United Nations Population Division

Patients with vertebral, hip, distal radius, and proximal humerus fractures are most common among the osteoporosis-related fractures. The incidences of these fractures increase with age, however, the increase patterns differ between the fracture sites. The prevalence of vertebral fracture for Japanese is similar or slightly higher and the incidences of osteoporosis-related limb fractures are lower than those for Caucacians. A decrease in prevalence of vertebral fractures and an increase in the incidence of limb fractures are the secular trend in Japan. Previous fractures are significant risk factor for both vertebral and hip fractures. Greater physical activity increases the risk of distal radius fractures, and decreases the risk of proximal humerus fractures.

Epidemiology of osteoporotic fractures

Due to the increasing life expectancy, orthopaedic surgeons are more and more often confronted with fragility fractures of the pelvis (FFPs). These kinds of fractures are the result of a low-energy impact or they may even occur spontaneously in patients with severe osteoporosis. Due to some distinct differences, the established classifications for pelvic ring lesions in younger adults do not fully reflect the clinical and morphological criteria of FFPs. Most FFPs are minimally displaced and do not require surgical therapy. However, in some patients, an insidious progress of bone damage leads to increasing displacement, nonunion and persisting instability. Therefore, new concepts for surgical treatment have to be developed to address the functional needs of the elderly patients. Based on an analysis of 245 consecutive patients with FFPs, we propose a novel classification system for this condition. This classification is based on morphological criteria and it corresponds with the degree of instability. Also in the elderly, these criteria are the most important for the decision on the type of treatment as well as type and extent of surgery. The estimation of the degree of instability is based on radiological and clinical findings. The classification gives also hints for treatment strategies, which may vary between minimally invasive techniques and complex surgical reconstructions.

Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment.

This review will define the role of collagen and within-bone heterogeneity and elaborate the importance of trabecular and cortical architecture with regard to their effect on the mechanical strength of bone. For each of these factors, the changes seen with osteoporosis and ageing will be described and how they can compromise strength and eventually lead to bone fragility.

/pdf/bone-mechanical-properties-and-changes-with-osteoporosis-5go5v8y6gw.pdf

Bone mechanical properties and changes with osteoporosis.

Abbreviated Injury Scale

Due to the high anatomical variability and limited visualization of the scapula, optimal screw placement for baseplate anchorage in reversed total shoulder arthroplasty (rTSA) is challenging. Image quality plays a key role regarding the decision of an appropriate implant position. However, these data a currently missing for rTSA and were investigated in the present study. Furthermore, the rate of required K-wire changes for the central peg as well as post-implantation inclination and version were assessed. In ten consecutive patients (8 female, 86 years, range 74–94) with proximal humeral fracture and indication for rTSA, an intraoperative 3D-scan of the shoulder with a 3D image intensifier (Ziehm Vision FD Vario 3D© [Ziehm Imaging GmbH, Nurnberg, Germany]) was performed after resection of the humeral head. Using the Vectorvision© Software (Brainlab AG, Feldkirchen, Germany), the virtual anatomy was compared to the visible anatomical landmarks. After implantation of the baseplate, a 3D scan was performed. All 3D scans included multiplanar reconstruction (MPR) and the cinemode to examine screw and baseplate placement. The rate of required K-wire changes was assessed. The intraoperative 3D image quality (modified visual analogue scale [VAS] and point system) was assessed before and after implantation of the glenoid component. Inclination and version were determined in post-implantation scans. The virtually presented anatomical landmarks always correlated to the anatomical visible points indicating an good virtual accuracy. The central K-wire position was corrected in three cases due to a deviation from the face plane technique position. The VAS was higher for the pre-implantation MPR (6.7, range 5–8) compared to the post-implantation acquired MPR (5.1, range 4–6; p = 0.0002). The point system showed a reduced quality in all subcategories, especially regarding the grading of the articular surfaces. The preoperative (7.9, range 6–9) and post-implantation (7.9, range 6–9) cinemode displayed no significant differences (p = 0.6). The present study underlines the need for the improvement of 3D image intensifiers algorithms to reduce artifact associated impaired image quality to enhance the benefit of real-time intraoperative 3D scans and navigation.

/pdf/real-time-intraoperative-3d-image-intensifier-based-ruy84zos6e.pdf

Real-time intraoperative 3D image intensifier-based navigation in reversed shoulder arthroplasty- analyses of image quality.

Die interdisziplinare Versorgung von polytraumatisierten PatientInnen ist personal- und ressourcenaufwendig. Seit der Einfuhrung des G‑DRG-Systems 2003 in Deutschland wurde in den meisten Untersuchungen ein finanzielles Defizit in der Schwerstverletztenversorgung festgestellt. Ziel dieser Studie war es, Auswirkungen des 2020 neu eingefuhrten aG-DRG-Systems auf die Kostendeckung in der Schwerverletztenbehandlung zu analysieren. Erstmals wurden auch die Kosten fur Organisation, Zertifizierung und Dokumentation sowie die Kosten fur nicht schwer verletzte SchockraumpatientInnen betrachtet. Eingeschlossen wurden alle PatientInnen, die im Jahr 2017 im chirurgischen Schockraum der Zentralen Notaufnahme des Universitatsklinikums Leipzig behandelt wurden. Fur die Analyse wurden das Kostenmodell nach Pape et al. um die Module Organisation, Dokumentation und Zertifizierung erganzt sowie die Kosten fur „ubertriagierte“ PatientInnen betrachtet. Es erfolgte die Berechnung der Kosten in den Jahren 2017–2020 im Vergleich der jeweiligen Erlose. Es wurden 834 PatientInnen im Schockraum behandelt. Die 258 schwer verletzten PatientInnen wurden in 3 Gruppen untergliedert: „ISS 9–15 + ITS“ (n 72; ∅ ISS 11,9; Kosten/PatientIn 14.715 €), „ISS ≥ 16“ (n 186; ∅ ISS 27,7; Kosten/PatientIn 30.718 €) und „DRG-Polytrauma“ (n 59; ∅ ISS 32,4; Kosten/PatientIn 26.102 €). Die Polytraumaversorgung im aG-DRG 2020 ist defizitar. Insgesamt entstand im Jahr 2020 ein Defizit von 5858 € pro schwer verletztem/verletzter PatientIn.

/pdf/ist-die-polytraumaversorgung-im-ag-drg-system-defizitar-1b12r7ja2g.pdf

Ist die Polytraumaversorgung im aG-DRG-System defizitär?

This article deals with the current state mid-2020 in the clinical and practical aspects from the perspective of orthopedics and trauma surgery. The risks, difficulties, potentials and options are discussed in detail. The following topics are specifically debated: infrastructure of telematics, apps and mobile health, online video consultation, electronic medical records and data protection. The advantages and disadvantages and the current state of each topic in the special case of orthopedics and trauma surgery are discussed. Additionally, seven meaningful examples from the field of digital applications are named. A survey of members of the Professional Association of Orthopedic and Trauma Surgeons (BVOU) is described and analyzed. In a concluding perspective the current hurdles and future topics that need clarification are addressed.

/pdf/digitalization-in-orthopedics-and-trauma-surgery-current-1s0iloj3q1.pdf

[Digitalization in orthopedics and trauma surgery: current status of clinical and practical aspects 2020]

For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques.A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: "(bone quality". Ti,ab.) AND "(human bone specimens)".The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included.Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens. 

https://josr-online.biomedcentral.com/track/pdf/10.1186/s13018-022-03041-4

Methods for bone quality assessment in human bone tissue: a systematic review

BACKGROUND

Carbon-reinforced PEEK (C-FRP) implants are non-magnetic and have increasingly been used for the fixation of spinal instabilities.

PURPOSE

To compare the effect of different metal artifact reduction (MAR) techniques in magnetic resonance imaging (MRI) on titanium and C-FRP spinal implants.

MATERIAL AND METHODS

Rod-pedicle screw constructs were mounted on ovine cadaver spine specimens and instrumented with either eight titanium pedicle screws or pedicle screws made of C-FRP and marked with an ultrathin titanium shell. MR scans were performed of each configuration on a 3-T scanner. MR sequences included transaxial conventional T1-weighted turbo spin echo (TSE) sequences, T2-weighted TSE, and short-tau inversion recovery (STIR) sequences and two different MAR-techniques: high-bandwidth (HB) and view-angle-tilting (VAT) with slice encoding for metal artifact correction (SEMAC). Metal artifact degree was assessed by qualitative and quantitative measures.

RESULTS

There was a much stronger effect on artifact reduction with using C-FRP implants compared to using specific MRI MAR-techniques (screw shank: P < 0.001; screw tulip: P < 0.001; rod: P < 0.001). VAT-SEMAC sequences were able to reduce screw-related signal loss artifacts in constructs with titanium screws to a certain degree. Constructs with C-FRP screws showed less artifact-related implant diameter amplification when compared to constructs with titanium screws (P < 0.001).

CONCLUSION

Constructs with C-FRP screws are associated with significantly less artifacts compared to constructs with titanium screws including dedicated MAR techniques. Artifact-reducing sequences are able to reduce implant-related artifacts. This effect is stronger in constructs with titanium screws than in constructs with C-FRP screws.

Georg Osterhoff

Papers

Real-time intraoperative 3D image intensifier-based navigation in reversed shoulder arthroplasty- analyses of image quality.

Ist die Polytraumaversorgung im aG-DRG-System defizitär?

[Digitalization in orthopedics and trauma surgery: current status of clinical and practical aspects 2020]

Methods for bone quality assessment in human bone tissue: a systematic review

Comparison of metal artifact reduction techniques in magnetic resonance imaging of carbon-reinforced PEEK and titanium spinal implants.