Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Orthopaedic Progress and Specialisation in the aG-DRG System: An Analysis from the Perspective of a Centre of the National Centre for Tumour Diseases with a Focus on Bone Sarcoma.","authors":"Katharina Awwad, Jendrik Hardes, Arne Streitbürger, Marcel Dudda, Carsten Gebert, Martin Wessling","doi":"10.1055/a-2641-9652","DOIUrl":"https://doi.org/10.1055/a-2641-9652","url":null,"abstract":"<p><p>The implantation of a tumour prosthesis for neoplastic indications can be considered to be a rare operation. After each tumour resection, the defect reconstruction plays a crucial role and always requires an individualised solution. In addition to modular tumour prostheses and growth prostheses for children, joint-preserving custom implants are being increasingly used. In most cases, the specific Diagnosis Related Groups (DRGs) I95A or I95B, which are available for tumour prostheses, are billed to the payers. The complex treatments require high professional expertise and are predominantly performed in specialised centres.This study addresses how these specialised services with various defect reconstructions achieve cost coverage within the modified DRG (aG-DRG) system in a university hospital centre.In this retrospective cost analysis, data from a university hospital were included for the period from mid-2021 to the end of 2023. The analysis considered case-related costs (personnel and material costs for surgery and on the ward, as well as service utilisation in functional areas). The actual costs were determined according to the current guidelines of the calculation manual issued by the German institute for the remuneration system in hospitals (InEK). As a result, each patient's internal hospital costs were compared with the respective cost blocks of the aG-DRG matrix.In total, 198 patients could be included, with an average age of 43.7 years (SD: 25.5), with a reduction of 2.7 days in the average length of stay compared to the duration specified by InEK.The cost-revenue analysis revealed an average undercoverage of € -1,223 per patient. The greatest discrepancy was found in the implant costs, with a hospital-specific undercoverage of € -1,445, primarily due to the location and the use of patient-specific implants. Both characteristics were identified as risk factors. The intensive care unit's costs and service utilisation in functional areas, particularly radiology and laboratory services, were lower in this patient group compared to the benchmark hospitals. These could almost compensate for the higher personnel costs of physicians - with a shortfall in both the operating theatre and on the normal ward.Despite its high specialisation, one of Germany's leading tumour orthopaedics centres is currently not reaching cost-coverage for the implantation of tumour prostheses. This is mainly due to the various types of bone defects that need to be treated following tumour resection. Surgeons are expected to achieve high functionality and limb preservation, which places significant demands on them. Each prosthesis implantation involves an individualised solution with varying costs for the implant. The current aG-DRG system does not adequately account for this individuality and the broad spectrum of a major centre. The introduction of flat fees for the availability of services will not improve the situation. A first step toward fairer compensation c","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Reduction of Paediatric Supracondylar Humerus Fractures has No Negative Impact on Long-term Functional Outcome and Quality of Life Compared to Closed Reduction.","authors":"Cornelius Feige, Christoph Gonser, Andreas Badke, Tina Histing, Daniel Körner","doi":"10.1055/a-2641-9717","DOIUrl":"https://doi.org/10.1055/a-2641-9717","url":null,"abstract":"<p><p>The aim of the study was to compare closed and open reduction of displaced paediatric supracondylar humerus fractures with regard to long-term functional outcome and quality of life.In this retrospective study, 30 patients were examined with a displaced supracondylar humerus fracture (14 boys and 16 girls with a median age of 7 years [5-12 years]). The right elbow was affected in 8 cases (27%) and the left elbow in 22 cases (73%). According to the Gartland/Wilkins classification, there were 3× type IIA (10%), 8 × type IIB (27%), 18 × type III (60%) fractures (missing data n = 1 [3%]). All fractures were fixed with a crossed K-wire osteosynthesis. In the 1st group (n = 12), the fractures were reduced closed. In the 2nd group (n = 18), an open reduction was performed. The Quick Disabilities of the Arm, Shoulder and Hand Score (Quick-DASH) and the Paediatric Quality of Life Score (PedsQL) were recorded as outcome parameters after a mean follow-up of 53 months. The two groups were compared in terms of patient- and treatment-related factors and outcome parameters.The proportion of right elbow fractures was significantly higher in group 1 than in group 2 (50% vs. 11%). In group 2, the proportion of more severely displaced fractures was significantly higher than in group 1 (Gartland/Wilkins type III: 98% vs. 17%) and the median operating time was significantly longer (93 min vs. 26 min). There were no significant differences between the two groups in the Quick-DASH (0 [0-39] vs. 0 [0-11], p = 0.219), in the additional module \"Sports and Music\" of the Quick-DASH (0 [0-37.5], missing data n = 2, vs. 0 [0-50], p = 0.284) and in the PedsQL (95 [63-100] vs. 96 [86-100], p = 0.328).Open reduction of displaced paediatric supracondylar humerus fractures does not lead to a reduction in long-term functional outcome and quality of life compared to closed reduction.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Applications of the CRISPR-Cas9 System for Research and Treatment of Osteoarthritis.","authors":"Long Liang, YaXuan Yang, Fiore Jacqueline Elise, Jie Yu, Xunlu Yin, Guangqi Lu, Bin Chen, Jianhua Xing","doi":"10.1055/a-2616-0819","DOIUrl":"https://doi.org/10.1055/a-2616-0819","url":null,"abstract":"<p><p>Osteoarthritis is a common degenerative disease of joint cartilage that affects millions of people in the world, especially the elderly. Progression of osteoarthritis is associated with a plethora of genetic and non-genetic factors. The CRISPR/Cas9 system is emerging as a powerful tool for genome engineering and has remarkable potential for guiding further research into osteoarthritis and may be a viable means for treating the disease. This review discusses existing and potential applications of the CRISPR/Cas9 system in osteoarthritis studies and treatments. Firstly, we briefly summarize the current status and mechanism of this technology. Next, we focus on the latest advances in the application of CRISPR/Cas9 system in elucidating the contributions of various factors to the pathogenesis of osteoarthritis as demonstrated through in vitro studies and animal models. Finally, we provide our perspective on the direction and challenges of studying and treating osteoarthritis with CRISPR/Cas9.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Results of a Prospective Cohort Study Assessing the Applicability of Step Counts as a Digital Mobility Outcome in Trauma Surgery - a Brief Report.","authors":"Dannik Haas, Kira Hofmann, Chiara Meierhofer, Maximilian M Menger, Tanja Maisenbacher, Carolina Vogel, Tina Histing, Benedikt Johannes Braun","doi":"10.1055/a-2596-9162","DOIUrl":"https://doi.org/10.1055/a-2596-9162","url":null,"abstract":"<p><p>The individual and socio-economic burden of delayed rehabilitation after a fracture is high. Early identification of patients with critical healing processes and timely intervention are key factors for successful treatment management. The aim of this study was to demonstrate how step counts, collected via patient-owned wearables, can assist in identifying critical recovery trajectories.The study included 56 patients who already had a wearable device. Data on age, gender, injury type, PROMIS - Global Health 10 score at 3 months, and work ability at 3 months were collected. Step counts were recorded both before and after the injury.Data from 56 patients were analysed. Postoperative healing was reliably monitored using the patients' own wearables for both upper and lower extremities. Significant differences in daily step counts were observed between patients with normal healing and those with delayed rehabilitation. Significant differences were also found in step counts between patients who regained work ability within 3 months and those who did not. PROMIS surveys conducted after 3 months revealed significant differences between daily step counts in patients above the 80th percentile compared to those below the 20th percentile.The analysis demonstrates that monitoring healing progress with patient-owned wearables can effectively estimate the risk of delayed recovery and prolonged work disability, as based on easily accessible personal activity data. Further refinement of the technology and inclusion of additional patients with defined injury types could help identify trauma patients in need of additional care during treatment. Early and targeted interventions could enable a return to pre-injury activity levels and reduce the duration of work disability.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Evaluation of the OF Pelvis Score for Osteoporotic Pelvic Ring Fractures - A Retrospective Assessment of Therapy Recommendations for 107 Patients.","authors":"Ulrich Josef Albert Spiegl, Klaus J Schnake, Max J Scheyerer, Thomas Mendel, Georg Osterhoff, Kai Sprengel, Martin Bäumlein, Lars Behr, Alexander Franck, Erol Gercek, Sebastian Grüninger, Philipp Hartung, Stefan Hauck, Cornelius Jacobs, Sebastian Katscher, Friederike Klauke, Katja Liepold, Christian W Müller, Michael Müller, Stefan Piltz, Robert Pätzold, Marion Riehle, Gregor Schmeiser, Akhil P Verheyden, Volker Zimmermann, Bernhard Ullrich","doi":"10.1055/a-2385-1747","DOIUrl":"10.1055/a-2385-1747","url":null,"abstract":"<p><p>The aim of this study was to develop a simple and reliable score which supports decision making between non-operative and operative treatment in patients with osteoporotic pelvic fractures.Between 2018 to 2020, the OF Pelvis Score was developed during a total of 5 meetings of the Working Group on Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma. The OF Pelvis Score as a decision aid between non-surgical and surgical treatment was developed by expert consensus after analysis of numerous geriatric sacral and pelvic ring fractures from several hospitals. Subsequently, retrospective evaluation of the score was performed on consecutive patients from three hospitals.The following parameters were considered relevant to decision making between non-surgical and surgical treatment and were incorporated into the score: fracture morphology using the OF Pelvis Classification, pain status, level of mobilisation, fracture-related neurological deficits, health status, and the modifiers already integrated into the OF Pelvis classification. If the score is < 8, non-surgical therapy is recommended; if the score is > 8, surgical therapy is recommended; if the score is 8, there is a relative indication for surgery. The OF Pelvis Score was then evaluated retrospectively in a total of 107 patients, according to records. The OF Pelvis Score was 8 points in 4 patients (3.7%), all of whom received surgical treatment. Of the remaining 103 patients, 93 received score-compliant therapy (90.3%). Among these, 4 of the patients who did not receive score-compliant care refused the recommended surgery, so the actual therapy recommendation was score-compliant in 94.2%.The OF Pelvis Score can be used to derive a therapy recommendation in many patients in clinical practice. Because of the possible change of clinical parameters during the course of the disease, the score has a dynamic character. In the retrospective evaluation, the recommendations from the OF Pelvis Score were in close accordance with the therapy actually performed.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"217-224"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro Efficacy of Phage Therapy Against Common Biofilm-forming Pathogens in Orthopedics and Trauma Surgery.","authors":"Alberto Alfieri Zellner, Dieter Christian Wirtz, Frank Alexander Schildberg","doi":"10.1055/a-2436-7394","DOIUrl":"10.1055/a-2436-7394","url":null,"abstract":"<p><p>Formation of biofilms by bacteria is a major challenge in a clinical setting. The importance of these biofilms increases in specialties where foreign bodies and prosthetic material are used. Orthopaedics is such a speciality and phage therapy could offer additional therapeutic options when dealing with biofilm infections.We conducted a systematic literature review using the PubMed database. We searched for phage activity against biofilms of the most common pathogens found in orthopaedics.The results of the systematic review were broken down into different categories and discussed accordingly. We concentrated on the time the biofilms were allowed to mature, and the surface they were grown on. In addition, we checked the efficacy of bacteriophages compared to antibiotics and when applied simultaneously with antibiotics. We also investigated the source of the phages, how they were tested for sensibility against the biofilms, as well the conditions (pH, temperature) under which they remained active and stable.The data suggests that the in vitro efficacy of phages does not change under a wide spectrum of temperature and pH. To further explore the use of bacteriophages in orthopaedics, we need further studies that test biofilms which matured for several weeks on surfaces that are common in arthroplasty and traumatology.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"250-264"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Monteggia and Monteggia-like Injuries].","authors":"Anna Goth, Alexander Klug, Reinhard Hoffmann","doi":"10.1055/a-2550-3007","DOIUrl":"10.1055/a-2550-3007","url":null,"abstract":"<p><p>Monteggia-(like)-lesions are a combination injury of the forearm characterised by a proximal ulnar fracture with concomitant dislocation of the radial head in the proximal radioulnar joint (PRUG). If there are also fractures of the radial head and/or the coronoid, these are referred to as Monteggia-like injuries. Monteggia(-like) injuries are serious lesions which, without adequate treatment, carry a high risk of permanent damage such as persistent movement restrictions, progressive osteoarthritis and pain. Adequate diagnosis and treatment are essential for a satisfactory postoperative outcome. CT imaging with 3D reconstruction is the gold standard for preoperative diagnosis and planning. Generally, anatomical reduction with osteosynthesis is the treatment of choice for Monteggia(-like) injuries. In the vast majority of cases, the surgical approach can be dorsal. Anatomical fixation of the ulnar fracture is crucial for surgical success and is usually achieved using (locking) plate osteosynthesis. Concomitant fractures of the radial head and/or coronoid as well as ligamentous injuries require special attention and should usually also be addressed.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 3","pages":"279-295"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internationaler Austausch zur Weiterbildung auf dem DKOU 2024.","authors":"Dominik Adl Amini, Sarah Keller","doi":"10.1055/a-2550-2829","DOIUrl":"https://doi.org/10.1055/a-2550-2829","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 3","pages":"211-212"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumoral Calcinosis at a Finger Metacarpophalangeal Joint.","authors":"Claudia Waltenspül, Christian Karl Spies, Jan Janzen","doi":"10.1055/a-2324-6535","DOIUrl":"10.1055/a-2324-6535","url":null,"abstract":"<p><p>A 51-year-old patient presented with a painful swelling palmar to the metacarpophalangeal joint of the ring finger. A round tumor was detected using X-rays and MRI. After excision, tumoral calcinosis could be verified histologically.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"265-268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Die Deutsche Gesellschaft für Orthopädische Rheumatologie trauert um ihr Ehrenmitglied Frau Prof. Dr. med. Erika Gromnica-Ihle.","authors":"Ralph Gaulke","doi":"10.1055/a-2586-6341","DOIUrl":"https://doi.org/10.1055/a-2586-6341","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 3","pages":"213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}