IntroductionIn this study, we used surface electromyography (EMG) electrodes in order to measure and compare activity in the neck, back and thigh muscles of soldiers wearing two different types of body armour. A secondary objective was to analyse shoulder and hip ranges of motion using inertial motion sensors.MethodsFourteen male soldiers were instructed to march 6 km on a treadmill while wearing different types of body armour. All participants wore shorts and a T-shirt and the same size vest regardless of their body size. We measured back and thigh muscle activity as well as shoulder and hip ranges of motion at regular intervals during the march.ResultsOver the course of a 6 km march, muscle activity was already increased to 1.3 to 2.0 times after putting on the vest and increased by up to 13 times during the march with equipment. The new vest with hip belt required higher levels of muscle activity.ConclusionsBody armour with hip belt placed higher levels of stress on back and neck muscles during a 6 km march than without. There was no major difference between the two types of body armour in terms of thigh muscle activity.Trial registration numberDRKS00016005.

INTRODUCTION:Carrying heavy loads and body armour may alter posture and increase the risk of low back pain in military personnel. This observational study aimed to assess how two designs of body armour affect posture and pain in German soldiers following loaded marches. METHODS:In this prospective observational study, 20 soldiers (male healthy volunteers) completed three 12-km marches under three conditions: without body armour (control), with old-design armour and with new-design armour featuring a hip belt. Spinal posture (forward trunk lean as primary outcome) and pain were assessed using video rasterstereography and visual analogue scales before and after each march. RESULTS:Significant differences in forward trunk lean were observed with new-design armour compared with control (mean difference 6.1 mm, p=0.006) and old-design armour (mean difference 5.4 mm, p=0.046). Pain increased significantly after marching with old-design armour (lumbar pain: p<0.01; thoracic pain: p=0.01), but not with the new-design armour. CONCLUSION:Body armour design notably affects spinal posture and pain. Although the new design increased forward trunk lean, it did not significantly increase pain, suggesting potential ergonomic advantages.

ObjectiveIntermittent claudication (IC) is known to be associated with impaired gait parameters, e.g. higher incidence of falls and higher oxygen consumption due to uneconomic walking. However, the influence of arterial desobliteration in patients with intermittent claudication (IC) on gait pattern has hardly been investigated so far. The aim of this study was to examine gait patterns before and after inflow revascularization by surgical desobliteration of pelvic and inguinal arteries (common iliac artery (CIA), external iliac artery (EIA), common femoral artery (CFA), profound femoral artery (PFA), superficial femoral artery (SFA)) in IC patients. Successful surgical desobliteration of inflow arteries (improvement of ankle-brachial-index (ABPI) 1 0,2 or more, patent CIA, EIA, CFA, PFA, SFA) is known to improve painless walking distance in patients with intermittent claudication (IC) due to peripheral arterial disease (PAD), but its influence on gait parameters is unclear. We hypothesized that gait parameters improve after operation as well. Improved gait parameters can lead to a more economic walking process, lower oxygen consumption, lower risk of falls and higher quality of life.MethodsIn a single-center exploratory longitudinal study, we examined gait parameters of 20 IC inpatients of our hospital before and after surgical desobliteration of pelvic and inguinal arteries. Spatiotemporal parameters such as range of motion (ROM) of hip and knee joint, stance phase, cadence, and foot rotation were obtained using the “Diers 4D motion Lab®”. Gait parameters were obtained under painful walking conditions preoperatively and walking pain free at the same speed postoperatively.ResultsA total of 20 patients were examined. Surgical revascularization led to a higher walking cadence (mean plus 7,88 steps, 95.5 steps/min vs 87.6; p =0,024), an increased ROM of the hip joint (mean plus 2°, 35.1° vs 33.1°; p =0.038) and improved foot rotation (mean plus 2,0°, 11.0° vs 9.0°; p=0.02). Regarding other parameters such as step length, stance phase and step duration smaller differences could be detected in this study.ConclusionsIn this exploratory study, we were able to see that surgical revascularization of pelvic and inguinal arteries in IC patients improved certain gait parameters. Further studies with larger patient numbers are needed to confirm this data and provide more evidence on this subject.

Purpose Damage control orthopaedics (DCO) und early total care (ETC) are well-established strategies for managing severely injured patients. There is no definitive evidence of the superiority of DCO over ETC in polytrauma patients. We conducted this study to assess the probability of a polytraumatised patient undergoing DCO. In addition, the effect of DCO on complications and mortality was investigated. Methods We analysed data from 12,569 patients with severe trauma (Injury Severity Score ≥ 16) who were enrolled in the trauma registry of the German Trauma Society (TraumaRegister DGU ® ) from 2009 to 2016 and had undergone surgery for extremity or pelvic fractures. These patients were allocated to a DCO or an ETC group. We used the propensity score to identify factors supporting the use of DCO. For a comparison of mortality rates, the groups were stratified and matched on the propensity score. Results We identified relevant differences between DCO and ETC. DCO was considerably more often associated with packed red blood cell (pRBC) transfusions (33.9% vs. 13.4%), catecholamine therapy (14.1% vs. 6.8%), lower extremity injuries (72.4% vs. 53.5%), unstable pelvic fractures (41.0% vs. 25.9%), penetrating injuries (2.8% vs. 1.5%), and shock (20.5% vs. 10.8%) and unconsciousness (23.7% vs. 16.3%) on admission. Based on the propensity score, patients with penetrating trauma, pRBC transfusions, unstable pelvic fractures, and lower extremity injuries were more likely to undergo DCO. A benefit of DCO such as reduced complications or reduced mortality was not detected. Conclusion We could identify some parameters of polytrauma patients used in the trauma registry (Traumaregister DGU ® ), which led more likely to a DCO therapy. The propensity score did not demonstrate the superiority of DCO over ETC in terms of outcome or complications. It did not appear to adequately adjust for the variables used here. Definitive evidence for or against the use of DCO remains unavailable.

Background Demographic change entails an increasing incidence of fragility fractures. Dual-energy CT (DECT) with virtual non-calcium (VNCa) reconstructions has been introduced as a promising diagnostic method for evaluating bone microarchitecture and marrow simultaneously. This study aims to define the most accurate cut-off value in Hounsfield units (HU) for discriminating the presence and absence of bone marrow edema (BME) in sacral fragility fractures. Methods Forty-six patients (40 women, 6 men; 79.7 ± 9.2 years) with suspected fragility fractures of the sacrum underwent both DECT (90 kVp / 150 kVp with tin prefiltration) and MRI. Nine regions-of-interest were placed in each sacrum on DECT-VNCa images. The resulting 414 HU measurements were stratified into “edema” ( n = 80) and “no edema” groups ( n = 334) based on reference BME detection in T2-weighted MRI sequences. Area under the receiver operating characteristic curve was calculated to determine the desired cut-off value and an associated conspicuity range for edema detection. Results The mean density within the “edema” group of measurements (+ 3.1 ± 8.3 HU) was substantially higher compared to the “no edema” group (-51.7 ± 21.8 HU; p < 0.010). Analysis in DECT-VNCa images suggested a cut-off value of -12.9 HU that enabled sensitivity and specificity of 100% for BME detection compared to MRI. A range of HU values between -14.0 and + 20.0 is considered indicative of BME in the sacrum. Conclusions Quantitative analysis of DECT-VNCa with a cut-off of -12.9 HU allows for excellent diagnostic accuracy in the assessment of sacral fragility fractures with associated BME. A diagnostic “one-stop-shop” approach without additional MRI is feasible.

Abstract Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008 – 2009: 5.0% vs. 2015 – 2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: − 3.66 vs. − 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher-grade fractures after FFP. Zusammenfassung Hintergrund Innerhalb der Fragilitätsfrakturen des Beckens (Fragility Fractures of the Pelvis, FFP) existieren mit der Fraktur nach niedrigenergetischem Trauma und der Insuffizienzfraktur ohne Trauma 2 Frakturentitäten. Unklar ist, ob sich beide Subgruppen bez. Diagnostik und Therapie differenzieren. Ziel dieser retrospektiven Studie war es, die Insuffizienzfrakturen hinsichtlich definierter Parameter zu evaluieren und spezifische Parameter mit den Frakturen nach niedrigenergetischem Trauma zu vergleichen. Patienten und Methoden Im Zeitraum von 2008 bis 2017 waren an unserer Klinik (überregionales TraumaZentrum DGU, SAV-Zulassung) 203 Patienten mit FFP zu verzeichnen. Davon hatten 25 eine Insuffizienzfraktur und 178 eine Beckenringfraktur nach niedrigenergetischem Trauma. Beleuchtet wurden epidemiologische, diagnostische und therapeutische Parameter. Ergebnisse Es zeigte sich eine relative Zunahme der Insuffizienzfraktur innerhalb der FFP (2008 – 2009: 5,0% vs. 2015 – 2017: 17,8%). Bei diesen Patienten war tendenziell eine ausgeprägtere Osteoporose im Vergleich zu Patienten nach niedrigenergetischem Trauma (t-Wert: − 3,66 vs. − 3,13) festzustellen. Diagnostisch zeigte sich bei Insuffizienzfrakturen ein vermehrter Einsatz von MRT und DECT (60,9 vs. 26,0%) und ein hoher Anteil an Typ-IV-Frakturen nach FFP (40,0 vs. 7,9%). Therapeutisch wurde häufiger eine operative Versorgung der Insuffizienzfraktur angestrebt (68,2 vs. 52,1%) mit tendenziell vermehrtem Einsatz kombinierter Osteosyntheseverfahren (14,3 vs. 7,6%). Schlussfolgerung Wir konnten zeigen, dass bei steigenden Fallzahlen die Insuffizienzfraktur innerhalb der FFP an Bedeutung gewinnt. Bei einer tendenziell ausgeprägteren Osteoporose dieser Patienten sollte insbesondere bei der Insuffizienzfraktur das Augenmerk auf die Diagnostik und adäquate Therapie der Osteoporose gelegt werden. Bemerkenswert ist neben der vermehrten Diagnostik mittels MRT und DECT zum Ödemnachweis und der vermehrten operativen Therapie bei dieser Frakturentität aber auch, dass die Insuffizienzfraktur höhere Frakturschweregrade nach FFP hervorrufen kann.

Background Fragility fractures of the pelvis (FFP) encompass two fracture entities: fracture after low-energy trauma and insufficiency fracture without trauma. It is unclear whether the two subgroups differ in terms of diagnosis and therapy. The aim of this retrospective study was to evaluate insufficiency fractures with regard to defined parameters and to compare specific parameters with the fractures after low-energy trauma. Patients and Methods In the period from 2008 to 2017, 203 patients with FFP were recorded at our clinic (Level 1 Trauma Centre DGU, SAV approval). Of these, 25 had an insufficiency fracture and 178 had a pelvic ring fracture after low-energy trauma. Epidemiological, diagnostic and therapeutic parameters were examined. Results There was a relative increase in the insufficiency fracture within the FFP (2008-2009: 5.0% vs. 2015-2017: 17.8%). In these patients, osteoporosis tended to be more pronounced than in patients after low-energy trauma (t-value: - 3.66 vs. - 3.13). The diagnosis of insufficiency fractures showed increased use of MRI and DECT (60.9% vs. 26.0%) and a high proportion of type IV fractures after FFP (40.0% vs. 7.9%). In terms of therapy, surgical treatment of the insufficiency fracture was sought more often (68,2% vs. 52,1%), with a tendency towards increased use of combined osteosynthesis procedures (14.3% vs. 7.6%). Conclusion We were able to show that as the number of cases increases, the insufficiency fracture becomes more important within FFP. If these patients tend to have more pronounced osteoporosis, particular attention should be paid to the diagnosis and adequate therapy of the osteoporosis, especially in the case of an insufficiency fracture. In addition to the increased diagnostic testing using MRI and DECT to detect oedema and the increased surgical therapy for this type of fracture, it is also noteworthy that the insufficiency fracture can cause higher- grade fractures after FFP.

Background Pelvic ring fractures type C present a special challenge due to their high instability, the possible accompanying injuries and the high mortality rate of up to 18.9%. The aim of this retrospective analysis was to use the data from the DGU pelvic register to identify changes in the epidemiology and therapy for type C pelvic ring fractures between 2004 and 2014. Materials and Methods 2,042 patients with type C pelvic ring injury were retrospectively included. Three time periods with roughly equal patient groups were specified and differences in epidemiology and the type of therapy were evaluated. For the surgical cases, the time of the operation, the duration of the operation, blood loss, the location of the fracture and the type of osteosynthesis were evaluated and the reduction result was recorded. Results For the period under review, there is an age shift in the incidence of a type C pelvic ring fracture towards older age. The isolated pelvic injury has increased, while the proportion of pelvic injuries in the context of polytrauma has steadily decreased. Complications and mortality decreased as a percentage. The tendency towards minimally invasive procedures could be shown in the surgical care. Navigated procedures in the area of the pelvic ring have so far not proven successful. Conclusions We were able to show that the majority of the patients are increasingly old, that there is no relevant trauma in the history and that there is an increase in the isolated pelvic fracture type C and a decrease in the number of polytraumatised or multiply injured patients. In conjunction with mortality from pelvic ring injuries, the successes of standardised, pelvic-specific emergency management, an adapted time of operation outside the vulnerable phase and stable osteosynthesis care, which enable early functional follow-up treatment, are also evident.

Bei Fragilitätsfrakturen des Beckenringes (FFP) vom Typ IV und den traumatischen Beckenfrakturen Typ C besteht häufig eine spinopelvine Instabilität. Daraus ergibt sich die Indikation zur operativen Stabilisierung mittels einer spinopelvinen Abstützung. Unklar ist aufgrund diverser operativer Verfahren zur spinopelvinen Abstützung, welche Bedeutung hierbei eine minimal-invasive spinopelvine Schrauben-Stab-Osteosynthese haben kann. In die retrospektive, klinische Studie wurden über einen Zeitraum von 2 Jahren 23 Patienten (Median 67 Jahre, 5 m und 18 f) mit instabiler Beckenfraktur (FFP Typ IV: n = 12, AO/OTA Typ C: n = 11) mittels triangulärer minimal-invasiver spinopelviner Stabilisierung (TMSS) in die Studie eingeschlossen. Die Patientendaten wurden hinsichtlich der Parameter Geschlecht, Alter, Frakturmorphologie, intraoperativer Blutverlust, Operationszeit, postoperativer Infekt, postoperatives Repositionsergebnis (im CT) sowie Schraubenlockerung untersucht. Das Durchschnittsalter der 11 Typ-C-Frakturen lag bei 43 Jahren und das der 12 FFP Typ IV bei 80 Jahren. Der Nachuntersuchungszeitraum betrug im Durchschnitt 12,2 Monate. Die durchschnittliche Operationszeit lag bei 67 min, der Blutverlust bei 70 ml, es gab 2 postoperative Infekte und 4 Schraubenlockerungen. Die Reposition nach Matta war bei allen FFP < 4 mm, bei den traumatischen Beckenfrakturen zwischen 4 und 20 mm. Symptomatische Pseudarthrosen traten in 3 Fällen auf. Die TMSS zeigte eine stabile und suffiziente Versorgung der Fragilitätsfrakturen Typ IV und bei den gering dislozierten traumatischen Becken-C-Frakturen. Grobe Frakturdislokationen limitieren das Verfahren.

Introduction As the average age of society increases, so does the number of cases of fragility fractures of the pelvis (FFP). Magnetic resonance imaging (MRI) can visualise associated oedema and is thus the gold standard for diagnosing such fractures. MRI, however, is costly, not always available, and involves certain exclusion criteria. Dual-energy computed tomography (DECT) appears to be a promising alternative. It is unclear, however, whether it could be used for diagnosing FFP with similar sensitivity/specificity. The aim of our study was thus to compare conventional CT and DECT with MRI in cases of suspected FFP. Materials and methods A total of 46 patients with suspected FFP underwent MRI, CT and DECT scans. There were three comparison groups for each of these patients: conventional CT image analysis without dual-energy modification (Arm 1), DECT analysis (Arm 2) and MRI as the gold standard (Arm 3). Diagnosis and FFP classification were performed by a radiologist in random order and without clinical information. The sensitivity and specificity of conventional CT and DECT were calculated in comparison with MRI as the reference standard. Results With 100% sensitivity and specificity, DECT is on par with MRI when it comes to diagnosing fragility fractures of the pelvis and is superior to conventional CT (90.3% sensitivity, 100% specificity). In terms of classification as well, there were no differences between DECT and MRI. On conventional CT, on the other hand, 16 patients were classified differently than they were on MRI. Conclusions Our study shows DECT to be reliable and superior to conventional CT in terms of oedema detection and specific fracture classification in FFP. DECT thus combines the advantages of conventional CT (good visualisation of bone matter) and MRI (medullary cavity and visualisation of occult fractures).

INTRODUCTION:The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options - sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) - has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. MATERIALS AND METHODS:We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. RESULTS:The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 - 2009: 5.3% vs. 2015 - 2017: 60.3%). CONCLUSION:We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

Introduction Isolated pelvic fractures are relatively rare with an incidence of 3-6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures - with adequate as well as inadequate trauma. Material and Methods In a retrospective clinical study, a total of 140 patients (median 68 years, range 15-97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups "with MRI" and "without MRI" were analyzed with regard to the parameters "sex", "age", "adequacy of the trauma", "fracture localization", "duration of admission to imaging", "type of therapy" and "duration to surgery" compared. Results It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19-94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision "conservative" vs. "operationally" our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI. Conclusions Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.

Background Meniscus injuries lead to increased knee joint instability. Currently, however, it is unclear whether a relevant medial meniscus part resection leads to an increased ventral tibia translation with intact anterior cruciate ligament. The aim of our study was therefore to clinically examine the stabilizer function of at least 30% resected medial meniscus for anterior tibial translation. Materials and methods In this prospective study, 18 patients with unilateral medial meniscus lesion were treated before and after arthroscopic medial meniscus resection. They were treated on the healthy and on the sick leg through the use of two different apparatus methods (dynamic translation measurement using hamstring reflex apparatus and KT-1000 arthrometers) as well as a functional test (computer-supported dynamic posturography (CDP)) and a clinical hop test. Further, the mean values for significance using non-parametric Wilcoxon test. Results After completing all the studies, we were not able to detect any significant differences in our study that would indicate increased ventral instability in the knee joint after arthroscopic medial meniscus resection. Conclusions Inner meniscal partial resection does not lead to increased ventral knee instability in intact VKB. Whether in patients with instability (feeling) after partial meniscus resection, a rotation instability is the cause or whether further injuries or disturbances in the capsular ligament apparatus are present, must be examined in further studies. Anterior knee joint instability cannot be adequately explained according to our study.

BACKGROUND:Fractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial.METHODS:In a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons.RESULTS:Of 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21).CONCLUSIONS:The results of this study further support the value of bone marrow edema detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.

Introduction Apophyseal avulsion fractures of the ischial tuberosity are rare injuries and therefore often not diagnosed in a timely manner. Healing may then result in massive hypertrophic ischial tuberosity. This can cause ischiofemoral impingement symptoms. Due to the low incidence and scarce literature, the optimal treatment and surgery is unclear. Materials and Methods A literature search was carried out using the online medical database "PubMed". The findings of the literature were then applied to a clinical case of delayed diagnosis of the apophyseal avulsion fracture of the ischial tuberosity. Results There is no gold standard in the literature for the treatment of avulsion fractures on the ischial tuberosity. Nearly 90% are treated conservatively and a fragment dislocation of more than 2 cm is often the indication for surgical care. However, the surgical procedures described are very diverse. An ischiofemoral impingement symptom may result from excessive ossification of the ischial tuberosity, bringing the ischiofemoral distance to the critical limit of 2 cm. Conclusions The timely correct diagnosis and initiation of a therapy is crucial for the later outcome of the patient. Ischiofemoral impingement symptoms may be the indication of bony displacement of the ischial tuberosity as a result of injury. Therapy is then surgical with partial resection of the ischial tuberosity and plate osteosynthesis.

Fragestellung: Die Inzidenz von Beckenfrakturen ist gering (0,3 -8%), zeigt jedoch uber die letzten zwei Dekaden einen deutlichen Anstieg. Dies ist nicht nur aufgrund traumatisch bedingter Frakturen, sondern im Speziellen auch wegen osteoporotisch bedingter Fragilitatsfrakturen relevant.[zum vollstandigen Text gelangen Sie uber die oben angegebene URL]

Abstract Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy. Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting. Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisherʼs Exact Test found that the parameters “adequacy of trauma” and “fracture type change” by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma. Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed. Zusammenfassung Hintergrund Zwar wurden Magnetresonanz- und Computertomografie (MRI, CT) bereits hinsichtlich ihrer Sensitivität zur Detektion von Beckenfrakturen miteinander verglichen. Unklar ist jedoch, ob der unterstellte diagnostische Mehrgewinn aus der MRT-Bildgebung gegenüber der CT auch zur Therapieänderung führt. Ziel unserer Studie war es daher, den Informationszugewinn aus der MRT gegenüber der CT in der Diagnostik von Beckenfrakturen zu erfassen und eventuelle Auswirkungen der Mehrinformation auf das Therapieregime herauszustellen. Patienten und Methoden Im Rahmen einer retrospektiven, klinischen Studie wurden 31 Patienten mit Beckenfraktur und CT- sowie MRT-Bildgebung (Median 81 ± 20 Jahre, 22 weiblich und 9 männlich) untersucht. Es erfolgte eine Einteilung nach AO-Klassifikation für adäquate bzw. FFP-Klassifikation für inadäquate Frakturen. Zudem wurden vaskuläre, muskuläre, hämatomatöse und organische Begleitverletzungen sowie Knochenmarködeme und abklärungsbedürftige Nebenbefunde evaluiert. Die Art der Therapie (konservativ vs. operativ) und ein eventueller Therapieartwechsel wurden für jeden Patienten dokumentiert. Mithilfe des Exakten Tests nach Fisher wurde orientierend getestet. Ergebnisse Insgesamt zeigte die MRT bei 29% (n = 9) der Patienten ein größeres Frakturausmaß der Beckenfrakturen als die CT. Vier Typ-I-Frakturen nach FFP-Klassifikation wurden als Typ-II-Frakturen und 4 Typ-II-Frakturen als Typ-IV-Frakturen erkannt. Eine Typ-B1-Fraktur nach AO-Klassifikation zeigte sich in der MRT als C2-Fraktur. Der Exakte Test nach Fisher ergab für die Parameter „Adäquatheit eines Traumas“ und „Änderung des Frakturtyps“ durch die MRT p = 0,38. Die MRT zeigte insgesamt 82 Begleitverletzungen an, die CT 31. Insgesamt zeigte sich ein Informationszugewinn durch die MRT bei 75% (n = 24) aller untersuchten Patienten. Ein Wechsel von konservativ auf operativ nach der MRT fand bei 2 Patienten statt. Kein Patient wurde von geplant operativ auf konservativ umgestellt. Inwiefern die MRT Änderungen innerhalb einer Therapieform (konservativ, operativ) bewirkte, konnte retrospektiv nicht festgestellt werden. Bei 18% der Patienten mit inadäquater Fraktur hätte sich aber pro forma laut Literatur mit dem Klassifikationstyp auch das Therapieregime ändern müssen. Schlussfolgerung Zusammenfassend kann man festhalten, dass die MRT in unserer Studie einen Informationszugewinn bei adäquaten und inadäquaten Beckenfrakturen sowie deren Begleitverletzungen lieferte und sich eine mögliche Therapierelevanz dieses Informationszugewinnes vor allem bei den inadäquaten Frakturen zeigte.

Meniskusverletzungen führen zu einer fraglich erhöhten Kniegelenksinstabilität. Bisher ist aber unklar, ob eine relevante Innenmeniskusteilresektion zu einer vermehrten ventralen Tibiatranslation bei intaktem vorderem Kreuzband führt. Ziel unserer Studie war es daher, die Stabilisatorfunktion eines um mindestens 30 % resezierten Innenmeniskus für die anteriore Tibiatranslation klinisch zu untersuchen. Im Rahmen dieser prospektiven Studie wurden 18 Patienten mit unilateraler Innenmeniskusläsion vor und nach arthroskopischer Innenmeniskusteilresektion am gesunden und kranken Bein mittels zwei verschiedener apparative Verfahren (dynamische Translationsmessung mittels Hamstring-Reflexapparatur und KT-1000 Arthrometer) sowie einem funktionellen Test (computergestützte dynamische Posturographie [CDP]) und einem klinischen Hop-Test untersucht und die Mittelwerte mittels nichtparametrischem Wilcoxon-Test auf Signifikanzen überprüft. Nach Abschluss aller Untersuchungen konnten wir in unserer Studie keine signifikanten Unterschiede nachweisen, die auf eine vermehrte ventrale Instabilität im Kniegelenk nach arthroskopischer Innenmeniskusteilresektion hinweisen. Die Innenmeniskusteilresektion führt bei intaktem VKB zu keiner vermehrten ventralen Kniegelenksinstabilität. Ob bei Patienten mit Instabilität(sgefühl) nach Meniskusteilresektion eine Rotationsinstabilität die Ursache ist oder ob weitere Verletzungen bzw. Störungen im Kapsel-Band-Apparat vorliegen, muss in weiteren Studien untersucht werden. Eine ventrale Kniegelenksinstabilität kann gemäß unserer Studie nicht hinreichend erklärt werden kann.

Abstract Introduction Chronic distal biceps tendon ruptures are rare and conservative or operative treatment options are suitable. There is a consensus in the literature in case of acute traumatic ruptures the operative refixation should be preferred. Disagreement exists in the best way of care of old ruptures (> 4 weeks) of distal biceps tendon. Several kinds of refixation possibilities up to tendon grafts are described. Aim of this publication is showing an overview of the literature of the approved methods in reconstruction of the distal biceps tendon using autogenous and allogenic grafts, comparing the outcomes and transferring them on an own case. Material and Methods A literature research was carried out using the online medical database “PubMed” with the following keywords “chronic rupture distal biceps tendon, surgical techniques”. 59 citations were found concerning the topic, 37 publications were relevant for this work. Results There is consensus that even in chronic ruptures the operative management of the distal biceps tendon generates the best results. Consistently the experiences and results of only little patient collectives are reported. Numerous techniques of surgery are described without predominance of one method. Reinsertions of the tendon butts are reported in different techniques: with achilles, palmaris longus, fascia lata, triceps, quadriceps and semitendinosus tendon grafts. All together they showed postoperative satisfactory results. Conclusion With surgical treatment of chronic ruptured distal biceps tendons comparable outcomes can be achieved by primary refixation and graft augmentations. In case of graft augmentations several tissue options are available which showed in all cases satisfactory functional results in the end. Zusammenfassung Einleitung Die chronische distale Bizepssehnenruptur ist immer noch eine Rarität, bei der konservative wie operative Behandlungsoptionen Anwendung finden. In der Literatur ist man sich einig, dass bei akut traumatischen Rupturen aufgrund des besseren funktionellen Outcomes der operativen Refixation Vorzug zu geben ist. Uneinigkeit herrscht vor allem hinsichtlich operativer Versorgungsoptionen veralteter (> 4 Wochen) Rupturen der distalen Bizepssehne. Beschrieben werden in der Literatur verschiedenste Refixationsmöglichkeiten bis hin zu diversen überbrückenden Sehnenplastiken. Ziel dieser Arbeit ist es, einen Überblick über die in der Literatur anerkannten Methoden zur Rekonstruktion der distalen Bizepssehne unter Verwendung autologer und allogener Transplantate zu geben, deren Outcome zu vergleichen und die Erkenntnisse auf einen aktuellen eigenen Fall zu übertragen. Material und Methoden Es erfolgte eine Literaturrecherche mithilfe der medizinischen Onlinedatenbank „PubMed“. Nach englischer Eingabe der Suchbegriffe „chronic rupture distal biceps tendon, surgical techniques“ wurden 59 Literaturstellen gefunden (1990 – 2019). Für die Thematik der Rekonstruktion chronisch distaler Bizepssehnenrupturen konnten sodann 37 Publikationen im Volltext ausgewählt und für die aktuelle Veröffentlichung berücksichtigt werden. Ergebnisse Konsens besteht darin, dass auch bei chronischen Rupturen die operative Versorgung der distalen Bizepssehne die besten Ergebnisse erbringt. Durchweg finden sich jedoch nur kleine Patientenkollektive, über deren Ergebnisse und Erfahrungen berichtet wird. Zahlreiche Operationstechniken werden berichtet, ohne dass sich eine den anderen überlegen zeigt. Dabei werden Re-Insertionen der Sehnenstümpfe mittels verschiedener Transplantattechniken berichtet: Anwendung finden Achillessehnen-, Palmaris-longus-, Fascia-lata-, Trizepssehnen-, Quadrizepssehnen- und Semitendinosussehnentransplantate. Allen gemein ist, dass postoperativ sehr zufriedenstellende Funktionen und nahezu altes Kraftpotenzial erzielt werden konnte. Schlussfolgerung Durch die operative Versorgung chronisch rupturierter distaler Bizepssehnen können mittels primärer Refixation des Sehnenstumpfes wie aber auch durch Transplantataugmentation gleichwertige Ergebnisse erzielt werden. Im Falle notwendiger Transplantataugmentation sind zahlreiche Gewebeoptionen obligat, die im Rahmen kleiner Fallzahlen durchweg gute funktionelle Ergebnisse erwarten lassen.

Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy. Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 +/- 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting. Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisher's Exact Test found that the parameters "adequacy of trauma" and "fracture type change" by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma. Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.