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Background: Many people have leg-length discrepancies of greater or lesser severity. No evidence-based studies on the need for treatment are currently available. Methods: This review is based on publications retrieved by a selective search in the PubMed database, as well as on published recommendations from Germany and abroad and on the authors' own clinical experience. Results: If the two legs are of different lengths, this is generally because one leg is too short. It is debated whether leg-length discrepancy causes pain or long-term musculoskeletal disturbances. A direct connection to back pain is questionable, but a mildly elevated incidence of knee arthritis seems likely. The evidence base on the indications for treatment of leg-length discrepancy is poor; only informal consensus recommendations are available. There are a wide variety of conservative and surgical treatment options. The final extent of a leg-length discrepancy first noted during the growing years can be estimated with predictive algorithms to within 2 cm. The treatments that can be considered include a shoe insert, a high shoe, or an orthosis, surgically induced slowing of growth by blockade of the epiphyseal plates around the knee joint, or leg lengthening with osteotomy and subsequent distraction of the bone callus with fully implanted or external apparatus. Changes in leg length exert marked mechanical stress on the soft tissues. If the predicted leg-length discrepancy exceeds 5 cm, initial leg-lengthening treatment can already be considered during the patient's growing years. Conclusion: It must be discussed with each patient individually whether the treatment should be conservative or surgical. The extent of the discrepancy is not the sole determining factor for the mode of treatment. The decision to treat is always elective. [ABSTRACT FROM AUTHOR]

Background and purpose -The PRECICE intramedullary limb lengthening system uses a new technique with a magnetic rod and a motorized external remote controller (ERC) with rotational magnetic field. We evaluated the reliability and safety of the PRECICE system. Methods-We compared our preliminary results with PRECICE in 24 patients (26 nails) with the known difficulties in the use of mechanical lengthening devices such as the ISKD. We used the Paley classification for evaluation of problems, obstacles, and complications. Results-2 nails were primarily without function, and 24/26 nails lengthened over the desired distance. Lengthening desired was 38 mm and lengthening obtained was 37 mm. There were 2 nail breakages, 1 in the welding seam and 1 because of a fall that occurred during consolidation. ERC usage was problematic mostly in patients with femoral lengthening. Adjustment of the ERC was necessary in 10 of 24 cases. 15 cases had implant-associated problems, obstacles were seen in 5 cases, and complications were seen in each of 4 cases. Merpretaion-The reliability of the PRECICE system is comparable to that of other intramedullary lengthening devices such as the ISKD. The motorized external remote controller and its application by the patients is a weak point of the system and needs strict supervision. [ABSTRACT FROM AUTHOR]

The article discusses a study that defined whether a symptomatic rotator cuff tear on one shoulder predisposes to a higher risk of a rotator cuff tear in the contralateral shoulder regardless of the patient's age or sex. One hundred ten people were examined by ultrasound. The tear extended to the infraspinatus as a posterosuperior massive tear in 10 cases in the tear group. A table is shown that outlines prevalence of supraspinatus tears.

Purpose: Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters., Methods: All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05., Results: A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.)., Conclusion: The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures., Level of Evidence: Level III., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background and purpose - Motorized intramedullary lengthening nails (ILNs) have been developed as an alternative to external fixators for long bone lengthening. The antegrade approach represents the standard method for tibial ILN insertion. In patients with preexisting ankle and hindfoot fusion a retrograde approach provides an alternative technique that has not been evaluated so far. We report the outcome of this method in 10 patients. Patients and methods - This retrospective study included 10 patients (mean age 18 years [13-25]) with preexisting ankle and hindfoot fusion who underwent tibial lengthening with a retrograde ILN (PRECICE). The mean leg length discrepancy (LLD) was 58 mm (36-80). The underlying conditions were congenital (n = 9) and post tumor resection (n = 1). The main outcome measures were: ILN reliability, distraction achieved, distraction index (DIX), time to bone healing, consolidation index (CIX), complications, and functional results. Results - All patients achieved the goal of lengthening (mean 48 mm [26-80]). Average DIX was 0.6 mm/day (0.5-0.7) and mean CIX was 44 days/cm (26-60). Delayed consolidation occurred in 2 patients and healed after ILN dynamization or nail exchange with grafting. Toe contractures in 2 other patients were resolved with physiotherapy or tenotomy. Until last follow-up (mean 18 months [12-30]) no true complications were encountered, knee motion remained unaffected, and full osseous consolidation occurred in all patients. Interpretation - In patients with LLD and preexisting ankle and hindfoot fusion distal tibial lengthening using a retrograde ILN is a reliable alternative to the standard approach with equivalent bone healing potential and low complication rates leaving the knee unaffected.

Objective: Teaching of basic open surgical skills like skin closure has been well established in medical schools' surgical curricula. The same cannot be said for basic arthroscopic skills even though the importance of arthroscopic surgery in Orthopaedics has been well documented. The goal of this study was to evaluate the relationship between basic skills in open surgery and basic arthroscopic skills in a cohort of medical students. Our hypothesis was that performance in open surgical skills does not correlate with skills in arthroscopic surgery., Design: The performance of medical students in basic tasks in open surgery (porcine model: subcutaneous and skin suturing) and arthroscopic surgery (bench top model: arthroscopic triangulation and object transfer) was assessed. For both surgical techniques an introductory course was given followed by a standardized assessment. After 1 week both open and arthroscopic tasks were reassessed. All procedures were recorded and scored by 2 independent observers in a blinded fashion., Setting: The study was performed at the skills lab of the Clinic for Orthopaedics and Tumororthopaedics at University Hospital Muenster in Muenster Germany., Participants: A cohort of 21 medical students (average age 22.2 years) participated in this study. The cohort consisted of 17 female (81%) and 4 male (19%) students. All students were in the clinical part of their study and had not received any prior surgical education., Results: Interobserver reliability was very high for the arthroscopic tasks and high for the open surgery tasks. No correlation was found between open and arthroscopic skills. For the first assessment the correlation coefficient was r = 0.197 (p = 0.391). For the second assessment the correlation coefficient was r = 0.212 (p = 0.356). Significant improvement from first to second assessment was only found for the arthroscopic tasks (p < 0.0001) while improvement in the open surgery performance failed to reach statistical significance (p = 0.184)., Conclusions: The results of this study suggest that performance in open surgical skills does not correlate with performance in arthroscopic skills and should be taught independent from each other. Arthroscopic skills can effectively be taught with bench top training systems in a time- and resource efficient manner, with measurable results even in a 1-day-course setup. Arthroscopic skills training may be offered in undergraduate curricula in addition to open surgical skills training to students with an interest in Orthopaedics., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the prevalence of shoulder-related acute and overuse injuries in triathletes and examine the role of possible risk factors, in order to identify potential preventive measures., Methods: We performed a retrospective epidemiologic study of 193 amateur triathletes between June and August 2013 and evaluated their competition and training habits, as well as the presence of acute and overuse injuries of the shoulder sustained during the past 12 months. Contingency tables were analyzed using Pearson's chi-squared test. Normally distributed data were compared with the independent samples t-test, while non-parametric analyses were performed with the Mann-Whitney U test. Binary logistic regression was used to identify important predictors of injuries., Results: 12 participants (6%) sustained acute injuries and 36 athletes experienced an overuse injury. The acute injury rate amounted to 0.11 per 1000 hours of training and the overuse injury rate to 0.33 per 1000 hours of training. There was no association between athletes' age, height, weight, BMI, a history of shoulder complaints or triathlon experience in years and acute or overuse injuries. Male athletes had a trend for sustaining more acute injuries then female athletes (8% vs. 2%, p = 0.079). Athletes with acute injuries spent a significantly higher amount of time per week doing weight training (p = 0.007) and had a trend for a higher weekly duration of cycling training (p = 0.088). Athletes with overuse injuries participated in a significantly higher number of races compared to athletes without overuse injuries (p = 0.005). The regular use of paddles was associated with a significantly higher rate of overuse injuries (24% vs. 10%, p = 0.014)., Conclusion: The regular use of paddles during swimming training appears to be a risk factor for the development of overuse injuries, while an increased duration of weight and cycling training seems to be associated with a higher rate of acute injuries., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: GG is board member of 2 international societies (EMSOS, ISOLS) and receives royalties from 1 patent (unrelated to this work). DL is a consultant for ConMed Deutschland GmbH and has received reimbursements for travel and accommodation expenses from ConMed (unrelated to this work). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The Quality of Life Profile for Spine Deformities (QLPSD) is a self-reporting questionnaire designed for studying patients with spinal deformities., Purpose: The aim of the present study was to systematically translate the QLPSD into German (G-QLPSD) and to test its reliability and validity. Special emphasis was intended to be given to patients with different Cobb angles and ages., Methods: The QLPSD was systematically translated into German and was responded to in a web-based online survey by patients with idiopathic scoliosis and by healthy control individuals to carry out a matched-pair analysis. Participants aged 14 years and older were included. All participants answered a battery of validated questionnaires (SRS 22-r, PHQ-9, PANAS, FKS, WHO-5, BFI-S, PTQ). Reliability testing included Cronbach's alpha and test-retest reliability (retest 8 weeks after initial testing). Factorial, convergent, divergent, concurrent, and discriminant validity were calculated., Results: A total of 255 scoliosis patients (age 30.0 ± 16.7 years, Cobb angle 43.5° ± 20.9°) and 189 matched healthy control individuals were finally included. Cronbach's alpha for the G-QLPSD total score was 0.93 and the test-retest reliability was 0.84. The G-QLPSD total score correlated with the SRS 22-r total score (r = -0.86). All concurrently applied scores showed strong correlations with the G-QLPSD (e.g., depression score PHQ-9: r = 0.70). The matched-pair analysis of 189 pairs showed strong discriminant validity (Cohen's d = 0.78). Patients with more severe Cobb angles (≥40°) and those ≥18 years of age had significantly poorer results than patients with minor curves and younger patients., Conclusion: The G-QLPSD proved to be a highly reliable and valid instrument that can be recommended for clinical use in scoliosis patients.

Purpose: The Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S) is a seven-item questionnaire inquiring into patients' worries about back shape and associated problems at school, at work, with friends or family, and whether the patients are avoiding certain activities. The aim of this study was to translate the BIDQ-S into German (G-BIDQ-S), test its reliability, and establish its convergent, divergent, concurrent, and discriminant validity., Methods: In a prospective cohort study, 259 patients with idiopathic scoliosis (mean age 30.2; 221 female; mean Cobb angle 43.8°) completed the G-BIDQ-S; Scoliosis Research Society 22-r (SRS 22-r); Patient Health Questionnaire (PHQ-9); Positive and Negative Affect Schedule (PANAS); Questionnaire on Body Dysmorphic Symptoms (FKS); and WHO-5 Well-Being Index. Healthy control individuals matched by age, sex and BMI (n = 149; mean age 36.1; 133 female; BMI = 23.0) answered the same questions to establish discriminant validity. Discriminant statistics, and Pearson and Spearman correlations were calculated., Results: The G-BIDQ-S proved to be one-factorial, internally consistent (Cronbach alpha = 0.87), and stable over time (total score 2.22 vs. 2.21 during retest; retest reliability r = 0.79, P < 0.001). It correlated significantly with the mean SRS 22-r (r = -0.72, P < 0.001) and with Cobb angles (r = 0.30, P < 0.001)-convergent validity; much less with body mass index (r = 0.19, P < 0.001)-divergent validity; and with the PANAS (r = 0.55, P < 0.001), PHQ-9 (r = 0.53, P < 0.001), FKS (r = 0.67, P < 0.001), and WHO-5 (r = -0.54, P < 0.001)-concurrent validity. The G-BIDQ-S also showed discriminant validity, with a strong difference between the scoliosis group (total score 2.19) and the control group (total score 1.13; P < 0.001)., Conclusions: The G-BIDQ-S showed good internal consistency, reliability, and convergent, divergent, concurrent, and discriminant validity. This questionnaire is the first one inquiring into patients' body image disturbances that has been validated and is available in German.

Background: With an increasing life expectancy and improved treatment regimens for primary or secondary malignant diseases of soft tissue or bone, hemipelvectomy will have to be considered more often in elderly patients in the future. Scientific reviews concerned with the surgical and oncological outcome of elderly patients undergoing hemipelvectomy are scarce. Therefore, it is the purpose of this study to review the outcome of patients treated with that procedure at our hospital and investigate the feasibility of such extensive procedures at an increased age., Methods: A retrospective analysis of thirty-four patients who underwent hemipelvectomy at an age of 65 years or older was performed to determine their surgical and oncological outcome. The Kaplan-Meier method was used to calculate the cumulative probability of survival using the day of tumor resection as a starting point. Univariate analysis was carried out to investigate the influence of a particular single parameter., Results: The mean age at operation was 70.2 years. Thirty patients were treated for intermediate- to high-grade sarcoma and 81.8% of tumors were larger than or equal to 10 cm in the longest diameter. Thirteen patients underwent internal hemipelvectomy and nine patients external hemipelvectomy as a primary procedure. Twelve patients were treated with external hemipelvectomy after failed local tumor control at primary operation. Wound infection occurred in 61.7% of cases. Three patients underwent amputation for non-manageable infection after internal hemipelvectomy. Hospital mortality was 8.8%. Clear resection margins were obtained in 88% of patients; in another 6% of patients planned intralesional resections were performed. Local recurrence occurred in 8.8% of patients at a mean time of 26 months after operation. Eleven patients are alive with no evidence of disease and 23 patients died of disease or other causes. Patients with pulmonary metastases had a mean survival period after operation to DOD of 22 months compared to 37 months in the curative group., Conclusion: Despite an elevated rate in hospital mortality and wound infection, this study suggests that hemipelvectomy is feasible in elderly patients, although requiring long hospitalization periods and causing a limited functional outcome.

Introduction: The quality of abstracts presented at medical conferences reflects the scientific activity in the organisations involved. The aims of this study were to evaluate the publication rate of studies presented at the annual congress of the German Society of Orthopaedics and Trauma Surgery and to investigate predictive factors for publication. The results were to be compared with other international meetings., Method: All 1,100 abstracts presented at the Congress of the German Society of Orthopaedics and Trauma Surgery in 2003 were assessed. The publication rate for the corresponding articles in peer-reviewed journals within 5 years was examined using a PubMed search. The consistency of the congress abstracts with the publications was studied. Factors influencing publication rates were investigated, including level of evidence (LoE) and type of study., Results: The publication rate was 36%, with a mean of 15 months between conference and publication (mean impact factor 1.50). No significant differences were observed between publication rates for oral presentations and posters. Experimental studies and those with LoE I and II had higher publication rates (47.1%; 55.2%; 39.8%) than clinical studies and those with LoE III and IV (30.8%; 29.2%; 28.0%). Abstracts of randomised studies and prospective studies showed publication rates of 43.2 and 35.6% and were published more often than abstracts of non-randomised studies and retrospective studies, with publication rates of 35.3 and 27.1%., Conclusion: The publication rate was in the lower range of rates available for comparable conferences--e.g., the American Academy of Orthopaedic Surgeons, with rates between 34 and 55%--but lower than those of the Orthopaedic Trauma Association, at 52-67%. However, 64% of the abstracts remained unpublished, calling into question the acceptability of citing conference abstracts in the scientific literature and implementing them in clinical practice.

Purpose: The current study analyzes the potential role of radiotherapy (RT) in symptomatic vertebral hemangioma (SVH)., Methods and Materials: Seven cooperating German institutions collected clinical information, treatment plans, and outcome data for all patients with SVH referred for local RT., Results: From 1969 to 2008, a total of 84 patients with 96 symptomatic lesions were irradiated for SVH. The primary indication for radiotherapy was pain (97.6%), and 28.6% of patients had additional neurological symptoms. RT was performed at a median total dose of 34 Gy, with a median single dose of 2.0 Gy. After receiving a median follow-up of 68 months, the overall patient response rate was 90.5%. Complete symptom remission occurred in 61.9% of patients, 28.6% of patients had partial pain relief, and 9.5% of patients had no pain relief. In 26.2% of patients, radiological signs of reossification were observed in long-term follow-up but not significantly correlated with pain relief. Most importantly, total doses of >/=34 Gy resulted in significantly greater symptomatic relief and control rate than total doses of <34 Gy., Conclusions: This study consists of the largest database of cases reported so far using RT for SVH. RT is easy, safe, and effective for pain relief treatment for SVH. Total doses of at least 34 Gy give the best symptomatic response.

The surgical treatment of low-grade chondrosarcoma is controversial and the clinical course is difficult to predict. The purpose of this retrospective study was to review the authors' experience with the surgical treatment of 80 patients with grade I chondrosarcoma. Intralesional resection margins increased the rate of local recurrence statistically significant (p < 0.001). However, there was no influence of the resection margins on the overall survival (p > 0.05) or on the rate of metastasis (p > 0.05). Conservative surgery for special indications with adjuvant use of PMMA (poly-methylmethacrylate) offers satisfying local tumour control rates in the long bones. However, after intralesional tumour resection of pelvic chondrosarcoma, four out of four patients developed a local recurrence, whereas no patient treated with wide resection margins received a local relapse, which has been statistically significant (p < 0.001). In conclusion, intralesional resection of a grade I chondrosarcoma has a higher overall risk of local recurrence but is not associated with a poorer survival. This procedure can be recommended for stage I A tumours of the long bones of the extremities. However, in pelvic lesions it should be avoided because of a 100% recurrence rate.