Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Impact of Hospital Case Volume on the Complication Rate in Hip Arthroplasty: An Analysis of Nationwide AOK Data.","authors":"David Richard Krüger, Elke Jeschke, Thorsten Gehrke, Christian Günster, Andreas M Halder, Hanna Leicht, Jürgen Malzahn, Peter Schräder, Dieter C Wirtz, Josef Zacher, Karl-Dieter Heller","doi":"10.1055/a-2538-6446","DOIUrl":"10.1055/a-2538-6446","url":null,"abstract":"<p><p>Aufgrund des demografischen Wandels und damit verbundener erwarteter Steigerungen der Fallzahlen von primärer Hüftendoprothetik und Revisionseingriffen ist es wichtig, Faktoren zu identifizieren, die Komplikationen und Revisionen reduzieren können. Ein solcher Faktor ist die Fallzahl eines Krankenhauses. Studien haben gezeigt, dass Krankenhäuser mit höheren Fallzahlen niedrigere Morbiditäts- und Komplikationsraten aufweisen. Die meisten Studien basieren dabei auf Registerdaten, die oft unvollständig sind und keine patientenspezifischen Faktoren beinhalten.In dieser Studie wurden bundesweite pseudonymisierte stationäre Abrechnungsdaten und Versichertenstammdaten der Allgemeinen Ortskrankenkassen (AOK) im Zeitraum von 2017 bis 2019 bei Patienten mit primärer Hüftendoprothese analysiert. Zur Analyse des Einflusses der Fallzahl auf das Outcome wurden 5 Fallzahlkategorien gebildet (I: 1-49, II: 50-99, III: 100-199, IV: 200-399, V: ≥ 400 Operationen pro Jahr). Als Endpunkte wurden 90-Tage-Sterblichkeit, 1-Jahres-Revisionsoperationen, chirurgische Komplikationen (90 Tage bzw. 365 Tage), periprothetische Femurfrakturen (90 Tage) und schwere Allgemeinkomplikationen im Krankenhausaufenthalt betrachtet. Der Einfluss der Fallzahl auf das Outcome wurde mittels multipler logistischer Regression unter Berücksichtigung patientenspezifischer Faktoren bestimmt.Die Analyse von 137494 Fällen aus 993 Kliniken zeigt einen statistisch signifikanten Zusammenhang zwischen der Fallzahlgruppe und der Häufigkeit von Revisionsoperationen, chirurgischen Komplikationen, periprothetischen Femurfrakturen und allgemeinen Komplikationen. Bei Kliniken mit einer Fallzahl von weniger als 50 pro Jahr zeigte sich eine Risikoerhöhung um 65%-88% für diese Endpunkte gegenüber der fallzahlstärksten Gruppe. Für den Endpunkt Sterblichkeit ergibt eine dichotome Betrachtung der Fallkategorien ebenfalls einen signifikanten Einfluss der Fallzahlen.Die Studie zeigt, dass, auch unter Berücksichtigung patientenspezifischer Faktoren, höhere Fallzahlen bei primärer Hüftendoprothetik in Krankenhäusern mit niedrigeren Komplikationsraten verbunden sind. Diese Erkenntnisse unterstreichen die Bedeutung der Fallzahl als Faktor zur Verbesserung der Versorgungsqualität in der Hüftendoprothetik.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660251","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":"Learning Objective Mapping of the National Competence-Based Learning Objectives Catalogue of Medicine in Orthopaedic Surgery - an Option to implement an Existing Structure.","authors":"Tobias Schöbel, Christoph-Eckhard Heyde, Anne Elisabeth Postler, Philipp Pieroh","doi":"10.1055/a-2533-4832","DOIUrl":"https://doi.org/10.1055/a-2533-4832","url":null,"abstract":"<p><p>With the new licensing regulations and the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM), the learning objectives and certificates of achievement are no longer assigned to specific subjects. In addition to the opportunity for the subject of orthopaedics and trauma surgery to present itself more prominently and at an earlier stage, there is also a need to identify the relevant subject-related learning objectives in order to integrate them into the curricula and prepare for internal faculty discussions on teaching assignments. At present, it remains unclear whether the new licensing regulations will be accompanied by the initially planned complete restructuring in the form of the so-called Z-curriculum, but the new learning objectives of the NKLM will become part of the training for future doctors.The learning objectives contained in the current draft of the NKLM from December 2023 were screened and evaluated by two teaching coordinators using the dual control principle. The learning objectives that should and can be meaningfully taught by the O & U were selected from the 2646 formulated contents. A total of 276 (10.32%) learning objectives were detected for the teaching of O & U and 2399 (89.68%) were excluded. The selected learning objectives were then assigned to the existing courses and the institute's own teaching was optimised accordingly in preparation.In this study, the learning objectives of the NKLM were compared with the current learning objectives of O & U at Leipzig University and the learning objectives of the NKLM were integrated into the curricula. Of the NKLM, 10.32% of the learning objectives relate to the subject O & U, which underlines its importance. In addition, the approach presented here shows that the learning objectives of the NKLM can be quickly implemented in an existing curriculum.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607648","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":"Vielen Dank!","authors":"","doi":"10.1055/a-2513-3445","DOIUrl":"https://doi.org/10.1055/a-2513-3445","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 1","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191350","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":"[Radial Head Arthroplasty: Pearls and Pitfalls].","authors":"Jan Philipp Hockmann, Valentin Rausch, Tim Leschinger, Lars P Müller","doi":"10.1055/a-2342-1642","DOIUrl":"10.1055/a-2342-1642","url":null,"abstract":"<p><p>Fractures of the radial head are among the more common injuries of the upper extremity. Their incidence is increasing, and these fractures are often associated with ligamentous injuries or occur as part of complex injury patterns, such as the terrible triad, Monteggia-like lesions, or Essex-Lopresti injuries. Radial head fractures are classified according to the Mason/Johnston system. In cases where the fracture is not reconstructable, or when osteosynthesis fails, radial head arthroplasty may be indicated.Several prosthetic designs are available, each offering unique features. These include differences in polarity, modularity, and shaft fixation techniques, such as cemented, cementless, or \"intentionally loose\" fixation. This article, supported by case reports, highlights the indications, surgical approach, and implantation techniques for radial head arthroplasty. Additionally, common pitfalls are discussed, along with strategies to prevent or manage them. These pitfalls include postoperative elbow stiffness, elbow joint instability, and prosthetic overstuffing.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 1","pages":"94-107"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191334","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":"Direct high-pressure Injury of the Palm after Injection of a Capsaicin-filled Gas Pistol.","authors":"Güner Sönmez, Jan Janzen, Christian Karl Spies","doi":"10.1055/a-2294-1098","DOIUrl":"10.1055/a-2294-1098","url":null,"abstract":"<p><p>High injection lesions of the hand are among the most serious injuries, with concomitant consequences. These lesions are often underestimated and may entail additional damages if that is the case. Not only the physical impact but also the chemical nature of the substance dictate the treatment.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"87-90"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422382","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":"Hängepartie: Wann kommt die neue Approbationsordnung?","authors":"Frank Lichert","doi":"10.1055/a-2498-8200","DOIUrl":"https://doi.org/10.1055/a-2498-8200","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"163 1","pages":"7-8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191344","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":"Anticoagulant Medication in Endoprosthetically Treated Proximal Femur Fracture - Complications and Mortality Considering the Time of Treatment as a Quality Criterion.","authors":"Christoph Johannes Neumann, Tim Dario Kaiser, Rüdiger Smektala","doi":"10.1055/a-2324-1877","DOIUrl":"10.1055/a-2324-1877","url":null,"abstract":"<p><p>There is an international debate on the optimal time to surgery following hip fracture in older patients. Pre-existing anticoagulation seems to be a major concern when it comes to a delay in operative fracture treatment. The aim of this study was to examine complication and mortality rates for elderly anticoagulated hip fracture patients considering early (< 24 h) vs. delayed (> 24 h) surgery.Our Analysis is based on data of the external inpatient quality assurance of North Rhine Westphalia as the most populous German federal state. We identified 13,201 hip fracture patients with antithrombotic medication and a minimum age of 65 years treated from January 2015 to December 2017.Delayed surgery was associated with significantly higher rates of general and surgical complications as well as mortality. Except for pre-existing heart failure, we were not able to identify certain comorbidities that could clearly indicate, why there might have been a delay.In most cases, patients with antithrombotic medication have a poor outcome to be expected due to serious comorbidity. If there was a delay in surgery for those patients, treatment results were even worse. Thus, surgery with a delay of > 24 h must be avoided to reduce the risk of complications.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"44-52"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422381","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":"One Year of Experience in the Orthopaedic and Trauma Surgical Care of War Refugees and Soldiers from Ukraine in a Maximum Care Trauma Centre.","authors":"Christian Prangenberg, Lisa Fiona Roder, Kristian Welle, Jonas Roos, Alberto Alfieri Zellner, Soufian Ben Amar, Christof Burger, Martin Gathen","doi":"10.1055/a-2331-1020","DOIUrl":"10.1055/a-2331-1020","url":null,"abstract":"<p><p>According to the United Nations, around 8,400 people have been injured and over 5,800 killed on the Ukrainian side in the Ukraine war, which has been going on for over 14 months. Extensive humanitarian aid operations were carried out to support Ukraine, so that war-wounded people from Ukraine were also cared for in Germany. In a retrospective cohort study, 10 patients were examined who were treated in the department between February 24th 2022 and February 24th 2023, using the cloverleaf system from Ukraine.The average duration of inpatient treatment was 53.10 days. The average ISS was 23.7. The patients were operated on an average of 3.3 times in our institution. All patients received consultative psychological care. All patients were initially put into protective isolation until the results of a corona test and microbiological swabs were available. After preliminary protective isolation, further isolation had to be carried out in 5 cases due to germs requiring isolation. Eight patients were released to state accommodation. Three patients were transferred back to Ukraine at their own request.The treatment of war-injured patients from Ukraine represents a particular challenge. It absolutely requires an interdisciplinary treatment concept that, in addition to special trauma surgery and orthopaedic expertise, also requires plastic-reconstructive, microbiological and, last but not least, psychological care. Due to the high rate of infections requiring isolation, long, costly therapy with multiple revision operations is often necessary.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"53-62"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989874","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":"Dislocation Does Not Seem To Be an Absolute Factor Effecting the Short- to Medium-Term Poor Prognosis of Patients with Acetabular Posterior Wall Fracture.","authors":"Yunfeng Yao, Houlong Ye, Wang Fang, Ru Feng, Chun Zhang, Liujie Zheng, Hao Lv, Jun Li, Juehua Jing","doi":"10.1055/a-2265-0446","DOIUrl":"10.1055/a-2265-0446","url":null,"abstract":"<p><p>Dislocation is a complication of acetabular fractures involving the posterior wall, but whether dislocation is an absolute factor impacting the short- to medium-term prognosis of the hip joint remains controversial. This study aimed to compare the short- to medium-term clinical and radiological results among patients diagnosed with an acetabular fracture involving the posterior wall, with or without dislocation.Seventy-nine patients diagnosed with an acetabular fracture involving the posterior wall were retrospectively divided into posterior dislocation and non-dislocation groups. All fractures were open reduction + internal fixation with a plate screw combination through the single Kocher-Langenbeck approach. The short- to medium-term radiographic outcomes of follow-up were evaluated using the Matta radiologic grading system, while the clinical outcomes were evaluated using the modified Merle d'Aubigné-Postel evaluation system.The mean follow-up duration for all patients was 43.90 (range 24-75) months. Both groups achieved similar short- to medium-term clinical and radiographic results. There seems to be no significant differences between the two groups regarding the short- to medium-term assessment of clinical and radiographic results and the occurrence of postoperative complications (p > 0.05).In patients with acetabular fractures involving the posterior wall, hip dislocation is probably not an absolute determinant of a poor outcome. Even with early reduction, the short- to medium-term prognosis results appear similar to those of patients without dislocation.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998791","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":"Biomechanical Stability of Femoral Neck System for Pauwels Type III Femoral Neck Fractures Based on Different Reduction Quality.","authors":"Daoqiang Huang, Xiaoping Wang, Bingze Chen, Zhiqiang Hu, Weili Feng","doi":"10.1055/a-2255-7438","DOIUrl":"10.1055/a-2255-7438","url":null,"abstract":"<p><p>To further investigate the biomechanics of a femoral neck system (FNS) for Pauwels type III femoral fractures based on three different reductions.We constructed three different reduction (anatomical reduction, negative buttress reduction, and positive buttress reduction) models of Pauwels type III femoral neck fractures. Then, three cannulated screws (3CS), dynamic hip screws (DHS), dynamic hip screws combined with an anti-rotation screw (DHS + ARS), one-hole femoral neck system (1HFNS), and two-hole femoral neck system (2HFNS) were assembled with the reduction models, respectively, to simulate the internal fixation surgical procedure. All models had a load of 2100 N in line with the femoral mechanical axis applied. The implant stress, the head and implant displacements, and the rotational angles of all models were recorded and analyzed.Compared to 3CS and 2HFNS, 1HFNS had higher implant stress (higher than 92.5 MPa and 46.3 MPa, respectively) and displacement (higher than 0.9 mm and 0.8 mm, respectively) in the anatomical reduction. 2HFNS exhibited the highest stress values (225.5 MPa) in the anatomical reduction but the lowest values (159.8 MPa) in the positive buttress reduction when compared to the other implants. 2HFNS showed the best rotational stability in the negative and positive buttress reduction (rotational angels of 0.8° and 0.6°, respectively).Based on the outcome of this computational study, it might be concluded that 2HFNS was an alternative fixation for the treatment of Pauwels type III femoral neck fracture, especially when anatomical reduction cannot be perfectly attained. More relevant clinical and biomechanical studies are needed in the future.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"17-26"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178531","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}