Werterhellende Umstände im Bilanzrecht

Die Arbeit analysiert die Abgrenzung werterhellender von wertbeeinflussenden Umständen. Dabei werden die bestehenden Grundlagen in Judikatur und im Gesetz analysiert und die Bedeutung der Werterhellung herausgearbeitet. Als Abgrenzung werterhellender von wertbeeinflussenden Umständen dient das Stichtagsprinzip. Dabei ist der am Markt realisierbare Stichtagswert für die Beurteilung, ob ein werterhellender Umstand vorliegt, maßgebend

Self-inflicted partial epiphyseolysis of the distal femur—a case report

Introduction Injuries to the epiphyseal plate are of great concern as they can affect bone growth. Although epiphyseal fractures are common in adolescents, fractures of the distal femoral epiphyseal plate are rare. Case presentation We present a case of a Salter–Harris type 1 fracture of the distal epiphysis of the femur that was self-inflicted by a patient with paraplegia due to spina bifida. The patient was brought to the pediatrician's attention during a routine checkup with an apparent swelling of the right thigh. Upon presentation, we performed a radiograph and an additional MRI, which revealed a partial ventero-medial epiphyseolysis, consistent with a Salter–Harris type 1 fracture. Due to the dislocation, we indicated closed reduction with K-wires. Repositioning was performed using a modified Kapandji maneuver and was completed with additional K-wires. Conclusion Distal epiphyseolysis is a relatively rare injury that can lead to serious complications. Therefore, although rare, epiphyseal fractures should be considered in pediatric patients presenting with uncertain limb swelling

Traumatic fractures of the sternum – typical distribution and need for subgroups within AO and OTA classification system?

Introduction Objective of this study is the morphologic validation of the AO-classification of the sternal bone and particularly define subgroups. Methods Analyzed were all patients of a level I trauma center of a 7-year period with fractures of the sternal bone and the anterior rib cartilage. A total number of n  = 124 patients was included. The detailed evaluation of the CT-data recorded anatomical basic data of the rib cage and every fracture with its position, dislocation, fracture pattern (which was classified following the AO). Results 116 (93.5%) patients showed 134 single fractures of the sternal bone, 48 (35.8%) of the manubrium, 81 (60.4%) of the corpus sterni and 5 (3.7%) of the xyphoid. 16 patients had a dual fracture of manubrium and corpus. Fractures of the corpus were mostly type A-fractures, followed by type B-and C-fractures. Manubrial fractures had the same number of type A- and B-fractures. Subgroups were theoretically defined by the senior author of our group and validated. based on location, dislocation and course of the fracture. Discussion Sternal fractures are mostly shown at the corpus. Fractures of the xiphoid are very uncommon. Generally, corpus fractures are simple fractures, the rarer manubrium fractures show more complex fractures, which presumes a high trauma energy. The defined subgroups can help draw conclusion to the trauma mechanism and its potential concomitant injuries.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546

Combined Odontoid (C2) and Atlas (C1) Fractures in Geriatric Patients: A Systematic Review and Treatment Recommendation

Study DesignSystematic review.ObjectiveThe aim of this study was to conduct a systematic overview of the pathogenesis and the treatment options of combined odontoid and atlas fractures in geriatric patients.MethodsThis review is based on articles retrieved by a systematic search in the PubMed and Web of Science databases for articles published until February 2021 dealing with combination fractures of C1 and C2 in geriatric patients.ResultsAltogether, 438 articles were retrieved from the literature search. A total of 430 articles were excluded. The remaining eight original articles were included in this systematic review depicting the topics pathogenesis, non-operative treatment, posterior approach, and anterior approach. The overall level of evidence of the studies is low.ConclusionCombined odontoid and atlas fractures in the geriatric population are commonly caused by simple falls and seem to be associated with atlanto-odontoid osteoarthritis. Non-operative treatment with a cervical orthosis is a feasible treatment option in the majority of patients with stable C2 fractures. In case of surgery posterior C1 and C 2 stabilization and anterior triple or quadruple screw fixation are possible techniques. Some patients may also deserve an occipito-cervical fusion. A possible treatment algorithm is proposed

Intraoperative navigation of a distraction injury of the thoracic spine with very severe scoliotic alterations

Zusammenfassung Geschildert wird der Fall eines 43-jährigen Patienten, welcher sich bei einem Verkehrsunfall mehrere Verletzungen, u. a. eine Distraktionsverletzung an der Brustwirbelsäule, zuzog. Besonderheit war hier die bestehende Spondylodese mit Materialbruch und sekundärem Repositionsverlust. Aufgrund dessen wurden bei fehlender Einstellbarkeit der Pedikel und abnormem Schraubenkorridor die Führungsdrähte der Pedikelschrauben navigiert gesetzt. Hierdurch kann eine optimale Positionierung mit damit verbundener Patientensicherheit garantiert werden.The case of a 43-year-old male patient is described, who suffered several injuries due to a traffic accident, including a distraction injury to the thoracic spine. A specific feature of this case was the existing spondylodesis with material fracture and secondary loss of reduction. Due to this, the guidewires of the pedicle screws were placed in a navigation pattern in the absence of adjustable pedicles and an abnormal screw corridor. This guarantees an optimal positioning with associated patient safety.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546

The distribution of lateral rib fractures: a validation and further development of the AO/OTA classification system in patients with fractures at the rib shaft

Introduction Rib fractures are prevalent and clinically significant injuries, often associated with thoracic trauma. Despite their frequency, the precise distribution and characteristics of rib shaft fractures remain underexplored. This study investigates the distribution, location, and classification of lateral rib fractures using the AO/OTA classification, focusing on fracture patterns and the relationship to neighbored ribs. Methods The study retrospectively analyzed 116 patients with 617 isolated rib fractures treated at a Level 1 trauma center over seven years. Using CT scans, fractures between the tubercle and osteochondral junction of the rib shaft were examined. Fracture type, dislocation, and location were categorized according to AO standards. The 116 patients underwent detailed statistical analysis to identify distribution patterns and correlations between fracture characteristics. Results The fractures predominantly occurred between the fifth and seventh ribs, with a focus in the anterolateral to lateral region (40°–69°). Type A fractures were more anteriorly located, while type B fractures and dislocations shifted posteriorly. A regression analysis confirmed the significance of fracture type and dislocation in determining fracture position. Moreover, fractures showed clustering patterns, with adjacent ribs more likely to be injured. A caudal shift in fracture density and localization from the cranial to the caudal thorax was also observed. Discussion and conclusion The findings validate the AO/OTA classification for rib fractures, highlighting the need for refined subsegmental divisions within the rib shaft for more precise clinical application. The study underscores the relationship between fracture location, type, and associated injuries, advocating for multicenter studies and a comprehensive classification system for thoracic trauma. This could enhance our understanding of injury patterns and inform treatment strategies.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546

Precision and effort in robot-assisted placement of pedicle screws compared to standard surgical navigation

Abstract Aim was to compare image-guided navigation with a robot-assisted solution for performing MISS regarding precision, required time and subjective aspects. 90 pedicles were instrumented on two torsos, half with navigation, half robot-assisted. Precision analysis between both solutions didn’t show a significant difference. Time measurement showed a significantly longer duration per wire for the robot-arm on the first torso and a not significant longer duration on the second torso, where a significant reduction in the mean duration was shown. There was no significant difference in the subjective impressions comparing navigation and robot except the possibility to change the procedure. Precision of both methods is suitable for clinical use. A time advantage using the robot-arm couldn’t be demonstrated in the present study. A significant learning curve was shown, so a reduction in the longer duration on the robot can be expected. Further studies in clinical use are necessary

CPR related injuries of the chest wall: direct and indirect fractures

Background Rib and sternum fractures are common injuries associated with cardiopulmonary resuscitation (CPR). The fracture mechanism is either direct by application of force on sternum and anterior ribs or indirect by bending through compression of the thorax. The aim of this study was to determine morphologies of rib fractures after CPR and to reevaluate prior findings on fracture localisation, type and degree of dislocation. Methods The present study was based on all inpatients treated for chest wall fractures after non traumatic cardiac arrest at a Level 1 Trauma Centre from 2010 to 2016 who had received CT scans. Each fracture was analyzed for location, degree of dislocation and fracture type classified according to AO/OTA and CWIS. We also analysed Fracture Line orientation. Results We enrolled 40 patients with a total of 423 rib fractures. We found most fractures anterolaterally between the 3rd to 6th rib symmetrically on both sides of the thorax. We found sternum fractures in 30% of the patients, 50% being located at the at the corpus sterni between rib 3 and 4. All patients with sternum fractures suffered from rib fractures and most had fractures of the cartilage or osteochondral junction. All cartilage fractures were straight, undisplaced type A fractures. Most indirect fractures occurred anterolaterally between 50 and 60° in the axial plane. More than 90% of those fractures were classified as type A, 70% showed a straight fracture line and 60% were undisplaced. There was no difference in degree of dislocation between straight and oblique fracture lines. We found 143 incomplete fractures. Conclusion We confirmed prior findings regarding fracture patterns in CPR related injuries. We observed approximately 2–3 times as many straight-lined fractures as oblique ones following indirect trauma. One third of all fractures are incomplete, these highlights the special characteristics like high elasticity of ribs.Open Access funding enabled and organized by Projekt DEAL.Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field