Variation in care and outcome for fragile hip fracture patients: a European multicentre study benchmarking fulfilment of established quality indicators.

Purpose: Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries.

Methods: This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients.

Experimental and numerical assessment of two reconstructive techniques for the fragility fractures of the pelvis type Ia.

Anterior pelvic ring fractures are common in geriatric patients. The Supraacetabular External Fixator (SEF) is a relatively simple and effective surgical procedure. On the other hand, there is the option of a Subcutaneous Iliopubic Plate (SIP) osteosynthesis.

Developing a Biomechanical Testing Setup of the Pelvis-Part II: Experimental Testing.

Biomechanical testbench emulating the physiological loading of the pelvis is crucial in developing reconstructive implants for fragility fractures of the pelvis. Additionally, it will help understand the influence of the common daily loading on the pelvic ring. However, most reported experimental studies were mainly comparative with simplified loading and boundary conditions.

Developing a Biomechanical Testing Setup of the Pelvis-Part I: Computational Design of Experiments.

Biomechanics of the human pelvis and the associated implants are still a medical and engineering debated topic. Today, no biomechanical testing setup is dedicated to pelvis testing and associated reconstructive implants with accepted clinical relevance. This paper uses the computational experiment design procedure to numerically design a biomechanical test stand that emulates the pelvis physiological gait loading.

The role of the bilateral subcutaneous plate in the minimal invasive stabilization of fragility fractures of the pelvis.

Introduction: Anterior pelvic ring fractures are common in geriatric patients. Current treatment algorithms recommend osteosynthesis if no pain free mobilisation is possible. For this a multitude of surgical techniques have been described.

Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus.

Purpose: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF).

The portal of Neviaser: a valid option for antegrade nailing of humerus fractures.

Introduction: The objective of this retrospective non-randomized study was to evaluate the portal of Neviaser (PN) as an alternative approach in antegrade humeral nailing.

Methods: The surgical approach for the straight antegrade intramedullary nail (SAIN) was either the anterolateral delta-split (group 2, n = 79) or the portal of Neviaser (group 3, n = 27). Length of surgery and time of radiation were extracted from charts.

Influence of pubic symphysis stiffness on pelvic load distribution during single leg stance.

This study focuses on the influence of the softening and stiffening of pubic symphysis on the load distribution within the bones of the pelvic ring under the physiological loadings of the single leg stance. Muscle forces and joint reaction forces were first determined by inverse dynamics and applied to a linear finite element model of the pelvis. With normal pubic symphysis stiffness, high Von Mises stresses are located on the anterior surface to the sacrum around the sacroiliac joint and on the superior ramus, both on the side of the weight-bearing leg.

Anterior buttress plate is successful for treating posterior sterno-clavicular dislocation.

Purpose: Traumatic posterior instability of the sternoclavicular joint is a potentially life-threatening injury. In contrast to the low incidence there is a plethora of different strategies to treat this lesion. It was the objective of this retrospective analysis to evaluate and further develop current strategies.

Finite element analysis of the pelvis including gait muscle forces: an investigation into the effect of rami fractures on load transmission.

Background: The objective of the study is to investigate the load transmission within the pelvic ring under physiological loading during gait and to correlate these results with clinical findings. In a second approach, we analysed how load distribution is altered by fractures of the anterior pelvic ring.

Methods: Muscle forces and joint reaction forces are calculated by inverse dynamics and implemented in a finite element pelvis model including the joints.

Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls.

Purpose: To give an overview of the basic knowledge of the functional surgical anatomy of the proximal lower leg and the popliteal region relevant to medial high tibial osteotomy (HTO) as key anatomical structures in spatial relation to the popliteal region and the proximal tibiofibular joint are usually not directly visible and thus escape a direct inspection.

Methods: The surgical anatomy of the human proximal lower leg and its relevance for HTO are illustrated with a special emphasis on the individual steps of the operation involving creation of the osteotomy planes and plate fixation.

Results: The posteriorly located popliteal neurovascular bundle, but also lateral structures such as the peroneal nerve, the head of the fibula and the lateral collateral ligament must be protected from the instruments used for osteotomy.

BMP-2-transduced human bone marrow stem cells enhance neo-bone formation in a rat critical-sized femur defect.

Synthetic graft materials are considered as possible substitutes for cancellous bone, but lack osteogenic and osteoinductive properties. In this study, we investigated how composite scaffolds of βTCP containing osteogenic human bone marrow mesenchymal stem cells (hBMSCs) and osteoinductive bone morphogenetic protein-2 (BMP-2) influenced the process of fracture healing. hBMSCs were loaded into βTCP scaffolds 24 h before implantation in a rat critical-sized bone defect.

[Open wedge osteotomy of the tibial head. Management of vascular complications].

Background: Lesions of the popliteal artery during high tibial osteotomy are rare complications, consequently the majority of publications are case related. The interval between surgery and diagnosis is reported to be as long 3 years; therefore, the current literature probably does not reflect the true incidence of vascular injuries.

Objective: The case reports published in the literature were further evaluated.

Iliopubic subcutaneous plate osteosynthesis for osteoporotic fractures of the anterior pelvic ring. An alternative to the supra-acetabular external fixator.

The majority of fractures of the anterior pelvic ring is treated non-operatively. However, a number of patients do not get pain free and cannot be mobilized. Since the supra-acetabular external fixator is associated with significant complications we developed an alternative technique based on recent anatomical studies.

[Intra-articular fractures of the distal humerus : aspects of fracture treatment in geriatric patients].

Background: In the context of osteoporotic fractures, injuries to the distal humerus are quite uncommon, meaning that each surgeon will have only limited experience.

Objective: This leads automatically to the question to what extent treatment recommendations can be transferred to the geriatric population.

Methods: Looking at the evidence-based literature, recommendations could be limited to three prospective studies.

[Fractures of the knee joint in the elderly: osteosynthesis versus joint replacement].

Background: The aim of open reduction and internal fixation (ORIF) of fractures around the knee joint is the exact anatomic reconstruction of joint surfaces in order to achieve an early and load stable bone situation. Primary endoprosthetics as the initial treatment can represent an alternative treatment option for a closely selected number of geriatric patients.

Objectives: The chances and risks of primary endoprosthetics in comparison to ORIF as the gold standard for initial treatment of fractures close to the knee joint in the elderly are presented

Material And Methods: A selective search of the literature was carried out in consideration of national recommendations and own experience gained as head of a center for geriatric traumatology.

Does bone compaction around the helical blade of a proximal femoral nail anti-rotation (PFNA) decrease the risk of cut-out?: A subject-specific computational study.

Objectives: Because of the contradictory body of evidence related to the potential benefits of helical blades in trochanteric fracture fixation, we studied the effect of bone compaction resulting from the insertion of a proximal femoral nail anti-rotation (PFNA).

Methods: We developed a subject-specific computational model of a trochanteric fracture (31-A2 in the AO classification) with lack of medial support and varied the bone density to account for variability in bone properties among hip fracture patients.

Results: We show that for a bone density corresponding to 100% of the bone density of the cadaveric femur, there does not seem to be any advantage in using a PFNA with respect to the risk of blade cut-out.

Transpatellar access for intramedullary stabilisation of the tibia.

Postoperative deformities of the knee and sequaelae after intraarticular surgery can interfere with a standard parapetallar approach for intramedullary stabilisation of the tibia. Even the suprapatellar approach can be rendered impossible. For these rare indications we describe the patella osteotomy and transpatellar approach.

[The prevalence of reduced acetabular anteversion in asymptomatic patients: a retrospective analysis].

Background: In patients with unilateral femoroacetabular impingement (FAI), bony characteristics predisposing to FAI (e.g., acetabular retroversion) are also commonly observed in the contralateral asymptomatic hip.

A clinical, radiological and computational analysis of the thrust plate prosthesis in young patients.

Background And Purpose: A thrust plate prosthesis can be used as an alternative to a conventional stem prosthesis, preserving the diaphyseal bone stock. Recent findings however predict a higher rate of aseptic loosening than with intramedullary devices. The purpose of our investigation was to compare the clinical outcome and radiological findings with a finite element analysis of bone remodeling.

[Transthoracic echocardiography as a diagnostic tool in patients with thoracic stab wounds: early ultrasonographic evaluation in the emergency room].

Penetrating chest trauma involving the heart is usually known with a high mortality rate. Neither the absence of hemodynamic depression nor ECG changes exclude a potential fatal injury to the heart. We report on the diagnosis and definitive treatment of a stab wound injury with transected coronary artery, concomittant ventricular penetration, and pulmonary injury.

[Open reduction and internal fixation by primary subtalar arthrodesis for intraarticular calcaneal fractures].

Objective: To prevent the development of painful posttraumatic degenerative joint disease by a primary one-stage procedure to treat calcaneal fractures involving obvious comminution or severe and extensive cartilage damage to the subtalar facet.

Indications: Sanders type IV calcaneal fractures with severe and extensive cartilage destruction. The definitive indication for arthrodesis can only be established intraoperatively.