Berufsgenossenschaftliche Unfallklinik Murnau

Neurological recovery following spinal cord injury (SCI) is commonly studied through changes in high-level descriptors of injury severity, such as the American Spinal Injury Association Impairment Scale (AIS) grade, or total upper and/or lower extremity motor scores. More recently, the analysis of segmental motor scores has attracted interest as it provides a more detailed understanding of the exact location and extent of changes occurring during recovery. We propose to augment the analysis of segmental motor recovery with a qualitative descriptor of local motor score patterns, which is defined for all upper and lower extremity myotomes below the neurological level of injury (NLI) and based on a categorization of the changes along the rostrocaudal motor score sequence. Our hypothesis is that recovery of segmental motor scores depends on the residual function as described by the newly proposed descriptors of local motor score patterns. Using data of 1385 patients from the European Multicenter Study about SCI, we analyze differences in recovery at approximately 6 months after injury between local motor score patterns and find an increased probability of full motor recovery for myotomes associated with increased motor scores in the caudal direction. We further use an aggregated descriptor of motor score patterns focusing on increases of motor scores in the caudal direction as an alternative or complementary feature to the AIS grade in prediction models for segmental motor scores at recovery. We observe equivalent predictive performance as measured by the root mean square error between actual and predicted motor scores below the NLI for models using the same set of features and additionally either the AIS grade (median = 0.79) or local pattern (median = 0.80). This is noteworthy as the definition of local motor score patterns requires only the examination of the 10 key muscles of the International Standards for Neurological Classification of SCI on each side of the body, while the AIS grade can only be reliably determined if extensive sensory testing is performed in addition. These results indicate the potential benefits of considering information inherent to the rostrocaudal sequence of motor scores for a better understanding of motor recovery. Furthermore, it supports the development and use of abbreviated sensorimotor examinations specifically in the early phase after SCI.

Spinal cord injury (SCI) incidence is rising among the elderly, yet the relationship between age and recovery remains controversial. The aim of this study was to evaluate the relationship between age and neurologic and functional outcomes and to identify an age cutoff associated with a decline in recovery. We conducted a prospective cohort study using data from patients with traumatic and ischemic SCI enrolled in the European Multicenter Study about Spinal Cord Injury between 2001 and 2022. Linear regression models assessed the relationship between age and changes from baseline to 1 year after SCI in the total motor score (TMS) of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and in the Spinal Cord Independence Measure (SCIM) total score. Additional analyses examined the relationship between age and the evolution of ISNCSCI light-touch and pinprick scores, as well as ambulation parameters (6-minute walking test, 10-meter walking test, and Walking Index for Spinal Cord Injury). Models were adjusted for baseline scores, sex, year of injury, American Spinal Injury Association Impairment Scale (AIS) grade, and level of injury. The age cutoff was determined using a change-point model. A total of 2,171 patients (median age 47 years, 77.9% male, 51.9% injured at the cervical level, and 50.0% with a motor complete injury [AIS-A and AIS-B]) were included in the analysis. Increased age was not associated with changes in TMS (p = 0.896) but was significantly associated with reduced SCIM improvement (p < 0.001), with an estimated decline of 4.3 SCIM points per decade of age. Sensory outcomes were not significantly affected by age (Δlight-touch: p = 0.273; Δpinprick: p = 0.520) while ambulation recovery declined with increasing age (all outcomes p < 0.01). A noticeable reduction in functional recovery was observed in patients older than 70 years. Older age does not seem to affect neurologic recovery but is linked to poorer functional and ambulation outcomes. These findings, including the identified age cutoff, should inform future clinical trial design and guide tailored care strategies for older adults with SCI. ClinicalTrials.gov Identifier NCT01571531.

Abstract Purpose: External fixators are essential for the surgical management of long-bone fractures, particularly in resource-limited settings where access to commercial systems is often restricted by cost and logistics. This study aimed to develop a low-cost external fixation concept using widely available construction materials and to evaluate its biomechanical performance under axial loading. Methods: An external fixator composed of M10 threaded rods, washers, and nuts was developed. Five configurations were tested: SP (Steinmann pins), KT (threaded K-wires), KS (smooth K-wires), and BKS (bilaterally applied, smooth K-wires). A commercial external fixator served as control (CG). Juvenile bovine ulnae with a standardized fracture gap were subjected to cyclic axial loading. Construct stiffness, elastic deformation, and plastic deformation were assessed. Results: CG showed the highest stiffness (107.80 ± 14.12 N/mm), followed by SP (87.73 ± 17.92 N/mm), BKS (83.81 ± 10.01 N/mm), KS (49.84 ± 3.80 N/mm), and KT (46.66 ± 2.39 N/mm). Post-hoc analyses showed no significant differences between CG vs. SP and CG vs. BKS, whereas KT and KS were significantly less stiff. Elastic deformation followed a similar pattern. Plastic deformation was greatest in CG, while SP and BKS showed significantly lower values. Conclusions: The threaded-rod fixator provides relevant mechanical stability at extremely low material cost. This concept may offer a practical and immediately deployable stabilization method for resource-limited settings when standard external fixators are unavailable, either as a definitive treatment or as part of a damage control strategy prior to transfer and definitive treatment.

SummaryOsteoporosis causes bone fragility and fractures, yet most patients receive no treatment. This German registry study of nearly 1500 elderly pelvic fracture patients found that two-thirds were untreated before fracture. Paradoxically, treated patients sustained more severe, displaced fractures requiring surgery more often, possibly reflecting advanced disease severity or altered bone properties from medication.BackgroundFragility fractures of the pelvis (FFP) are related to low-energy trauma and osteoporosis. Currently, data on secondary pharmacological fracture prevention and their effect on fracture morphology is rare. We aimed to determine the proportion of patients receiving specific osteoporosis medication (SOM), vitamin D supplementation only (VitD), or no treatment (NOT) before and after a FFP. Secondarily, we evaluated possible differences in fracture morphology and treatment in the study population.MethodsThis retrospective cohort study analyzed data from the German Pelvic Fracture Registry (2018–2024) of patients ≥ 60 years with an FFP. Patients were grouped hierarchically in the following groups: SOM, VitD, or NOT. Demographics, fracture morphology, treatment, and postfracture group changes regarding osteoporosis treatment were compared between groups.ResultsOf 1493 patients, mean age 82.34 ± 8.06 years, predominantly female (83.5%), 98 (6.6%) had a SOM, 386 (25.9%) VitD, and 1009 (67.6%) NOT before FFP. The SOM group was significantly older, predominantly female (p < 0.05), and demonstrated higher prefracture functional independence (71.4% SOM vs. 58.5% VitD vs. 66.4% NOT; p = 0.018). FFP Type IV fractures occurred more frequently in the SOM group (33.7% SOM vs. 23.3% VitD, 19.8% NOT; p = 0.006) and were more frequently operatively treated (45.9% SOM vs. 30.4% VitD, 29.2% NOT; p = 0.006). Following a FFP, in 527 patients (35.9%), the treatment regime was escalated; in 463 patients (31.0%), no change occurred.ConclusionsDespite established treatment guidelines, two-thirds of patients who sustained an FFP received neither SOM nor VitD in Germany. Patients with prefracture SOM treatment sustained more unstable fractures requiring surgical intervention, possibly reflecting advanced disease severity or altered bone biomechanics. Secondary fracture prevention remains suboptimal, with one-third of patients not receiving treatment postfracture.

Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future.

Zusammenfassung Die mediodermale Elastolyse (MDE) ist eine seltene, erworbene Hauterkrankung, erstmals 1977 beschrieben, die sich durch den selektiven Verlust elastischer Fasern in der mittleren Dermis äußert. Klinisch imponiert sie v.a. mit feinen, scharf abgegrenzten Falten, typischerweise an Rumpf und proximalen Extremitäten. Die Ursache bleibt unklar; diskutierte Risikofaktoren sind chronische UV-Exposition, hormonelle Einflüsse sowie assoziierte Autoimmunprozesse. Etwa 80% der berichteten Patienten waren weiblich. Wir berichten über eine 33-jährige Patientin, die sich mit einer 4-jährigen Vorgeschichte von progredienter feiner Faltenbildung und diskreten Erythemen am Rumpf vorstellte. Histologisch ließ sich in der Elastica-van-Gieson-Färbung ein charakteristischer, nahezu vollständiger Verlust elastischer Fasern in der mittleren Dermis nachweisen. Die Anwendung einer Pimecrolimus-haltigen Creme führte zu einer Verringerung der Erytheme, aber nicht zur Reduktion der Faltenbildung. Die Ätiologie der MDE ist multifaktoriell; neben enzymatischem Elastinabbau durch MMP-Überexpression könnten auch autoimmune Reaktionen und oxidativer Stress eine Rolle spielen. Zellulär zeigen sich bei einem Teil der Patienten CD68-positive Histiozyten mit Elastophagozytose. Abzugrenzen sind Anetodermie, Cutis laxa, anulär elastolytisches Riesenzellgranulom und Pseudoxanthoma-elasticum-artige papilläre dermale Elastolyse. Wesentliche Unterscheidungsmerkmale sind Verteilung und Ausmaß des Elastinverlusts, genetische Befunde sowie systemische Manifestationen und assoziierte Erkrankungen. Eine kausale Behandlung existiert derzeit nicht. Insgesamt fehlen aufgrund der Seltenheit der MDE klinische Studien; effektive Therapien müssten Abbauprozesse hemmen und gleichzeitig die Elastin-Neosynthese fördern.

Tibial plateau fractures (TPFs) are complex injuries associated with significant postoperative complications including infection, deformity and wound healing disorders. Limited data exist on risk factors for complications following surgical treatment, particularly in large multicenter cohorts. This retrospective study analyzed 1027 patients with intra-articular TPFs treated surgically at two level-I trauma centers in Germany (2011-2020). Preoperative CT imaging and follow-up data were required for inclusion. Complications were categorized into seven groups (infection, deformity, wound healing disorders, postoperative compartment syndrome, range of motion deficit and others). Statistical analyses assessed associations with fracture type (Schatzker classification), surgical approach, duration, and patient factors (BMI, age, smoking). Nineteen percent of patients required surgical revision, with deformity (5.7 %), infection (5.4 %), and wound healing disorders (3.3 %) being the most common complications. Complex fractures (Schatzker V-VI) and prolonged or multi-approach surgeries were associated with higher complication rates. Elevated BMI increased overall complication risk, while smoking was linked to wound healing disorders. The 19 % revision rate highlights the challenges of managing TPFs. Surgical factors, including operative duration and approach, play a critical role in the occurrence of complications, emphasizing the need for tailored strategies based on fracture complexity and surgical considerations.