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

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

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

BackgroundSimple elbow dislocations in childhood are rare. Nevertheless, they have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.AimThe purpose of the study was to review the literature and to derive arecommendation for the best treatment concept.Material and methodsAsystematic literature search was performed via Ovid Medline, whereby 1645 publications were identified (initially nonspecific for age) and evaluated in a stepwise approach. Of these publications four met the inclusion criteria of the authors. The analysis was carried out descriptively and in ameta-analysis.ResultsThe 4publications included described simple elbow dislocations in 81children (16years). The weighted average age was 9.9years with agender ratio of 3.8 (boys:girls). The median follow-up was 49months. Posterior and posterolateral dislocations were the most common with 73%. In 69children the treatment was conservative and of these 66 were immobilized for longer than 2weeks after closed reduction. The 12children who had surgical treatment suffered dislocations that had not been reduced for longer than 3weeks. The success rate of the conservatively treated immobilized group was 88%, of the conservatively treated non-immobilized group 70% and of the surgical group 42%. The differences between the success rates of the treatment methods was significant (p=0.032).ConclusionSimple elbow dislocations in children are rare. They most commonly occur in posterior and posterolateral directions. The prognosis is favorable; however atimely diagnosis and correct reduction are relevant for agood outcome.

Pelvic lateral compression fractures are the most stable of the unstable fractures. Therefore, decision making regarding operative or non-operative therapy is still a matter of debate. Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single Level-1 trauma center. The analysis included epidemiological records such as age and gender, and injury characterizing parameters such as degree of displacement and the Injury Severity Score (ISS). In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d’Aubigne and the EQ. 5D-3 L scores. Over an 11-year period (2004–14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures (33%). After excluding patients with clear indications for operation (complex pelvic fractures and pubic symphysis ruptures) and pediatric fractures, 114 patients could be included in the analysis. Sixty-one patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger (43.7 vs 58.3 years), had higher ISS (19.9 vs 15.5 points) and fracture displacements (2.3 vs 4.9 mm) (p < 0.001 for all). The length of hospital stay was shorter in the conservatively treated group (12.7 vs 17.3 days, p < 0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d’Aubigne and EQ. 5D-3 L scores were not different in the matched cohorts. Decision-making for operative therapy was favored in severely injured young patients with high displacement. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients. DRKS, no. 00000488 . Registered 14th July 2010 - Retrospectively registered

Die einfache Ellenbogenluxation im Kindesalter ist eine seltene Verletzung. Dennoch sie hat eine hohe Relevanz, da Folgeschäden und Bewegungseinschränkungen verbleiben können. Die Therapieoptionen werden kontrovers diskutiert.

Bei der Unterschenkelschaftfraktur handelt es sich um die häufigste Schaftfraktur im Kindesalter. Die Inzidenz wird in der Literatur mit 5,8 % angegeben. Unverschobene Tibiaschaftfrakturen können konservativ behandelt werden, instabile vollständige Unterschenkelschaftfrakturen werden häufig operiert. An Verfahren kommen hier die elastisch-stabile intramedulläre Nagelung (ESIN), der Fixateur externe und (eingeschobene) Plattenosteosynthesen zum Einsatz. Als Komplikation muss v. a. an das Kompartmentsyndrom gedacht werden, welches im Kollektiv der operierten Kinder häufiger Auftritt. Außerdem kann es zu Beinlängendifferenzen kommen. Insgesamt ist die Prognose bei richtiger Behandlung sehr gut.

Kindliche und adoleszente Schaftfrakturen an der unteren Extremität sind keine seltene Verletzung. Der Unterschenkel ist häufiger betroffen als der Oberschenkel. Zur Behandlung der Femurschaftfrakturen finden sich deutlich mehr Empfehlungen als zur Behandlung der Unterschenkelschaftrakturen. Die Femurschaftfrakturen im frühen Lebensalter sind eine Domäne der konservativen Therapie, für Ober- und Unterschenkel wird bis zu einem Körpergewicht von 50 kg als operatives Verfahren häufig die elastisch stabile intramedulläre Nagelung (ESIN) verwendet. Die Plattenosteosynthese stellt aber eine ernste Alternative dar. Vorteile der ESIN sind die kleinen Zugänge und die schnellere Belastbarkeit. Für einfache Querfrakturen ist die intramedulläre Stabilisierung klar überlegen. Nachteil der ESIN ist die hohe intraoperative Strahlenbelastung. Auch die Plattenosteosynthese kann minimalinvasiv durchgeführt werden, längere Trümmerzonen lassen sich damit gut überbrücken.

PURPOSE OF THE STUDY Various spine disorders are regularly treated by orthoses, and success of treatment depends on wearing these devices. In this study we examined the compliance, wear comfort, subjective stabilization and side effects associated with spinal orthoses using an individualized questionnaire and the Compact Short Form-12 Health Survey (SF-12). MATERIAL AND METHODS In this prospective pilot study of randomized cross-over design, twelve healthy volunteers with a mean age of 31.2 years wore three different types of orthoses, each for one week: A hyperextension brace (HB), a custom-made semirigid orthosis (SO) and a custom-made rigid orthosis (RO). The daily duration of wearing the orthosis was defined as primary endpoint; contentment was measured using an individualized questionnaire and the standardized SF-12. RESULTS In the study population calculated probability of wearing the HB and RO was between 0.2 und 38.5% (95% confidence interval). No volunteer wore the SO orthosis for the predefined time. The SO and RO each displayed high subjective stabilization, while the RO was more often associated with side effects like skin pressure marks than the SO. The need for rework due to discomfort was mainly necessary with the RO. We observed no substantial differences in feeling compression and sweating. Noteworthy, eight of 12 subjects complained of uncomfortable sternal pressure due to the upper pad of the HB. The SF-12: scores ranged from 52.1 to 48.6 on the physical (PCS), and from 53.7 to 50.8 on the mental component score (MCS), demonstrating an influence on QoL. DISCUSSION AND CONCLUSIONS The design as well as the orthosis itself influence the compliance of wearing and exert a moderate negative, but acceptable impact on QoL. The SO appeared to correlate with the best overall compromise between comfort and subjective stabilization. Further investigations are necessary in patients with spinal diseases, for whom the effect of orthosis wearing may surpass the potential discomfort. Key words: thoracolumbar spine, orthoses, SF-12 - Quality of Life - QoL, comfort, compliance.

Data of the TraumaRegister DGU® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase.

Although minimally invasive posterior spine implant systems have been introduced, clinical studies reported on reduced quality of spinal column realignment due to correction loss. The aim of this study was to compare biomechanically two minimally invasive spine stabilization systems versus the Universal Spine Stabilization system (USS).

Mit der Einführung der Qualitätsinitiative „Endoprothesenregister Deutschland (EPRD)“ und der Zertifizierung von Endoprothesenzentren soll die Endoprothetik in Deutschland zukünftig langfristig besser dokumentiert sowie qualitätsgesichert durchgeführt und weiterentwickelt werden. Obwohl die Operationsschritte in der elektiven und der traumaassoziierten Hüftendoprothetik vergleichbar sind, unterscheiden sich einige Rahmenbedingungen wesentlich. Die Deutsche Gesellschaft für Unfallchirurgie (DGU) ist deshalb der Frage nachgegangen, welchen Anteil die frakturassoziierte Endoprothetik in Deutschland am Gesamtvolumen hat.

Due to the elbow joint's complex functional anatomy, the multifragmentary nature of many fractures and concomitant destabilizing associated injuries, dislocated fractures of the radial head and neck still present a serious challenge for the orthopedic surgeon. Thorough knowledge of the elbow's anatomy and biomechanics is essential to analyze and understand the injury and plan its treatment. The aim of a differentiated therapy approach is to restore the joint's anatomy and kinetics, stable and painless joint function, and to avoid or at least delay posttraumatic joint changes. The degree of dislocation, stability of fragments, size and number of fractured joint surfaces and associated bony and ligamentous injuries (and the instability they incur) must be addressed in the therapy regimen. There are various treatment options depending on the injury's classification, i.e. a Mason I fracture is treated conservatively, while more severe injuries may require osteosynthesis and endoprosthesis. There is a lack of clear therapy recommendations based on solid evidence regarding Mason classification types III-IV. In particular expert opinions diverge and study results are inconsistent. Especially the value of radial head arthroplasty is still hotly debated. Key words: radial head fracture, radial head prosthesis, radial neck fracture, Mason classification, radial head arthroplasty, elbow injury.

Background: A common method to restore the sagittal alignment and stabilize the spinal column is a dorso-ventral spondylodesis. It is assumed that correction loss after posttraumatic spondylodesis results from inadequate incorporation of the autologous iliac crest graft.Materials and methods: Retrospective documentation of patients with unstable vertebral body fractures of the thoracic or lumbar spine with concomitant rupture of at least one adjacent intervertebral disk who received surgical treatment at our institution from 2000 to 2006. Followed by analysis of the computer tomography documentation of a total of 142 patients with unstable vertebral body fracture stabilized by posterior internal fixator and anterior iliac crest spondylodesis.Results: The following mean angle changes were derived from the second series of CT scans performed on average 283 days after anterior spondylodesis: vertebral wedge angle (VWA): 2.1 degrees; segmental kyphotic angle: 4.9 degrees; adjusted-SKA: 4.8 degrees; sagittal index (SI): -0.04; segmental-scoliotic-angle (SSA): 0 degrees; adjusted-SSA: 0 degrees. Changes in VWA, both SKAs and SI postoperatively and prior to ME, were statistically significant (P<0.05). The McAfee fusion assessment of the graft showed: full fusion: cranial 64%, caudal 47%; partial fusion: cranial 20.5%, caudal 29%; lysis: cranial 8.5%, caudal 17%; graft resorption: 7%. No correlation was found between the above-mentioned angle changes and fusions grade.Discussion: The importance of radiological evidence of fusion deficiency is questionable, because the extent of fusion only has a minimal effect on correction loss. (C) 2015 Elsevier Masson SAS. All rights reserved.

Femoral shaft fractures are severe injuries and are often associated with a high impact trauma mechanism, frequently seen in multiple injured patients. In contrast an indirect trauma mechanism can lead to a complex femoral shaft fracture especially in elderly patients with minor bone stock quality. Hence management of femoral shaft fractures is often directed by co-morbidities, additional injuries and the medical condition of the patient. Timing of fracture stabilization is depended on the overall medical condition of the patient, but definite fracture fixation can often be implemented in the early total care concept in management of multiple injured patients. The treatment of choice is intramedullary fracture fixation. Further development of existing intramedullary nailing systems now offer comfortable handling and different locking options. Ipsilateral fractures of the neck and shaft are therefore facilitated in management. Then again increasing numbers of obese patient are representing a new patient group with challenging co-factors in fracture management. Sufficient preoperative planning is helpful to choose the most adequate fixation device. Correct reduction of the fracture and perioperative control of the axis and rotation is mandatory to avoid postoperative malrotation, which still represents the most frequent complication.

Die Femurschaftfraktur ist die zweithäufigste Fraktur der unteren Extremität im Kindesalter. Es gibt Empfehlungen zur operativen Stabilisierung ab dem 3. Lebensjahr. Wir haben uns die Frage nach der Versorgungsrealität in Deutschland bei unter 3-jährigen Kindern gestellt.

To improve patient safety and quality in joint arthroplasty a certification of arthroplasty centers (EndoCertA (c)) and a German arthroplasty register (EPRD) have been implemented. This should guarantee a long-term improvement in documentation of arthroplasty in the future. Although the stages of operations in elective and trauma-associated joint arthroplasty are comparable, the surgical preconditions are often quite different. As required by the German Society of Trauma Surgery (DGU) this study analyzed the current situation with respect to the proportion of fracture-associated joint arthroplasties among the total volume carried out in Germany.A uniform internet-based questionnaire was sent to all listed trauma centers in Germany by the central office of the DGU. In addition any information regarding hip joint arthroplasty in 2011 was collected from the Federal Statistical Office of Germany.The questionnaire was returned by 324 (47 %) out of 690 of the trauma centers contacted. A total of 34,135 total hip arthroplasties (THA) and 26,753 total knee arthroplasties (TKA) were carried out in 2011 by these clinics. The absolute numbers for total endoprosthesis replacement cited by the trauma centers were 5718 THAs and 3829 TKAs. According to the data from the Federal Statistical Office of Germany 131,966 hip fractures were registered in 2011, including 69,582 femoral neck fractures (patient age > 19 years) and 62,384 pertrochanteric fractures. From a total number of THAs of approximately 200,000 in Germany 47,695 (approximately 25 %) of these were associated with trauma.The data analyzed in this study and the results obtained from known literature sources demonstrate that THA is the most frequently performed procedure in trauma management of femoral neck fractures. Because of the ubiquitous and high incidence and the need for emergency treatment due to correlated risks and complications of delayed treatment, a high and standardized around the clock (24 h and 7 days a week) treatment option is mandatory. Long waiting times to treatment or transfer are inacceptable due to the increased mortality and complications.

PURPOSE OF THE STUDY:Whole-body computed tomography is accepted as the standard procedure in the primary diagnostic of polytraumatised adults in the emergency room. Up to now there is still controversial discussion about the same algorithm in the primary diagnostic of children. The aim of this study was to survey the participation of German trauma-centres in the care of polytraumatised children and the hospital dependant use of whole-body computed tomography for initial patient work-up.MATERIAL AND METHODS:A questionnaire was mailed to every Department of Traumatology registered in the DGU (German Trauma Society) databank.RESULTS:We received 60,32% of the initially sent questionnaires and after applying exclusion criteria 269 (53,91%) were applicable to statistical analysis. In the three-tiered German hospital system no statistical difference was seen in the general participation of children polytrauma care between hospitals of different tiers (p = 0.315). Even at the lowest hospital level 69,47% of hospitals stated to participate in polytrauma care for children, at the intermediate and highest level hospitals 91,89% and 95,24% stated to be involved in children polytrauma care, respectively. Children suspicious of multiple injuries or polytrauma received significantly fewer primary whole-body CTs in lowest level compared to intermediate level hospitals (36,07% vs. 56,57%; p = 0.015) and lowest level compared to highest level hospitals (36,07% vs. 68,42%; p = 0.001). Comparing the use of whole-body CT in intermediate to highest level hospitals a not significant increase in its use could be seen in highest level hospitals (56,57% vs. 68,42%; p = 0.174).CONCLUSION:According to our survey, taking care of polytraumatised children in Germany is not limited to specialised hospitals or a defined hospital level-of-care. Additionally, there is no established radiologic standard in work-up of the polytraumatised child. However, in higher hospital care -levels a higher percentage of hospitals employs whole-body CTs for primary radiologic diagnostics in polytraumatised children.