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Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Osteoporotic pelvic ring fractures show a continuously increasing incidence. In addition to the fracture morphology, the clinical situation of the patients is also crucial for therapy. The osteoporotic fracture working group of the spine section of the German Society for Orthopaedics and Trauma Surgery (DGOU) has developed a score for the treatment decision that is based on the OF-Pelvis classification and on essential clinical parameters. The score includes the clinical parameters of mobilization ability, pain situation, fracture-related neurological deficits and risk factors for an increased surgical complication rate. In addition, the fracture morphology is determined according to the OF-Pelvis classification including the fracture modifiers. For each parameter, points are awarded or deducted depending on the characteristics and the total is then calculated. If a parameter cannot be determined, no point are awarded. A score below 8 means a recommendation for conservative therapy, while a score above 8 means a recommendation for surgical therapy. If there are exactly 8 points, conservative or surgical treatment is possible. The OF-Pelvis score was evaluated retrospectively in 5 trauma centers based on records and imaging in 107 patients and compared with the therapy actually carried out. There was an overall agreement of 91 % between the therapy recommendation of the OF-Pelvis score and the therapy actually carried out (conservative versus surgical). Collecting the score took about 5 minutes. The OF-Pelvis score is an easy-to-use decision-making aid for determining the indication for conservative or surgical treatment of osteoporotic pelvic ring fractures. [ABSTRACT FROM AUTHOR]

Copyright of Die MKG-Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die MKG-Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article provides an overview of osteoporosis, including definition, epidemiology, and risk factors. The fracture risk in osteoporosis depends on various factors such as age, body mass index, previous fractures, and medication intake. The FRAX fracture risk assessment tool can be used to calculate individual risk. The diagnosis of osteoporosis requires a comprehensive evaluation, including medical history, imaging, and bone density measurement. Treatment includes fall prevention, adequate calcium and vitamin D intake, as well as medication therapy. Various medications such as bisphosphonates, denosumab, and teriparatide are recommended, with individual adjustment of therapy being important. Fall prevention is also of great importance. Vitamin D supplementation is controversial, and high-dose therapies may increase fracture risk. [Extracted from the article]

Geriatric fragility fractures of the pelvis are among the most frequent osteoporosis-associated fractures. They usually result from a minor fall and their fracture morphology differs fundamentally from pelvic fractures in younger patients. Besides the differences concerning the fracture morphology, the special demands of the mostly multimorbid and frail patients have to be considered in the treatment. Fragility fractures of the pelvis lead to increased mortality and long-lasting deterioration in mobility, quality of life, and activities of daily living, comparable with hip fractures. [ABSTRACT FROM AUTHOR]

After conservative treatment nonunion (pseudarthrosis) of the clavicle can be observed approximately 10 times more frequently (15-24%) than after surgical treatment (1.4%). Risk factors include the fracture location, displacement, fracture type, sex, the severity of the accident and refractures. The diagnosis of pseudarthrosis of the clavicle can be made by a thorough medical history, clinical examination and imaging procedures. The main symptom is pain, often accompanied by malalignment, instability, neurological symptoms and restricted mobility of the affected shoulder. The diagnosis is confirmed by X‑ray images and, if necessary, a computed tomography (CT) scan. Pseudoarthrosis is classified according to the morphological appearance in X‑ray images and the cause. A differentiation is made between vital and nonvital pseudarthroses. Only symptomatic pseudarthrosis requires treatment. Nonoperative methods, such as magnetic field therapy or ultrasound are minimally effective. Surgical interventions are indicated for pain, movement restrictions or neurovascular problems. The goals of surgical treatment are to restore the vitality, bone length and stability through angular stable osteosynthesis. In cases of surgical pretreatment the anteroinferior plate position offers a good alternative to the superior plate position. In some cases double plating osteosynthesis can be indicated. Autogenous bone material, allogeneic substitute material and vascularized grafts are used for bony defects. Surgical treatment shows high rates of healing but also carries an increased risk of infection., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Injurie to the lateral clavicle and acromioclavicular joint (ACJ) are frequent events which are relevant to everyday life and particularly affect active adults at the age of 20-40 years. The Rockwood classification has been established for the classification of ACJ injuries. Lateral clavicle fractures are classified according to the Neer classification or the Jäger and Breitner classification. A newly established classification is the Cho classification. Depending on the injury pattern and in particular the presence of instability, various conservative and surgical care strategies are used. This article provides an overview of the various treatment concepts., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The two-dimensional (2D) imaging represents an essential and cost-effective component of intraoperative position control in fracture stabilization, even in the era of new three-dimensional (3D) imaging capabilities., Objective: The aim of the present study, in addition to a current literature review, was to examine whether the intraoperative use of 2D images leads to a quality of fracture reduction comparable to postoperative computed tomographic (CT) analysis including 3D reconstructions., Material and Methods: A comparative retrospective analysis of intraoperative 2D and postoperative 3D image data was performed on 21 acetabular fractures stabilized via a pararectus approach according to an established protocol using the Matta criteria., Results: The assessment of fracture reduction in intraoperative fluoroscopy compared with postoperative CT revealed a difference only in one case with respect to the categorization of the joint step reduction in the main loading zone., Conclusion: In the intraoperative use of 2D imaging for fracture treatment it is important to select the correct adjustment planes taking the anatomical conditions into account in order to achieve optimum assessability. In this way, the reduction result can be adequately displayed in fluoroscopy and is also comparable to the postoperative CT control. In addition, depending on the findings, optional intraoperative dynamic fluoroscopic assessment can have a direct influence on the further surgical procedure., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The assessment of causal connections and accident sequences does not have an age limit. The assessment of old insured persons does not differ from the assessment of young patients; however, older patients are more likely to have pre-existing conditions, which may even have to be taken into account when assessing the expert opinion. In the case of bone fractures, this includes osteoporosis and texture alterations in the case of connective tissue injuries. [ABSTRACT FROM AUTHOR]

Operative fracture treatment has become established worldwide with four principles: anatomical reduction, stable internal fixation, preservation of blood supply and early active pain-free mobilization. The paramount importance of preservation of the blood supply to the bone fragments was recognized from the very beginning and is still just as valid as early and pain-free mobilization. Also still valid is striving for the best possible anatomical reduction in joints but in diaphyseal fractures it was recognized that anatomical reduction, especially in multifragmentary fractures, is not possible without considerable impairment of the bood supply. In multifragmentary fractures the correct positioning of the main proximal fragment to the main distal fragment is decisive, where bone wedges and comminuted fracture areas should be bridged and not fixed. The aim of absolute stability, which was previously strived for, is nowadays only valid for joints and diaphyseal fractures are currently treated by osteosynthesis with relative stability, which results in healing via calluses. The failure rates for diaphyseal fractures could be considerably reduced by changing the target from absolute to relative stability and preservation of the blood supply to the fragments. [ABSTRACT FROM AUTHOR]

Copyright of Der MKG-Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Definition: The transitional fracture represents the typical joint injury of adolescents in the period of growth plate closure. The partially ossified growth plate leads to a change in the stereotype fracture pattern in children. The result is a specific fracture pattern which can be classified into two- and triplane fractures, according to the number of fragments. Diagnosis: Conventional radiographs play a major role in diagnosis, whereby cross-sectional imaging helps to distinguish between the specific fracture types. Treatment: The goal of therapy is anatomical joint reconstruction to avoid long-term consequences of early osteoarthritis. [ABSTRACT FROM AUTHOR]

The pararectal approach represents a valuable alternative to the ilioinguinal and Stoppa approaches and has substantial advantages compared to these standard approaches, particularly with respect to visualization of the fractures and possibilities for repositioning. This approach allows repositioning to be carried out with a complete view of the fractures and also against the direction of the dislocation. In this way anatomical repositioning results can be achieved in a higher number of cases, even for age-related fractures and combined fractures. According to the current data, the rate of repositioning without irregularities in this patient collective is over 90 %. The approach is primarily limited in obese patients because in most cases sufficient angulation cannot be achieved to be able to place the screws medially and even long retractors are possible too short. [ABSTRACT FROM AUTHOR]

Background: Pelvic ring injuries occur in patients aged 20-30 years old after high energy trauma and also in patients over the age of 65 years predominantly after low energy trauma. The latter have greatly increased. The necessity for treatment depends on the degree of instability and on the accompanying injuries and comorbidities. Emergency treatment: Despite following effective treatment algorithms, pelvic ring injuries caused by high energy force still have a high mortality rate. The differentiation between pelvic ring fractures with or without life-threatening bleeding is extremely important in the initial phase of treatment of these patients. The emergency treatment of life-threatening pelvic ring fractures should be embedded in a standardized protocol for the treatment of severely injured patients. Among the first measures are external stabilization, such as pelvic ferrules and external fixators as well as surgical hemostasis of the lesser pelvis. The final osteosynthesis should be performed in the secondary phase when the patient shows stable vital signs. Elective treatment: A pelvic ring fracture without relevant circulatory instability can be electively treated after completion of clinical diagnostics. Type A injuries are predominantly conservatively treated. In type B injuries stabilization of the anterior pelvic ring via osteosynthesis of the symphysis or external fixator is sufficient. The restoration of stability of the dorsal pelvic ring is the main task in type C injuries. Sacral fractures are a special feature. In cases of neurological disorders these fractures need immediate osteosynthesis after decompression of the neural structures. Highly unstable injuries require spinopelvic stabilization. Results: The outcome of patients depends on the extent of the injuries suffered and on the quality of repositioning and stabilization. The results of radiological investigations were better than the functional outcome. [ABSTRACT FROM AUTHOR]

Background: The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high.Aim: This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients.Material and Methods: A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management.Results: Elderly trauma patients should undergo operative interventions as soon as possible. Many of these patients have a high risk profile. This can be estimated using risk scores in order to allow a prognosis for the outcome of patients. The informed consent needs to be discussed accordingly. The perioperative management is ideally addressed in a multidisciplinary approach. An array of questions in perioperative management, such as the mode of anesthesia, the ideal individual transfusion trigger and fluid management have not yet been adequately addressed in studies.Conclusion: The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines. [ABSTRACT FROM AUTHOR]

Background: Incomplete greenstick fractures and complete fractures without shortening occurring at the distal metaphysis of the forearm are very frequent fractures in childhood. The treatment of these fractures is a matter of controversial discussion. Despite manipulation and/or pinning the risk of redisplacement is approximately 30 %. Objective: Is repositioning with K-wire osteosynthesis or other synthesis procedures necessary for these fractures or can the spontaneous remodeling capacity be used for treatment and make an operation superfluous? Methods: Analysis of existing studies on this topic. Results: There are no clear guidelines and not enough studies that take the remodeling potential into consideration. Conclusion: A study similar to the angulated fractures of the distal forearm in children (AFIC) study is needed that compares a purely conservative treatment with repositioning and fixation via K-wires in a controlled, randomized and prospective study. [ABSTRACT FROM AUTHOR]

The treatment of supracondylar humeral fractures in children has been a point of discussion and controversial opinions for many years, particularly where the topic of operations is concerned. The specific complication rates could be reduced over the years but the elbow is still generally considered a complex and demanding region in pediatric traumatology. Independent of the improvement in knowledge on treatment, operation-related difficulties repeatedly occur during the operative treatment of supracondylar humeral fractures, which can only be avoided through knowledge of the operative procedure being used and optimization of the intraoperative strategies. This article deals with the pitfalls and the resulting consequences and presents solutions for specific recurrent problems. [ABSTRACT FROM AUTHOR]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In recent years standardized algorithms have been developed for sonographic fracture diagnostics (sonographic algorithm for fracture evaluation, SAFE) which allow a broad field of utilization. The main application area is in the diagnostics of children up to 12 years of age. For the wrist (wrist-SAFE) completely radiation-free diagnostics and treatment control of wrist fractures can be performed with a sensitivity of 96-98 %, a specificity of 98-100 %, a positive predictive value (PPV) of 0.98-1 and a negative predictive value (NPV) of 0.95-0.96. The elbow-SAFE uses the sonographic fat pad (SOFA) sign to predict or exclude a fracture (sensitivity 97.9 %, specificity 95 %, PPV 0.95 and NPV 0.98). A lack of detection means that a fracture can be excluded with a high degree of probability. The shoulder-SAFE diagnoses proximal humerus fractures with a sensitivity of 94.4 % and a specificity of 100 %. The use of ultrasound allows an effective reduction of radiation exposure, time consumption and costs. [ABSTRACT FROM AUTHOR]

Background: Proximal fractures of the ulna in combination with radial head dislocation are named Monteggia injuries after the person who first described them. They are comparatively rare and necessitate a consolidated anatomical and biomechanical knowledge, operative experience and suitable implants for reconstruction of the elbow joint. Methods: Proximal ulnar fractures in combination with radial head dislocation can be subdivided into four groups according to the Bado classification depending on the direction of dislocation. The most frequent type II (dorsal dislocation) can be subdivided into subgroups A-D according to Jupiter depending on the location and morphology of the ulnar fracture. Rotational fracture dislocations of the elbow which do not fit into these categories are named Monteggia-like lesions. New treatment strategies with ulnar double plates and radial head reconstruction or replacement are presented and the results from the literature are summarized. Results: New implants, such as polyaxial angular stable screw fixation using a double plate osteosynthesis strategy can improve the primary stability and an exact screwing of the individual coronoid fragments. Although experts agree that a successful anatomical reduction of the joint is an important prognostic factor, the outcome is still hard to predict and comparatively moderate. [ABSTRACT FROM AUTHOR]

The radial head plays a pivotal role in the functional anatomy of the elbow and forearm. It is an important stabilizer together with the collateral ligaments and the coronoid process. Due to the importance of the radial head for the function of the elbow joint, a differentiated therapy is indispensible. The article presents the current diagnostics, classification, treatment algorithms and techniques for reconstruction of radial head fractures depending on the fracture morphology. [ABSTRACT FROM AUTHOR]

Fractures of the distal humerus are rare and account for only a small proportion of fractures in adult patients. Due to demographic changes surgeons will be faced with an increasing number of complex multifragment fractures with diminished bone quality in geriatric patients. As conservative treatment frequently leads to limited and painful elbow function, open reduction and stable internal fixation with early range of motion exercises are considered the gold standard. However, in combination of comminution and an osteoporotic bone stock, complication rates remain considerably high and stable fixation might be impossible. In these patients primary total elbow arthroplasty has become increasingly popular in recent years. Since Cobb and Morrey published their landmark paper on the use of total elbow arthroplasty for distal humeral fractures it has become accepted that this technique is a valuable treatment option. Detailed knowledge and understanding of the technical aspects of total elbow arthroplasty are the key factors for a successful procedure and patient satisfaction. This articles highlights the history of total elbow arthroplasty for trauma fractures, provides detailed information on the correct indications, the operative procedure, results and complications. [ABSTRACT FROM AUTHOR]

Background: In contrast to elbow fracture dislocations, the therapeutic management of simple elbow dislocations has not yet been adequately clarified with uniform guidelines. Aim: The aim of this review is to provide an answer to whether surgical or conservative therapy is the optimal solution for the various types of simple elbow dislocation. Diagnostics and therapy: This article presents a structured diagnostic approach to identify instability after elbow dislocation followed by an algorithm for therapeutic decision-making. Both non-operative treatment and surgical repair of simple elbow dislocations are presented in detail. [ABSTRACT FROM AUTHOR]

Background: Elbow dislocation fractures belong to the complex elbow dislocations with participation of ligamental and bony injuries. Therapy: The treatment complies with the pattern of injuries and the resulting instability. Simple elbow dislocations can be treated conservatively if they are stable after repositioning. The ligamental and bony injuries in complex dislocation fractures need to be reconstructed to restore elbow stability. Follow-up treatment: Early mobilization and functional treatment are very important for a good outcome and to prevent subsequent damage of the elbow joint. [ABSTRACT FROM AUTHOR]

Definition: The transitional fracture represents the typical joint injury of adolescents in the period of growth plate closure. The partially ossified growth plate leads to a change in the stereotype fracture pattern in children. The result is a specific fracture pattern which can be classified into two- and triplane fractures, according to the number of fragments. Diagnosis: Conventional radiographs play a major role in diagnosis, whereby cross-sectional imaging helps to distinguish between the specific fracture types. Treatment: The goal of therapy is anatomical joint reconstruction to avoid long-term consequences of early osteoarthritis. [ABSTRACT FROM AUTHOR]