The effect of an infra-acetabular screw for anatomically shaped three-dimensional plate or standard plate designs in acetabulum fractures: a biomechanical analysis

Background Various plate shapes and implant configurations are used for stabilization of acetabulum fractures via anterior approaches. Little is known about the biomechanical stability of a two-dimensionally shaped “conventional” plate (“J-Plate”—JP) in comparison to three-dimensionally shaped plate configurations (3DP). In addition, the augmentary effect of an infra-acetabular lag-screw (IACS) fixation for anterior column and posterior hemi-transverse acetabulum fractures has not been clarified in comparison of JP and 3DP constructs. This study analyzed the difference between the biomechanical stability of JP compared to 3DP and the role of an IACS in a standardized acetabular fracture model in a single-leg stance loading configuration. Methods In an artificial bone substitute pelvis model (Synbone© Malans, Switzerland), a typical and standardized fracture pattern (anterior column and posterior hemi-transverse) was created with osteotomy jigs. After anatomic reduction the stabilization was performed using JP or 3DP. Eight pelvises per group were axially loaded in a single-leg stance model up to 400 N. After the load cycle, an additional infra-acetabular screw was placed and the measurement repeated. Fragment displacement was recorded by an optical tracking system (Optitrack Prime 13®, Corvallis, USA). Results In the pure placement, 3DP provided significantly superior stability when compared to JP. Augmentation of JP by IACS increased the stability significantly, up to the level of 3DP alone, whereas augmentation of the 3DP did not result in further increase of overall stability. Conclusion The anatomically shaped plate alone provides a superior biomechanical stability in fixation of an anterior column and posterior hemi-transverse fracture model. In a JP fixation the augmentation by IACS provides similar strength as the anatomically shaped 3DP. By use of the anatomically shaped 3DP the need of a clinically risky application of IACS might be avoidable

Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures

Introduction Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases. Material and methods In the present retrospective study geriatric patients with FNF (n=100) treated either by anterior minimal-invasive surgery (AMIS; n=50) or lateral conventional surgery (LCS; n=50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed. Results Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not difer between the two groups. Further, more patients in the AMIS group achieved full weightbearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No signifcant diferences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively. Conclusions In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients

Das komplexe Beckentrauma: Matching des Beckenregisters DGU mit dem TraumaRegister DGU®

BACKGROUND Complex pelvic traumas, i.e., pelvic fractures accompanied by pelvic soft tissue injuries, still have an unacceptably high mortality rate of about 18 %. PATIENTS AND METHODS We retrospectively evaluated an intersection set of data from the TraumaRegister DGU® and the German Pelvic Injury Register from 2004-2009. Patients with complex and noncomplex pelvic traumas were compared regarding their vital parameters, emergency management, stay in the ICU, and outcome. RESULTS From a total of 344 patients with pelvic injuries, 21 % of patients had a complex and 79 % a noncomplex trauma. Complex traumas were significantly less likely to survive (16.7 % vs. 5.9 %). Whereas vital parameters and emergency treatment in the preclinical setting did not differ substantially, patients with complex traumas were more often in shock and showed acute traumatic coagulopathy on hospital arrival, which resulted in more fluid volumes and transfusions when compared to patients with noncomplex traumas. Furthermore, patients with complex traumas had more complications and longer ICU stays. CONCLUSION Prevention of exsanguination and complications like multiple organ dysfunction syndrome still pose a major challenge in the management of complex pelvic traumas

Lung Transplantation for Primary Ciliary Dyskinesia and Kartagener Syndrome: A Multicenter Study.

Primary ciliary dyskinesia, with or without situs abnormalities, is a rare lung disease that can lead to an irreversible lung damage that may progress to respiratory failure. Lung transplant can be considered in end-stage disease. This study describes the outcomes of the largest lung transplant population for PCD and for PCD with situs abnormalities, also identified as Kartagener's syndrome. Retrospectively collected data of 36 patients who underwent lung transplantation for PCD from 1995 to 2020 with or without SA as part of the European Society of Thoracic Surgeons Lung Transplantation Working Group on rare diseases. Primary outcomes of interest included survival and freedom from chronic lung allograft dysfunction. Secondary outcomes included primary graft dysfunction within 72 h and the rate of rejection ≥A2 within the first year. Among PCD recipients with and without SA, the mean overall and CLAD-free survival were 5.9 and 5.2 years with no significant differences between groups in terms of time to CLAD (HR: 0.92, 95% CI: 0.27-3.14, p = 0.894) or mortality (HR: 0.45, 95% CI: 0.14-1.43, p = 0.178). Postoperative rates of PGD were comparable between groups; rejection grades ≥A2 on first biopsy or within the first year was more common in patients with SA. This study provides a valuable insight on international practices of lung transplantation in patients with PCD. Lung transplantation is an acceptable treatment option in this population

Einfluss des Beckenregisters der DGU auf die Versorgung von Beckenringfrakturen

Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and international publications, the dramatically changing epidemiology of pelvic ring fractures, further developments in diagnostics and the changes in operative procedures over time could be demonstrated. Last but not least the now well-established diagnostic and therapeutic algorithms for pelvic ring fractures, which could be derived from the information collated in registry studies, reflect the clinical impact of the registry.Zusammenfassung Die Inzidenz von Beckenringfrakturen ist mit einem Anteil von je nach Studienlage 2–8 % aller Frakturen vergleichsweise gering. Das Erscheinungsbild einer Beckenringfraktur ist sehr vielfältig und reicht von einfachen und meist „harmlosen“ Typ-A-Verletzungen bis hin zu lebensbedrohlichen komplexen Typ-C-Verletzungen. Während in der Vergangenheit postuliert wurde, dass ein hohes Energieniveau erforderlich ist, um den Beckenring zu frakturieren, wurde in den letzten Jahren nicht zuletzt durch Daten des Beckenregisters der DGU evident, dass bei osteoporotischem Knochen oft auch ein Bagatelltrauma zu einer Beckenringfraktur führen kann. Es kristallisierte sich heraus, dass bei einem rasant wachsenden geriatrischen Patientenkollektiv sogar ohne vorangegangenes Trauma Insuffizienzfrakturen des Beckenrings zu beobachten sind. Auch an großen Traumazentren ist die Anzahl der Patienten mit Beckenringfrakturen vielfach nicht ausreichend, um durch Monocenterstudien valide Aussagen über epidemiologische, diagnostische und therapeutische Entwicklungen treffen zu können. Aus diesem Grunde wurde bereits 1991 von der AG Becken der DGU das weltweit erste und bis heute einzige Register zur Dokumentation und Evaluation von Beckenverletzungen ins Leben gerufen. Standen anfänglich v. a. epidemiologische und diagnostische Fragestellungen im Vordergrund der Dokumentation, entwickelte sich im Laufe der Zeit ein zunehmend wachsender Datensatz mit umfassenden Parametern zu Verletzungsmustern, operativen und konservativen Therapieregimen sowie dem kurz- und langfristigen Outcome der Patienten. Während das Beckenregister ursprünglich in 10 Einrichtungen gestartet wurde, nehmen mittlerweile über 30 Kliniken auch außerhalb Deutschlands an der Datendokumentation teil. Allein in der dritten Phase der Registerarbeit konnten seit 2004 an die 15.000 Patienten mit Becken- und Azetabulumfrakturen in die Datenbank eingeschlossen werden. Neben dem wissenschaftlichen Einfluss des Beckenregisters, der sich in zahlreichen nationalen und internationalen Publikationen widerspiegelt, konnten durch die Datenerhebungen die sich dramatisch wandelnde Epidemiologie von Beckenringverletzungen, Weiterentwicklungen in der Diagnostik sowie die sich über den Zeitverlauf ändernden operativen Therapieverfahren aufgezeigt werden. Nicht zuletzt die aus der Datenlage abgeleiteten und heute etablierten Diagnostik- und Therapiealgorithmen bei Beckenringfrakturen spiegeln den klinischen Wert des Beckenregisters wider