The healing of a bone fracture depends on the complex interaction between biology and mechanics. If this interaction is disrupted, a pseudarthrosis may develop. This results in significant impairments in quality of life for the affected individuals. For the selection of the appropriate therapy, which often requires surgical intervention, the frequently multifactorial underlying etiology must be accurately identified. The five pillars of pseudarthrosis treatment are: stable fixation, mechanical alignment, biological stimulation, optimization of modifiable factors, early functional rehabilitation.

A 25-year-old female patient complained of intermittent pseudoradicular, ulnar-accentuated tingling paraesthesias of the right arm, accompanied by swelling and cyanotic skin discolouration of the forearm 9 days following plate osteosynthesis of a clavicle shaft fracture in the middle third (OTA classification type B). CT angiography revealed almost complete obstruction of the lumen of the subclavian vein at the junction between the clavicle and the first rib, which was consistent with a thoracic inlet syndrome. This was triggered by a haematoma of the concomitantly fractured first rib and a cortical screw protrusion in the area of the constriction between the clavicle and the first rib. Revascularisation was achieved by evacuating the fracture haematoma, partial resection of the first rib, and replacement of the two protruding screws. This case demonstrates that screw protrusion must be avoided during plate osteosynthesis of clavicle shaft fractures, particularly in the medial third of the clavicle - due to its proximity to the first rib. Injuries to the subclavicular neurovascular bundle can be comprehensively detected and treated by resection of the first rib.

Delirium is a common complication in elderly patients after total hip arthroplasty (THA). Malnutrition is common in the elderly and is closely associated with developing postoperative delirium (POD). Therefore, preoperative assessment of the patient's nutritional status is necessary. The geriatric nutritional risk index (GNRI) is a reliable indicator of nutritional status in the elderly population, but the relationship with postoperative delirium is not clear.The aim of this study was to determine the effect of preoperative GNRI on postoperative delirium.We reviewed 688 elderly patients who underwent primary elective THA at our medical center between 2013 and 2023. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, using diagnostic criteria from the Diagnostic and Statistical Manual IV and the Confusion Assessment Method. Propensity matching was used to match patients in the delirium and non-delirium groups. Multiple logistic regression analysis was used to determine the association between GNRI and postoperative delirium. The validity of the GNRI for predicting POD was assessed by the area under the receiver operating characteristic curve (AUC) and the optimal prediction threshold was calculated.When matched, the GNRI was significantly higher for the delirium group than the non-delirium group (89.0 ± 8.0 vs. 99.8 ± 8.1, p < 0.001). In multivariate logistic regression analysis, GNRI was an independent risk factor for POD, and the incidence of POD increased with lower GNRI (OR 0.846, 95% CI 0.792-0.904, p < 0.001). The results of the ROC analysis showed an AUC of 0.827 and a prediction cut-off of 95.7 for the GNRI (sensitivity: 85.7%, specificity: 68.6%).In elderly patients, a lower GNRI was significantly associated with the occurrence of POD after THA. Assessing GNRI prior to THA in elderly patients may be effective in predicting the risk of POD.

For the osteosynthetic treatment of fractures of the femur and optimal exposure of the fractured region including radiological fluoroscopy, it is often recommended to carry out positioning on an extension table, with positioning of the contralateral lower limb on a leg holder. It is not uncommon for this to result in peri- and postoperative damage of varying severity as a result of patient positioning. Some cases of damage due to improper positioning can be found in the literature in the context of urological, general and gynaecological surgery. This is often associated with the responsible surgical speciality, which often requires a lithotomy position and thus the bilateral positioning of the healthy lower extremities. The aim of this article is to draw attention to the well leg compartment syndrome (WLCS) of the unaffected side in orthopaedic surgery, by presenting a case of our own and to point out particular risks on the basis of a current literature review, as well as to discuss procedural suggestions for prevention.A literature search was carried out using the online medical database "PubMed" (search date 20.02.2025). After entering the search terms "Well leg compartment syndrome AND orthopaedic surgery", "Well leg compartment syndrome AND orthopaedics" and "Well leg compartment syndrome AND hemilithotomy positioning", a total of 175 search hits were found. After removal of duplicates and an extended full-text search, a total of 14 case reports were selected and included in the current publication.This report describes a compartment syndrome of the lower leg of the positioned uninjured limb (well leg compartment syndrome, WLCS) in a 63-year-old patient following prolonged emergency intramedullary nail osteosynthesis of a complex femur fracture, with an operating time of 8:12 h.In the literature, WLCS of the lower leg in orthopaedic surgery is found in most cases after intramedullary nail osteosynthesis of the femur in patients positioned in modified lithotomy. The operating time was over 2 h in most cases. The diagnosis of compartment syndrome was made in a wide time window between immediately postoperatively and up to 3 days after the operation. The treatment of choice in the majority of cases was fasciectomy of all 4 compartments of the lower leg. No statement can be made about other risk factors in the cases presented in the research - due to missing or limited data.Position-associated acute compartment syndrome in orthopaedic surgery is a rarely described complication. Risk factors include a long operating time, increased BMI, increased blood loss, low intraoperative blood pressure and peripheral vascular disease. The uninjured leg should be correctly positioned in the lithotomy position intraoperatively (90° flexion in hip and knee) and be as little as possible in the case of known risk factors. Regional procedures can also be used safely in high-risk patients, but often obscure the initial diagnosis.

Pilon tibial fractures are intra-articular fractures of the distal tibial metaphysis, typically resulting from high-energy axial trauma. Accurate classification using AO/OTA type 43-C and advanced imaging, including CT with 3D reconstruction, is essential for preoperative planning. Initial management of displaced fractures includes prompt reduction and temporary immobilization, often with a spanning external fixator. Definitive treatment follows a staged protocol based on soft tissue status and involves open reduction and internal fixation via approach-specific surgical access. Conservative management is reserved for stable, non-displaced fractures. Anatomical reduction is critical for favorable long-term outcomes. Postoperative care includes early physiotherapy, individualized weight-bearing, and close radiological monitoring.

We aimed to evaluate the effectiveness of compression by assessing finite element analysis with clinical and radiological evaluation of patients undergoing compressive and conventional intramedullary nailing for femur shaft fractures.We retrospectively examined a total of 162 patients from November 2012 to August 2019. The patients were divided into Group 1 (n = 79) in which the conventional intramedullary nailing was used, Group 2 (n = 42) in which 1.0-mm compressive nails were used, and Group 3 (n = 41) in which 1.5-mm compressive nails were used. Group 2 (n = 42) with 1.0-mm compressive nails, and Group 3 (n = 41) with 1.5-mm compressive nails used. The mean follow-up period was 14.3 ± 4.2 (12-22) months for Group 1, 15.4 ± 5.2 (13-26) months for Group 2, and 14.2 ± 5.2 (13-24) months for Group 3.The mean union period and functional score were calculated as 13.6 ± 2.6 months (12-17 months) and 79.4, respectively, in Group 1, which is a good degree result. The mean union period and functional score were calculated as 12.2 ± 2.8 months (11-17 months) and 85, respectively, in Group 2, which is excellent. Lastly, the mean union period and functional score were calculated as 11.1 ± 2.5 months (10-19 months) and 86, respectively, in Group 3, (p < 0.001) which is also excellent. In Group 1, union was observed in three cases. In Group 2, union delay was observed in one case, whereas in Group 3, union was observed in all cases.Compression of femur shaft fractures speeds up bone healing and improves functional scores in adult femur shaft fractures, and compression can the fracture union period. Finite element analysis showed that there was no statistically significant difference between the compression amounts of 1.5 mm and 1.0 mm, but the effect of compression on bone union.

Erfahrungen medizinischer Kompetenzzentren für Menschen mit Thalidomid-Embryopathie legen nahe, dass sturzbedingte Verletzungen vergleichsweise häufig vorkommen. Da Stürze im Alter Morbidität und Autonomieverluste begünstigen, wurden Sturz- und Frakturrisiken bei Thalidomid-Geschädigten untersucht.Onlinebefragung (Survey Monkey) zu funktionellen Einschränkungen sowie Sturzereignissen von Personen mit Thalidomid-Embryopathie (TE-Gruppe) und Nichtbetroffenen (Kontrollgruppe).206 Personen der TE-Gruppe und 183 der Kontrollgruppe wurden befragt. Einschränkungen des Hörens, des Gleichgewichtssinns, des Sehens, der Sensibilität und der Kraft waren in der TE-Gruppe signifikant häufiger als in der Kontrollgruppe. Personen der TE-Gruppe gaben signifikant häufiger Stürze und Verletzungen an als in der Kontrollgruppe.Menschen mit Thalidomid-Embryopathie haben im Vergleich zu Nichtbetroffenen häufiger Stürze mit schwerwiegenderen Verletzungen. Die Ergebnisse der vorliegenden Untersuchung verdeutlichen die Notwendigkeit einer individuellen Risikobewertung und präventiver Maßnahmen zur Sturzvermeidung in dieser Patientengruppe.

The placement of chest tubes in Bülau position is an established method for treating pneumothorax resulting from thoracic trauma. While complications involving nerve structures are rare, they can be clinically relevant. This case report describes a complication not previously mentioned in the literature: recurrent laryngeal nerve palsy caused by the position of the tube tip near the recurrent laryngeal nerve at the upper lung apex.A 47-year-old patient with right-sided traumatic pneumothorax and rib fractures developed progressive hoarseness following initial chest tube placement. Clinical examination revealed recurrent laryngeal nerve palsy. CT imaging showed the tube tip located at the junction of the lung apex and mediastinum in close proximity to the recurrent laryngeal nerve, which was considered the likely cause.After partial retraction of the chest tube, administration of systemic prednisolone, and initiation of speech therapy, the patient showed rapid clinical improvement. Following the full resolution of the pneumothorax, the patient was discharged. At follow-up, the recurrent laryngeal nerve palsy had completely resolved.This case emphasizes the importance of precise chest tube positioning, particularly in the region of the lung apex and mediastinum, to prevent rare neurological complications such as recurrent laryngeal nerve palsy. In the event of new neurological symptoms, immediate radiological assessment is essential to identify potential complications and initiate appropriate measures.

Fractures of the forearm shaft are common injuries in everyday clinical practice. Surgical stabilization is usually performed to ensure smooth interaction between the radius and ulna. Compression plate osteosynthesis is used to enable early functional follow-up treatment. Concomitant injuries of the DRUG or PRUG must be reliably excluded or treated accordingly. In the postoperative course, nerve lesions, infections or pseudarthrosis can significantly impair the outcome, especially after open, multi-fragmentary fractures. Early metal removal carries the risk of refractures of the forearm shaft.

Osteoporosis is a chronic underdiagnosed condition that weakens bone structure with increased risk of fragility fractures. While the prevalence of osteoporosis is expected to increase due to demographic developments in many countries, there is found to be a serious treatment gap for patients. This is partly due to inadequate diagnostic procedures at healthcare facilities. Considering this, there is a need to understand factors that affect processes involving diagnosis and treatment in osteoporotic patients. This study's primary aim is to explore the management of patients with fragility fractures and osteoporosis by conducting and analyzing semi-structured interviews with healthcare professionals at a German maximum care provider. Insights from the interviews were used to map out the pathway of clinical care for patients and the results suggest a multitude of factors including disease awareness, communication, and up-to-date information to be particularly important for increased treatment quality. Future studies shall focus on improving generalizability and exploring the effectiveness of recently updated guidelines for management of osteoporosis.

Habilitation is a procedure by which one of the highest university degrees is achieved in the field of medicine in Germany. We hypothesize that this academic milestone represents an incentive for scientific productivity that drops off once a scientist has reached this career steep. This study aims to compare scientific performance of German scientists before and after completing this milestone with special focus on orthopedic surgeons and traumatologists (O&T).Scientists who had completed their habilitation in human medicine were researched from public announcements in the period Jan-Dec 2018. The periods Jan 2016 to Dec 2018 and Jan 2020 to Dec 2022 were defined as pre- and post-habilitation phases, respectively. Scientific performance was calculated using normalized citation percentiles (NCPs) from author records in Web of Science. Association between sex, subject area, and change in performance were analyzed.NCP values of 742 scientists were analyzed showing a significant decrease after completing habilitation ( < 0.001). This applied to men and women ( = 0.015,  = 0.003) and non-surgical disciplines ( = 0.001), while surgical disciplines such as O&T only demonstrated a statistically non-significant decrease. Interestingly, women showed an increase in performance after habilitation in this male-dominated discipline at only 4.5% (2) females compared to males. Most scientists in the population experienced a decline in performance (53.9% [400]). This drop amounted to over 50% in 35.5% (142) of these cases. No association was found regarding gender or subject area.Scientific performance seems to be incentive-dependent and significantly decreases after completing a career milestone in Germany. This decline is not statistically significant in O&T; women, who are strongly underrepresented, even show an increase in performance.

Unstable distal clavicle fractures are clinically common, and there is no consensus regarding gold-standard treatment. The purpose of this study was to report on a new surgical technique for the treatment of unstable distal clavicle fracture with modified coracoclavicular (CC) stabilization using a ligament augmentation and reconstruction system (LARS) of an artificial ligament, and to compare the clinical and radiographic outcomes with hook-plate fixation.Thirty patients with unstable distal clavicle fractures were treated with modified coracoclavicular (CC) stabilization using either a ligament augmentation and reconstruction system (LARS) or open reduction internal fixation with a hook plate. Indexes for evaluation included fracture healing, quality of reduction, and presence of complications. Shoulder function was evaluated using the Constant-Murley score.Patients were assessed at a mean time of 31.2 ± 10.1 months follow-up. All patients experienced radiographic union. The result at the last follow-up showed that patients treated surgically with ligament augmentation and reconstruction system had better Constant-Murley scores for shoulder function and lower complication rates than those treated with a hook plate.Treatment using LARS for unstable distal clavicle fractures resulted in excellent union rates and functional outcomes. This simple surgical technique is considered to be an efficient method for treating fractures that naturally restores stability of the distal clavicle fracture.