz the ra pie stellt eine Ver pflichtung in der Pa ti en ten ver sor gung dar. Ein brei tes Spekt rum an me di ka men tö sen, tech nischen und or ga ni sa to ri schen Op tio nen wird in der Or tho pä die und Un fall chi rur gie ange wandt. Die Schmerz mes sung ist eben so wich tig, wie die rich ti ge An wen dung von Anal ge ti ka bzw. Ap pli ka ti ons ver fah ren. Schmerz the ra pie stan dards sol len des halb zu ei ner mög lichst gro ßen Selbst stän dig keit in der Schmerz be hand lung ope rier ter Pa ti en ten führen. Er gän zend wer den spe zi el le Schmerz the ra pie ver fah ren zur in di vi du el len oder opera ti onss pe zi fi schen Be hand lung be nö tigt, wie die pa ti en ten kon trol lier te An al ge sie oder die Ner ven ka the ter ver fah ren. Die ba lan cier te post ope ra ti ve An al ge sie kann Ne ben wirkungsund Kom pli ka ti ons ra ten sen ken, die Mo bi li sier bar keit der Pa ti en ten stei gern und de ren Zu frie den heit för dern.

AIM:Lateral release is a substantial component of the distal soft tissue procedure, which plays a major role in the framework of the lapidus-fusion and the near-to-basis osteotomy in the hallux valgus surgery. The extent of release which is reached during this procedure is controversially discussed. The goal of this anatomic study was the evaluation of the effect of the sequential disconnection of lateral contraction structures on the alignment of the large toe.METHOD:On 8 anatomical hallux valgus preparations in which each foot was fastened in a holding device under defined continuous lateral pull, the soft tissue at the lateral aspect of the large toe was surgically split in the following sequential order: the lateral joint capsule, the tendon of the adductor hallucis muscle and afterwards the transverse metatarsal ligament. Before each procedure an X-ray was taken. We documented the different changes of the hallux valgus angle, the intermetatarsal 1/2 angle as well as the proximal and distal articulation angles.RESULTS:The hallux valgus angle was predominantly and significantly improved by capsule splitting and tenotomy of the tendon of the adductor hallucis muscle. A significant correction of the intermetatarsal angle did not take place however.CONCLUSION:It was shown that the substantial element of an effective distal soft tissue procedure for hallux valgus is the splitting of the capsule. The disconnection of the transverse metatarsal ligament did not lead to a further correction and can therefore be neglected.

Provision of sufficient post-operative pain therapy is an obligation in the clinical management of patients. A wide range of medical, technical and organizational options is used to improve post-operative pain management in orthopaedic surgery. Measurement of pain is as important as the correct use of analgesics and application techniques. Standardized pain therapy algorithms should facilitate autonomous treatment of patients. Additional procedures like patient-controlled analgesia or local catheter for pain are necessary for individualized or operation-specific pain therapy. The balanced combination in post operative pain therapy could reduce side effects and complication rates, increase mobility and enhance patient satisfaction.