Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Chronic Injuries to the Distal Biceps and Triceps Tendons: Current Evidence, Treatment Strategies, and Clinical Implications.","authors":"Marc Maximilian Weber, Valentin Rausch, Tim Leschinger, Lars Müller","doi":"10.1055/a-2836-0245","DOIUrl":"10.1055/a-2836-0245","url":null,"abstract":"<p><strong>Background: </strong>Chronic ruptures to the distal biceps and triceps tendons of the elbow are rare but clinically relevant injuries that may result in persistent functional impairment if left untreated. Tendon retraction, scarring, and degeneration significantly complicate surgical management and require meticulous diagnostic and therapeutic planning.</p><p><strong>Objective: </strong>This review summarises current evidence on the epidemiology, diagnosis, and treatment strategies for chronic ruptures to the tendon of the distal biceps and triceps tendon and aims to provide clinically applicable recommendations.</p><p><strong>Content: </strong>Conservative treatment of chronic distal biceps ruptures frequently results in persistent strength deficits, particularly in supination. Surgical reconstruction-either primary or using autograft or allograft augmentation-generally yields favourable functional outcomes, although it is associated with the risk of specific complications. For chronic triceps ruptures, partial tears may achieve satisfactory results with conservative management, whereas complete or > 50% defects typically require surgical reconstruction. Graft-based reconstructions are often necessary and can restore good function, although re-rupture rates remain relevant.</p><p><strong>Conclusion: </strong>Surgical treatment is particularly beneficial for young, active, and physically demanding patients, while conservative approaches may be reasonable in low-demand individuals. Careful indication, detailed imaging assessment, and individualised decision-making are essential. Further high-quality prospective studies are required to refine surgical techniques, graft selection, and postoperative rehabilitation protocols.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"469-475"},"PeriodicalIF":0.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159678","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":"Neue Wege gehen.","authors":"Frank Hildebrand, Jörn Dohle, Wolfgang Böker","doi":"10.1055/a-2916-1720","DOIUrl":"https://doi.org/10.1055/a-2916-1720","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 5","pages":"413-414"},"PeriodicalIF":0.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077258","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":"Aktuelle Bedrohungslage – medizinische Versorgung in der Landes- und NATO-Bündnisverteidigung.","authors":"Matthias Manych","doi":"10.1055/a-2916-1930","DOIUrl":"https://doi.org/10.1055/a-2916-1930","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 5","pages":"405-406"},"PeriodicalIF":0.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077219","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":"Central Sensitization as a Risk Factor in Work-related Musculoskeletal Pain - New Aspects of Functional Disorders.","authors":"Gerhard Opitz","doi":"10.1055/a-2803-9867","DOIUrl":"10.1055/a-2803-9867","url":null,"abstract":"<p><strong>Abstract: </strong>When analyzing work-related complaints, it is important to consider not only external and psychosocial factors but also conditions that have their origin in neurological processes, which lead to sensitization. This results in a lowering of receptor thresholds, leading to increased sensitivity to often inadequate stimuli. This hypersensitivity manifests not only as pain but also in the form of various discomforts. The basis of many workplace problems may therefore not be isolated causes, but rather an underlying sensitization process as an expression of dysfunctional regulatory feedback loops. This underlying background should be considered before initiating therapy. Otherwise, there is a significant risk of misguided treatment, which often leads to the chronification of the condition.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"444-450"},"PeriodicalIF":0.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489244","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":"[Pilon Tibial Fractures - What Can We Achieve?]","authors":"Robin Dreisbach, Johannes Gabel, Fabian Stuby, Alexander Trulson","doi":"10.1055/a-2950-5752","DOIUrl":"https://doi.org/10.1055/a-2950-5752","url":null,"abstract":"<p><strong>Abstract: </strong>Pilon fractures, as intra-articular fractures of the distal tibia involving the ankle joint, represent one of the most challenging injuries in trauma surgery. This review analyzes current treatment concepts and their outcomes based on a narrative review. Pilon fractures account for 3-10% of all tibial fractures and typically result from axial compression mechanisms in high-energy trauma or torsional forces in low-energy injuries. The complex anatomy of the tibial plafond with its limited vascular supply and thin soft tissue coverage considerably complicates treatment. Established classification systems such as the Rüedi-Allgöwer and AO classifications enable systematic fracture analysis, while the Tang 4-column classification supports anatomically oriented surgical approach planning. Surgical management often follows a staged concept, with initial external fixator stabilization and definitive reconstruction after soft tissue consolidation. Multiple surgical approaches according to the 4-column anatomy allow targeted fragment stabilization, with locking plate osteosynthesis representing the standard procedure. Intraoperative 3D imaging has become indispensable for assessing articular congruence. Despite technical advances, complication rates remain high, at up to 50%, and are dominated by wound healing disorders, infections, and post-traumatic arthritis. Functional outcomes show significant limitations with AOFAS scores between 50 and 82 points depending on fracture type and treatment method. At 57%, the return-to-work rate is dramatically limited. Complex AO type C fractures develop post-traumatic arthritis in more than 50% of cases with corresponding long-term consequences. Pilon fractures require an individualized, multidisciplinary treatment strategy with realistic prognostic communication regarding expected functional limitations and occupational consequences.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121241","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":"\"Crooked and Short Legs\" in Childhood.","authors":"Carina Antfang, Richard Placzek, Kim Friele, Lisa Roder, Milena Maria Plöger","doi":"10.1055/a-2938-9940","DOIUrl":"https://doi.org/10.1055/a-2938-9940","url":null,"abstract":"<p><strong>Abstract: </strong>For decades, paediatric orthopaedics have been analysing the developmental changes in axes, length and torsion in children. Throughout the entire growth period, these relationships change continuously. Understanding them and being able to classify them as physiological or pathological is essential. If, during growth, greater axis deviations or limb length discrepancies arise, minimally invasive growth modulation can often be performed.Guided growth using staples or screws is among the most well-established method. By far the most common indication is the axis deviation in the frontal plane, such as valgus or varus deformities of the knee joint. In these cases, the growth plates around the knee are partially restrained on one side, leading to increased growth on the opposite side and thus gradually correcting the deformity over time. Knee extension deficits or reduced osseous dorsiflexion of the ankle joint can also be improved through growth modulation.Leg length discrepancies can likewise correct themselves over time through inhibition of the growth plates at the knee. Both temporary and permanent methods are used, each with their respective advantages and disadvantages. Torsional deformities, however, remain a problem that has not yet been fully resolved. Although various approaches to modulation exist, no concept has yet become established in clinical practice.All guided growth methods share one common feature: their dependence on growth and the associated uncertainty in prediction. Clinical experience, as well as various models that use chronological or skeletal age, can help determine the optimal timing of intervention.Through guided growth, angular deformities of the legs can be corrected using a minimally invasive procedure making use of the childrens' natural growth.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032478","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":"Ceramic Bone Substitutes in Orthopaedic Surgery: Standards, Trends and Future Perspectives.","authors":"Marcus Jäger, Eleftherios Papaeleftheriou, Marcel Haversath, Alexander Wegner, Andrea Sowislok","doi":"10.1055/a-2938-4578","DOIUrl":"https://doi.org/10.1055/a-2938-4578","url":null,"abstract":"<p><strong>Abstract: </strong>In contrast to other tissues and organs, bone and its marrow have been successfully transplanted to promote bone healing for more than 100 years. Nevertheless, the amount of autologous bone grafts is limited and associated with relevant donor site morbidity. Therefore, intensive efforts have been made to develop adequate bone substitute materials. In combination with regenerative strategies including the application of bone marrow /mononuclear stroma cells, growth factors, cytokines (VEGF, PDGF, BMP2 etc.) as well as extracellular vesicles (EVs), bone substitutes (BS) may augment, supplement or even replace autologous bone grafts. BS provide a three-dimensional network that allows guided cellular migration, proliferation, differentiation, and mineralisation. In accordance with bionic principles, defined CaP-based BS have shown promising clinical results and are frequently applied in daily orthopaedic practice. In recent years and with better understanding, new technologies have been introduced in this area. These trends include ex vivo coating strategies for BS, the implementation of AI in BS design and planning, the combination with growth factors such as NELL-1 or P-15, the consideration of osteoimmunologic aspects, and the application of new material composites. In this study, we provide an overview and update to well-established standards and innovations in the field of ceramic BS and discuss findings reported in the literature.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908596","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":"Osteotomies Around the Knee - a Narrative Review of the Current Standard.","authors":"Steffen Schröter, Marc-Daniel Ahrend","doi":"10.1055/a-2882-4087","DOIUrl":"https://doi.org/10.1055/a-2882-4087","url":null,"abstract":"<p><strong>Abstract: </strong>Knee osteotomies have been established for more than a century as an effective treatment for degenerative and post-traumatic deformities of the lower limb. The aim of this narrative review is to present the current state of knee osteotomies and to outline the relevance of correction in the coronal, sagittal, and axial planes, as based on current evidence and clinical examples.Technical advances, such as digital preoperative planning, biplanar osteotomy techniques, and modern locking plate fixation have significantly reduced complication rates and improved overall clinical outcomes. Open-wedge high tibial osteotomy remains the standard procedure for tibial-based varus deformities and yields excellent results when appropriately indicated. For femoral-based varus or valgus malalignment, biplanar distal femoral osteotomy has become the preferred technique. The use of a hinge wire led to a reduced risk of intraoperative hinge fractures. Double osteotomies are particularly useful in combined deformities of the femur and tibia, and allow preservation of the orientation of the physiological joint line. Several studies have reported excellent functional outcomes with this approach. Corrections in the sagittal and axial planes are gaining increasing importance, especially in cases of patellofemoral pathology, increased tibial slope, or post-traumatic rotational deformities. Overall, knee osteotomies are a reliable and effective method for managing complex deformities. When properly indicated, they can delay or even avoid the need for knee arthroplasty, offering a durable joint-preserving treatment option.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868737","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":"Postgraduate Medical Education in Arthroplasty: Between Ambition and Reality.","authors":"Kim Lydia Klepka, Theresa Wallner, Matthias Schnetz, Georgi Wassilew, Anne Elisabeth Postler","doi":"10.1055/a-2825-5325","DOIUrl":"https://doi.org/10.1055/a-2825-5325","url":null,"abstract":"<p><strong>Introduction: </strong>The number of arthroplasty procedures on hip and knee joints is expected to continue to rise in the coming years. At the same time, postgraduate training in arthroplasty faces significant structural challenges in German-speaking countries. This study aimed to assess the current state of postgraduate clinical training, the role of external education offered by the German Society of Arthroplasty (AE), and the ways in which young physicians can access AE-YOUTH (the AE's youth organisation).</p><p><strong>Methodology: </strong>An online survey was distributed to members of AE-YOUTH. The structured questionnaire included 20 items covering demographic information, clinical training experiences, and participation in AE-provided educational activities. Data analysis was performed, using descriptive and exploratory methods in Excel and SPSS.</p><p><strong>Results: </strong>A total of 92 AE-YOUTH members responded to the survey (response rate: 21.4%). While 75.3% reported that they had had the opportunity to perform arthroplastic procedures as primary surgeon, only about 22 % met the procedural volume required by official training regulations. Gender (p = 0.021) and stage of training (p = 0.001) were significantly associated with the number of procedures performed. In response to structural deficits, participants expressed a desire for stepwise surgical training concepts and structured mentoring programmes. Satisfaction with clinical training in arthroplasty averaged 2.9 out of 5, while AE-provided continuing education was rated higher, at 4.0 out of 5. More than half of respondents used online formats, and one-third participated in hands-on training courses. Most became aware of AE-YOUTH through colleagues or the AE website, with social media playing only a minor role.</p><p><strong>Discussion: </strong>The results reveal a clear discrepancy between expectations and reality in clinical arthroplasty training. In contrast, educational programmes provided by the professional society were perceived as more structured and accessible. These offerings may effectively complement clinical training, which is often constrained by time pressure and administrative workload. Digital content, simulation-based training, and practical courses are especially valuable in this context. As a low-barrier and needs-driven platform, AE-YOUTH has the potential to foster early-career engagement in arthroplasty and to support postgraduate education in a more structured and sustainable manner.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835202","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":"Patient-Reported Outcome Measures in Inpatient Spine Care: A Prospective Pilot Study on Feasibility and Process Integration.","authors":"Anna Tiedt, Isabell Weber, Dina Wiersbicki, Christoph-Eckhard Heyde, Anna Völker","doi":"10.1055/a-2917-8086","DOIUrl":"https://doi.org/10.1055/a-2917-8086","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are key instruments in value-based healthcare but are not yet routinely implemented in inpatient clinical practice. This prospective pilot study aimed to evaluate the organizational feasibility and integration of a digital PROM collection in a university spine center.</p><p><strong>Methods: </strong>In this prospective pilot study, consecutive patients scheduled for elective inpatient conservative or surgical spine treatment were included. PROMs were collected digitally via tablet at two time points: at admission (T1) and prior to discharge (T2). Both generic and disease-specific PROMs were used. Primary endpoints were participation rate, data completeness, and process-related barriers. In addition, usability of the software was assessed using the System Usability Scale (SUS).</p><p><strong>Results: </strong>Of 225 screened patients, 144 (64%) were included. PROM collection at admission was complete (100%), whereas complete data at discharge (T2) were available for 62.5% of patients. The main reason for incomplete data was failure to administer the survey during the discharge process (n = 44). The majority of patients were digitally contactable and preferred email contact for potential follow-up assessments. Usability of the software was rated high (median SUS score 87.5). PROM trajectories showed overall clinically plausible changes.</p><p><strong>Conclusion: </strong>Digital PROM collection in routine inpatient care is feasible and can be successfully integrated into clinical workflows. However, the discharge process represents a critical point of data loss. Structured integration into routine processes, including defined responsibilities and workflow-based triggers, appears necessary to improve data completeness.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815360","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}