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

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

Acceleration of Longitudinal Track and Field Performance Declines in Athletes Who Still Compete at the Age of 100 Years

While physical performance decline rates accelerate after around the age of 70 years, longitudinal athletic performance trends in athletes older than 95 years are unknown. We hypothesized a further accelerated decline in human performance in athletes who still perform at the age of 100 years. To investigate this, longitudinal data of all athletes with results at or over the age of 100 years were collected from the “World Master Rankings” data base spanning 2006–2019 (138 results from 42 athletes; 5 women, 37 men; maximum 105 years) and compared to previously published longitudinal data from 80- to 96-year-old athletes from Sweden (1,134 results from 374 athletes). Regression statistics were used to compare performance decline rates between disciplines and age groups. On average, the individual decline rate of the centenarian group was 2.53 times as steep (100 m: 8.22x; long jump: 0.82x; shot put: 1.61x; discus throw: 1.04x; javelin throw: 0.98x) as that seen in non-centenarians. The steepest increase in decline was found in the 100-m sprint (t-test: p < 0.05, no sign. difference in the other disciplines). The pooled regression statistics of the centenarians are: 100 m: R = 0.57, p = 0.004; long jump: R = 0.90, p < 0.001; shot put: R = 0.65, p < 0.001; discus throw: R = 0.73, p < 0.001; javelin throw: R = 0.68, p < 0.001. This first longitudinal dataset of performance decline rates of athletes who still compete at 100 years and older in five athletics disciplines shows that there is no performance plateau after the age of 90, but rather a further acceleration of the performance decline

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

Diagnostik arbeitsbedingter Erkrankungen und arbeitsmedizinisch-diagnostische Tabellen

Eine ganze Reihe von beruflichen Belastungen und ungünstigen Arbeitsbedingungen kann zu zahlreichen berufsbedingten Erkrankungen und Beschwerden führen, von denen nur ein kleiner Teil als Berufskrankheit oder Arbeitsunfall anerkannt wird. Der größere, versicherungsrechtlich nicht anerkannte Teil gilt als "arbeitsbedingte Erkrankung" im engeren Sinne. Es sind Erkrankungen und Beschwerden, die beruflich verursacht, teilweise beruflich verursacht oder in ihrer Dynamik beeinflusst werden. Neue Technologien und andere Arbeitsanforderungen führen zu einem geänderten Spektrum und zur Zunahme der arbeitsbedingten Erkrankungen und Beschwerden. Während einzelne Berufskrankheiten aufgrund der Präventionsmaßnahmen seltener geworden sind, verbergen sich viele arbeitsbedingte Erkrankungen im allgemeinen Krankheitsspektrum der Bevölkerung und sind bei der hausärztlichen und klinischen Betreuung zunehmend zu berücksichtigen. Unsere "Diagnostik arbeitsbedingter Erkrankungen und arbeitsmedizinisch-diagnostische Tabellen" gehen einerseits von allgemeinen und speziellen Krankheitsbildern aus und geben eine Übersicht über die möglichen Ursachen. Andererseits werden bestimmte Gefährdungen und die möglichen Beschwerden und Erkrankungen aufgeführt. Bei ausgewählten Erkrankungen werden Hinweise zur spezifischen Diagnostik und Differentialdiagnostik gegeben. Die Darstellungen orientieren sich daher auch am allgemeinen Krankheitsspektrum und sind nicht nur auf die anerkannten Berufskrankheiten eingeengt. Unsere Ausführungen und Tabellen, die in Kooperation mit den jeweiligen Fachvertretern der Medizinischen Fakultät in Homburg erarbeitet wurden, umfassen arbeitsbedingte Atemwegs- und Lungenkrankheiten, Herz- und Kreislaufkrankheiten, Karzinome, Leberkrankheiten, neurologische Krankheiten, Nieren- und Harnwegserkrankungen, ophthalmologische Krankheiten, orthopädisch-chirurgische Erkrankungen der Bewegungsorgane, sensibilisierende Arbeitsstoffe, Virus- und Infektionskrankheiten und verschiedene aktuelle Kurzinformationen. Aufgrund unserer besonderen poliklinischen Tätigkeit haben wir über Jahrzehnte Informationen über arbeitsbedingte Erkrankungen gesammelt und im Jahr 2000 in einer ersten Form zusammen gestellt und im Internet veröffentlicht. Die jetzige Fassung 2007 gehört längst zur Pflichtlektüre für unsere Studierenden und für die Facharztweiterbildung. Die Aktualisierung und Ergänzung ist laufend vorgesehen

Modified triangular posterior osteosynthesis of unstable sacrum fracture.

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31 years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9 days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6 mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12 months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3 months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screws

Pelvic trauma : WSES classification and guidelines

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Peer reviewe