[Organizational redistribution of Ukrainian war wounded for care in Germany]. / Organisatorische Weiterverteilung ukrainischer Kriegsverletzter zur Versorgung in Deutschland.

Due to the war in Ukraine, which began on February 24th, 2022, countless people are injured every day, regardless of whether they are civilians or soldiers. This has led to the Ukrainian healthcare system being massively overburdened and for this reason these patients are brought to Germany, among other places, to be treated here. This article is intended to show the way and the organizational effort required to distribute the patients to the clinics in Germany.

[Percutaneous stabilization of the anterior pelvic ring in osteoporotic fractures]. / Perkutane Stabilisierung bei osteoporotischen Frakturen des vorderen Beckenrings.

The number of low energy traumas in older people with subsequent pelvic ring fractures is increasing in contrast to high energy traumas with pelvic injury in younger people. Geriatric pelvic fractures can be treated conservatively with analgesics and physiotherapy-assisted mobilization, depending on the symptoms. If physical complaints do not allow adequate mobilization, surgical stabilization is indicated. It is often possible to stabilize the dorsal pelvic ring with transiliosacral screws. If additional instability associated with anterior pelvic ring complaints is prevalent, stabilization of the anterior ring can be achieved by invasive osteosynthesis using a plate or percutaneously by implanting an intramedullary plastic polymer.

[Biomechanical comparison of six different fixation techniques for treatment of metacarpal neck fractures]. / Biomechanischer Vergleich sechs verschiedener Fixationstechniken zur Versorgung von Halsfrakturen der Metakarpale.

PURPOSE: The purpose of this study was to evaluate the primary stability of commonly used fixation techniques for metacarpal neck fractures and to compare it with that of an innovative osteosynthesis device: IlluminOss™, the photodynamic bone stabilization system™. MATERIAL AND METHODS: Metacarpal neck fractures were created on the second to fifth metacarpal bones of 24 freshly frozen human cadavers using a band saw. Specimens were randomly assigned to one of six groups and treated with (1) K-wire fixation, (2) dorsal plating, (3) external fixation, (4) cross-threaded K­wire fixation, (5) IlluminOss™ and (6) locked IlluminOss™. In each group 16 specimens each underwent either monocyclic or polycyclic loading protocols. RESULTS: During monocyclic loading none of the specimens failed prior to a maximum deformation of 3 mm. With intramedullary K­wire fixation the mean loads were significantly lower than those of the other techniques. Mean loads causing 2 mm deformation with external fixation were significantly lower than those with dorsal plate osteosynthesis. The mean linear stiffness of the K­wire osteosynthesis was significantly lower than for the other fixation techniques and all methods of external fixation were significantly lower than dorsal plates. There were no significant differences with respect to the linear stiffness between the groups with dorsal plates, fragment fixation system (FFS), IlluminOss™ and locked IlluminOss™. During polycyclic testing the loss of resistance in dorsal plate osteosynthesis was significantly lower than with K­wire and IlluminOss™ fixation. No significant differences in loss of resistance could be shown between dorsal plate osteosynthesis, external fixation, FFS and locked IlluminOss™. CONCLUSION: In summary, IlluminOss™ can be used as an intramedullary stabilization system for treatment of metacarpal neck fractures. In combination with locking screws the biomechanical characteristics of IlluminOss™ are comparable to the other fixation techniques.

[10 years German Society for Orthopedics and Trauma Surgery (DGOU): trauma surgery-quo vadis?] / 10 Jahre DGOU: Unfallchirurgie ­ quo vadis?

On the occasion of the 10th anniversary of the foundation of the German Society for Orthopedics and Trauma Surgery (DGOU), the current General Secretary of the German Society for Trauma Surgery sees the need for a standpoint on trauma surgery in Germany. This manuscript outlines future options and perspectives for the development of trauma surgery in Germany.

[Nationwide implementation of a hospital resource register for daily trauma care, mass casualties and disasters : Position paper of the German Trauma Society and the Federation of German Medical Directors of Emergency Medical Services]. / Bundesweite Einführung eines Krankenhauskatasters in den Klinikalltag und bei Großschadens- und Bedrohungslagen : Positionspapier der DGU und des BV-ÄLRD e. V.

The introduction of requirements for a minimum intake capacity of trauma patients by the German Trauma Society (DGU) into the so-called white book of treatment of seriously injured patients, is helpful for a sufficient preparation for threats and for dealing with mass casualties for trauma centers as well as for the emergency medical services (EMS). In the hospital information database provided by the Federation of German Medical Directors of Emergency Medical Services, more than 1300 hospitals are currently listed. This information supports the allocation of trauma patients from the field to the appropriate trauma center. Currently, without any coordination requirements, the current 626 trauma centers in Germany are able to immediately handle 6260 patients. This number could be doubled by activating the local hospital action plan, where a priority plan is set up. Additionally, the implementation of a nationwide flexible standardized communication structure between the dispatch center of the ambulance service and the hospitals, would improve daily care as well as the management of threats and mass casualties. It is the obligation of the local medical director of the EMS, to maintain and update the hospital database. Providing the information in the database with the hospital resources and the flexible standard communication structure, is appropriate to improve the daily collaboration and the preparation for mass casualties.

[Knee laxity in anterior cruciate ligament reconstruction : The influence of graft rotation using interference screw fixation]. / Kniegelenklaxizität beim vorderen Kreuzbandersatz : Einfluss der Transplantatrotation um die Interferenzschraube.

BACKGROUND: The use of interference screws for femoral graft fixation in anterior cruciate ligament (ACL) reconstruction with hamstring grafts can result in rotation of the graft around the screw leading to changes in the final position of the graft within the bone tunnel. MATERIAL AND METHODS: In a prospective study 107 patients (54 right and 53 left knees) underwent ACL reconstruction with a hamstring tendon autograft. Femoral fixation of the graft was performed with a standard right-thread screw in all cases. Patients were assessed at 6 months postoperatively with the international knee documentation committee (IKDC) standard evaluation including instrumented laxity measurements and the results were compared between right and left knees. RESULTS: A significantly higher postoperative anterior laxity was observed in left knees with a negative Lachman test in only 64 % of the cases compared with 87 % in the group of right knees. Accordingly, instrumented laxity measurements of the reconstructed knee compared with the contralateral knee revealed significant differences between left and right knees (left knees 1.8±1.2 mm and right knees 1.0±1.4 mm). CONCLUSIONS: This study demonstrates the importance of femoral graft positioning and its sensitivity to multiple influencing factors. The use of standard right-thread interference screws for femoral graft fixation in the mirrored situation of right and left knees may produce a systematic error in ACL reconstruction. Due to a possible rotation of the graft around the screw, the final position of the transplant may vary thus leading to significant changes in anterior translation of the operated knee.

[Knee laxity in anterior cruciate ligament reconstruction. The influence of graft rotation using interference screw fixation]. / Kniegelenklaxizität beim vorderen Kreuzbandersatz. Einfluss der Transplantatrotation um die Interferenzschraube.

BACKGROUND: The use of interference screws for femoral graft fixation in anterior cruciate ligament (ACL) reconstruction with hamstring grafts can result in rotation of the graft around the screw leading to changes in the final position of the graft within the bone tunnel. MATERIAL AND METHODS: In a prospective study 107 patients (54 right and 53 left knees) underwent ACL reconstruction with a hamstring tendon autograft. Femoral fixation of the graft was performed with a standard right-thread screw in all cases. Patients were assessed at 6 months postoperatively with the international knee documentation committee (IKDC) standard evaluation including instrumented laxity measurements and the results were compared between right and left knees. RESULTS: A significantly higher postoperative anterior laxity was observed in left knees with a negative Lachman test in only 64 % of the cases compared with 87 % in the group of right knees. Accordingly, instrumented laxity measurements of the reconstructed knee compared with the contralateral knee revealed significant differences between left and right knees (left knees 1.8±1.2 mm and right knees 1.0±1.4 mm) CONCLUSIONS: This study demonstrates the importance of femoral graft positioning and its sensitivity to multiple influencing factors. The use of standard right-thread interference screws for femoral graft fixation in the mirrored situation of right and left knees may produce a systematic error in ACL reconstruction. Due to a possible rotation of the graft around the screw, the final position of the transplant may vary thus leading to significant changes in anterior translation of the operated knee.

Biomechanical evaluation of the primary stability of pedicle screws after augmentation with an innovative bone stabilizing system.

INTRODUCTION: In today's aging population, diminished bone quality often affects the outcome of surgical treatment. This occurs especially when surgical implants must be fixed to bone, as it occurs when lumbar fusion is performed with pedicle screws. Besides Polymethylmethacrylate (PMMA) injection, several techniques have been developed to augment pedicle screws. The aim of the current study was to evaluate the primary stability of an innovative system (IlluminOss™) for the augmentation of pedicle screws in an experimental cadaveric setup. IlluminOss™ is an innovative technology featuring cement with similar biochemical characteristics to aluminum-free glass-polyalkenoate cement (GPC). MATERIALS AND METHODS: IlluminOss™ was inserted transpedicularly via a balloon/catheter system in 40 human cadaveric lumbar vertebrae. For comparability, each vertebra was treated bilaterally with pedicle screws, augmented and non-augmented. The maximum failure load during pull out test was documented by a universal material testing machine. RESULTS: The results showed significantly higher failure loads for the augmented pedicle screws (Median 555.0 ± 261.0 N, Min. 220.0 N, Max. 1,500.0 N), compared to the native screws (Median 325.0 ± 312.1 N, Min. 29.0 N, Max. 1,400.0 N). CONCLUSIONS: Based on these data, we conclude the IlluminOss™ system can be used to augment primary screw stability regarding axial traction, compared to native screws. The IlluminOss™ monomer offers ease of control for use in biological tissues. In contrast to PMMA, no relevant heat is generated during the hardening process and there is no risk of embolism. Further studies are necessary to evaluate the usefulness of the IlluminOss™ system in the in vivo augmentation of pedicle screws in the future.

[Treatment of proximal humerus fractures: relative position of different locking plates to the axillary nerve]. / Versorgung von Humeruskopffrakturen: Lagebeziehung proximaler Verriegelungsplatten zum N. axillaris.

OBJECTIVES: Placement of a proximal humerus locking plate through a percutaneous transdeltoid approach bears the advantages of a minimally invasive approach but may compromise the anterior branches of the axillary nerve. This anatomic study aimed to develop a risk profile for 6 types of modern proximal humerus locking plates as to their interference with the axillary nerve. MATERIALS AND METHODS: In this study six different implants (Arthrex®, DePuy®, Königsee®, Smith & Nephew®, Stryker® and Synthes®) were placed on the intact proximal humerus of 33 embalmed cadaveric upper extremities and the relative positioning between the axillary nerve and the screw holes was determined. RESULTS: All locking plates displayed an area of risk which concerned 3 out of 7 (Arthrex®), 4 out of 10 (DePuy®), 2 out of 9 (Königsee®), 3 out of 11 (Smith & Nephew®), 3 out of 11 (Stryker®) and 6 out of 12 (Synthes®) screw holes of the plate. CONCLUSIONS: Using the anterolateral percutaneous deltoid splitting approach the relative position of the axillary nerve to the holes of a specific implant is of relevance for avoidance of iatrogenic lesions to the nerve.

[Distraction arthroplasty for treatment of posttraumatic elbow stiffness]. / Distraktionsarthroplastik zur Behandlung der posttraumatischen Ellenbogensteife.

A stiff elbow is usually defined as having less than 30° in extension or less than 130° in flexion. Most activities of daily living are possible if the elbow has a range of motion of 100° (30-130° of flexion, Morrey's arc of motion). Loss of mobility of the elbow is not uncommon after trauma, burns or coma and severely impairs upper limb function. Loss of mobility may be difficult to avoid and is challenging to treat. Detailed analysis of the etiology and diagnostic evaluation is of utmost importance for planning any surgical intervention for elbow stiffness. Current operative techniques, such as closed distraction with external fixation (arthroplasty), are presented and evaluated. Elbow arthrolysis is a technically demanding procedure but if the indications and techniques are used correctly and the surgeon, physiotherapist and even the patient are familiar with the procedure, good long-term results may be achieved. Contraindications are poor compliance, poorly controlled diabetes mellitus, active hepatitis B and C infections, HIV infection and acute articular infections.

[Fixator with motion capacity and distraction arthrodiatasis in post-traumatic elbow stiffness]. / Bewegungsfixateur und Distraktionsarthroplastik zur Behandlung der posttraumatischen Ellenbogensteife.

Elbow stiffness may result from trauma, burns and head injuries. It is defined as a total range of motion of <100° with no relevant loss of forearm rotation. Of particular relevance is the flexion deficit. A detailed analysis regarding the development of the elbow stiffness is required together with an exact diagnosis in order to plan the surgical intervention. Closed distraction of the elbow joint as arthrodiatasis with an external fixator is described and evaluated. Adequate long-term results can be achieved with this technique, which reflects proper selection of patients as well as coordination between surgeon, aftercare and physiotherapist. Contraindications are poor compliance, poorly controlled diabetes mellitus, active hepatitis B and C infection, HIV infection and acute articular infection.

[External fixation with motion capacity in acute dislocations and fracture dislocations of the elbow. Fixation with motion capacity]. / Die Behandlung der akuten Luxation und Luxationsfraktur des Ellenbogens. Bewegungsfixateur.

Dislocations and fracture dislocations with their typical fracture patterns may substantially affect the complex anatomy and integrity of the elbow joint. The more components of the joint are injured, the more technically demanding is the therapy. Standardized diagnostic and therapeutic algorithms help to avoid misinterpretations regarding the severity of the injury and the subsequent complications. In elbow dislocations and fracture dislocations with persistent instability the hinged external fixator is an excellent device to improve joint stability and allows physiotherapeutic assistance at an early stage.

[External fixation with motion capacity and radius fractures. Methods and results]. / Bewegungsfixateur und distale Radiusfraktur. Methodik und Ergebnisse.

Both the radiocarpal and distal radioulnar joints are often affected in"distal radius fractures". The incidence of this injury increases markedly among women over the age of 40. Bearing in mind the wide variety of distal radius fractures, a fixation system should be used which permits trans- and extra-articular application and subsequent reduction by means of distraction, as well as wrist mobilization. It is important that both reduction and position of the carpal bones can be checked. The possibility of extra-articular (radioradial) fixation should always be considered. AO group A2 and A3 fractures with sufficiently large fragments are suitable for this procedure. In other cases, transarticular application is advised. Complementary measures are justified in the case where two or more cortices in AP and lateral X-rays are destroyed. Adequate implants are also used to stabilize the articular surface. Large bone defects should be filled with corticocancellous material.

[External fixation with motion capacity in complex dislocation of the knee joint and associated injuries]. / Der Bewegungsfixateur bei komplexer Kniegelenkluxation mit Begleitverletzung.

Closed and open dislocations of the knee joint with vascular and nerve injuries are treated immediately and may present an indication for external fixation. In acute trauma definitive treatment and reconstruction of the complex capsule and ligamentous injuries are often impossible. The application of a medial transarticular external fixator with motion capacity combines the treatment of remaining joint instability with the benefit of early joint movement. Disadvantages of prolonged joint immobilisation until definitive stabilisation of the knee are reduced.

Biomechanical comparison of tension band- and interfragmentary screw fixation with a new implant in transverse patella fractures.

AIM: The aim of the present study was to compare the primary fixation stability and initial fixation stiffness of two established fixation techniques, the tension band wiring technique and interfragmentary screw fixation, with a mini-screw fragment fixation system in a model of transverse patella fracture. It was hypothesised that the biomechanical loading performance of the fragment fixation system would not significantly differ from the loading characteristics of the two established methods currently investigated. MATERIALS AND METHODS: Ninety-six calf patellae were used in this biomechanical model. A standardized transverse patella fracture was induced and three different fixation methods, including the modified tension band wiring technique, interfragmentary screw fixation, and the mini-screw fragment fixation system, were used for fragment fixation. Specimens were mounted to a loading rig which was secured within a material testing machine. In each fixation group, eight specimens were loaded to failure at a simulated knee angle of either 0 degrees or 45 degrees . Another eight specimens were submitted to a polycyclic loading protocol consisting of 30 cycles between 20N and 300N at a simulated knee angle of 0 degrees or 45 degrees . The residual displacement between the first and the last cycle was recorded. Differences in the biomechanical performance between the three fixation groups were evaluated. RESULTS: No significant differences between the three fixation groups were observed in the parameters maximum load to failure and linear fixation stiffness with monocyclic loading. Specimens being loaded at 45 degrees showed significantly lower maximum failure loads and linear stiffness when compared with 0 degrees . During polycyclic loading, no significant differences in the residual displacement were observed between the groups at 0 degrees loading angle, while at 45 degrees , residual displacement was significantly higher with tension band fixation when compared with interfragmentary screw fixation or the fragment fixation system. CONCLUSION: The biomechanical performance of the fragment fixation system was comparable to interfragmentary screw fixation and superior to the tension band wiring technique. Given the advantages of a system which provides interfragmentary compression and which simplifies fracture fixation after open or closed reduction, we believe the fragment fixation system to be an adequate alternative in the osteosynthesis of transverse patella fractures.

Reconstruction of a Mason type-III fracture of the radial head using four different fixation techniques. An experimental study.

We have evaluated four different fixation techniques for the reconstruction of a standard Mason type-III fracture of the radial head in a sawbone model. The outcome measurements were the quality of the reduction, and stability. A total of 96 fractures was created. Six surgeons were involved in the study and each reconstructed 16 fractures with 1.6 mm fine-threaded wires (Fragment Fixation System (FFS)), T-miniplates, 2 mm miniscrews and 2 mm Kirschner (K-) wires; four fractures being allocated to each method using a standard reconstruction procedure. The quality of the reduction was measured after definitive fixation. Biomechanical testing was performed using a transverse plane shear load in two directions to the implants (parallel and perpendicular) with respect to ultimate failure load and displacement at 50 N. A significantly better quality of reduction was achieved using the FFS wires (Tukey's post hoc tests, p < 0.001) than with the other devices with a mean step in the articular surface and the radial neck of 1.04 mm (SD 0.96) for the FFS, 4.25 mm (SD 1.29) for the miniplates, 2.21 mm (SD 1.06) for the miniscrews and 2.54 mm (SD 0.98) for the K-wires. The quality of reduction was similar for K-wires and miniscrews, but poor for miniplates. The ultimate failure load was similar for the FFS wires (parallel, 196.8 N (SD 46.8), perpendicular, 212.5 N (SD 25.6)), miniscrews (parallel, 211.8 N (SD 47.9), perpendicular, 208.0 N (SD 65.9)) and K-wires (parallel, 200.4 N (SD 54.5), perpendicular, 165.2 N (SD 37.9)), but significantly worse (Tukey's post hoc tests, p < 0.001) for the miniplates (parallel, 101.6 N (SD 43.1), perpendicular, 122.7 N (SD 40.7)). There was a significant difference in the displacement at 50 N for the miniplate (parallel, 4.8 mm (SD 2.8), perpendicular, 4.8 mm (SD 1.7)) vs FFS (parallel, 2.1 mm (SD 0.8), perpendicular, 1.9 mm (SD 0.7)), miniscrews (parallel, 1.8 mm (SD 0.5), perpendicular, 2.3 mm (SD 0.8)) and K-wires (parallel, 2.2 mm (SD 1.8), perpendicular, 2.4 mm (SD 0.7; Tukey's post hoc tests, p < 0.001)). The fixation of a standard Mason type-III fracture in a sawbone model using the FFS system provides a better quality of reduction than that when using conventional techniques. There was a significantly better stability using FFS implants, miniscrews and K-wires than when using miniplates.

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction.

Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.

Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion.

A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.