Trochanteric fractures are common in geriatric patients, and cephalomedullary nailing is widely used. However, its ability to restore and maintain native hip geometry over time remains unclear. In this retrospective single-center study, patients aged ≥ 75 years treated with cephalomedullary nailing between June 2022 and August 2024 were included. Centrum-collum-diaphyseal (CCD) angle, femoral offset, and leg length discrepancy (LLD) were assessed on the operated and contralateral sides postoperatively and at final follow-up (minimum 6 weeks). Changes over time and correlations with the cortical thickness index (CTI) and AO/OTA classification were analyzed. Implant-related complications were systematically recorded in the overall cohort and analyzed descriptively. Sixty-six patients (mean age 86.2 ± 6.4 years, 76

STUDY DESIGN:Retrospective cohort study. OBJECTIVE:To identify risk factors for revision surgery due to persistent cerebrospinal fluid (CSF) leakage after an intraoperatively recognized and repaired incidental durotomy (ID) in lumbar spine surgery. BACKGROUND:ID is a common complication in spine surgery, often leading to CSF leakage, prolonged hospitalization, and increased morbidity. While risk factors for ID are well described, limited data exist on predictors of persistent CSF leakage requiring revision surgery. MATERIALS AND METHODS:A total of 323 patients who sustained an intraoperatively recognized and repaired ID during lumbar spine surgery were retrospectively analyzed. Patients with traumatic dural tears or bacterial infections were excluded. Demographic data, comorbidities, surgical details, and complications were recorded. Univariate and multivariate logistic regression analyses identified independent risk factors for revision surgery. RESULTS:Fifteen patients (4.64%) required revision surgery for persistent CSF leakage. Univariate analysis identified type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and metastatic tumor history as risk factors. Multivariate analysis confirmed type 2 diabetes (aOR: 3.732; 95% CI: 1.093-12.739; P = 0.036), metastatic tumor history (aOR: 15.758; 95% CI: 2.339-106.160; P = 0.005), and male sex (aOR: 4.018; 95% CI: 1.022-15.794; P = 0.046) as independent risk factors. Revision patients had significantly longer hospital stays (16 vs. 8 d, P = 0.014) and higher rates of wound infection and ischemic stroke. CONCLUSIONS:Type 2 diabetes, metastatic tumor history, and male sex are independent risk factors for revision surgery due to persistent CSF leakage after ID repair. These findings highlight the need for increased vigilance and potentially modified dural repair strategies in high-risk patients.

Background: Surgically treated proximal femoral fractures in geriatric patients are a major debilitating condition, with continuously rising numbers, impacting patients and the healthcare system. Models of care based on orthogeriatric co-management (OGCM) have suggested promising clinical outcomes compared with the standard of care (SOC) model in the treatment of frail elderly patients. Methods: A retrospective cohort study investigating clinical outcomes in two comparable cohorts of patients aged 75 and older, who underwent surgical treatment for proximal femoral fractures in 2023 was conducted. Included individuals all originated from the same geographic area, therefore presenting a unique cohort. The cohorts were differentiated by the perioperative care protocols implemented: an OGCM protocol (n = 147) versus a SOC protocol (n = 143). The main outcome measures were readmission, revision, and mortality rates at 30 days and one-year post-surgery, as well as the length of hospital stay. Results: Findings revealed a positive impact for patients treated under the OGCM protocol, with a significant reduction in the length of hospital stay (6 vs. 7 days, p = 0.001), while no consistent differences were observed in readmission (36.2% vs. 39.7%, p = 0.676), surgical revision (8.4% vs. 12.4%, p = 0.485), and mortality (24.1% vs. 31.7%, p = 0.781) rates one-year after surgery. Conclusions: Despite the absence of significant differences in major outcomes such as mortality, readmission, and surgical revision between the two protocols, the implementation of a more resource-intensive multidisciplinary care pathway resulted in a significant reduction in hospital length of stay. Beyond its clinical value, this improvement may contribute to reducing the burden on healthcare staff and support the sustainability of hospital systems facing increasing pressure.

The increase in femoral neck fractures in elderly individuals is primarily attributable to reduced bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA), has been demonstrated to be a reliable bone mineral density (BMD) estimate. Femoral cortical thickness index (CTI), and Dorr classification are reliable assessment methods of the femoral cortical thickness. Patients with low BMD, low CTI or Dorr C who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). Dual-energy X-ray absorptiometry (DEXA), femoral cortical thickness index (CTI), and Dorr classification have been demonstrated to be reliable bone mineral density (BMD) estimates. Patients with low BMD who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). The objective of this study was to investigate the relationship between CTI, Dorr classification, and early FSS, hypothesizing that these indicators can predict stem subsidence. A retrospective analysis was conducted on patients with femoral neck fractures treated by uncemented THA or HA using the direct anterior approach (DAA). Preoperative radiographs were utilized to assess CTI and Dorr classification. Postoperative FSS was the primary outcome measure, with follow-up X-rays averaging 403 days (range 38–3371). The canal fill ratio (CFR) was observed at four levels postoperatively. A subsequent statistical analysis was conducted to examine the correlation between CTI, Dorr classification, CFR, BMI, age, and FSS. The study’s sample population included 64 patients (20 male, 44 female) with a mean age of 73 ± 9 years, who were treated between June 2020 and February 2024. The mean femoral CTI was 0.51 ± 0.08 on the fractured side and 0.54 ± 0.06 on the contralateral unaffected side. The mean FSS was 1.02 ± 1.49 mm. A subsidence of at least 5 mm was identified in a mere two patients, both of whom were classified as Dorr B. A modest correlation (r = 0.27) was noted between FSS and CRF 2. Neither decreased BMD nor cortical thickness correlated with femoral stem subsidence. Level III, Therapeutic study.

The cortical thickness index (CTI) is a radiological measure and correlates with diminishing local bone quality in the proximal femur. The objective of this study was to assess the association between a lower CTI and the occurrence of peri- and postoperative surgical complications. A total of 228 consecutive patients treated with endomedullary nailing for trochanteric fracture (TFx) (AO/OTA 31A1.1-31A2.3) (n = 99) and hemi-/total hip arthroplasty for femoral neck fracture (AO/OTA 31B1-B3) (FNFx) (n = 129) with a mean age of 82 ± 9.9 (50-99) years were retrospectively reviewed. An evaluation of these cases was conducted to ascertain the presence of any surgery-related complications. Eighteen patients (7.9%) undergoing revision surgery were identified. Patient demographics and radiographic measurements of these groups were compared to the cases without complications (n = 210) and statistically analysed. A total of 18 patients (7.9%) with complications who underwent revision surgery were identified. Among the total number of patients, 10 (55.6%) exhibited mechanical complications. The remaining patients underwent a subsequent revision due to infection (n = 4), seroma/hematoma (n = 3), or a running wound (n = 1). The FNFx group exhibited a lack of intraoperative fractures; however, two periprosthetic fractures occurred subsequent to another fall (36 and 59 days postoperatively). A total of five incisions or extractions of the helical blade were identified in the TFx group. The following factors contributed to the necessity for revision: tractus irritation (n = 2), one intraoperative fracture, one running wound, and one seroma. Among all of the variables that were analyzed, including age, body mass index, and hemoglobin level, only the CTI of the affected side in the TFx group was found to be significantly higher in the complications group, as well as the mechanical complications group (0.51 ± 0.09, 0.58 ± 0.05, 0.58 ± 0.05; p = 0.029). Poor local bone quality, as indicated by a low CTI, is not associated with increased complication rates following surgically managed proximal femoral fractures. Instead, the predominant contributors to mechanical complications seem to emanate from alternative factors, such as insufficient fracture reduction and suboptimal blade positioning.

Background/Objectives: Osteoporosis is prevalent in the elderly and increases fracture risk. Bone density is commonly assessed using dual-energy X-ray absorptiometry (DEXA). The femoral cortical thickness index (CTI) also provides indirect information for osteoporosis. It remains unclear whether there are intra-individual differences and if a correlation to fracture risk of the CTI in fractured femora results due to fracture related malrotation during X-rays. The aim of this study was to investigate the individual bilateral CTI in patients with proximal femoral fractures. Methods: A retrospective analysis of 200 surgically treated patients (100 trochanteric, 100 femoral neck fractures) was performed. Measurements included the bilateral CTI at 10 and 15 cm below the lesser trochanter. Analysis of the correlation of those examinations, in comparison to the contralateral CTI at 15 cm, and correlation of the CTI with the body mass index (BMI) and age was performed. Results: Results showed significant differences (p < 0.001) in bilateral CTIs for both fracture types at 15 cm with a strong inter-rater reliability (ICC > 0.9). There was no significant correlation between age and CTI, as well as BMI and CTI in both cohorts (p > 0.1). Sex-specific subgroup analyses revealed that females exhibited significant differences in CTI between fractured and non-fractured sides (p < 0.001). Conclusions: In conclusion, CTI, and the modified CTI at 15 cm below the lesser trochanter in fractured proximal femora, is lower compared to the non-fractured side. The femoral CTI could help in daily clinical routines and circumstances, where more detailed risk prediction tools are lacking.

Background:The functional outcome in patients with preexisting osteoarthritis after surgically treated trochanteric fracture is not yet fully elucidated. As the global population ages, the coexinsting of degenerative joint osteoarthritis and fragility fractures is increasing. Consequently, it is imperative to provide affected patients with information regarding the anticipated clinical outcomes. The objective of this study is to examine the impact of preexisting hip osteoarthritis in elderly patients on the clinical outcome following trochanteric fracture fixation. Methods:In this retrospective single-center study elderly patients aged ≥70 years who underwent intramedullary nailing between January 2016 and March 2023 have been analysed. The severity of hip osteoarthritis was stratified into two categories: grade 0-II and grade III-IV, according to the Kellgren-Lawrence classification system. Radiological signs of consolidation were ascertained. A comprehensive evaluation of the patients' demographics and patient-reported outcome measures (Oxford Hip Score, WOMAC-score, and SF-36-score) was conducted, followed by a thorough statistical analysis, with a significance set at P < 0.05. Results:21 patients with 23 affected hips were included (mean age 81 ± 7.5 years; 81% female) with a mean follow-up duration of 15.1 ± 13.8 months. Patients with advanced OA (KL III-IV) reported significantly lower Oxford Hip Scores (33.3 ± 6.3 vs 43.1 ± 6.7; P = 0.003), and higher total WOMAC and WOMAC pain scores (P = 0.016 and P = 0.003). Conclusion:The severity of pre-existing osteoarthritis of the hip in patients with intertrochanteric fractures is a significant risk factor, potentially leading to a diminished quality of life postoperatively. Further studies are necessary to provide therapeutic guidance.

(1) Background: The prevention of proximal femoral fractures among people of very advanced age is relevant as they are common and increasing in number. The aim of this study was to determine if the hip axis length (HAL) and the neck-shaft angle (caput–collum–diaphyseal CCD) are risk factors for those fractures among people aged 80 years and over. Consequently, it was additionally analysed if these parameters are associated with a certain fracture type. (2) Methods: Anteroposterior radiographs of the pelvis were collected to form three groups (femoral neck fractures (FNFx), trochanteric fractures (TFx) and non-fractured femora (NFx)). Two independent blinded observers separately conducted each measurement of the HAL and CCD. Statistical analysis was performed to determine the association between the measured parameters and type of fracture. (3) Results: One hundred and fifty patients (50 per group) were examined, of which the mean age was 92.7 ± 3.5 (range 81–104) years. Both the HAL and CCD of the FNFx group were significantly larger than in the TFx group (p = 0.013, 0.003). The CCD was higher in the FNFx than that of the NFx group (p = 0.001). No further significant differences of HAL and CCD were observed between the groups. (4) Conclusions: For people aged 80 years and over, an increased HAL represented no risk factor for proximal femur fractures, and a large HAL was associated with an increased occurrence of FNFx instead of TFx. A large CCD was associated with an increased risk of suffering a femoral neck fracture, showing evidence of the CCD being a risk factor for the extremely old population.

Background: The cortical thickness index (CTI) is a measure of bone quality and it correlates with the risk of proximal femoral fractures. The purpose of this study was to investigate the CTI in femoral neck, trochanteric fractures and non-fractured femora in geriatric patients and to determine whether there is a correlation between the CTI and the presence of a fracture. Methods: One hundred and fifty patients (fifty femoral neck- (FNFx), fifty trochanteric fractures (TFx) and fifty non-fractured (NFx)) with a mean age of 91 (range 80–104) years were included. Hip radiographs (antero-posterior (ap), lateral) were evaluated retrospectively. Measurements on the proximal femoral inner and outer cortices, including CTI and Dorr’s canal calcar ratio (CCR), were assessed for inter-observer reliability (ICC), differences of each fracture and correlation of parameters. Results: The mean ap CTI on the affected side was 0.43, 0.45 and 0.55 for FNFx, TFx and NFx, respectively. There was a significant difference of the ap CTI and CCR comparing the injured and healthy side for both fracture cohorts (p < 0.001). Patients with FNFx or TFx had significantly lower CTI on both sides compared to the NFx group (p < 0.05). There was no difference for CTI (p = 0.527) or CCR (p = 0.291) when comparing both sides in the NFx group. The mean inter-observer reliability was good to excellent (ICC 0.88). Conclusions: In proximal femoral fractures, the CTI and CCR are reduced compared with those in non-fractured femora. Both parameters are reliable and show a good correlation in geriatric patients. Therefore, especially for geriatric patients, the CTI and CCR may help to predict fracture risk and consult patients in daily practice.

Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 –275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) tolead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor formajor amputation if at least one re-amputation had to be performed. There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. Retrospective comparative study (Level III).

Background Increasing expectancy of life and levels of activity in the growing geriatric population lead to a rising number of prosthetic implants of the hip and consequently the incidence of periprosthetic fractures of the femur increase. The fracture pattern and the possible instability of the stem are a challenge to the orthopaedic surgeon. Treatment options are complete replacement of the implant or a solitary osteosynthesis. The goal of this study was to analyse the feasibility of the operative intervention using a contralateral reversed anatomic distal femoral LISS® locking plate and the radiological and functional outcome in a geriatric cohort. Methods We included all patients older than 75 years of age with a Vancouver type B fracture, which have been treated by osteosynthesis using a LISS® (contralateral reversed) plate in our institution in an interdisciplinary ortho-geriatric setting between 7/2013 and 12/2021. Perioperative morbidities, clinical and radiological outcome during follow-up were retrospectively analysed. Results During the observed time period, 83 patients (mean age: 88 years (range: 76–103), male/female: 26/57) were treated. Most fractures were Vancouver type B2 (n = 45, 54%) followed by B1 (n = 20, 24%) and B3 (n = 18, 22%). The most prevalent postoperative surgical complication was anaemia (n = 73, 88%) followed by infections (n = 12, 14%, urinary infections, pneumonia) and cardiovascular decompensation (n = 8, 10%). Clinical and radiological follow up 6–8 weeks postoperative was possible for 59 patients (70%). The majority of them did not describe pain (n = 50, 85%) and had a good or excellent radiological outcome. Three cases needed revision surgery due to infection and another three due to non-union, loosening of the stem or an additional fracture. 1-year mortality was 30%. Conclusion We are convinced that the reversed contralateral LISS-plate is an easy-to-use implant with a small complication rate but a very successful and high healing rate in a geriatric, polymorbid cohort.

Purpose:This study looked at postoperative malunion with restricted function after elastic stable intramedullary nailing (ESIN) in pediatric patients in their childhood or adolescence. The primary objective was to compare the magnitude of the osseous malposition to the healthy opposite side. Second, these individuals were treated with patient-specific surgical instrumentation, and functional outcomes were documented. Methods:Patients under the age of 18 at the time of a corrective osteotomy due to a forearm malunion after initial ESIN treatment were included in this study. The healthy contralateral side was used as a reference for preoperative analysis and planning of the osteotomy. Osteotomies were performed using patient-specific guides and the direction and extent of the malunion were compared to the change in range of motion (ROM) after the operation. Results:Fifteen patients met the inclusion criteria at three years after initial ESIN placement, with the most pronounced malposition in the rotational axis. The postoperative function significantly improved by 12° (pre-op: 60° ± 17; post-op: 72° ± 10) of pronation and 33° (pre-op: 43° ± 26; post-op: 76° ± 13) of supination. There was no correlation between the amount and direction of malformation and the change in ROM. Conclusions:The most noticeable malunion after forearm fractures treated with the ESIN technique is in the rotational direction. Patient-specific corrective osteotomy of pediatric forearm malunion following forearm fracture fixation with ESIN achieves significant improvement in forearm range of motion. Clinical relevance:The findings are clinically relevant since forearm fractures are the most common pediatric fracture, affecting a large number of patients who can benefit from the findings of this study. It has the potential to raise awareness of the significance of the accurate rotational component of intraoperative bone alignment in the ESIN procedure.

Trimalleolar fractures are difficult to treat and malreduction can lead to functional impairment. Involvement of the posterior malleolus has a poor predictive value. Current computed-tomography (CT)-based fracture classifications led to an increase in fixation of the posterior malleolus. The aim of this study was to describe the functional outcome after a two-stage stabilisation with direct fixation of the posterior fragment in trimalleolar dislocation fractures. In a retrospective study, all patients presenting with a trimalleolar dislocation fracture, an available CT scan, and a two-stage operative stabilisation including the posterior malleolus by a posterior approach were included. All fractures were treated with initial external fixator and delayed definitive stabilisation including fixation of the posterior malleolus. Next to clinical and radiological follow-up, outcome measures (Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS), Activity of Daily Living (ADL), Hulsmans implant removal score) and complications were analysed. Between 2008 and 2019, of 320 trimalleolar dislocation fractures, 39 patients were included. Mean follow-up was 49 months (standard deviation (SD) 29.7, range 16–148). Mean age was 60 years (SD 15.3, 17–84) with 69% female patients. The mean FAOS was 93/100 (SD 9.7, 57–100), NRS 2 (interquartile range (IQR) 0–3) and ADL 2 (IQR 1–2). Four patients showed a postoperative infection, three re-operations had to be performed and implants were removed in 24 individuals. A two-stage procedure of trimalleolar dislocation fractures with in-direct reduction and fixation of the posterior tibial fragment through a posterior approach leads to good functional outcome scores with a low rate of complications.

In recent years a trend from conservative to operative treatment of displaced scapula fractures has evolved. The aim of this study was to assess surgical and patient-based radiological and functional outcome after open reduction and internal fixation (ORIF) of displaced scapula fractures following predefined operative indications. We retrospectively analyzed data of a consecutive series of patients with displaced scapula fractures following operative fixation at our institution between 06/2010 and 02/2020. The primary endpoint was a functional outcome using the QuickDASH score. Secondary outcomes were the Subjective Shoulder Value (SSV), numeric rating scale (NRS) for pain, Activities of Daily Living score (ADL) and complications. Twenty-six male patients were treated operatively. Twenty-three of whom were available for follow-up after a median follow-up time of 33 months (interquartile range [IQR] 8–70 months). In 18 (69%) cases a standard open approach and in 8 (31%) cases a minimal invasive (MI) approach was used. The median QuickDASH was 0 (IQR 0–0) with a median SSV of 95 (IQR 90–98). Patients reported a median NRS of 0 (IQR 0–1) and a median ADL score of 1 (IQR 1–1). Radiological fracture union was 100% without the occurrence of implant failure or mal-union. Two patients (7.7%) required early correction osteosynthesis, one patient (3.8%) developed a frozen shoulder 3 months postoperatively, and one patient (3.8%) presented with a superficial wound infection. Following previously published indications for ORIF of displaced scapula body and neck fractures a good functional outcome and a low rate of complications could be achieved.

Purpose Adolescent idiopathic scoliosis (AIS) affects up to 3% of otherwise healthy adolescents. The extreme long-term outcomes of nonoperative treatment are underreported. This study aimed to investigate the long-term outcome of nonoperative-treated AIS patients. Comparison between a bracing and an observation approach were performed. Methods In a retrospective cohort study, 20 nonoperatively treated AIS patients were observed concerning patient-related outcome measures (PROM) (visual analog scale (VAS), Short Form Health Survey 36 item (SF 36), Scoliosis Research Society (SRS 24), Oswestry Low Back Pain Disability Index (ODI), Psychological General Well-Being Index (PGWBI)), radiological curve progression and health-related quality of life (HRQoL). Baseline characteristics and radiological imaging were collected. At follow-up, anteroposterior and lateral X-rays as well as questionnaires were analyzed. Results Twenty patients (16 females, mean age: 14.6 ± 3.2 years) with a follow-up time of 42 ± 9 years were included. Nine patients (initial Cobb 35° ± 19°) were treated with bracing for a mean time of 26 ± 9 months, while the other 11 patients (initial Cobb 29° ± 11°) were observed. The primary curve progressed from 32° ± 15° to 52° ± 25° in average with no significant difference between the cohorts ( p = 0.371). At final follow-up, a mean ODI score of 7 ± 7.9 points with no difference depending on the treatment ( p = 0.668) was seen. No significant differences were observed for PROMs. Curve magnitude correlated neither at diagnosis ( p = 0.617) nor at follow-up ( p = 0.535) with the ODI score at final follow-up. Conclusion After a mean of 42 years, patients with nonoperative treatment of moderate AIS demonstrated a good clinical outcome despite progression of the deformity. Level of evidence Level IV, therapeutic study.

Abstract Background Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints. Methods Computer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)). Results Ten patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98). Conclusion The use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.

The aim of this study was to describe the nonoperative treatment outcomes of finger flexor tenosynovitis in sport climbers and to evaluate the association with baseline measures and therapy contents. Sixty-five sport climbers (49 males, mean age 34.1 years) diagnosed with tenosynovitis of the finger flexors were retrospectively asked about injury triggers, therapy contents and outcomes. Pulley thickness was measured by ultrasound. All patients were initially treated conservatively, and only one of the patients needed further therapy (single injection with hyaluronic acid); none of them underwent surgical treatment. The most frequently applied therapy was climbing-related load reduction (91%). The treatment resulted in a statistically significant reduction in pain intensity during climbing (before/after therapy ratio [Visual Analog Scale (VAS)/VAS] = 0.62, 95% CI = 0.55, 0.68). The average duration of the symptoms was 30.5 weeks (range 1–120 weeks). In a multiple linear regression analysis, initial daily life pain intensity and a climbing level higher than 7b according to the French/sport grading scale were the only predictive parameters for the relative change in pain intensity and symptom duration, respectively. All patients were able to resume climbing, with 75% regaining or even exceeding their initial climbing level. The good to excellent outcomes and no correlation between particular therapy contents and therapy outcome may suggest that finger flexor tenosynovitis in sport climbers has a favorable natural course without requiring invasive therapy. However, further cohort studies and, ultimately, randomized controlled trials are needed to conclusively confirm our promising observations.

BACKGROUND:Fully absorbable polymeric scaffolds, as a potential alternative to permanent metallic stents, are entering the clinical field. The aim of this study is to assess the in vivo biocompatibility of a novel Sirolimus-eluting (SIR) absorbable scaffold based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for interventional application. METHODS:Absorbable PLLA/P4HB scaffolds either loaded with SIR coating or unloaded scaffolds were implanted interventionally into common carotid arteries of 14 female. Bare metal stents (BMS) served as control. Peroral dual anti-platelet therapy was administered throughout the study. Stented common carotid arteries segments were explanted after 4 weeks, and assessed histomorphometrically. RESULTS:The absorbable scaffolds showed a decreased residual lumen area and higher stenosis after 4 weeks (PLLA/P4HB: 6.56 ± 0.41 mm² and 37.56 ± 4.67%; SIR-PLLA/P4HB: 6.90 ± 0.58 mm² and 35.60 ± 3.15%) as compared to BMS (15.29 ± 1.86 mm² and 7.65 ± 2.27%). Incorporation of SIR reduced the significantly higher inflammation of unloaded scaffolds however not to a level compared to bare metal stent (PLLA/P4HB: 1.20 ± 0.19; SIR-PLLA/P4HB: 0.96 ± 0.24; BMS: 0.54 ± 0.12). In contrast, the BMS showed a slightly elevated vascular injury score (0.74 ± 0.15), as compared to the PLLA/P4HB (0.54 ± 0.20) and the SIR-PLLA/P4HB (0.48 ± 0.15) groups. CONCLUSION:In this preclinical model, the new absorbable polymeric (SIR-) scaffolds showed similar technical feasability and safety for vascular application as the permanent metal stents. The higher inflammatory propensity of the polymeric scaffolds was slightly reduced by SIR-coating. A smaller strut thickness of the polymeric scaffolds might have been a positive effect on tissue ingrowth between the struts and needs to be addressed in future work on the stent design.

Midshaft clavicle fractures represent about 4% of all fractures in the emergency department. Non-operative treatment of displaced midshaft clavicle fractures (DMCF) can result in a relatively high non-union rate. Several operative techniques, including intramedullary fixation (IMF) using elastic stable intramedullary nailing (ESIN), have therefore been established. IMF through the medial approach is less suitable for fractures of the lateral diaphysis. IMF of DMCF of the lateral diaphysis through a lateral approach can be an alternative approach for these fractures. The aim of this study is to describe the technique of IMF from the lateral side and to present the functional outcome and complications. A retrospective cohort study was performed. All patients with a traumatic DMCF treated with IMF using ESIN through a lateral approach between 2014 and 2019 were included. Endpoints were the functional outcome (QuickDASH, Subjective Shoulder Value (SSV)), pain (numeric rating scale (NRS)), daily impairment (activities of daily living (ADL)), complications and implant removal. Forty out of 43 patients were available for follow-up. Mean follow-up was 37 months. Mean age was 24 years (range 13–70). The median QuickDASH score was 0 (IQR 0.0–0.0) and the median SSV was 100 (95–100). The median ADL score was 1 (1–4) and the median NRS was 0 (0–0). No non-union occurred. Implant related irritation occurred in 11 patients (27.5%). Implants were removed in a total of 38 (95%) patients; in 10 cases due to irritation, in 28 cases routinely or on patient’s request. IMF of DMCF of the lateral diaphysis through a lateral approach leads to excellent functional results and seems to be a suitable option for internal fixation. However, as with IMF from the medial side, it is not without complications and implant-related irritation.

# Presentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spine {#article-title-2} Regular corticosteroid has become standard for slowing disease progression in Duchenne muscular dystrophy (DMD). However, patients must contend with the insidious side effect of osteopenia and