High return to sports rates after operative treatment of patella fractures.

BACKGROUND: Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. METHODS: This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. RESULTS: Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). CONCLUSION: The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).

Good to Excellent Functional Outcome and High Return to Sports Rate after Operative Treatment of Unstable Lateral Clavicle Fractures: Comparison of Two Coracoclavicular Button Fixation Techniques.

PURPOSE: Operative therapy for unstable lateral clavicle fractures is necessary to reduce the risk of bony non-union. Irritation and restriction during sportive activities due to the implanted materials are a common reason for impaired function and implant removal. The aim of this study was to gain information on functional outcome and time until return to sport (RTS) after surgical treatment of unstable lateral clavicle fractures, comparing two coracoclavicular button techniques. METHODS: A retrospective chart review of patients who were consecutively treated for unstable lateral clavicle fractures at our level one trauma center from 2014 to 2018 was conducted. Two different surgical techniques were evaluated and compared. Group 1 was treated using a locking compression plate and knotted DogBone™ Button, while group 2 received an LCP and knotless DogBone™ Button. Functional outcome (ASES (American Shoulder and Elbow Score), Constant-Score, DASH (Disability of Arm, Shoulder and Hand), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index) and time until RTS were investigated and compared between both groups, 1 year postoperatively. RESULTS: A total of 56 patients (n = 35 group 1, n = 21 group 2) with a mean age of 45.1 ± 14.6 years met the inclusion criteria. Functional outcome reached good to excellent results (ASES 94.7 ± 9.8, Constant Score 85.1 ± 8.1, DASH 5.5 ± 8.4, MSQ 90.9 ± 7.2, SPADI 96.1 ± 5.7). Implant removal rates were higher in group 1 (48.3% vs. 35.3%) yet without statistical significance (p = 0.122). All patients returned to sports postoperatively with a mean time period until return to sport of 4.6 (3-9) months. CONCLUSION: Locking compression plating and coracoclavicular fixation using a knotless Dogbone™ technique provides good to excellent functional outcomes, a high and fast rate of return to sport and lower irritation rates compared to the knotted DogBone™ technique.

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

BACKGROUND: In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome. METHODS: In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively. RESULTS: Fifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22-64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II. CONCLUSIONS: The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery. TRIAL REGISTRATION: Registered 20 April 2020, retrospectively on ClinicalTrails.gov ( NCT04370561 ).

[E-scooter accidents and their consequences : First prospective analysis of the injury rate and injury patterns in the urban area of a German city with over 1 million residents]. / E-Scooter-Unfälle und deren Folgen : Erste prospektive Analyse der Verletzungsrate und Verletzungsmuster im urbanen Raum einer deutschen Millionenstadt.

BACKGROUND: Since their approval in Germany in June 2019 e­scooters have become increasingly more popular; however, with growing popularity and easy access for everybody the number of accidents has increased, sometimes even resulting in severe injuries. OBJECTIVE: The purpose of this study was to collect demographic data and analyze injury patterns of accidents due to e­scooter use in a large German city and to give suggestions on future safety concepts and rules of conduct. METHODS: All patients who presented at the interdisciplinary emergency room of the Klinikum rechts der Isar, University hospital of the Technical University in Munich between 1 July 2019 and 1 April 2020 after suffering an e­scooter accident were included in this study. Demographic data as well as information with respect to the trauma mechanism were prospectively collected. RESULTS: During the study period 60 patients were identified of which 34 (56.7%) were male with an average age of 34.7 years (range 18-73 years) at the time of the accident. Of the patients 22 rode the e­scooter under the influence of alcohol and only 1 wore a helmet. The head was the most injured body region, followed by the upper and lower extremities and 2 (3.3%) patients were severely injured with an injury severity score (ISS) ≥16. CONCLUSION: Due to the growing popularity of e­scooter use more injuries have been registered. The head was the most affected body region, therefore emphasis should be put on wearing a helmet. Furthermore, strict rules and more police controls should take place to identify and reduce the number of accident victims under the influence of alcohol.

Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case series of 35 patients and literature review.

INTRODUCTION: The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. METHOD: Literature review of treatments for FRI and description of own cases. RESULTS: We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. CONCLUSION: The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.

Concomitant Intra-Articular Glenohumeral Lesions in Fractures of the Scapula Body.

BACKGROUND: Scapula body fractures are rare injuries with an incidence of 1% of all fractures accounting for 3% to 5% of all upper extremity fractures. Fractures of the scapula commonly result from high-energetic trauma and fall from great height. While several studies focused on concomitant injuries of chest and head as well as the cervical spine, up to now in the common literature, no study exists analyzing the prevalence of concomitant intra-articular glenohumeral injury following extra-articular scapular fracture. OBJECTIVES: The aim of this study was to analyze the prevalence of concomitant intra-articular glenohumeral injuries in acute fractures of the scapula by performing magnetic resonance imaging (MRI) of the shoulder joint. STUDY DESIGN AND METHODS: This prospective cohort study was performed at our academic Level I trauma center from November 2014 to October 2016. According to our clinical algorithm, all patients suffering from an acute scapula body fracture primarily underwent computed tomography (CT) for assigning the fracture according to the Orthopedic Trauma Association (OTA)-classification and therapy planning. In addition, 3 T MRI-scans of all patients were performed within seven days after trauma. RESULTS: Twenty-one (16 male/5 female, mean age 53 years (25-83 y) patients with scapula body fractures (OTA 14.A3.2 80.1%, OTA 14.A3.1 4.8%, OTA14.B3.1 4.8%, OTA14.C3 9.5%) were enrolled. MRI revealed 11 acute intra-articular injuries in 8 of 21 patients (38%). In all 21 patients, hematoma of the rotator cuff and periarticular muscles was present. Three patients (14.3%) presented a partial bursa sided tear of the supraspinatus tendon, whereas in 5 (23.8%), a partial articular sided supraspinatus tendon tear and in 2 (9.5%) patients, a subtotal tear was observed. One patient (4.8%) showed a complete transmural supraspinatus tendon tear. CONCLUSIONS: Traumatic concomitant glenohumeral injuries in scapula body fractures seem to be more frequent than generally expected. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce the postoperative complication rate following scapula body fractures.

Augmentation of simultaneous acetabular and femoral neck fracture in osteogenesis imperfecta using photodynamic bone stabilization - A case report.

BACKGROUND: Surgical fracture treatment in patients suffering from "osteogenesis imperfecta" (OI) is challenging and often results in unsatisfactory fixation of implants due to altered bone quality. Even the use of locking plates bears a residual risk to develop a loss of reduction leading to secondary fracture dislocation. However, the augmentation with an intramedullary photodynamic bone stabilization system (PBS) (e.g. Illuminoss®) may increase bone stability and allow for a sufficient anchorage of established implants even in OI patients. CASE PRESENTATION: We report the case of a 41-year-old male patient with the diagnosis of OI. He sustained a medial femoral neck fracture (Garden type IV, Pauwels type III) and a fracture of the acetabulum (AO-Type 62-B.3) - both right-sided - after a blunt trauma during a bicycle accident. The medial femoral neck fracture was subsequently surgically treated to preserve the femoral head. After augmentation of the proximal femur with the PBS, a Dynamic Hip Screw (DHS) was implanted. After a short recovery, the acetabular fracture was surgically treated by intramedullary augmentation and locking plate fixation.The patient was discharged seven days after the surgical intervention of the acetabular fracture. Partial weight-bearing activities of the right lower extremity were performed on crutches for 6 weeks. The patient was able to do his outpatient rehabilitation program without any complications. He returned to work eight weeks after surgery. After a follow-up of four months, the patient presented full weight-bearing without assistance. No physical complaints were reported 14 months after surgery (Harris Hip Score 90). CONCLUSION: To the best of our knowledge, we report the augmentation with a photodynamic bone stabilization system of internal fixation techniques in an OI patient with fractures of the femoral neck and the acetabulum for the first time. This advanced surgical procedure shows the high potential of intramedullary photodynamic bone stabilization in patients with minor bone quality.

Management of acetabular fractures in the geriatric patient.

INTRODUCTION: Open reduction and internal fixation (ORIF) is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR) is increasing. Alarmingly, about 20-25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR. METHODS: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern. RESULTS: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures. DISCUSSION: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed.