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Zusammenfassung: Ziel dieser Untersuchung war es, die Versorgungssituation von Patienten mit osteoporotischer Fraktur in Deutschland zu ermitteln. Mittels eines Fragebogens wurden 409 unfallchirurgische Kliniken im gesamten Bundesgebiet zu Diagnostik und Therapie dieser Frakturen befragt. Über 80% der Fragebögen wurden zurückgesandt. Die Daten wurden mit den Leitlinien des Dachverbands der deutschsprachigen osteologischen Fachgesellschaften verglichen. 35% der Abteilungen verfügen über ein standardisiertes Vorgehen. Von diesen Kliniken führen 30% die Diagnostik und 51% die Therapie in Übereinstimmung mit den Leitlinien durch. Eine leitliniengerechte Diagnostik und Therapie, also eine leitliniengerechte Versorgung, wird von 12% angeboten. Die Mehrheit der unfallchirurgischen Kliniken verfügt demnach über kein definiertes Vorgehen bei Patienten mit osteoporotischen Frakturen. Unsere Ergebnisse zeigen die momentan unzureichende Versorgungswirklichkeit, aber auch das enorme Verbesserungspotenzial, das unseres Erachtens durch eine verstärkte Aufklärung und interdisziplinäre Zusammenarbeit ausgeschöpft werden kann.

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Thoracic outlet syndrome (TOS) is a clinical phenomenon resulting from compression of the neurovascular structures at the superior aperture of the thorax which presents with varying symptoms. Regarding to the varying symptoms, the diagnosis of TOS seems to be a challenge and predictors for the outcome are rare. The purpose of this study was therefore to analyze the different clinical examinations and tests relative to their prediction of the clinical outcome subsequent to surgery. During a period of five years, 56 patients were diagnosed with TOS. Medical history, clinical tests, operative procedure and complications were recorded and analysed. Mean follow-up of the patients was 55.6 ± 45.5 months, median age of the patients was 36.4 ± 12.5 years. Different clinical tests for TOS showed an acceptable sensitivity overall, but a poor specificity. A positive test was not associated with a poor outcome. Analyses of the systolic blood pressure before and after exercise showed, that a distinct decrease in blood pressure of the affected side after exercises was associated with a poor outcome (p = 0.0027). Clinical tests for TOS show a good sensitivity, but a poor specificity and cannot be used as predictors for the outcome. A distinct decrease in blood pressure of the affected side after exercises was associated with poor outcome and might be useful to predict the patients' outcome.

Ollier’s disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier’s disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23°. He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.