Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Osteoid Osteoma of the Trochlea Tali: A Rare Cause of Treatment-resistant Ankle Pain.","authors":"Ann-Sophie Clara Weigel, Max Masthoff, Alexander Milstrey, Klemens Horst, Sabine Ochman","doi":"10.1055/a-2913-1640","DOIUrl":"https://doi.org/10.1055/a-2913-1640","url":null,"abstract":"<p><strong>Background: </strong>Osteoid osteoma is a benign but painful bone tumour that typically occurs in the long bones of young adults. Intra-articular localisation in the trochlea tali is rare and may significantly delay diagnosis.</p><p><strong>Case report: </strong>We report the case of a 41-year-old patient presenting with persistent, predominantly nocturnal pain of the right ankle joint, despite previous arthroscopic treatment of an osteochondral lesion. Initial conventional imaging was unremarkable. The diagnosis of an osteoid osteoma of the trochlea tali was established only after targeted re-evaluation using contrast-enhanced magnetic resonance imaging (MRI) and high-resolution computed tomography (CT). A diagnostic trial with acetylsalicylic acid resulted in marked symptom relief and further supported the suspected diagnosis, consistent with the known NSAID sensitivity of osteoid osteoma. Definitive treatment was performed using CT-guided radiofrequency ablation (RFA). The patient was completely symptom-free four weeks after the intervention.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of intra-articular osteoid osteomas in atypical locations. Careful clinical assessment, appropriate imaging, and interdisciplinary collaboration are essential for timely diagnosis and successful treatment.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803952","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":"Minimally Invasive Hip Arthroplasty via SuperPath Approach in Obese Patients - A Prospective Study.","authors":"Henning Quitmann, Marcus Jäger, Mika Vasiliuk, André Busch","doi":"10.1055/a-2914-3785","DOIUrl":"https://doi.org/10.1055/a-2914-3785","url":null,"abstract":"<p><strong>Introduction: </strong>The use of minimally invasive techniques for total hip arthroplasty (THA) in at-risk patients is still debated. The purpose of this prospective study was to determine the clinical and radiographic results of obese patients undergoing THA compared with those of normal-weight patients. Material and methods: A total of 476 patients of the 516 patients who underwent THA via the minimally invasive SuperPath approach between January 2016 and December 2019 attended the 1-year follow-up. Based on the WHO criteria for obesity, 22 patients were underweight, 147 were normal-weight, 186 were overweight, 73 were grade 1 obese, 25 grade 2 obese and 22 grade 3 obese. The clinical outcomes were evaluated using the Forgotten Joint Score (FJS). Radiographic analysis was performed with the digital software tool mediCad (HECTEC, Landshut, Germany).</p><p><strong>Results: </strong>The mean operating time was significantly longer at 81 min (55-96) in grade-3 obese patients than in underweight patients with 67 min (52-79; p = 0.01), normal-weight patients with 71 min (34-105; p = 0.04) and overweight patients with 70 min (50-100; p = 0.04). There were no significant differences between the six groups with regard to the hemoglobin drop between the preoperative state and the 2nd and 4th postoperative day. The mean \"time to stairs\" did not differ significantly (p > 0.05) between the six study groups. Normal-weight patients had a significantly lower inclination with 38.6° compared to overweight patients (40.3°; p = 0.04) and patients with grade 1 obesity (41.2°; p = 0.02). The inclination angles of patients with grade 2 (42.5°) and grade 3 obesity (42.6°) were highly significantly higher (p < 0.01) than in normal-weight patients. The mean anteversion angle of underweight patients (16.2°) was significantly lower than in normal-weight patients (17.6°; p = 0.03), overweight patients (17.8°, p = 0.02) and patients with grade 2 obesity (17.4°; p = 0.04). The mean anteversion angles in patients with grade 1 (18.3°) and grade 3 (18.1°) obesity were highly significantly higher than in underweight patients. The mean FJS-12 did not differ significantly (p > 0.05) between the six cohorts. Five patients had complications in the early postoperative period, three of whom were normal-weight.</p><p><strong>Discussion: </strong>The current study shows that obese patients undergoing THA via the minimally invasive SuperPath approach have equivalent complication rates and clinical and radiographic outcomes at the 1-year follow up compared with normal-weight and overweight patients.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762921","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":"The Role of Perioperative C-Reactive Protein Measurement in Primary Hip and Knee Arthroplasty.","authors":"Mari Babasiz, Andreas Christian Strauss, Max Jaenisch, Marius Bruehl, Robert Ossendorff, Martin Resl, Dieter Christian Wirtz, Thomas Wallny","doi":"10.1055/a-2906-0174","DOIUrl":"https://doi.org/10.1055/a-2906-0174","url":null,"abstract":"<p><strong>Background: </strong>C-reactive protein (CRP) is an established component of perioperative diagnostics in primary hip and knee arthroplasty; however, its clinical value and the validity of commonly used thresholds remain controversial. The aim of this study was to assess the pre- and postoperative handling of CRP at certified German arthroplasty centres (EPZ) and to critically appraise its clinical relevance.</p><p><strong>Methods: </strong>A 12-item internet-based questionnaire on the perioperative use of CRP was mailed to all 659 centres certified in April 2024; 134 centres participated anonymously. In 2023, these centres had performed a total of 91793 primary hip and knee arthroplasties.</p><p><strong>Results: </strong>Preoperatively, 130 of 134 centres (97.0%) determined CRP routinely. The thresholds applied varied considerably (< 5 mg/l: 48 centres; < 10 mg/l: 69; > 10 mg/l: 11). When the threshold was exceeded, 78 centres primarily referred patients for external evaluation, whereas 39 performed the work-up themselves. Most centres considered the probability of identifying a treatable focus to be low; when no focus was found, 67 of 130 centres proceeded with surgery nonetheless. Postoperatively, 126 centres determined CRP, but only 93 considered this necessary. The timing varied markedly, with 40.5% measuring as early as the first postoperative day. Additional inflammatory parameters were rarely obtained. Only seven centres based the indication for revision primarily on the CRP value.</p><p><strong>Conclusion: </strong>CRP is used frequently but heterogeneously in perioperative diagnostics. Given its limited specificity, particularly for mildly elevated values, and the well-known physiological postoperative increase, routine postoperative CRP measurement appears dispensable in uncomplicated cases. A standardised checklist and a stronger clinical focus could render diagnostics more efficient.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690642","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":"Systematic Analysis of Surgical Management in Traumatic Cervical Spondyloptosis.","authors":"Nina Hamacher, Klemens Trieb","doi":"10.1055/a-2814-4176","DOIUrl":"10.1055/a-2814-4176","url":null,"abstract":"<p><strong>Background: </strong>Traumatic spondyloptosis has been described as the most severe form of vertebral dislocation. It is characterised by the complete subluxation of a vertebral body by more than 100% relative to the adjacent vertebra. In general, traumatic spondyloptosis can occur in all sections of the spine. It is an extremely unstable injury that requires immediate surgical stabilisation. The aim of this study was to conduct a systematic analysis and evaluation of diagnostic procedures, therapeutic concepts, and surgical strategies for this serious injury.</p><p><strong>Methods: </strong>Due to the limited number of studies, the systematic literature analysis mainly includes case reports. The updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline were used for methodological structuring and evaluation.</p><p><strong>Results: </strong>A total of 106 publications were identified, of which 43 met the defined inclusion criteria. The focus was on case reports on the surgical treatment of traumatic spondyloptosis in humans. A total of 12 articles related to the cervical section of the spine and formed the basis for further analysis.</p><p><strong>Conclusion: </strong>Surgical treatment of traumatic cervical spondyloptosis is essential to ensure stable reconstruction and neurological care. Early diagnosis, preoperative neurological status, and an individualised surgical approach are crucial for the functional outcome.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"311-314"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597340","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":"Predictive Value of Inflammatory, Nutritional, and Renal Markers for Surgical Site Infection-related Revision after Lumbar Fusion Surgery.","authors":"Tamara Babasiz, Maximilian Weber, Mari Babasiz, Maximilian Lenz, Vincent Heck, Krishnan Sircar, Peer Eysel, Philipp Egenolf","doi":"10.1055/a-2801-0817","DOIUrl":"10.1055/a-2801-0817","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of patients at risk for surgical site infection (SSI) after lumbar interbody fusion (LIF) may allow timely intervention. This study assessed the predictive value of inflammatory, nutritional, and renal markers for SSI-related revision surgeries.</p><p><strong>Methods: </strong>In this retrospective single-center study, 187 patients undergoing LIF were analyzed. C-reactive protein (CRP), leukocyte count, glomerular filtration rate (GFR), creatinine, and albumin were measured perioperatively. Patients requiring revision for SSI were compared with those without the need for revision surgery. Receiver operating characteristic (ROC) analysis was used to determine cut-offs, area under the curve (AUC), sensitivity, and specificity. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>SSI-related revision was required in 14.4% of patients. CRP peaked on postoperative day (POD) 3-4 in both groups but declined significantly only in non-revision cases (p < 0.0001). On POD 3-4, CRP > 111 mg/l predicted SSI (AUC = 0.72, 95%CI: 0.61-0.82, p = 0.012; OR = 3.48, 95%CI: 1.30-9.30, p = 0.013). Preoperative albumin was significantly lower in the SSI group (p = 0.004) with a predictive value on POD 1-2, when albumin < 33 g/l had the best discrimination (AUC = 0.74, 95%CI: 0.62-0.84, p = 0.04; OR = 4.15, 95% CI: 1.35-12.74, p = 0.038). The decline in GFR from baseline to POD 7-8 was significantly greater in group 1 (p = 0.021).</p><p><strong>Conclusion: </strong>Persistent CRP elevation beyond POD 3-4, early postoperative hypoalbuminemia, and greater GFR decline identify patients at increased risk for SSI-related revision after LIF. Combined perioperative monitoring of inflammatory, nutritional, and renal markers may enable early risk stratification and targeted intervention.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"354-364"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470732","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":"Schlusslicht Unfallchirurgie – wie unser Fach zum unbeliebtesten PJ-Tertial wurde und was jetzt passieren muss.","authors":"Moritz Lenz, Hanna Danielzik, Christopher Cramer, Bertil Bouillon, Moritz Bäumken","doi":"10.1055/a-2878-6460","DOIUrl":"https://doi.org/10.1055/a-2878-6460","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 4","pages":"306-308"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671800","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":"[Clinical trials - what matters?]","authors":"Alexander P F Ehlers, Alexander F M Oehmichen, Dominik Kollmar, Madalena Lindenthal-Schmidt","doi":"10.1055/a-2894-3857","DOIUrl":"https://doi.org/10.1055/a-2894-3857","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 4","pages":"381-393"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671779","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":"Entwicklung der DGOU: „Qualität setzt sich durch, wenn man konsequent daran arbeitet.“.","authors":"Matthias Manych","doi":"10.1055/a-2878-6712","DOIUrl":"https://doi.org/10.1055/a-2878-6712","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 4","pages":"298-299"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671741","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 DGOU im Jahr 2026 – große Herausforderungen offensiv annehmen.","authors":"Matthias Manych","doi":"10.1055/a-2878-6542","DOIUrl":"https://doi.org/10.1055/a-2878-6542","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 4","pages":"300-302"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671751","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":"Waste Management and Recycling in the Operating Theatre - A Sustainability-oriented Approach.","authors":"Annika Steinmeier, Nicole Feder, Oliver Birkelbach, Robert Mahlow, Ulrich Stöckle, Robert Karl Zahn","doi":"10.1055/a-2784-0755","DOIUrl":"10.1055/a-2784-0755","url":null,"abstract":"<p><strong>Background: </strong>Waste management is an essential component of ecological sustainability. The healthcare sector generates approximately 5 million tons of waste annually, contributing about 5% of national CO₂ emissions. A major proportion originates from hospitals, up to 30% from operating theatres. The disposal of this waste produces high emissions. However, a significant part of this waste consists of valuable materials that could be recycled.</p><p><strong>Methods: </strong>In this prospective study, volume and weight of waste generated in operating theatres for trauma surgery were measured and analysed statistically. After analysis of standard disposal practice, the surgical staff received training, followed by waste segregation into potentially recyclable material and hospital-specific waste.</p><p><strong>Results: </strong>Prior to waste segregation, the mean volume and weight of waste per operation were 219.6 l (± 88.4 l) and 6.65 kg (± 2.92 kg), respectively. The implementation of waste separation resulted in a reduction by 39.48% in volume (z=-4.11; p < 0.01) and 15.44% in weight (z=-2.59; p = 0.01).</p><p><strong>Conclusion: </strong>Effective waste segregation in the operating theatre enables the reintegration of recyclable materials into circular economies, leads to significant reduction of waste and decreases the carbon footprint. Comprehensive staff education and structured implementation of waste separation in operating theatres are therefore essential.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"347-353"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230424","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}