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Purpose Numerous approaches to the management of juvenile and aneurysmal bone cysts (ABC) are described in the specialist literature together with discussion of the associated healing and recurrence rates. Since there is currently no evidence-based treatment standard for these conditions, the aim of this systematic literature review with meta-analysis was to examine the different management approaches, evaluate the corresponding clinical outcomes and, as appropriate, to formulate a valid treatment recommendation. Methods A systematic search on OVID Medline® based on a pre-existing search strategy returned 1333 publications. Having defined inclusion and exclusion criteria and analysis of the relevant full texts, 167 publications were included in the descriptive analysis and 163 in the meta-analysis. For this purpose, different subgroups were created, based on the type of cyst and the therapeutic procedure. Those subgroups were then analysed in relation to their healing rates, the number of recurrences and complication rates. Results For aneurysmal bone cysts, both surgical removal and Doxycycline injection lead to excellent outcomes (98% healing) and low recurrence rates (6% and 11% resp.). Curettage (91% healing), including its combination with autologous cancellous bone graft (96% healing), showed very good healing rates but higher recurrence rates (22% and 15%, resp.), which were however improved by preoperative selective arterial embolization. A critical view must be taken of radiotherapy (90% healing) and the injection of alcohol (92% healing) because of their high complication rates (0.43/cyst and 0.42/cyst, resp.). In the management of juvenile bone cysts, surgical interventions like curettage and cancellous bone graft (87% healing) are far superior to non-surgical approaches (51% healing), furthermore, the application of autologous cancellous bone graft reduced the recurrence rate (3% recurrence) compared to curettage alone (20% recurrence). In subgroup analysis, treatment by ESIN was found to produce excellent outcomes (100% healing), though the patient collectives were small. Conclusion Surgical procedures to treat aneurysmal bone cysts appear to be the method of choice whereby Doxycycline injection may be an alternative. A surgical approach should be preferred in the treatment of juvenile bone cysts.

Background: The aim of this study was to determine whether traumatic dislocation of the patella is provoked by the presence of predisposing factors and examine the role of the mechanism of injury. Methods: Cases diagnosed with dislocation of the patella and covered by the workers’ compensation program were identified and classified as traumatic based on insurance regulations. We examined predisposing factors (e.g., frontal axis, torsional deviation, trochlear dysplasia, patella alta) in case groups based on age at dislocation and trauma mechanism. Retrospective cohort study, level of evidence III. Results: Our sample size comprised 104 cases, consisting of 54 children and 50 adults. The most common mechanism of injury in children and adults was rotational trauma. Only 20% of the children and 21% of the adults exhibited no relevant predisposing factors. Group specifically, falls accounted for the highest number of cases exhibiting none of the defined anatomical predisposing factors. Children are more frequently affected by predisposition-related dislocations than adults. Conclusion: The proportion of predispositions is high. A fall, direct impact, or rotational trauma can be viewed as an adequate mechanism of trauma. For successful treatment, it is paramount to analyze the exact mechanism of the trauma and address any underlying predispositions.

Osteosynthesis refers to various surgical procedures, closed or open, for the treatment of fractures of any age. To document and control the osteosynthesis and the healing process X‑ray controls of the affected skeletal segment are performed during the operation and at regular intervals. To assess the quality of an osteosynthesis or to identify a complication, a comprehensive and systematic image review is useful. This includes the assessment of the restoration of the functional anatomy, the position of the material in relation to the surrounding structures, an evaluation of the stability as far as this is possible, and a control of the bone healing in a functionally correct position.Unter Osteosynthesen versteht man verschiedenste Operationsverfahren, geschlossen oder offen, zur Versorgung von Frakturen in jedwedem Alter. Zur Dokumentation und Kontrolle der Osteosynthese und des Heilverlaufs werden im Operationssaal und im Verlauf in regelmäßigen Zeitabständen Röntgenkontrollen des betroffenen Skelettabschnitts angefertigt. Zur Beurteilung der Güte einer Osteosynthese oder zur Feststellung einer Komplikation ist eine umfassende und systematische Bildbetrachtung sinnvoll. Hierzu gehören die Beurteilung der Wiederherstellung der funktionellen Anatomie und der Lage des Materials in Relation zu den umgebenden Strukturen sowie, falls möglich, der Stabilität sowie eine Kontrolle der Knochenheilung in funktionsgerechter Stellung.

Clavicle shaft fractures are among the most common fractures in childhood and adolescence. In the past they were almost exclusively treated conservatively but in recent years there has been an increase in surgical treatment. Nevertheless, exact recommendations for the choice of diagnostics and for the treatment regimen do not yet exist.Therefore, our aim was to develop a consensus within the 7th scientific working meeting of the section for pediatric traumatology in the German Society for Trauma Surgery based on expert opinion.Single-plane radiographic imaging is considered the gold standard diagnostic tool. Children younger than 10 years are primarily treated conservatively, and the type of immobilization is secondary. In girls older than 12 years and boys older than 14 years, fractures dislocated by more than the shaft width and shortened by 2 cm should be treated by open reduction and stabilized by osteosynthesis, followed by free-functional follow-up treatment.In addition to X‑rays, diagnostics using ultrasound must be further established. Treatment continues to be primarily conservative, but surgical treatment is also important, especially in adolescents. If the indications are correct, a good outcome can be expected regardless of the choice of treatment.EINLEITUNG: Claviculaschaftfrakturen gehören zu den häufigsten Frakturen im Kindes- und Jugendalter. Früher wurden diese fast ausschließlich konservativ therapiert, in den letzten Jahren zeigte sich jedoch eine Zunahme der operativen Versorgungen. Klare Empfehlungen zur Diagnostik und zur Therapiewahl für diese Verletzung gibt es bisher nicht.Ziel war deshalb, im Rahmen des 7. wissenschaftlichen Arbeitstreffens der Sektion für Kindertraumatologie in der Deutschen Gesellschaft für Unfallchirurgie einen Konsens auf Basis der Expertenmeinung zu erarbeiten.Die Röntgendarstellung in einer Ebene gilt als Goldstandarddiagnostikum. Kinder unter 10 Jahren werden vornehmlich konservativ behandelt; die Art der Ruhigstellung ist zweitrangig. Bei Mädchen älter als 12 Jahre und Jungen älter als 14 Jahre sollten um mehr als Schaftbreite dislozierte und 2 cm verkürzte Frakturen offen reponiert und osteosynthetisch stabilisiert werden, gefolgt von einer freifunktionellen Nachbehandlung.Neben dem Röntgen gilt es, die Ultraschalldiagnostik weiter zu etablieren. Die Therapie erfolgt weiterhin vornehmlich konservativ, die operative Therapie hat jedoch ebenfalls einen Stellenwert, insbesondere bei Jugendlichen. Bei korrekter Indikationsstellung ist unabhängig von der Therapiewahl von einem guten Outcome auszugehen.

The student accident insurance has been part of the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) for 50 years. In order to assess the reduction in working capacity (Minderung der Erwerbsfahigkeit, MdE) in the event of permanent consequences of accidents and injuries, the recommendation to treat the affected child or adolescent "as an average adult" is currently still valid. The present work deals with the everyday practice of the MdE assessment in children and adolescents and their weaknesses through the transfer of the principles from adulthood. In addition, proposals for the adaptation of the assessment principles for the growth age are drawn up.

Journal of synchrotron radiation 28(5), 28 (2021). doi:10.1107/S1600577521007335, The European XFEL delivers up to 27000 intense (>1012 photons) pulses per second, of ultrashort (≤50 fs) and transversely coherent X-ray radiation, at a maximum repetition rate of 4.5 MHz. Its unique X-ray beam parameters enable groundbreaking experiments in matter at extreme conditions at the High Energy Density (HED) scientific instrument. The performance of the HED instrument during its first two years of operation, its scientific remit, as well as ongoing installations towards full operation are presented. Scientific goals of HED include the investigation of extreme states of matter created by intense laser pulses, diamond anvil cells, or pulsed magnets, and ultrafast X-ray methods that allow their diagnosis using self-amplified spontaneous emission between 5 and 25 keV, coupled with X-ray monochromators and optional seeded beam operation. The HED instrument provides two target chambers, X-ray spectrometers for emission and scattering, X-ray detectors, and a timing tool to correct for residual timing jitter between laser and X-ray pulses., Published by Wiley-Blackwell, [S.l.]

For decades projection radiography has been the standard in the diagnostics of fractures and injuries, including patients in childhood and adolescent; however, each examination with X‑rays should also be based on an individual assessment of the benefits and risks. The pediatric traumatology section of the DGU has developed a consensus paper on various aspects of imaging for diagnostics and assessment of progression, on setting options for intraoperative imaging, on X‑ray imaging of the opposite side, on polytrauma and computed tomography (CT), on postoperative radiological checks and the use of sonography after an accident.Seit Jahrzehnten ist die Projektionsradiographie Standard in der Diagnostik von Frakturen und Verletzungen auch bei Patienten im Kindes- und Jugendalter. Bei jeder Untersuchung mit Röntgenstrahlen sollen aber auch individuell Nutzen und Risiko gegeneinander abgewogen werden. Die Sektion Kindertraumatologie der DGU hat zu verschiedenen Aspekten der Bildgebung zu Diagnostik und Verlaufsbeurteilung, zu Einstellungsmöglichkeiten der intraoperativen Bildgebung, zum Röntgen der Gegenseite, zu Polytrauma und CT, zu postoperativen radiologischen Kontrollen und dem Einsatz der Sonographie ein Konsenspapier erarbeitet.

Generell stellen Wirbelsaulenverletzungen bei Kindern im Alter unter 16 Jahren eine seltene Verletzungsentitat dar. Fur Deutschland liegen keine belastbaren Daten bezuglich der Epidemiologie von Verletzungen der Wirbelsaule im Kindesalter vor. Gerade bei padiatrischen Patienten, bei denen sowohl die Anamnese, die klinische Untersuchung, aber auch die Durchfuhrung der bildgebenden Diagnostik haufig erschwert sind, mussen samtliche Hinweise auf eine Verletzung der Wirbelsaule mitberucksichtigt werden. Das Ziel der vorliegenden Studie war die Bereitstellung epidemiologischer Daten von padiatrischen Patienten mit Wirbelsaulenverletzungen in Deutschland, um diese zukunftig in die Entscheidungsfindung bei der Diagnostik und Therapie dieser Patienten einfliesen lassen zu konnen. Im Rahmen einer nationalen Multizenterstudie wurden retrospektiv Patientendaten innerhalb eines Zeitraums von 7 Jahren aus 6 Wirbelsaulenzentren erhoben. Neben den demografischen Daten wurden der Unfallmechanismus, die betroffene Wirbelsaulenregion und auch die Begleitverletzungen erhoben. Zudem erfolgte die Erfassung der bildgebenden Diagnostik sowie der jeweiligen Therapie. Es konnten 367 Kinder (weiblich: mannlich = 1:1,2) mit insgesamt 610 Verletzungen an der Wirbelsaule in die Studie eingeschlossen werden. Das mittlere Alter betrug 12 (±3,5) Jahre. Die haufigsten Unfallmechanismen in allen Altersgruppen waren ein Sturz aus unter 3 m Hohe sowie Verkehrsunfalle. Die bildgebende Diagnostik musste nur in Ausnahmefallen in Narkose durchgefuhrt werden. Wahrend jungere Kinder (0 bis 9 Jahre) eher Verletzungen im Bereich der Halswirbelsaule erlitten, zeigten sich Verletzungen der thorakolumbalen Wirbelsaule eher bei Kindern >10 Jahren. Die Kinder wiesen haufige Begleitverletzungen an Kopf und Extremitaten auf. Im Bereich der Wirbelsaule befanden sich weitere Verletzungen meist benachbart und nur selten in anderen Regionen. Rund 75 % der Kinder wurden konservativ behandelt. Die Ergebnisse unterscheiden sich von den Erkenntnissen aus der Erwachsenenmedizin und beschreiben spezielle Gegebenheiten fur padiatrische Patienten mit Wirbelsaulenverletzungen. Trotz gewisser Limitationen konnen sie so bei der Entscheidungsfindung uber die durchzufuhrende Diagnostik und Therapie dieser Patienten helfen.

Wirbelsaulenverletzungen im Kindesalter sind insgesamt sehr selten. Aktuelle einschlagige Studien mit grosen Fallzahlen, aus welchen sich evidenzbasierte Empfehlungen zu Diagnostik und Therapie von Wirbelsaulenverletzungen bei padiatrischen Patienten ableiten lassen, existieren nicht. Formulierung von Empfehlungen zu Diagnostik und Therapie von Verletzungen der Brust- und Lendenwirbelsaule im Kindesalter. Zunachst erfolgte eine Recherche von Primar-, aber auch Sekundarliteratur zum Themenkomplex Diagnostik und Therapie von Verletzungen der Wirbelsaule bei Kindern. Eine entsprechende interne Literaturdatenbank wurde angelegt und gepflegt. Im Zeitraum von April 2017 bis Dezember 2019 fanden sich die Mitglieder der Arbeitsgemeinschaft Wirbelsaulentrauma im Kindesalter der Sektion Wirbelsaule der Deutschen Gesellschaft fur Orthopadie und Unfallchirurgie zu einem Konsensusprozess zusammen. In 9 Arbeitstreffen wurden systematisch Empfehlungen zu Diagnostik und Therapie von Verletzungen der Wirbelsaule bei Kindern formuliert. Es konnten Empfehlungen zu Diagnostik und Therapie von Verletzungen der Brust- und Lendenwirbelsaule fur 3 Altersstufen (Altersstufe I: 0 bis 6 Jahre; Altersstufe II: 7 bis 9 Jahre; Altersstufe III: 10 bi s16 Jahre) formuliert werden. Die Prinzipien der Diagnostik und Therapie aus der Erwachsenenmedizin konnen nicht problemlos ubertragen werden. Wirbelsaulenverletzungen im Kindesalter sind selten und sollten der Behandlung in geeigneten Zentren zugefuhrt werden. Die MRT-Diagnostik sollte beim kardiopulmonal stabilen Kind mit Verdacht auf ein Monotrauma der Wirbelsaule als initiale Bildgebung indiziert werden. Die grundlegenden Therapieziele bei Verletzungen der Brust- und Lendenwirbelsaule im Kindesalter sind die Wiederherstellung der Stabilitat, der Schutz der neurogenen Strukturen und das Wiederherstellen der anatomisch korrekten Verhaltnisse. Bei der Indikationsstellung zur konservativen vs. operativen Therapie mussen das Korrektur- und Regenerationspotenzial der einzelnen Wirbelsaulenabschnitte in Abhangigkeit vom Patientenalter berucksichtigt werden. Die operative Stabilisierung soll v. a. uber minimalinvasive Techniken, im Sinne einer Instrumentierung ohne Spondylodese und fruhzeitiger Metallentfernung, erfolgen.

Background Radial extracorporeal shock wave therapy (rESWT) is an effective and safe non-invasive therapeutic option for various musculoskeletal pathologies. However, data on possible application of radial extracorporeal shock waves (rESWs) on soft tissue components of fingers is still scarce. Objective We now aimed to analyze the feasibility of applying rESWs to human fingers ex vivo. Methods Fresh frozen human cadaveric fingers were exposed to rESWs of varying energy density. The penetration of the rESWs into the soft tissue was determined using pressure sensitive Fuji films that were placed underneath the flexor tendons and other soft tissue components at the proximal phalanx. Then, rESWs were applied and activation of the Fuji film was recorded. Software based image analysis was performed on all films treated with rESWT under ultrasound gel. Results Penetration of the rESWs through the soft tissue was detected in all settings. Increasing energy density of the rESWs resulted in increasing film activation. Image analysis of films used under ultrasound showed a significant difference among the groups. Conclusion The results of this study demonstrate that rESWs can penetrate soft tissues including the flexor tendons of human cadaveric fingers. rESWT should be considered as a valuable potential therapeutic option of different finger pathologies. Further studies focusing on the clinical application of rESWT for finger pathologies are required.

While many finger conditions in climbers have been studied extensively, no data exist on the treatment of rock climber's finger flexor tenosynovitis. The purpose of this study was to evaluate the outcomes after corticosteroid injection. The study included rock climbing athletes suffering from chronic (longer than 6 weeks) finger flexor tenosynovitis who were seen at our clinic in 2017. All 42 patients received two corticosteroid injections within a 7-10 day period. Thirty-one climbers (73.8%) were pain free after the second injection and a mean of 20.9±23.1 days. The climbers reported an 84.2% decrease in pain level and no complications. The positive outcome after corticosteroid injection therapy and the absence of complications justifies this invasive approach in rock climbing athletes.

Background: Pelvic lateral compression fractures are the most stable of the unstable fractures. Therefore, decision making regarding operative or non-operative therapy is still a matter of debate. Methods: Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single Level-1 trauma center. The analysis included epidemiological records such as age and gender, and injury characterizing parameters such as degree of displacement and the Injury Severity Score (ISS). In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d'Aubigne and the EQ. 5D-3 L scores. Results: Over an 11-year period (2004-14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures (33%). After excluding patients with clear indications for operation (complex pelvic fractures and pubic symphysis ruptures) and pediatric fractures, 114 patients could be included in the analysis. Sixty-one patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger (43.7 vs 58.3 years), had higher ISS (19.9 vs 15.5 points) and fracture displacements (2.3 vs 4.9 mm) (p < 0.001 for all). The length of hospital stay was shorter in the conservatively treated group (12.7 vs 17.3 days, p < 0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d'Aubigne and EQ. 5D-3 L scores were not different in the matched cohorts. Conclusion: Decision-making for operative therapy was favored in severely injured young patients with high displacement. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients. Trial registration: DRKS, no. 00000488. Registered 14th July 2010 - Retrospectively registered.

Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear.This study investigated whether the analysis of the accident mechanism and anatomical predisposition in juvenile patellar dislocations enables a conclusion as to the causality.Retrospective cohort study, evidence level III. In-house employers' liability insurance association (BG) cases with the diagnosis of patella dislocation in patients under 18 years were descriptively evaluated with respect to demographic and predisposing aspects as well as regarding accident information. The accident mechanisms were sorted into subgroups: direct impact, trivial trauma, fall, torsional trauma.A total of 54 patellar dislocations were identified with a patient age of 14 years (range 9-18 years). A mild valgus configuration was found in 39% of the cases, on average normal torsion, a tibial tuberosity-trochlea groove (TTTG) distance of 17 mm (range 8-24mm), with 41% a high proportion of patella alta and a trochlear deformity in 57%. Only 20% of the children had no relevant predispositions. The trivial traumas showed the highest proportion of recurrent dislocations with 50% and in the other accident categories the proportion of first dislocations was75%. In the fall cohort the rate of children without relevant predisposition was highest.The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.HINTERGRUND: Für Patellaluxationen sind zahlreiche prädisponierende Faktoren bekannt. Ob diese oder das Trauma die wesentliche Ursache sind, ist häufig unklar.Untersucht wurde, ob die Analyse von Unfallmechanismus und anatomischer Prädisposition bei kindlichen Patellaluxationen eine Aussage zur Ursächlichkeit erlaubt.Retrospektive Kohortenstudie, Evidenzlevel III. Betrachtet wurden hausinterne Berufsgenossenschafts(BG)-Fälle mit der Diagnose Patellaluxation bei ≤18-Jährigen, und deskriptiv bzgl. demografischer und prädisponierender Gesichtspunkte sowie Unfallinformationen ausgewertet. Die Unfallhergänge wurden in Subgruppen unterteilt: Direktanprall, Bagatelltrauma, Sturz, Verdrehtrauma.Es wurden 54 Patellaluxationen identifiziert, bei einem Patientenalter von 14 Jahren (Range 9–18 Jahre). In 39 % der Fälle fanden sich eine milde Valgusachse, im Mittel normwertige Torsionen, ein Tuberositas-tibiae-Trochleagrube(TTTG)-Wert von 17 mm (Range 8–24 mm), mit 41 % ein hoher Patella-alta-Anteil und zu 57 % eine Trochleadeformität. Lediglich 20 % der Kinder wiesen keine relevanten Prädispositionen auf. Die Bagatelltraumata zeigten den höchsten Anteil der Redizivluxationen mit 50 %, bei den übrigen Unfallkategorien betrug der Anteil der Erstluxationen75 %. In der Sturzkohorte war die Rate der Kinder ohne relevante Prädisposition am größten.Der Prädispositionsanteil bei kindlichen Luxationen ist hoch. Stürze sind jedoch immer wesentliche Unfallereignisse, ebenso der mediale Direktanprall. Das Verdrehtrauma ist, sofern keine hochgradige Trochleadysplasie vorliegt, ebenfalls wesentlich ursächlich, Bagatelltraumen hingegen nicht.

Journal of synchrotron radiation 28(3), 688 - 706 (2021). doi:10.1107/S1600577521002551, The high-precision X-ray diffraction setup for work with diamond anvil cells (DACs) in interaction chamber 2 (IC2) of the High Energy Density instrument of the European X-ray Free-Electron Laser is described. This includes beamline optics, sample positioning and detector systems located in the multipurpose vacuum chamber. Concepts for pump–probe X-ray diffraction experiments in the DAC are described and their implementation demonstrated during the First User Community Assisted Commissioning experiment. X-ray heating and diffraction of Bi under pressure, obtained using 20 fs X-ray pulses at 17.8 keV and 2.2 MHz repetition, is illustrated through splitting of diffraction peaks, and interpreted employing finite element modeling of the sample chamber in the DAC., Published by Wiley-Blackwell, [S.l.]

Review of scientific instruments 92(3), 039901 (2021). doi:10.1063/5.0043951, This article was originally published online on 4 January 2021 with an error in the title and Ref. 6 should have been deleted from the reference section and the text. The title is correct above. All online and printed versions of the article were corrected on 7 January 2021. AIP Publishing apologizes for this error., Published by American Institute of Physics, [S.l.]

The journal of physical chemistry letters 12(12), 3246 - 3252 (2021). doi:10.1021/acs.jpclett.1c00150, The ultrafast synthesis of ε-Fe$_3$N$_{1+x}$ in a diamond-anvil cell (DAC) from Feand N$_2$ under pressure was observed using serial exposures of an X-ray free electron laser (XFEL). When the sample at 5 GPa was irradiated by a pulse train separated by 443 ns, the estimated sample temperature at the delay time was above 1400 K, confirmed by in situ transformation of $α$- to $γ$-iron. Ultimately, the Fe and N$_2$ reacted uniformly throughout the beam path to form Fe$_3$N$_{1.33}$, as deduced from its established equation of state (EOS). We thus demonstrate that the activation energy provided by intense X-ray exposures in an XFEL can be coupled with the source time structure to enable exploration of the time-dependence of reactions under high-pressure conditions., Published by ACS, Washington, DC

Review of scientific instruments 92(1), 013101 (2021). doi:10.1063/5.0022886, We introduce a setup to measure high-resolution inelastic x-ray scattering at the High Energy Density scientific instrument at the European X-Ray Free-Electron Laser (XFEL). The setup uses the Si (533) reflection in a channel-cut monochromator and three spherical diced analyzer crystals in near-backscattering geometry to reach a high spectral resolution. An energy resolution of 44 meV is demonstrated for the experimental setup, close to the theoretically achievable minimum resolution. The analyzer crystals and detector are mounted on a curved-rail system, allowing quick and reliable changes in scattering angle without breaking vacuum. The entire setup is designed for operation at 10 Hz, the same repetition rate as the high-power lasers available at the instrument and the fundamental repetition rate of the European XFEL. Among other measurements, it is envisioned that this setup will allow studies of the dynamics of highly transient laser generated states of matter., Published by American Institute of Physics, [S.l.]

In contrast to all other members of the $R{\mathrm{Mn}}_{2}{\mathrm{O}}_{5}$ family with nonzero $4f$ electrons ($R$ = Nd to Lu), ${\mathrm{PrMn}}_{2}{\mathrm{O}}_{5}$ does not show any spin driven ferroelectricity in the magnetically ordered phase. By means of high-field electric polarization measurements up to 45 T, we have found that this exceptional candidate undergoes a spin driven multiferroic phase under magnetic field. X-ray magnetic circular dichroism studies up to 30 T at the Pr ${L}_{2}$ edge show that this ferroelectricity originates from and directly couples to the ferromagnetic component of the ${\mathrm{Pr}}^{3+}$ spins. Experimental observations along with our generalized gradient-approximation $+\phantom{\rule{4pt}{0ex}}U$ calculations reveal that this exotic ferroelectric-ferromagnetic combination stabilizes through the exchange-striction mechanism solely driven by a $3d\ensuremath{-}4f$-type coupling, as opposed to the other $R{\mathrm{Mn}}_{2}{\mathrm{O}}_{5}$ members with $3d\ensuremath{-}3d$ driven ferroelectric-antiferromagnetic-type conventional type-II multiferroicity.

Scientific reports 10(1), 14564 (2020). doi:10.1038/s41598-020-71350-x, Published by Macmillan Publishers Limited, part of Springer Nature, [London]

Sacral U‑shaped fractures are rare but severe injuries. Due to the resulting spinopelvic dissociation they are highly unstable. Reduction and stabilization are usually required and decompression may be necessary due to frequent concomitant neurological injuries. In the literature there is no consensus with respect to the selection of the surgical approach.After a road traffic accident an 18-year-old woman suffered a U-fracture of the sacrum type II according to Roy-Camille and was treated with bilateral double sacroiliac screw osteosynthesis and sacral laminectomy. A 76-year-old man with a U‑fracture type I according to Roy-Camille after falling down the stairs was treated by lumbopelvic fixation. A 24-year-old man with U‑fracture type II according to Roy Camille after a road accident was treated with triangular vertebropelvic stabilization and sacral laminectomy. For all patients the outcome was good.Surgical treatment is necessary, with minimally invasive techniques offering advantages over open surgery. A distinction must be made between lumbopelvic fixation and posterior pelvic ring fixation. Multiple aspects must be taken into consideration of the indications when selecting the surgical technique.

Aims and Objectives: High tibial osteotomies (HTO) are nowadays an established method to treat unicompartmental, medial gonarthrosis. Common surgical HTO techniques include medial open wedge (MOW) and lateral closed wedge osteotomies (LCW). In addition to the intended change in the frontal plane these surgical techniques take influence on various other biomechanical issues of the knee joint e.g. the posterior tibial slope (PTS). Aim of this study was to rate and evaluate changes of the tibial slope by HTOs dependent on the used surgical technique (MOW versus LCW). Materials and Methods: 414 HTOs, that had been performed in our institution between 2004 and November 2018, were reviewed retrospectively. 135 cases were excluded. The included 279 cases from 247 patients were divided into two groups dependent on the used surgical technique (MOW/LCW). In both groups the values of PTS were defined by measuring the proximal posterior tibia angle (PPTA) on lateral x-rays of the knee from before and 4 to 6 weeks after surgery. The change of PTS was evaluated as delta-PPTA. Microsoft Excel was used for statistical analysis. Results: 279 cases were included: 190 were assigned to the group of MOW and 89 to the group of LCW osteotomies. Considering demographic data the MOW-group showed a gender distribution of 124 men/ 46 women in 93 left and 97 right knees, and the LCW-group of 46 men/43 women in 40 left and 49 right knees. The mean value of age in the MOW group was 47,6 +/- 10 years (15-70 years) and in the LCW-group 40,6+/-13,7 years (15-67 years). Before surgery there was no statistical significant difference in the PPTA-values between both groups (p=0,720): The mean PPTA in the MOW-group measured 79,9°+/-3,2° (68-88°), in the LCW-group 80,6°+/-2,6° (74-88°). The change caused by surgery showed no statistical significance in the MOW-group (delta-PPTA 0,07°+/- 2,9° [-12° bis 11°]). However, in the LCW-Gruppe we observed a significant (pConclusion: As the PTS plays a relevant role in biomechanics of the knee joint a consideration of the impact of changes in PTS by HTOs is indispensable. Our results support the common thesis of a slope-reduction by LCW osteotomies but nevertheless the analysis throughout the study period showed a reduction of the slope-decrease over timeline. The common thesis of a slope-increase by MOW osteotomies was not supported by our results which showed no significant change.

Background Simple elbow dislocations in childhood are rare. Nevertheless, they have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed. Aim The purpose of the study was to review the literature and to derive a recommendation for the best treatment concept. Material and methods A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified (initially nonspecific for age) and evaluated in a stepwise approach. Of these publications four met the inclusion criteria of the authors. The analysis was carried out descriptively and in a meta-analysis. Results The 4 publications included described simple elbow dislocations in 81 children (≤16 years). The weighted average age was 9.9 years with a gender ratio of 3.8 (boys:girls). The median follow-up was 49 months. Posterior and posterolateral dislocations were the most common with 73%. In 69 children the treatment was conservative and of these 66 were immobilized for longer than 2 weeks after closed reduction. The 12 children who had surgical treatment suffered dislocations that had not been reduced for longer than 3 weeks. The success rate of the conservatively treated immobilized group was 88%, of the conservatively treated non-immobilized group 70% and of the surgical group 42%. The differences between the success rates of the treatment methods was significant (p = 0.032). Conclusion Simple elbow dislocations in children are rare. They most commonly occur in posterior and posterolateral directions. The prognosis is favorable; however a timely diagnosis and correct reduction are relevant for a good outcome.

Background Various diseases of the spine are treated by immobilization via orthoses, although detailed evidence on the efficiency of orthotic bracing remains elusive. The present study sought to investigate the impact of 3 different orthoses on spinal immobilization using 3-dimensional (3D) kinematic measurements. Methods Twelve healthy volunteers performed different motion tasks, including trunk flexion/extension and bilateral trunk bending. Movements were performed under 4 different conditions: 1) without orthosis, 2) while wearing a 3-point hyperextension brace (HB), 3) while wearing a custom-made semirigid orthosis (SO), and 4) while wearing a custom-made rigid orthosis (RO). Spinal motion was analyzed using a 3D optical motion capture system assessing regional, intersegmental, and segmental range of motion (ROM). Results Assessment of spinal motion was successfully accomplished in all subjects. Overall, orthoses significantly reduced spinal motion compared with no bracing. RO caused the greatest restriction of regional, intersegmental, and segmental spinal motion among all orthoses. For flexion/extension, the mean percentage decreases between T3 and L5 in full active ROM with HB, SO, and RO compared with no orthosis were 38%/30%, 48%/47%, and 51%/55%, respectively ( P ≤ 0.05). Lateral bending was impaired by 28%, 44%, and 70%, respectively ( P ≤ 0.05). Assessment of lateral bending revealed greater immobilization by SO and RO compared with HB ( P ≤ 0.05). Conclusions The present 3D kinematic system allows for precise assessment of spinal motion. Custom-made orthoses cause superior restriction on gross spinal motion compared “off-the-shelf” orthoses. If orthotic bracing is indicated, design, comfort, and patient compliance need to be carefully considered to guarantee successful therapy.

Herein, evidence for the long-sought finite hyperfine interaction in the high-pressure hexagonal close-packed $\ensuremath{\epsilon}$-iron is gained through synchrotron radiation perturbed angular correlation spectroscopy. This method yields an energy splitting of $3.5(5)\phantom{\rule{4.pt}{0ex}}\text{neV}$ between the ${m}_{{I}_{\text{e}}}=\ifmmode\pm\else\textpm\fi{}1/2$ and ${m}_{{I}_{\text{e}}}=\ifmmode\pm\else\textpm\fi{}3/2$ nuclear sublevels of the iron-57 $14.412\text{-keV}$ nuclear excited state at $30(1)\phantom{\rule{4.pt}{0ex}}\text{GPa}$ and room temperature. This energy splitting is related to a nuclear quadrupole hyperfine interaction with an electric field gradient of $eq=1.2(2)\ifmmode\times\else\texttimes\fi{}{10}^{16}{\phantom{\rule{0.16em}{0ex}}\mathrm{V}/\mathrm{cm}}^{2}$. However, there is still a possibility that the splitting of the iron-57 nuclear levels is related to a modest magnetic hyperfine interaction of ca. $0.40(5)\phantom{\rule{4.pt}{0ex}}\text{T}$.

We explore alternative ways to Mossbauer spectroscopy such as nuclear forward scattering of synchrotron radiation, and synchrotron radiation perturbed angular correlation spectroscopy to reveal the elusive and long-sought hyperfine interactions in e-Fe. We indicate that synchrotron radiation perturbed angular correlation spectroscopy is the most viable method.

BACKGROUND AND PURPOSE: Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate.PATIENTS AND METHODS: The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n = 957 with vs n = 4,542 without). Furthermore, the subgroups with secondary surgery (n = 713 vs n = 1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n = 24 vs n = 219). Calculated odds ratios were adjusted for potential confounders.RESULTS: Patients treated by CC/EF were younger (45 ± 20 vs 62 ± 24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3 mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p INTERPRETATION: Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

We report on x-ray magnetic circular dichroism experiments in pulsed fields up to 30 T to follow the rotations of individual magnetic moments through the field-induced phase transition in the ferrimagnet ${\mathrm{HoFe}}_{5}{\mathrm{Al}}_{7}$. Near the ground state, we observe simultaneous stepwise rotations of the Ho and Fe moments and explain them using a two-sublattice model for an anisotropic ferrimagnet with weak intersublattice exchange interactions. Near the compensation point, we find two phase transitions. The additional magnetization jump reflects the fact that the Ho moment is no longer rigid as the applied field acts against the intersublattice exchange field.

X-ray magnetic circular dichroism (XMCD) studies at the Er ${L}_{2,3}$ edges of ${\mathrm{Er}}_{3}{\mathrm{Fe}}_{5}{\mathrm{O}}_{12}$ exhibit a change of the spectral shape as a function of temperature and magnetic field. Using singular value decomposition, this variation is understood as a linear combination of two components. The dominating component is associated with the Er magnetization, while the second contribution is identified as an induced signal from the Fe sites. XMCD at either of the $L$ edges in ${\mathrm{Er}}_{3}{\mathrm{Fe}}_{5}{\mathrm{O}}_{12}$ provides information on the net magnetization of both sublattices. Their evolution in fields up to 30 T reveals details of the ferrimagnetic interactions on two very different scales.

Luxation of the elbow occurs around the age of 7 years instead of a supracondylar humeral fracture. The most common complication is a fracture of the medial epicondyle of the ulna in the sense of a bony avulsion of the ligament. There are only few case reports regarding collateral injuries of the brachial artery. All authors have described this complication as being very rare.This article reports the case of a 10-year-old boy, who suffered a dorsal luxation of the left elbow. After reduction the left hand was noticeably pale and cold. The diagnostics showed a complete rupture of the brachial artery, associated with a dislocated fracture of the medial epicondyle of the ulna. In addition to the case report, the available literature concerning traumatic rupture of the brachial artery in pediatric elbow dislocation was evaluated.Because of the results of the clinical examination and the Doppler examination with a lack of blood flow in the brachial artery of the left arm, computed tomography angiography was directly performed. The result was a complete interruption of the brachial artery at the level of the left elbow. The brachial artery rupture was treated using a local vein graft from the brachial vein. The fracture of the medial epicondyle of the ulna was treated by open reduction and an osteosynthesis with Kirschner (k) wires was performed.The clinical suspicion of an injury of the brachial artery justifies a rapid diagnostic investigation by CT angiography and an open vascular intervention as the only possibility to recreate a sufficient blood flow.

Fractures and dislocations of the cuneiform bones are rare injuries to the midtarsal foot. The injury severity is often unclear, and the prognostic factors are unknown. The purpose of the present study was to characterize our insights of the diagnostics, therapy, and fracture patterns. We questioned whether the number of involved cuneiform bones and the type of injury would affect the clinical outcome. With this information, we aimed to develop a classification system for injuries of the cuneonavicular joint. Five patients who had sustained complex fracture-dislocation of the cuneiform bones were prospectively registered, underwent surgery, and were followed. We reviewed the published data and found 47 reports that included 55 patients to improve the informative value of our study. The injury mechanisms and therapy were evaluated, and the postoperative limitations and pain were assessed. The clinical outcome was correlated with the number of involved cuneiforms and the fracture/dislocation pattern. Direct trauma was associated with isolated fracture, and indirect injury was associated with isolated dislocations. Occasionally, these injuries were overlooked on conventional radiographs, and closed reduction frequently failed. The number of cuneiform bones involved and the type of injury were shown to affect the clinical outcome. We devised an easily applicable classification system for injuries to the cuneiform bones using this information. All cases were classified as isolated fractures (1), isolated dislocations (2), or fracture-dislocations (3) involving 1 (A), 2 (B), or 3 (C) cuneiform bones. The classification system we propose will facilitate a better understanding of the fracture patterns at the cuneonavicular joint line and is a good prognostic tool that requires validation in clinical settings.

Background Currently, closed reduction and percutaneous pinning are considered the treatment of choice for displaced supracondylar humerus fractures. However, indications exist for the use of external fixation with Schanz screws. In this in vitro study, we evaluate the biomechanical properties of a new variation for external fixation and compare them to an established construct. Methods Twenty distal cadaver humeri (10 pairs) were allocated to 2 groups. The humeri of the first group were fixed by an external fixator consisting of Schanz screws and an oblique K-wire inserted from the distal radial cortex of the humerus, those of the second group were fixed by a new variation with the oblique K-wire inserted from the distal ulnar cortex of the humerus. Displacement and stiffness in static loading in internal and external rotation, as well as in extension and flexion were evaluated and compared. Findings The variation of the external fixator of the second group proved to be statistically significantly superior to the variation of the first group in internal rotation loading (p > 0.05). In sagittal loading conditions and external rotation loading, the variations were equally stable (p > 0.05). There was no significant effect of the samples' bone density on displacement and stiffness values in any direction of loading. Interpretation In cases of pediatric supracondylar humerus fractures when an external fixator is used for osteosynthesis, the insertion of an additional ulnarly inserted anti-rotation K-wire should be preferred to a radially inserted one as it reduces secondary displacement of the distal fragment.

Kindliche und adoleszente Schaftfrakturen an der unteren Extremitat sind keine seltene Verletzung. Der Unterschenkel ist haufiger betroffen als der Oberschenkel. Zur Behandlung der Femurschaftfrakturen finden sich deutlich mehr Empfehlungen als zur Behandlung der Unterschenkelschaftrakturen. Die Femurschaftfrakturen im fruhen Lebensalter sind eine Domane der konservativen Therapie, fur Ober- und Unterschenkel wird bis zu einem Korpergewicht von 50 kg als operatives Verfahren haufig die elastisch stabile intramedullare Nagelung (ESIN) verwendet. Die Plattenosteosynthese stellt aber eine ernste Alternative dar. Vorteile der ESIN sind die kleinen Zugange und die schnellere Belastbarkeit. Fur einfache Querfrakturen ist die intramedullare Stabilisierung klar uberlegen. Nachteil der ESIN ist die hohe intraoperative Strahlenbelastung. Auch die Plattenosteosynthese kann minimalinvasiv durchgefuhrt werden, langere Trummerzonen lassen sich damit gut uberbrucken.

Simple elbow dislocations in childhood are rare. Nevertheless, they have a high relevance because they can result in subsequent damage and limitations in range of motion. The treatment options are controversially discussed.The purpose of the study was to review the literature and to derive a recommendation for the best treatment concept.A systematic literature search was performed via Ovid Medline, whereby 1645 publications were identified (initially nonspecific for age) and evaluated in a stepwise approach. Of these publications four met the inclusion criteria of the authors. The analysis was carried out descriptively and in a meta-analysis.The 4 publications included described simple elbow dislocations in 81 children (≤16 years). The weighted average age was 9.9 years with a gender ratio of 3.8 (boys:girls). The median follow-up was 49 months. Posterior and posterolateral dislocations were the most common with 73%. In 69 children the treatment was conservative and of these 66 were immobilized for longer than 2 weeks after closed reduction. The 12 children who had surgical treatment suffered dislocations that had not been reduced for longer than 3 weeks. The success rate of the conservatively treated immobilized group was 88%, of the conservatively treated non-immobilized group 70% and of the surgical group 42%. The differences between the success rates of the treatment methods was significant (p = 0.032).Simple elbow dislocations in children are rare. They most commonly occur in posterior and posterolateral directions. The prognosis is favorable; however a timely diagnosis and correct reduction are relevant for a good outcome.

The new energy-dispersive XAS beamline at the European Synchrotron Radiation Facility is presented. A technical description of the beamline (optical scheme, detection, sample environments) is provided and its performance is illustrated with a few recent examples of experiments by different user groups., The European Synchrotron Radiation Facility has recently made available to the user community a facility totally dedicated to Time-resolved and Extreme-conditions X-ray Absorption Spectroscopy – TEXAS. Based on an upgrade of the former energy-dispersive XAS beamline ID24, it provides a unique experimental tool combining unprecedented brilliance (up to 1014 photons s−1 on a 4 µm × 4 µm FWHM spot) and detection speed for a full EXAFS spectrum (100 ps per spectrum). The science mission includes studies of processes down to the nanosecond timescale, and investigations of matter at extreme pressure (500 GPa), temperature (10000 K) and magnetic field (30 T). The core activities of the beamline are centered on new experiments dedicated to the investigation of extreme states of matter that can be maintained only for very short periods of time. Here the infrastructure, optical scheme, detection systems and sample environments used to enable the mission-critical performance are described, and examples of first results on the investigation of the electronic and local structure in melts at pressure and temperature conditions relevant to the Earth’s interior and in laser-shocked matter are given.

Introduction Prospective collected data of the TraumaRegister DGU® were analyzed to derive survival rates and predictors for non-survival in the children who had suffered traumatic cardiorespiratory arrest. Different time points of resuscitation efforts (only preclinical, in the emergency room (ER) or preclinical + ER) were analyzed in terms of mortality and neurological outcome. Methods The database of the TraumaRegister DGU® comprising 122,742 patients from 1993 to 2013 was analyzed. The main focus of this survey was on the paediatric group defined by an age ≤14 years who could be compared to adults. Different statistical analysis (univariate and multivariate analysis, logistic regression) were performed with mortality as the target variable. Differences between the paedatric group and adults were analysed by Fisher's exact test. Results Data after preclinical and/or ER resuscitation from 152 children and 1690 adults were analyzed. A good or moderate outcome (GOS 5 + 4) was found in 19.4% of the children's group compared to 12.4% of the adults (p = 0.02). Analysis of the GOS 5 + 4 subgroups after preclinical resuscitation only revealed that these outcomes were achieved by 19.4% of the paediatric group and 13.2% of the adults (p = 0.24), after ER-only resuscitation by 37.0% of the children and 19.6% of the adults (p = 0.046), and after preclinical and ER resuscitation by only 10.9% of the children compared to 2.5% of the adults (p = 0.006). Taking only survivors into account, 84.8% of the children and 62% of the adults had a GOS 4 + 5. The highest risk for mortality in the logistic regression model was associated with preclinical intubation, followed by GCS 3, blood transfusion and severe head injury with AIS ≥3 and ISS. Conclusions CPR in children after severe trauma seems to yield a better outcome than in adults, and appears to be more justified than the current guidelines would imply. Resuscitation in the ER is associated with better neurological outcomes compared with resuscitation in a preclinical context or in both the preclinical phase and the ER. Our children's outcomes seem to be better than those in most of the earlier studies, and the data presented might support algorithms in the future especially for paediatric resuscitation.

BACKGROUND: Closed reduction and percutaneous pinning is regarded as the treatment of choice for unstable supracondylar humerus fractures, but there are cases in which the use of external fixation is preferable. OBJECTIVE: The aim of this study was to investigate whether the method of external fixation could be considered as a stable alternative to percutaneous pinning and whether there was a difference in stability between two different external fixator constructs. METHODS: Eighteen synthetic humeri were allocated to three groups of six bones each. The specimens of group 1 were fixed by crossed pinning, those of group 2 by a new variation of an external fixator and the specimens of group 3 by an established variation of it. Osteotomy displacement was measured under static loading in internal and external rotation, as well as in extension and flexion. RESULTS: The external fixators proved to be significantly more stable than crossed pinning in sagittal loading. In internal rotation loading the new variation of the external fixator showed the best results. CONCLUSIONS: In case of fractures that can’t be replaced by closed reduction the new variation of external fixator should be preferred to the established variation or open reduction and crossed pinning.

Kindliche und adoleszente Femurschaftfrakturen sind keine seltene Verletzung. Obwohl bei Kleinkindern die konservative Therapie immer noch bevorzugt wird, ist ein Trend zur operativen Stabilisierung mit zunehmendem Alter deutlich festzustellen. Einige Publikationen weisen darauf hin, dass Kinder, sobald sie laufen konnen, in vielen Fallen schon operativ stabilisiert werden. Im Alter zwischen 1 und 6 Jahre ist eine gewisse Grauzone. Konsens besteht, dass ab dem Schulalter eine Osteosynthese angeraten wird. Das haufigste Verfahren ist bis 50 kg Korpergewicht die elastisch stabile intramedullare Marknagelung (ESIN). Als Alternativverfahren kommen der Fixateur externe, die eingeschobene Platte oder fur Adoleszente spezielle Verriegelungsnagel zum Einsatz.

PURPOSE OF THE STUDY Various spine disorders are regularly treated by orthoses, and success of treatment depends on wearing these devices. In this study we examined the compliance, wear comfort, subjective stabilization and side effects associated with spinal orthoses using an individualized questionnaire and the Compact Short Form-12 Health Survey (SF-12). MATERIAL AND METHODS In this prospective pilot study of randomized cross-over design, twelve healthy volunteers with a mean age of 31.2 years wore three different types of orthoses, each for one week: A hyperextension brace (HB), a custom-made semirigid orthosis (SO) and a custom-made rigid orthosis (RO). The daily duration of wearing the orthosis was defined as primary endpoint; contentment was measured using an individualized questionnaire and the standardized SF-12. RESULTS In the study population calculated probability of wearing the HB and RO was between 0.2 und 38.5% (95% confidence interval). No volunteer wore the SO orthosis for the predefined time. The SO and RO each displayed high subjective stabilization, while the RO was more often associated with side effects like skin pressure marks than the SO. The need for rework due to discomfort was mainly necessary with the RO. We observed no substantial differences in feeling compression and sweating. Noteworthy, eight of 12 subjects complained of uncomfortable sternal pressure due to the upper pad of the HB. The SF-12: scores ranged from 52.1 to 48.6 on the physical (PCS), and from 53.7 to 50.8 on the mental component score (MCS), demonstrating an influence on QoL. DISCUSSION AND CONCLUSIONS The design as well as the orthosis itself influence the compliance of wearing and exert a moderate negative, but acceptable impact on QoL. The SO appeared to correlate with the best overall compromise between comfort and subjective stabilization. Further investigations are necessary in patients with spinal diseases, for whom the effect of orthosis wearing may surpass the potential discomfort. Key words: thoracolumbar spine, orthoses, SF-12 - Quality of Life - QoL, comfort, compliance.

Many publications, mainly from other countries, suggest that the treatment of seriously injured children might be better in specialised paediatric trauma centres than in general trauma centres. Data from Germany are not available yet, but those from abroad were used for the recommendations made by the German Association for Trauma Surgery (DGU) on the topic of paediatric trauma in the "White Paper on Trauma Care". The goal of this study was to analyse whether the outcome of severely injured children is dependent on treatment level and on the availability of a paediatric surgeon based on the given data.Data from the "TraumaRegister DGU" between 2002 and 2012 were used. Children aged 1-15 years treated during the period 2002-2012 were included. Severity had to reach a minimum Injury Severity Score (ISS) of 9 and the treatment had to involve a stay at an Intensive Care Unit. Patients with an ISS ≥9 who died were also included to take into consideration children with particularly severe injuries.Hospitals without a paediatric surgeon transferred the patients significantly more frequently (p 0.001). Mean hospital stay was shorter in centres with a paediatric surgeon, with slightly longer median stays at an Intensive Care Unit. Hospitals without a paediatric surgeon performed slightly more frequent surgical interventions on injured children (barely significant at p = 0.045). The death rate and the calculated Revised Injury Severity Classification (RISC) II prognosis were the same with or without the presence of a paediatric surgeon. No difference was found in the Glasgow Outcome Score (GOS) between the group with and the group without involvement of a paediatric surgeon.Overall, the medical care of seriously injured and polytraumatised children in Germany is good at all levels of treatment whether a paediatric surgeon is involved or not.

Viele Publikationen vor allem aus anderen Landern legen nahe, dass die Versorgung von schwerverletzten Kindern in speziellen kindertraumatologischen Zentren besser ist als in allgemeinen Traumazentren. Daten aus Deutschland liegen bisher nicht vor. Fur die Empfehlungen im Weisbuch Schwerverletztenversorgung der Deutschen Gesellschaft fur Unfallchirurgie (DGU) zum Thema Kindertraumatologie wurden bisher diese verfugbaren Daten aus dem Ausland verwendet. Ziel unserer Arbeit war es, anhand verfugbarer Daten in Deutschland zu analysieren, ob das Outcome schwerverletzter Kinder abhangig von der Versorgungsstufe und von der Verfugbarkeit eines Kinderchirurgen ist. Es wurden Daten aus dem TraumaRegister DGU® der Deutschen Gesellschaft fur Unfallchirurgie (DGU) aus dem Zeitraum 2002–2012 verwendet; Kinder im Alter von 1–15 Jahren, die im Zeitraum von 2002–2012 in einem deutschen Krankenhaus behandelt wurden. Die Verletzungsschwere musste mindestens 9 Punkte im Injury Severity Score (ISS) betragen, und die Patienten mussten auf einer Intensivstation behandelt worden sein. Verstorbene Patienten mit einem ISS ≥9 wurden ebenfalls eingeschlossen, um besonders schwer verletzte Kinder, welche die Intensivstation nicht mehr erreicht haben, ebenfalls zu berucksichtigen. Aus Kliniken ohne einen Kinderchirurgen wurde signifikant haufiger innerhalb der ersten 48 h das Kind weiterverlegt (p < 0,001). Die durchschnittliche Krankenhausliegedauer war etwas kurzer in Kliniken mit einem Kinderchirurgen bei gering langerer Intensivstationsliegezeit. In Kliniken ohne einen Kinderchirurgen wurden haufiger Operationen bei verletzten Kindern durchgefuhrt, was mit p = 0,045 knapp signifikant war. Die Sterblichkeit sowie die errechnete RISC 2-Prognose waren mit und ohne Kinderchirurg gleich. Der GOS unterschied sich ebenfalls nicht in den Gruppen mit und ohne Kinderchirurg. Insgesamt ist die Versorgung von schwerverletzten und polytraumatisierten Kindern in Deutschland uber alle Versorgungsstufen mit und ohne Kinderchirurg gut.

BACKGROUND: Fracture of the distal humerus is a fairly rare injury and makes high demands on the treating surgeon. Prerequisites for a good outcome are anatomical reconstruction and osteosynthesis stable enough for exercises. A method permitting early restoration of function is especially important for patients with osteoporosis. The extensive surgical approach necessary for open reduction is associated with a high number of wound healing disorders and infections with a frequency of 11% being reported in the literature. Although open reduction and internal fixation in double-plating technique is unavoidable for complex intraarticular fractures, an alternative, minimally invasive and, consequently, tissue-preserving procedure is desirable for simpler fractures. OBJECTVE: To investigate this issue further an angular stable nail system developed for the distal radius was implanted as a stabilizer and the construct tested biomechanically as part of a feasibility study. METHODS: Distal humerus fractures were stabilized by insertion of a distal radius nail, namely, the Targon DR (Aesculap, Tuttlingen) and a K-wire. To test the hypothesis six cadaveric bones fixed in formalin were tested biomechanically for displacement, implant failure, and stiffness. Displacement was determined by means of an ultrasound-based system. RESULTS: An average displacement of 1.6 mm ± 0.7 was recorded at a maximum compression force of 100 N in extension and an average displacement of 1.4 mm ± 0.9 in flexion. Implant failure was not observed for any of the constructs. CONCLUSIONS: The study presented here permits the conclusion that a minimally invasive procedure is possible at the distal humerus and does ensure adequate stability. Although the nail was not specifically designed for the humerus, current findings form the basis for a promising approach that will be pursued further after modification of the nail design.

For the treatment of distal humerus an approach involving olecranon osteotomy is frequently preferred as it offers a clearer view, especially in cases of complex intraarticular fractures. It is however associated with the high risk of osteotomy-related complications such as nonunion, delayed healing, implant failure and migration of wires. The aim of the present study was to evaluate the stability of different new procedures that stabilize olecranon osteotomy compared with conventional tension band wiring. We hypothesize that the new implants provide equivalent stability as the conventional tension band wiring. To test the hypothesis 27 biomechanically evaluated synthetic ulnae were osteotomized and stabilized with either the application of tension band wiring, the Olecranon Hook LCP (Synthes, Switzerland), or the Olecranon Osteotomy nail (Synthes, Switzerland). Loading was performed providing a tensile load to simulate the tensile force applied by the triceps muscle. Cyclic force-controlled loading was performed at 300 alternating forces between 10N and 500N at a speed of 200N/sec. An ultrasound-based system measured displacement to an accuracy of 0.1 mm. Statistical analysis showed significantly less displacement in the Olecranon Hook LCP and Olecranon Osteotomy nail groups compared with tension banding. Comparison of plate and nail yielded no differences in stability. Biomechanical testing did however show significantly higher stability for newer fixation methods for olecranon osteotomies compared with the frequently applied technique of tension band wiring. Whether the use of these implants will also lower complication rates remains to be evaluated in future clinical studies.Level of evidence: Basic Science Study, Biomechanical Study.