Quantitative Erhebung distaler Motorik bei Parkinson-Patienten mit und ohne Mutation im LRRK2-Gen sowie klinisch nicht betroffenen LRRK2-Mutationsträgern und Gesunden

Die vorliegende Arbeit untersucht die quantitative distale Motorik bei Parkinson-Patienten mit und ohne (IPS= idiopathisches Parkinson-Syndrom) LRRK2-Mutation, sowie bei klinisch nicht betroffenen LRRK2-Mutationsträgern und Gesunden. Zur Erfassung der distalen motorischen Funktion wurde das Q-Motor-System benutzt. Im Bereich des PGLT konnten keine signifikanten Unterschiede innerhalb der symptomatischen Kohorte gefunden werden. Beim Speeded Tapping zeigten die Parameter für die mittlere Kraft und die mittlere Tapdauer signifikante Unterschiede zwischen den Kohorten der erkrankten LRRK2-Träger, der IPS-Gruppe und der gesunden Probanden. Die asymptomatische Gruppe, bestehend aus klinisch gesunden LRRK2-Mutationsträgern und Gesunden ohne diese Mutation, wies in keinem Test signifikante Unterschiede auf. Lediglich im PGLT waren Trends zu erkennen. Die Ergebnisse weisen darauf hin, dass erkrankte LRRK2-Träger trotz längerer Krankheitsdauer eine geringere motorische Dysfunktion als IPS-Patienten haben. Ein langsamerer Verlauf der Erkrankung, sowie eine bessere Kompensation bei jüngeren Erkrankungsalter könnten ursächlich dafür sein. Auch im Q-Motor konnten diese Unterschiede nachgewiesen werden. Vor allem die Aufgaben Speeded Tapping und Metronomic Tapping offenbarten signifikante Unterschiede zwischen den Kohorten. Änderungen distaler Bewegungsmuster konnten in asymptomatischen LRRK2-Trägern nicht detektiert werden. Zusammenfassend konnten mittels Q-Motor Erhebung Unterschiede in der distalen Motorik detektiert werden, welche eine Basis für größere longitudinale Studien darstellt. Sollten die Ergebnisse bestätigt werden, könnte diese Form der Erhebung u.a. zur Darstellung eines Progressionsmarkers für den Verlauf aber auch für Interventionsstudien genutzt werden

Changing epidemiology of lower extremity fractures in adults over a 15-year period – a National Hospital Discharge Registry study

Background!#!Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in 2002 compared to 2017 and to evaluate those changes.!##!Methods!#!Inpatient data from the German National Hospital Discharge Registry (ICD10) for 2002 and 2017 were evaluated. Changes in total counts and incidence rates were analysed for fractures in the following locations: femoral neck, pertrochanteric, subtrochanteric, distal femur, femoral shaft, proximal and distal tibia, tibial shaft, medial and lateral malleolus, and other parts of the lower leg (including bi- and trimalleolar fractures), calcaneus, talus, other tarsal bones, metatarsal bones, greater toe, lesser toe, other fractures of foot or unspecific fractures of foot and toe. Patients were classed into age groups by sex: 15-24, 25-34,35-44, 45-54, 55-64, 65-74, 75-84, 85-90 and >  90 years.!##!Results!#!The total count for lower extremity fractures in men and women increased slightly by 4.5% from 305,764 in 2002 to 319,422 in 2017. Hip and femur fractures increased by 23.5% from 150,565 in 2002 to 185,979 in 2017. The number of these fractures among men increased by 46% and among women by 15.3%. The total count of lower leg fractures decreased by 15.4% from 131,162 in 2002 to 110,924 in 2017. Especially, younger age groups showed a decline for all tibial segments and ankle fractures. For both sexes, the number of lower leg fractures in those 75 years or older increased in all lower leg fracture locations. Most femur and lower leg fractures occurred in women. The incidence of fractures rose sharply from 2002 to 2017, especially for older cohorts.!##!Conclusion!#!The total numbers of lower extremity fractures increased slightly in 2017 compared to 2002 - especially hip and femur fractures among men. The incidence of almost all lower extremity fracture types among older people increased during this time. Women were particularly affected. Therefore, focused prevention programmes should be considered including an extended fracture spectrum in the elderly

Outcome Analysis of Distal Radius Fracture with Orthosis Versus Cast Immobilization after Palmar Plate Osteosynthesis: A Randomized Controlled Study

Although the benefits of hand orthoses were shown in previous studies, they have not been able to establish themselves in clinical routines. With a focus on patient satisfaction, this study aimed to evaluate the latest generation of hand orthoses after palmar plate osteosynthesis for isolated distal radius fractures in comparison with circular plaster casts. 50 patients (16% dropout rate) were randomly assigned to an orthotic group (immobilization by orthosis, OG) or a control group (immobilization by a plaster cast, CG). Intra-articular fractures were present in 74% of the cases, and unstable AO C3 fractures in 26%. Questionnaires on patient satisfaction, documentation of the time required, clinical scores (DASH, SF-36), range of motion, grip measurements and radiographs were used for evaluation. The OG proved to be equivalent to the plaster treatment in terms of patient satisfaction, and stability of the reduction, as well as clinical scores DASH and SF-36. The OG was even superior in terms of personal hygiene (p = 0.011), handling (p = 0.008) and better adaptability (p = 0.013). Significantly less time was required to apply the orthosis (p < 0.001). In addition to the good results achieved so far, the study showed that the latest generation of orthoses has several advantages over plaster cast therapy, and could therefore become established in everyday clinical practice