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Background: Kyphoplasty is used to alleviate pain and to restore the initial height of osteoporotic vertebral fractures (OVF). One of the most recent procedures is radiofrequency-targeted vertebral augmentation (RFTVA). We investigated whether restoration with this method is similar and as adequate as with the established procedure of balloon kyphoplasty (BKP), as assessed by the anatomical height of the vertebral body. The aim of our study was to compare the intravertebral angles (base-endplate) post- and preoperatively with these two procedures., Patients and Methods: The base and endplate angles were measured on 142 vertebral bodies treated by kyphoplasty (67 BKP and 75 RFTVA), on the basis of pre- and postoperative X-rays in the upright position in 87 volunteers (46 BKP and 41 RFTVA). The main object was to detect the degree of correction (Δpost-preop) with BKP compared to RFTVA. Furthermore, the sagittal alignment of the adjacent heathy levels were measured., Results: Significant correction was detected with both BKP (BKPpre: 11.5 ± 6.0°, BKPpost: 6.2 ± 4.6°, p < 0.001) and RFTVA (RFTVApre: 9.9 ± 6.2°, RFTVApost: 6.3 ± 4.4°, p < 0.001). Potential correction was greater with BKP than with RFTVA (Δpost-pre BKP: - 5.3 ± 4.4°, Δpost-pre RFK: - 3.6 ± 4.4°, p = 0.03). Neither procedures gave a significant change in the sagittal angle in the adjacent segment (segment BKPpre: 13.8 ± 8.0°, Segment BKPpost: 12.5 ± 9,2°, p = 0.638; Segment RFTVApre: 18,8 ± 14,3°, Segment RFTVApost: 15.0 ± 13.2°, p = 0.330)., Conclusion: BKP gave significantly better correction, even though both methods were able to restore significant improvement in the kyphotic angle. In the adjacent levels, correction of the sagittal angle was not significant, although the influence of the intervention on alignment tended to be less., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Dual energy computed tomography (DECT) is a constantly evolving technology, which opens up new diagnostic possibilities. It is particularly valuable for musculoskeletal (MSK) imaging. Due to the lack of recognition and availability of dual energy scanners, routine use is only established in a few centres. The intention of this review is to show the possibilities and fields of applications of the DECT in MSK imaging, as well as to describe technical principles and typical indications. We mainly focus on the use of DECT in the context of fragility fractures of the pelvis. The use of the DECT in pelvic fractures of the elderly could combine the advantages of CT diagnostics - fast and continuous availability, lower costs by dispensing with a supplementary MRI examination - and the high sensitivity of MRI to oedema in fragility fractures. Furthermore, the latest DECT scanners are dose neutral, so that these examinations can also be carried out without increased radiation exposure., Competing Interests: Conflict of Interest/Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Background Treatment of the injured from war zones with wounds with multi-resistant pathogens is becoming more common in Germany, especially in German Armed Forces Hospitals. In most cases, the pre-treatment of these patients has been inadequate and they have a high load of rare pathogens. In Germany, hospitals have to evaluate these pathogens by law. The aim of this study was to review current German guidelines and data on the array of pathogens of complex trauma wounds in Germany and to compare patients with wounds and multi-resistant pathogens from war zones treated in Germany. Patients and Methods A PubMed search was performed on all multiresistant pathogens, antibiotic resistance and guidelines in Germany from 2005 to 2015. The databases and recommendations of the Robert Koch Institute, the Paul Ehrlich Society and the National Reference Centre for the Surveillance of Nosocomial Infections were analysed. The screening results of injured patients from war zones treated in the German Armed Forces Hospital Ulm were included. Results The array of pathogens for nosocomial infections has not changed, but the ratios of the pathogens has altered. Methicilin-resistant Staphylococcus aureus (MRSA) has decreased, but vancomycin-resistant enterococci have increased continuously. Enterococcus faecium (E. faecium) now make up the largest fraction of VRE. The databases do not yet provide data on the relatively new classification of multiresistant gramnegative (MRGN) pathogens. MRGN pathogens play the main role in injured patients from war zones. Conclusion In the last ten years, there have been changes in the resistance and ratios of multi-resistant pathogens. MRSA has decreased over the last ten years, but reserve antibiotics are increasingly needed. VRE are increasing and even some reserve antibiotics have lost their efficacy because of the use of modern antibiotics. There are not yet any German datasets available on 3- and 4-MRGN. These pathogens play the main role in injured patients from war zones treated in Germany: it is crucial to perform routine screening and to take all precautions, including isolation. Surgical wound therapy is of increasing importance and uncritical and expensive antibiotic therapy is becoming becomes less important., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction Talar dislocation fractures of type IV (Marti and Weber) are extremely rare injuries with special challenges to the surgeon and poor results. Due to their low incidence and the sparse literature, it is unclear what is the optimal treatment and how complications can be minimised. Material and Methods A literature research was carried out using the online medical database "PubMed". The findings of the literature were then applied to a clinical case of type IV talar dislocation fracture (Marti and Weber). Results Modern osteosynthesis with generous and multiple access paths is to be preferred to the previously prioritised methods of talectomy and arthrodesis. Priority is put on the fastest possible reposition of the fracture, while sparing the soft tissue and the conditions of vascularisation. It can be assumed that with increasing degree of dislocation the risk of necrosis of the talus rises too, but this does not necessarily correlate with the clinical outcome. Conclusions In totally dislocated fractures of the talus, the focus is on prompt reposition and sufficient osteosynthetic supply. Nevertheless, frequent complications have to be expected. Medial explantation, which is described in the clinical example and lateral re-implantation of the talar body have never been described before in the literature and were an encouraging development., (Georg Thieme Verlag KG Stuttgart · New York.)

Background The incidence of fragility fractures of the pelvis is increasing. Established methods to diagnose this condition include X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Dual energy CT (DECT) is a modern technology for the imaging of bone oedema/bruises and has been used in injuries of the extremities and spine. It is unclear whether this technique can also be used in fragility fractures of the pelvis. The aim of this study was to perform a literature research and survey of the "AG Becken III" members of the German Society of Trauma Surgery (DGU) on the usefulness of DECT in fractures of the pelvis. Material and Methods A PubMed-based literature search on DECT comprised the key words "Dual Energy CT", "Pelvis/Pelvic", "Insufficiency" and "Fractures" and their combinations. Thirty-two publications were reviewed completely (full text). Finally, 15 articles were chosen and included in the current study. The survey of the members of the "AG Becken III" was based on a questionnaire and aimed to determine the popularity and potential benefits of DECT in comparison to established diagnostic options. Results No studies on the use of DECT in fragility fractures of the pelvis were identified; the few articles found referred to fractures of the extremities and spine. The response rate to the questionnaire was 25/83 (30.1 %). The participants had a mean personal experience of 8.4 years/151.6 interventions in pelvic surgery. Although some respondents had heard of DECT, this technique - if available - was only used in other indications. However, the potential benefit of DECT was recognised, especially in the acute diagnostic testing of fragility fractures. There is limited consensus on the optimal diagnostic test (CT vs. MRI) of pelvic fractures. Conclusion Although DECT is already established for other indications and is regarded as a promising method by all respondents of the "AG Becken III", DECT is not yet routinely used for diagnostic testing of fragility fractures of the pelvis. Potential advantages of DECT include its greater sensitivity than CT in detecting bone oedema with equal radiation exposure. Unlike MRI, it is available 24 hours/7 days., (Georg Thieme Verlag KG Stuttgart · New York.)