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The increasing number of surgical fracture care using osteosynthesis devices poses a challenge for orthopedics and trauma surgery. While approximately 1.23 % of all fractures result in a fracture-related infection (FRI), 10-13 % of all FRIs affect the upper extremity. Accurate diagnosis of this often-complex condition is crucial for successful therapy. Since 2018, confirmatory criteria and suggestive parameters have been established that must be considered in the diagnosis. Clinical routine diagnostics are also followed for the upper extremity. In addition to the obligatory medical history and clinical examination, radiological imaging such as X-ray, CT, MRI, and nuclear medicine procedures are included. Furthermore, 3-5 tissue samples from the fracture region should be sent for microbiological diagnosis, and a histopathological examination should be arranged for diagnostic confirmation. Treatment should be interdisciplinary. In addition to surgical and usually twelve-week antibiotic therapy, an interdisciplinary treatment approach to optimize comorbidities and surgical assessment by a plastic surgeon is advisable, especially in complex cases. Special aspects of the upper extremities, such as options for joint preservation or conversion to a joint replacement procedure, should be evaluated depending on the blood flow and osteosynthesis situation. Diaphyseal bone defects of smaller extent in the humerus can be treated better with shortening, and monorail fixator systems can be applied safely without additional intramedullary implants, unlike in the lower extremity. The commonly occurring Cutibacterium acnes can often be effectively treated with antibiotics. However, the surgeon must be aware of a three-week cultivation period by microbiological diagnostics. Separate patient-reported outcome measurements (PROMs) for assessing treatment outcomes are not available. PROMs for the upper extremity, such as the disabilities of the arm, shoulder and hand questionnaire, are applied here. [ABSTRACT FROM AUTHOR]

The spherical agglomeration offers the possibility of a separation by two particle properties. The first separation property is the wetting behavior of the solids in relation to the suspension and binding liquid followed by a size separation. The aim of this work is to gravimetrically determine the purity of the resulting graphite agglomerates in a mixture with quartz sand and to correlate this with the wetting properties. The quality of these results is investigated by means of micro X‐ray tomography (µ‐CT). It has been shown that quartz cannot be wetted with paraffin oil and thus purities of 99.5 % to 99.9 % can be achieved, which was confirmed by the µ‐CT results. An influence of the quartz sand particle size could not be verified in the investigated range. [ABSTRACT FROM AUTHOR]

Whiplash injury of the cervical spine often occurs during motor vehicle accidents involving rear-end collisions and represents a common cervical trauma. The injury usually results from a rapid "whiplash-like" movement of head and neck (reclination followed by inclination). The typical symptoms of the whiplash injury like pain, tenderness and stiffness of the neck may occur with a latency of several hours and may persist chronically over a long period of time in some patients. Diagnostic imaging studies rarely show posttraumatic changes after a whiplash injury. In acute clinical trauma-workup, x-ray imaging like plain films and/or computed tomography is performed to evaluate bone injuries. Magnetic resonance imaging may sometimes show posttraumatic changes of the soft tissues (muscles, ligaments) as well as bone contusions or occult fractures. The Quebec Task Force classification may be used for grading of the whiplash injury and is based on the symptom severity. [ABSTRACT FROM AUTHOR]

Kindliche Verletzungen im Bereich der Halswirbelsäule sind selten. Wesentlich sind eine frühzeitige Diagnosestellung und die rasche, konsequente Therapie. Dies ist die wahrscheinlich beste Ausgangssituation, um Spätfolgen zu vermeiden, denn diese würden das Kind ein Leben lang behindern. Entsprechend behandelt dieser Beitrag die Akutversorgung und Spätfolgen bei kindlichen Verletzungen der Halswirbelsäule. [ABSTRACT FROM AUTHOR]

Injuries of the cruciate ligaments are frequent in sport and are one of the most frequent causes of sport invalidity. Conservative and surgical treatment options are possible for ruptures of the anterior cruciate ligament. What are the current treatment recommendations? This article examines exactly this question and presents the surgical and conservative therapy options. The anamnesis is given priority in the diagnostics. The following are established tests to investigate the integrity of the anterior cruciate ligament: the Lachman test, the pivot shift test and the anterior drawer test. Whereas accompanying bony injuries can be detected by native X-ray imaging, magnetic resonance imaging (MRI) is suitable for the diagnostics of cruciate ligament injuries. Although conservative therapy of anterior cruciate ligament lesions can be successful, it has been shown that surgical reconstruction is more often necessary, particularly for highly demanding sporting activities; however, the original knee function can never be restored in an identical fashion by reconstruction of the anterior cruciate ligament. This explains why not all athletes can return to the same performance level achieved before the cruciate ligament lesion and only 55 % can maintain sport at a competition level. [ABSTRACT FROM AUTHOR]

Fractures of the distal radius represent the most common fracture in adults. All degrees of severity can occur depending on the fracture morphology, ranging from complete recovery up to extremely severe courses. In addition, the outcome is strongly influenced by possible accompanying carpal injuries. The patient population is divided into young patients under 40 years old with approximately equal proportions of female and male patients presenting with relevant traumatic events and into predominantly female patients over 60 years old with poor bone quality due to osteoporosis and minor traumatic events. Up to approximately 35 years ago treatment was almost exclusively conservative. Surgical procedures, such as Kirschner bore-wire fixation were performed in cases of severe dislocation and external fixation in cases of severe soft tissue problems. The development of modern locking compression plates has led to a paradigm shift in treatment. Conservative treatment is now predominantly limited to stable fractures. The identification of typical errors in the positioning of implants and the development of new X-ray imaging techniques increase the safety of the surgical treatment with volar locking compression plates and establish its position as the standard treatment. At the same time, a more differentiated perception of geriatric trauma patients is evolving, which initiated a change in treatment strategies within this patient population. [ABSTRACT FROM AUTHOR]

Background: Soft tissue infections of the hand and forearm belong to most frequently occurring syndromes in hand surgery. They often arise following minor injuries and less commonly due to hematogenic spreading, they can have a protracted course and result in permanent functional limitations of the affected hand. Therefore, an immediate and adequate treatment which not uncommonly requires one or more operative interventions, is imperative. Diagnostics: For every suspected infection of the hand a detailed symptom-oriented medical history with clinical examinations and extensive laboratory and if necessary X-ray investigations are indicated. Accompanying injuries must not be overlooked and comorbidities which could complicate the course of the infection must be clarified. Therapy: The rapid induction of an empirical broad spectrum antibiotic therapy with good tissue permeating agents and in particular good effectiveness with respect to Staphylococcus aureus is absolutely recommended. This should be rapidly switched to a pathogen-specific antibiotic therapy when an antibiogram has been carried out. Essential components of the operative treatment are surgical relief by incision and soft tissue excision or radical débridement. This is followed by postoperative immobilization in a plaster cast, functional physiotherapy as early as possible, wound irrigation and if possible a pathogen-specific antibiotic therapy. Complications are not always avoidable even after adequate therapy. [ABSTRACT FROM AUTHOR]

Background: One quarter of all broken bones are distal radius fractures and are treated daily in every accident and emergency clinic and practice. Diagnostics: Standard procedures for classification, X-ray examination and criteria for instability have been established. Therapy: In addition to conservative therapy, various operative techniques are also available. In recent years there has been a clear increase in operative treatment due to the availability of locking plates. The treatment of distal radius fractures is still a challenge, particularly in the elderly. Although guidelines have been established there are no evidence-based recommendations for unstable fractures. Summary: An analysis of the literature showed that radiological parameters do not correlate with the clinical results. Multicenter studies are necessary in order to achieve an improvement in the treatment of unstable fractures. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is one of i ! the most commonly performed imaging modalities in radiology. This is mainly the result of wide availability, robustness, and fast image acquisition. However, CT is associated with ionizing radiation to the patients. Various recent techniques help to reduce the radiation dose considerably. These include automated attenuation-based tube current modulation and automated selection of the tube voltage. In addition, iterative reconstruction techniques allow for a dramatic decrease in radiation dose while image quality can be maintained. Using all these techniques, it has become possible to perform a diagnostic CT examination of the lungs with a radiation dose that is comparable to that of a conventional chest X-ray. [ABSTRACT FROM AUTHOR]

With sufficient experience fractures in the region of the elbow during childhood and adolescence can be diagnosed with conventional X-rays in the frontal and sagittal planes. Radial condyle fractures can be difficult to diagnose in initial X-ray images and in such cases symptomatic immobilization should be initiated and control X-rays taken 5 days later. If stable, non-dislocated radial condyle fractures can be treated by immobilization in an upper arm cast. For unstable fractures compression screw osteosynthesis is indicated. Monteggia fractures must be correctly diagnosed and treated within short time frame in order to avoid extensive reconstruction procedures. For supracondylar humeral fractures with malpositioning in the frontal plane, reduction and osteosynthesis are carried out. Growth plates close to shoulder and wrist joint have the highest growth and correction potential within the region of the upper extremity; nevertheless, situations can occur where the limits of this corrective potential are reached and surgical intervention under anesthesia is indicated. [ABSTRACT FROM AUTHOR]

For most but not all state medical associations X-ray diagnostics are no longer included in the regulations for further education to specialist for orthopedics and casualty surgery. In most cases it is only necessary to provide evidence that intraoperative radiological control of findings has been included in the training and moreover the supplementary further education topic'X-ray diagnostics of the skeleton' has been introduced in the further education regulations. Overall the current further education situation in X-ray diagnostics for casualty surgeons and orthopedists is unsatisfactory because the often necessary referral to a radiologist hinders the rapid treatment of patients. In order to find a solution to this problem orthopedists and casualty surgeons should also try to ensure that when amendments are being made to the further education and X-ray regulations, ways should be found which do not unnecessarily limit access to X-ray examination. [ABSTRACT FROM AUTHOR]

Osseous lesions and injuries around the elbow joint in children are feared lesions since the turn of the nineteenth century. Complications are often and blunders in treatment have often been published. Skeletal healing and remodelling is modest. Furthermore there are other characteristics than in adult lesions related to the pattern of lesions, diagnostics and treatment. Comparative x-rays of the non-injured side are strictly contraindicated. Radial head subluxation is a typical lesion of toddlers and young children and the diagnosis is made based on the history of a pulled arm and physical findings. Fractures of the radial neck are almost exclusively metaphyseal and epiphysiolysis lesions (Harris-Salter I and II). Due to blood supply disturbances a radial head overgrowth is often observed. Best therapeutic outcome is achieved with conservative treatment. Up to the age of 9-10 years corrective potential and remodelling is excellent. Open procedures and extensive osteosynthesis are associated with major complications. The Monteggia fracture in children has a better prognosis than in adults, provided dislocation of the radial head was diagnosed and conservative treatment is possible in nearly 50% of cases. Reconstructive procedures after missed dislocations are possible but children end up with a clearly inferior result. [ABSTRACT FROM AUTHOR]

Only a standartized, systematic approach allows a complete review of a chest x-ray and the collection of all relevant informations. In detail, alterations of the following structures should be sought: soft tissue, bones, pleura, mediastinum, lung, heart, pulmonary circulation and hili. Technical factors and the position of the patient should also be considered. [ABSTRACT FROM AUTHOR]

The indication for wrist arthroscopy is established on the basis of clinical examination and X-rays of the wrist. Cartilage, ligament and triangular fibrocartilage complex (TFCC) lesions can be diagnosed and, to a certain extent, treated arthroscopically. The most important ligament rupture concerns the scapholunate intercarpal ligament (SLIL). Partial tears can be débrided arthroscopically. In complete ruptures we prefer open reduction and ligament reconstruction. In osteoarthritis wrist arthroscopy serves in the planning for further open surgery. Occasionally, free osteochondral fragments can be removed. TFCC lesions are classified according to their location if traumatic in origin (1A-D), or according to their severity (2A-E) if degenerative in origin. Central TFCC tears are typically located close to the sigmoid notch of the radius and are either traumatic (1A) or degenerative in origin (2C+), the latter being associated with ulno-dorsal cartilage damage to the lunate cartilage. Central TFCC lesions can be treated by arthroscopic débridement using small joint punches or a bipolar high frequency system. Ulnar TFCC avulsions (1B) can be refixed arthroscopically. [ABSTRACT FROM AUTHOR]

In a project funded by the German state of Lower Saxony, macro- and microscopic analyses, X-ray examinations, 3D computed tomography and metal analyses (trace element analyses and lead isotope analyses) were carried out on Early Bronze swords from Lower Saxony. The evaluation provides some new insights, including the discovery of an exceptional ornamental technique involving inserted bolts on the pommels of two Nordic full-hilted swords. Furthermore, the investigations confirm the theory that Nordic full-hilted swords and Southern Central European octagonal hilted swords were produced by craftsmen of different traditions. Remarkably, Nordic full-hilted swords bear evidence of a limited adaptation of casting and mounting techniques of Southern Central European origin. This sheds light on complex relations and a selective technology transfer between these two different craft traditions. In addition, it can be shown that some craft traditions of the Early Bronze metal-hilted daggers live on in some full-hilted swords of later times. The octagonal hilted swords were probably produced in several small workshops. The long-postulated workshop trading areas of Nordic full-hilted swords could unfortunately not be reassessed according to technological criteria because of the scarce data available. The distribution of octagonal hilted swords in the north may be explained by the import of swords with 'southern' ornamentation and other non-decorated swords which were finished in the north. This led to reciprocal contact and influences. Besides their primary function as a weapon, the swords would certainly also have carried social and symbolic meanings. [ABSTRACT FROM AUTHOR]

ute aortic rupture is associated with a high mortality. The leading symptoms are chest pain, dyspnea and hemodynamic instability as well as hemoptysis. In the current case report a patient with known coronary artery disease and prior coronary artery bypass surgery presented with hemoptysis. He was initially treated for a presumed gastroenterological disorder. The chest X-ray delineated a structure suggestive of aortic rupture and this diagnosis was confirmed by computed tomography. Emergency treatment was performed by implantation of an endovascular stent prosthesis. This procedure is currently regarded the standard treatment of rupture of the descending thoracic aorta. We conclude our case report with a discussion of epidemiology, symptoms, pathogenesis and therapy of this clinically dramatic disease. [ABSTRACT FROM AUTHOR]

The diagnosis of fractures in children is based on conventional X-rays. Computed tomography or magnetic resonance imaging scans are done as supplementation for a specific question and with a focus on additional information. Ultrasound is still not established as a standard procedure. [ABSTRACT FROM AUTHOR]

A 54-year-old alcohol-dependant male patient suffering from severe alcohol withdrawal syndrome had to be intubated and artificially ventilated because of autonomic instability, convulsions and pulmonary dysfunction. A nasogastric tube (NGT) was inserted for enteral feeding and although placement was difficult the NGT was finally inserted after repeated attempts. Correct positioning of the NGT was evaluated by clinical means using insufflation of air and epigastric auscultation. As a typical “bubble” sound was epigastrically audible it has been assumed that the NGT was in the correct position. However, a routine control chest X-ray revealed a right-sided pneumothorax due to misplaced insertion of the tube into the bronchial system. Furthermore the patient developed massive cutaneous emphysema. The pneumothorax was treated successfully using pleural drainage. The patient was transferred to a peripheral ward 3 weeks after admission to the intensive care unit. The presented case report shows the importance of a correct position control of NGTs to avoid severe complications. [ABSTRACT FROM AUTHOR]

The necessity for insertion of a thorax drainage can lead to serious complications. Especially the use of a trocar instead of a minithoracotomy has a notable risk of misplacement or complications. Chest tubes per se can perforate the parietal pleura resulting in an extrathoracic position of the tube and contraindications for chest tubes should always be considered. Accidental lacerations of blood vessels should be avoided by a correct technique and a clear indication. A chest X-ray in one plane is not sufficient to prove correct positioning of a chest tube and suspected misplacement of a chest tube has to be assessed radiographically in at least two planes. A case of a fatal complication of a misplaced chest tube causing a laceration of the right subclavian vein is described. [ABSTRACT FROM AUTHOR]

With the current technological options, X-ray examinations, imaging and interpretation can be carried out at different sites or even delegated. Particular problems arise for delegation of the examination (e.g. from radiologists to non-medical personnel) or interpretation (e.g. from radiologists to specialists in orthopedics and casualty surgery) with respect to invoicing or proportioning of the invoiced service. According to the current legal situation a specialist in orthopedics and casualty surgery cannot bill for the interpretation of X-rays carried out. In order not to risk professional or even criminal proceedings when invoicing by referral it is necessary to seek advice in each individual case. [ABSTRACT FROM AUTHOR]

X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) form the three classic pillars of diagnostic imaging of the wrist and hand. Diagnostic imaging is indicated in the case of post-traumatic changes, invasive and inflammatory processes, degenerative changes and deformities/anomalies (normal variants). In the case of correct indication, accurate patient positioning and optimal technical settings, a high rate of correct diagnoses can already be obtained from X-rays and special views. Using modern CT techniques, high-resolution thin-slice images of all body areas can be used for multiplanar reformatting or reconstruction. MRI is additionally able to visualize soft-tissue structures. To optimize the use of diagnostic procedures, constant dialogue between clinics and radiologists is of great importance. [ABSTRACT FROM AUTHOR]

A 56 year old female patient presented to the emergency room because of a progressive, painful swelling of her thigh, dinically suspected to be a haematoma. Trauma was denied. Ultrasonography revealed a hyperechogenic structure, which appeared to be an intramuscular foreign body on computed tomography. Intraoperatively, a large piece of glass was found. Glass foreign bodies can be detected by x-rays with a high sensitivity. The threshold to order x-ray for the detection of glass foreign bodies should be low. [ABSTRACT FROM AUTHOR]