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Purpose: Besides the multi-layered capsule-ligamentous complex of the elbow joint the high bony congruence in the ulnohumeral joint contributes to elbow stability. Therefore, we assume that specific anatomical configurations of the trochlear notch predispose to dislocation. In case of ligamentous elbow dislocation both conservative and surgical treatment is possible without a clear treatment algorithm. Findings of constitutional bony configurations could help deciding for the best treatment option., Methods: In this retrospective matched-pair analysis we compared MRI imaging from patients sustaining a primary traumatic elbow dislocation (instability group) with patients suffering from chronic lateral epicondylitis (control group), treated between 2009 and 2019. Two independent observers measured different anatomical landmarks of the trochlear notch in a multiplanar reconstructed standardized sagittal trochlear plane (SSTP). Primarily, opening angle and relative depth of the trochlear notch were determined. After adjustment to the proximal ulnar rim in the SSTP, coronoid and olecranon angle, the articular angle as well as the ratio of the tip heights of the trochlear notch were measured., Results: We compared 34 patients in the instability group (age 48 ± 14 years, f/m 19/15) with 34 patients in the control group (age 47 ± 16 years, f/m 19/15). Instability group showed a significantly larger opening angle (94.1° ± 6.9° vs. 88.5° ± 6.9°, p = 0.0002), olecranon angle (60.9° ± 5.3° vs. 56.1° ± 5.1°, p < 0.0001) and articular angle (24.7° ± 6.4° vs. 22.3° ± 5.8°, p = 0.02) compared to the control group. Measuring the height from the coronoid (ch) and olecranon (oh) tip also revealed a significantly larger tip ratio (tr = ch/oh) in the instability group (2.7 ± 0.8 vs. 2.2 ± 0.5, p < 0.0001). The relative depth (61.0% ± 8.3% vs. 62.7% ± 6.0%, p = 0.21) of the trochlear notch as well as the coronoid angle (32.8° ± 4.5° vs. 31.7° ± 5.2°, p = 0.30) showed no significant difference in the instability group compared to the control group. The interrater reliability of all measurements was between 0.83 and 0.94., Conclusion: MRI of patients with elbow dislocation show that there seems to be a bony anatomical predisposition. According to the results, it seems reasonable to include predisposing bony factors in the decision-making process when surgical stabilization and conservative treatment is possible. Further biomechanical studies should prove these assumptions to generate critical bony values helping surgeons with decision making., Level of Evidence: III., (© 2021. The Author(s).)

Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. Most classifications are based on rupture location, extent and time of injury. In addition to clinical presentation and sonography, magnetic resonance imaging is now established as the gold standard in diagnosing PM pathologies. Surgical management is indicated for all lateral PM ruptures with relevant strength deficits. Treatment in the acute interval (<3 weeks) is the primary goal; however, even in chronic cases or after failed conservative management a secondary operative approach enables notable clinical improvement. Conservative therapy mostly affects patients who have muscular injuries close to the anatomic origin and smaller partial tears. Surgical management aims for anatomic reconstruction of the PM unit with restoration of the original tension to enable optimal strength transmission. Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.

In septic joint surgery, the most frequently used antiseptics are polyhexanide, hydrogen peroxide and taurolidine. The aim of this study was to examine the effects of these antiseptics on viability of human chondrocytes. Our hypothesis was that antiseptics and supplemental irrigation with sodium chloride lavage are less toxic on human chondrocytes than treatment with antiseptics only. Primary human chondrocytes were isolated and cultured from six donated human knee joints. Polyhexanide, hydrogen peroxide or taurolidine were added to the cultures. Toxicity analysis was performed by visualisation of cell structure using light microscopy and LDH activity. The determination of vital cells and total cell numbers of chondrocytes treated with antiseptics partly followed by irrigation with sodium chloride solution was performed by using Casy Cell-Counter. Light microscopic data revealed a defect in cell structure after addition of antiseptics. We showed a significant increase of LDH enzyme activity after the treatment with polyhexanide or taurolidine. After treatment with antiseptics followed by sodium chloride solution a significant increase of vital and total cell numbers resulted in comparison with the chondrocytes that were only treated with antiseptics. The data show that treatment with polyhexanid, hydrogen peroxide or taurolidine induces cell death of human chondroctes in vitro. The application of sodium chloride solution after the treatment with polyhexanide and hydrogen peroxide possibly has a protective effect on chondrocyte viability.

The reasons for a shortage of young people in trauma surgery and orthopedics have often been discussed. Atypical progression of medical operating levels, antisocial working hours and an inadequate financial compensation for on-call duties have been given as the reasons for a lack of interest in the discipline. Additionally a progressive feminization of the medical profession and rejection of surgical disciplines because of a mismatch with family interests and the demands of advanced surgical training have also been named. Surveys on the choice of medical specialization reveal that experiences during the course of studying have a great influence on future prospects and are immensely important for the further focusing on the future as a medical doctor. In order to increase the attractiveness of the specialization, programs for students were initiated by the heads of the Conventions of Higher Education Lecturers for Orthopedics and Trauma Surgery and the management of the German Society for Orthopedics and Trauma Surgery. Due to the enormous popularity auxiliary projects were demanded. Consequently a "Trauma Surgery and Orthopedic Day for Students" was organized on 16th February 2010 in the Musculoskeletal Centre of the Charité in Berlin. The aim was to convey practical skills and to inspire the choice of this specialization in the future.

LV segmentation is often an important part of many automated cardiac diagnosis strategies. However, the segmentation of echocardiograms is a difficult task because of poor image quality. In echocardiography, we note that radio-frequency (RF) signal is a rich source of information about the moving LV as well. In this paper, first, we will investigate currently used, important RF derived parameters: integrated backscatter coefficient (IBS), mean central frequency (MCF) and the maximum correlation coefficients (MCC) from speckle tracking. Second, we will develop a new segmentation algorithm for the segmentation of the LV boundary, which can avoid local minima and leaking through uncompleted boundary. Segmentations are carried out on the RF signal acquired from a Sonos7500 ultrasound system. The results are validated by comparing to manual segmentation results.