Low-dose radiotherapy is an established treatment option for non-malignant skeletal disorders. It is used in the treatment of Heberden's osteoarthritis (HA), but the evidence of efficacy does not seem to be certain. This paper reviews current literature for scientific evidence of efficacy in the treatment of HA.The PubMed and Cochrane Library databases were searched for relevant publications.9 publications were identified that published data from 7 studies. Only one study was randomised, placebo-controlled and double-blinded. None of the studies exclusively investigated HA. The studies were all inhomogenous with regard to inclusion criteria, follow-up criteria, radiation mode and interpretation or treatment success. In the RCT, no difference was found between the verum and control groups.The study situation is currently weak. The researched publications are not sufficiently focused on the collective of Heberden's osteoarthritis and are generally too inhomogenous with regard to the criteria applied. Future targeted studies are therefore required to prove efficacy.

Patients with knee osteoarthritis (KOA) often have impaired muscle function of the weight-bearing muscles, particularly in the knee and hip joints. This can lead to a significant loss of strength and power and may play a role in the perceived instability of the knee joint. The purpose of this study was to compare the maximum isometric strength of the hip abductor and knee extensor muscles between patients with KOA with and without perceived instability.Nineteen patients with KOA participated in this cross-sectional study and were divided into two groups. The first group (n = 10; women = 4, men = 6, mean age = 67.4 ± standard deviation [SD] 6.4 years) consisted of patients with self-reported instability in the knee joint, and the second group (n = 9; women = 5, men = 4, mean age = 69.6 ± SD 6.7 years) consisted of patients without self-reported instability. Functional and activity limitations were quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Maximum isometric strength of the hip abductors and knee extensors was measured using a belt-mounted handheld dynamometer and expressed as torque (Newton meters [Nm]) by multiplication with the determined lever arm. Torque was normalized to body weight and height.Patients with instability (median WOMAC score = 68) achieved a significantly lower mean torque in hip abduction than the patients without instability (median WOMAC score = 39) (p = 0.01; Cohen's d = 1.31). There was no significant difference in knee extension torque between the groups (p = 0.202; Cohen's d = 0.58).KOA patients with instability were able to develop significantly lower hip abductor strength than those without instability, suggesting that targeted strength training of this muscle group may be important for this group of patients.

The treatment of acetabular defects in revision arthroplasty is an increasing challenge. Different classifications have been introduced for preoperative planning to achieve the best possible result. 3D printing is a way to better visualize and understand these defects. The aim of this study was to facilitate classification, provide young doctors with a better understanding of complex defects, and ultimately improve preoperative planning and patient safety.The study was conducted at the 2022 BOUT congress, where health care professionals were provided with X-rays, a computed tomography (CT) scan, and a 3D print to classify acetabulums according to Paprosky and ADC. A questionnaire was administered to gather information on their familiarity with the classification systems and perception of 3D models in the clinic.The study involved 14 participants, mostly resident physicians, with some familiarity with the Paprosky and ADC classifications. The 3D printing method resulted in the highest rate of correct classifications for acetabular defects compared to X-ray and CT imaging. Participants found the 3D model useful for clinical applications and rated it higher than X-ray and CT imaging for classifying acetabular defects.Acetabular defects present a challenge in assessment, preoperative planning, and surgical management due to their complex anatomy. Overall, we were able to show that the use of a 3D model increases the accuracy in the classification of acetabular defects. The use of 3D printing in orthopedics and trauma surgery is showing more and more advantages and has opened up new methods for the education of medical students and young surgeons.

Formation of biofilms by bacteria is a major challenge in a clinical setting. The importance of these biofilms increases in specialties where foreign bodies and prosthetic material are used. Orthopaedics is such a speciality and phage therapy could offer additional therapeutic options when dealing with biofilm infections.We conducted a systematic literature review using the PubMed database. We searched for phage activity against biofilms of the most common pathogens found in orthopaedics.The results of the systematic review were broken down into different categories and discussed accordingly. We concentrated on the time the biofilms were allowed to mature, and the surface they were grown on. In addition, we checked the efficacy of bacteriophages compared to antibiotics and when applied simultaneously with antibiotics. We also investigated the source of the phages, how they were tested for sensibility against the biofilms, as well the conditions (pH, temperature) under which they remained active and stable.The data suggests that the in vitro efficacy of phages does not change under a wide spectrum of temperature and pH. To further explore the use of bacteriophages in orthopaedics, we need further studies that test biofilms which matured for several weeks on surfaces that are common in arthroplasty and traumatology.

Hip fractures (HFs) are common in elderly patients and are associated with high mortality rates and functional impairment. Malnutrition has been shown to negatively impact postoperative survival rates in HF patients. However, the relationship between the Geriatric Nutrition Risk Index (GNRI) and the risk of HF remains unclear. This study aims to evaluate the association between GNRI and HF risk, with a particular focus on the elderly male population.We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) for the periods 2007-2010, 2013-2014, and 2017-2018. Through multivariate regression analysis, we assessed the association between GNRI and HF and performed stratified and subgroup analyses to further explore this relationship. Additionally, we utilized restricted cubic splines (RCSs) to investigate the potential nonlinear relationship between GNRI and HF risk.The study found that gender significantly influenced the relationship between GNRI and HF (p for interaction = 0.002). In males, GNRI was significantly negatively associated with the risk of HF (OR < 1, p < 0.05). RCS analysis showed that the relationship between GNRI and HF risk in elderly males might be linearly negative. The critical threshold for GNRI was identified as 104.14, beyond which the risk of HF significantly decreased.This study demonstrates a linear negative correlation between GNRI and the risk of HF in elderly males, with a GNRI of 104.14 identified as the critical threshold for predicting the risk of hip fractures.

Arthroplasty of the hip has become one of the most successful surgical interventions and has seen significant advancements over the last century. With these developments, patient expectations have shifted from merely achieving pain-free daily mobility to anticipating a full recovery, including the ability to participate in sports. This shift has driven innovations in prosthetic materials and surgical techniques, such as the development of wear-resistant materials like highly cross-linked polyethylene and the adoption of minimally invasive procedures to enhance recovery.However, concerns persist among patients about the risks of resuming sports postoperatively, particularly the fear of prosthesis-related accidents or failures. A survey of 300 German surgeons identified periprosthetic fractures as the greatest risk, followed by polyethylene wear and implant loosening. The study also examines osteoporosis as a risk factor, suggesting that while sports can help prevent periprosthetic osteoporosis, high-energy trauma may increase the severity of injuries. Although modern prosthetic materials have reduced wear and improved durability, the type and intensity of physical activity continue to influence prosthesis longevity.Therefore, it is recommended that low-impact sports be resumed 3-6 months postoperatively, while high-impact sports should be approached with caution, particularly during the first year after surgery, to minimize the risk of complications. Coordination training before and after surgery is also emphasized to reduce the risk of falls and injuries. In summary, the study highlights that high-impact sports cannot be generally recommended, as coordination deficits may persist for up to 12 months following total hip replacement. Such activities should only be considered later-on and only by patients who are experienced in these specific sports.

Despite the increasing number of cases in recent years, there are currently no data available on the disease and care situation for degenerative shoulder diseases and shoulder injuries, as well as on the ICD-10 coding behaviour of the treating physicians. This paper presents, for the first time, a descriptive analysis based on billing data from 2022 of coded shoulder diseases affecting 4.9 million insured individuals of a statutory health insurance in Baden-Württemberg. The study distinguishes between accident-related shoulder injuries and diseases caused by degenerative changes in the shoulder. In ICD-10 coding, a distinction is made between specific codes (using key numbers of the underlying disease) and non-specific codes that only encode the symptom. According to billing data, women were slightly more affected by shoulder diseases than men (7.3% vs. 6.9%), with women being significantly older on average at the time of diagnosis. For fractures, the gender difference averaged 20 years. The analysis of coding behaviour revealed that general practitioners coded non-specific shoulder diseases, such as joint pain or impingement syndrome, more frequently than other specialist groups. The analysis of the claiming of benefits showed that only one-third of the evaluated patients received imaging, and only 40% received a prescription for physiotherapy due to a shoulder diagnosis. The investigation of comorbidities found that patients with degenerative shoulder diseases were more frequently affected by metabolic diseases and hypertension than those without shoulder diseases. These results regarding the frequency of coded shoulder diseases in various health sectors demonstrate their importance in the Federal Republic of Germany for both men and women. In summary, the evaluations-despite methodological limitations-suggest that there may be potential for more specific coding in the diagnosis and prescription of therapeutic measures. A more precise understanding of the actual cause of claiming health services can be helpful for the provider to initiate specific diagnostic and therapeutic measures and identify a potentially increased need for care within the health system in the Federal Republic of Germany.

Pertrochanteric femoral fractures are among the most common injuries in geriatric patients. Intramedullary implants are used to restore patient mobility. We report coil embolisation of an aneurysma spurium of the profunda femoral artery as a complication after distal nail locking of a proximal femoral nail.

We report on an 18-year-old female who sustained complete loss of her knee extensor mechanism (patella, quadriceps and patellar tendon) due to a motorbike injury with severe soft tissue loss of the ventral aspect of the knee and subsequent infection. After infection control and successful latissimus dorsi free flap surgery, reconstruction of the knee extensor mechanism was performed using a fresh frozen extensor mechanism allograft with patella, quadriceps- and patellar tendon and integrated tibia tuberosity fragment. After a follow-up of 18 months, there was infection free integration of the allograft with a range of motion 0-0-90° (extension/flexion) and pain free gait.

This article describes the technique of a multidimensional, V-shaped, and self-centering osteotomy of the tibial tuberosity with cortical bone block support, which enables combined distoanteromedialisation of the tibial tubercule.

Despite open growth plates, reconstruction of the medial patellofemoral ligament (MPFL) is recommended for the treatment of patellar dislocation in children and adolescents. However, the open physis on the medial distal femur requires a tailored surgical approach with an essential knowledge of the anatomical relationship of the femoral MPFL insertion to the physis. This video illustrates the technique of MPFL reconstruction using an autologous pedicled quadriceps tendon graft with femoral drill channel fixation distal to the epiphyseal growth plate.

The principle of regenerative medicine in the treatment of osteoarthritis pursues a functional restoration of cartilage tissue instead of just repairing cartilage defects. The use of blood products is intended to inhibit chronic inflammatory processes and promote tissue regeneration. Intraarticular injection of autologous platelet-rich plasma (PRP) is a prominent procedure. Clinical evidence supports PRP injection over hyaluronic acid or glucocorticoid injection. Comparability of studies is difficult due to missing standardisation of production procedures, dosing and donor variability. In particular, whether presence of residual leukocytes is required or should be avoided is an open debate. In contrast, stem cell therapies in osteoarthritis therapy are often based on mesenchymal stem cells (MSC) from adipose tissue or bone marrow aspirate. Different sources of MSC might render the cells more suitable for application in a given context. Nevertheless, it became evident that their secretome rather than the cells themselves are responsible for observed regenerative processes. Research on the mechanisms of action have focused on growth factors. However, an overlooked component of blood products called extracellular vesicles (EV) came to the center of attention, which are also released by MSC as intercellular signal carriers. EV cargo molecules such as miRNAs open up new dimensions in the investigation and explanation of clinically observed anti-inflammatory and regenerative effects.

The aim of this study was to develop a simple and reliable score which supports decision making between non-operative and operative treatment in patients with osteoporotic pelvic fractures.Between 2018 to 2020, the OF Pelvis Score was developed during a total of 5 meetings of the Working Group on Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma. The OF Pelvis Score as a decision aid between non-surgical and surgical treatment was developed by expert consensus after analysis of numerous geriatric sacral and pelvic ring fractures from several hospitals. Subsequently, retrospective evaluation of the score was performed on consecutive patients from three hospitals.The following parameters were considered relevant to decision making between non-surgical and surgical treatment and were incorporated into the score: fracture morphology using the OF Pelvis Classification, pain status, level of mobilisation, fracture-related neurological deficits, health status, and the modifiers already integrated into the OF Pelvis classification. If the score is < 8, non-surgical therapy is recommended; if the score is > 8, surgical therapy is recommended; if the score is 8, there is a relative indication for surgery. The OF Pelvis Score was then evaluated retrospectively in a total of 107 patients, according to records. The OF Pelvis Score was 8 points in 4 patients (3.7%), all of whom received surgical treatment. Of the remaining 103 patients, 93 received score-compliant therapy (90.3%). Among these, 4 of the patients who did not receive score-compliant care refused the recommended surgery, so the actual therapy recommendation was score-compliant in 94.2%.The OF Pelvis Score can be used to derive a therapy recommendation in many patients in clinical practice. Because of the possible change of clinical parameters during the course of the disease, the score has a dynamic character. In the retrospective evaluation, the recommendations from the OF Pelvis Score were in close accordance with the therapy actually performed.

The guideline of the Federal Joint Committee (G-BA) on quality assessment measures for the care of patients with hip fracture makes it mandatory for hospitals to use an appropriate geriatric screening instrument in the context of acute inpatient care. After systematic application of GeriNOT and data collection in the admission process with integration into the Hospital Information System (HIS), it is possible to identify potential risks in geriatric patients with other diagnoses as well.With the integration of GeriNOT into the acute inpatient admission process, it was examined whether vulnerable geriatric patients with other diagnoses could benefit from the early initiation of risk identification.The data base for the present study was a retrospective bicentric collection of electronic case records (May 2014 to April 2015, n = 3,443). From this primary data set, the subgroup of inpatient acute admissions (n = 821) in the orthopaedic/trauma surgery of a study centre was analysed and evaluated with respect to the endpoints "utilisation of needs-based post-inpatient care services" and "new admission to inpatient permanent/short-term care". The predictive power and classification accuracy of GeriNOT of these patients who were 70 years and older to the endpoints were assessed for several groups: total acute admissions, total fractures, hip fracture, and spinal disorders including spinal fractures.A total of 821 patients were admitted as acute inpatients during the study period. The mean age of the patients was 81.4 ± 6.8 years (n = 821; 68.1% women, 31.9% men). The following subgroups were formed and analysed: total fractures (n = 490), spinal disorders (n = 265) including spinal fractures (n = 174), and hip fracture (n = 108). Both in the overall group (n = 821; M = 4.279; SD = 2.180) and in the subgroups, the mean GeriNOT score was above the threshold ≥ 4. The highest score was found in the hip fracture group (M = 4.852; SD = 2.022), and the lowest in the spine fracture group (M = 4.177; SD = 2.171). At admission, if the terms of variables for requiring treatment were "polypharmacy" and "nursing services already used as needed", there were only slight differences in the diagnostic groups. Admissions from short-term and long-term care occurred in the total group in 16.44% of cases, most frequently with 31.48% in the group of hip fractures, compared to spinal diseases with 6.79%. For this group, GeriNOT detected an elevated risk with respect to the defined endpoints. However, only 4.26% of all patients with identified geriatric risk potential received further geriatric care.The results showed increased geriatric risk in all analysed groups, but most pronouncedly within the group of spinal diseases. The HIS-supported use of GeriNOT offers the possibility of systematic risk identification in acute inpatient admission management. The continuous visualisation of results at HIS workstations throughout the workflow could be used as a starting point for the subsequent application of standardized assessment tools and risk-adjusted treatment pathways. These findings could potentially improve outcomes.