Background context Many institutions' retrospective studies investigated the effect of the timing of surgery on outcomes of polytraumatized patients with severe lesions of the thoracic spine and mainly found a better outcome for patients who were operated on less than 72 hours posttrauma. Purpose We conducted a prospective study in a Level I trauma center to validate the retrospective data and to investigate other variables, in addition to the timing of surgery that may influence patient outcomes. Study design Prospective observational clinical study. Patient sample Within this prospective study at a Level I trauma center, we enrolled 38 multiple injured patients with unstable fractures of vertebral column from Level Th1 to L1. Further inclusion criteria consisted of an injury severity score of 16 or more and an intensive care unit (ICU) stay of more than 7 days. The age of included patients was limited from 16 or more to 75 or less years. Outcome measures Hospital stay, stay on ICU, and mortality. Methods Twenty-two patients were operated on less than or equal to 72 hours posttrauma, and 16 received late surgery greater than or equal to 72 hours posttrauma. Results Patients who received early surgery had a significantly higher mortality rate (p<.01) than those who received late surgery. Sixty-seven percent of our patients who had an initial hemoglobin (Hb) less than 10 mg/dL died. Seventy-five percent of those patients who had an Hb less than 10 mg/dL and received a thoracic drain died. Conclusions Although some reports indicate advantages for early surgery for thoracic spine trauma in the polytraumatized patient, careful patient selection should be used. Based on the results of this prospective study, early surgery for thoracic spine trauma in patients with concomitant severe thoracic trauma and low initial Hb levels may pose a risk for poor clinical outcomes.

Septic arthritis due to endocarditis is a rare and life-threatening disease. Endocarditis occurs with an incidence of 30 patients per 1 million citizens/year. Staphylococcus aureus is one of the most common causative pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) can lead to a severe outcome with a high mortality rate, and embolic complications of the kidney, brain, and spleen are seen in one third of all cases. The diagnosis and treatment of endocarditis is a challenge for all health care providers. We report about a patient who was admitted to our hospital with generalized sepsis of unknown origin.

Die septische Arthritis als Folge einer floriden Endokarditis ist eine seltene, jedoch durchaus lebensbedrohliche Erkrankung. Die Endokarditis tritt in der heutigen Zeit mit ca. 30 Neuerkrankungen/1 Mio. Einwohner/Jahr auf und ist nach wie vor mit einer hohen Letalität verbunden. Staphylococcus aureus ist mit bis zu 25% der häufigste Erreger einer Endokarditis. Besonders hohes Risiko besteht bei einer Infektion mit einem MRSA-Nachweis. Während eines stationären Verlaufs können als Komplikationen septische Embolien der inneren Organe wie z. B. Milz und Niere oder ein septischer Apoplex auftreten. Die septische Arthritis als Manifestation einer floriden Endokarditis wird in der Literatur als eine Rarität beschrieben und ist für den Kliniker eine diagnostische Herausforderung. Wir berichten über einen Patienten, der sich in unserer chirurgischen Klinik mit einem septischen Krankheitsbild vorstellte.

Die Schriftleitung von Der Unfallchirurg dankt den Herausgebern der Zeitschrift und insbesondere allen weiteren Experten und Expertinnen für ihre Unterstützung als wissenschaftliche Gutachter im Jahr 2013. Durch ihren Einsatz garantieren sie im Rahmen des Peer-Review-Verfahrens der eingereichten Manuskripte die hohe Qualität und klinische Relevanz von Der Unfallchirurg. Schriftleitung Der Unfallchirurg Unfallchirurg 2013 · 116:1048–1049 DOI 10.1007/s00113-013-2545-4 Online publiziert: 6. Dezember 2013 © Springer-Verlag Berlin Heidelberg 2013

The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration.

The authors conducted a retrospective study on 183 cases of spondylodiscitis, treated conservatively (44%) or surgically (56%) between November 1991 and June 2006. The male/female ratio was 99/84, and the mean age 62.6 years. The mean follow-up period was 12 years (range 4-19). Interesting from a clinical viewpoint: temperature, white blood cell count, and CRP were sometimes normal, while pain varied from slight to unbearable. The commonest risk factor was diabetes mellitus, and the most frequent pathogen was Staphylococcus aureus. Methicillin resistant Staphylococcus aureus (MRSA) was found in 6 patients, and 3 or 50% of these died, in sharp contrast with the overall mortality rate of 8.7%. A neurological deficit was seen in 43.7% of the patients; complete recovery occurred in 71% of the patients with a Frankel D stage, but in only 15.4 to 222% of those with a stage A, B or C.

Allergien gegen Knochenzement oder dessen Bestandteile sind im Rahmen der Endoprothetik eine Seltenheit. Wir berichten über einen 63-jährigen Patienten, der eine Woche nach Implantation einer zementierten Knieprothese bei Gonarthrose eine ausgeprägte Vitiligo entwickelte. Ein Epikutantest ergab ein positives Ergebnis auf Benzoylperoxid, einem Bestandteil des Knochenzements. Fünf Monate nach der Implantation kam es zum Auftreten eines Protheseninfekts, woraufhin eine Explantation der Knieprothese vorgenommen wurde. Nach Sanierung des Infekts erfolgte die Implantation eines zementfreien Arthrodesenstabs. Bei der Erstmanifestation unklarer Hauteffloreszenzen nach Implantation zementierter Fremdmaterialien sollte neben dem Ausschluss einer Infektion auch ein Augenmerk auf eine mögliche Allergie auf Inhaltstoffe von Knochenzement gelegt werden.

Die ankylosierende Spondylitis (AS) ist eine entzündlich-rheumatische Systemerkrankung. Durch die vermehrte Steifigkeit der Wirbelsäule können schon bei geringer Krafteinwirkung Frakturen im Bereich der Wirbelsäule auftreten. Die operative Stabilisierung ist ein etabliertes Therapieverfahren. Anhand dieser Studie wurde bei 119 Patienten mit einer AS das klinische Outcome nach operativer Versorgung untersucht.

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old woman was admitted with a bimaleollar right ankle fracture. The patient underwent an emergency operation with open reduction and internal fixation. Six weeks after the surgery, the syndesmotic screw was removed without complication. The patient presented 4 weeks after removal of the screw complaining of persistent swelling and tenderness of the right ankle without a history of trauma. Radiographs showed a non-displaced distal tibial fracture around the site at which the syndesmotic screw was inserted. The distal tibial fracture was treated conservatively with a toe-to-knee cast for 6 weeks. In summary, the authors present a rare case of distal tibial fracture. Surgeons should bear this additional complication in mind.

Background: Little attention has been devoted to subtalar dislocations without an associated bone injury in the literature to date. The aim of this study was to assess the functional and subjective results of a cohort of patients with this injury.Methods: A total of ninety-seven patients with a subtalar dislocation were treated at two major university trauma centers from January 1994 to March 2007. Computed tomographic scans indicated a subtalar dislocation without associated bone injury in twenty-three of these patients. Clinical and radiographic examinations were performed on all twenty-three patients at an average of 58.3 months after the completion of treatment. The postoperative clinical examination was supplemented by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and the degree of arthritis was assessed radiographically.Results: The average score on the AOFAS ankle-hindfoot scale score was 82.3 points. Twenty-one patients achieved a good result, and two patients had a satisfactory result. The range of motion of the subtalar joint was an average of 41.3 degrees. No difference between the results of the medial and lateral subtalar dislocations was observed. Only six patients had minor radiographic changes.Conclusions: The intermediate-term results for a subtalar dislocation without an associated osseous injury are good, and the direction of the dislocation does not appear to make a difference with regard to clinical or radiographic outcome.

Aufgrund der demografischen Bevölkerungsentwicklung sehen wir uns mit einer jährlichen Zunahme medialer Schenkelhalsfrakturen betagter Patienten konfrontiert. Im vorliegenden Beitrag werden die Behandlungsmodalitäten der Frakturen des koxalen Femurendes geriatrischer Patienten insbesondere mittels Duokopf- und Totalendoprothese anhand der vorliegenden Literatur und unter Betrachtung der für die Therapie der Schenkelhalsfraktur des Erwachsenen vorliegenden Leitlinien der Deutschen Gesetzlichen Unfallversicherung (DGU) diskutiert. Auch die Frage der Verwendung zementierter oder zementfreier Schäfte bei der endoprothetischen Versorgung dieser Verletzungen wird aufgegriffen und reflektiert.

Non-displaced fractures of the radius head are in most cases treated conservatively. Open reduction and anatomical internal fixation of displaced radius head fractures is the method of choice. In comminuted fractures of the radius head (Mason type III and type IV) replacement with a radius head prosthesis achieves joint stability and prevents secondary complications, such as valgus elbow deformity and proximal radial migration. Modern anatomically formed prostheses show promising results in the medium-term view. Typical complications after radius head replacement are limited range of motion in the elbow joint, arthritis of the capitulum and heterotopic ossifications. In cases of capitulum arthritis, capitulum prostheses were developed to resurface the lateral compartment of the elbow joint. Short-term results are encouraging with improvements in pain and range of movement.