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.

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Bone mechanical properties and changes with osteoporosis.

Abbreviated Injury Scale

Im Rahmen der Kontaktbeschrankungen aufgrund der COVID-19-Pandemie vom Marz 2020 wurde zur Aufrechterhaltung der Patientenversorgung eine videobasierte Sprechstunde eingefuhrt. Als Basis einer kontaktminimierenden Kommunikation wurde diese nach den Masnahmen fortgefuhrt. Ziel dieser prospektiven Pilotstudie ist die Beurteilung hinsichtlich der Effektivitat, der technischen Machbarkeit sowie der Steuerung von Patientenstromen sowohl unter Lockdown-Bedingungen sowie in der Zeit danach. Die Auswertung erfolgte vom Beginn des ersten Lockdowns am 16.03.2020 bis zum Stichtag der zweiten einschrankenden Masnahmen am 14.12.2020. Dokumentiert wurde die Qualitat der Verbindungen bezuglich Ton und Bild. Weiterhin wurden die Konsequenzen aus den Gesprachen dokumentiert. Unterschieden wurde hierbei in 4 Kategorien: 1. keine erneute Vorstellung, 2. Wiedervorstellung in der Videosprechstunde, 3. operative Therapie und 4. Vorstellung zur klinischen Untersuchung. Es erfolgten 236 Patientenvorstellungen mittels Videosprechstunde. Insgesamt erfolgten 182 (82 %) Gesprache ohne Einschrankungen. Bei 47 (21 %) Konsultationen handelte es sich um Erstvorstellungen. Bei 41 (18 %) Patienten erfolgte keine erneute Vorstellung. Bei 36 (16 %) Patienten wurde eine Wiedervorstellung in der Videosprechstunde geplant, bei 36 (16 %) Patienten erfolgte die direkte Einweisung zur Operation, und bei 105 (47 %) Patienten wurde eine Wiedervorstellung zur klinischen Untersuchung vereinbart. Bei 40 % der Patienten konnte durch den Kontakt in der Videosprechstunde eine definitive Entscheidung gestellt werden. Auf der anderen Seite erfolgte bei 47 % der Patienten eine Vorstellung zur klinischen Untersuchung. Die Videosprechstunde ist eine sehr nutzliche Masnahme, um Patientenaufkommen zu leiten und den direkten Arzt-Patient-Kontakt sichtbar zu unterstutzten.

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Die Videosprechstunde in einer unfallchirurgisch/orthopädischen Spezialsprechstunde

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Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating

There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. The aim of this study was to evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared to hemiarthroplasty (HA) in the management of these fractures. A cost–utility analysis using decision tree and Markov modelling based on data from the published literature was conducted. A single-payer perspective with a lifetime time horizon was adopted. A willingness to pay threshold of CAD $50,000 was used. The incremental cost-effectiveness ratio (ICER) was used as the study9s primary outcome measure. In comparison to HA, the incremental cost per QALY gained for RTSA was $13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural costs. Two-way sensitivity analysis suggested RTSA could also be cost-effective within the first two years of surgery with an early complication rate as high as 25% (if RTSA implant cost was approximately $3,000); or conversely, RTSA implant cost could be as high as $8,500 if its early complication rates were 5%. The ICER of $13,679 is well below the WTP threshold of $50,000 and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favoured RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared to HA. The ICER of RTSA is well-below standard willingness to pay thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopaedic strategies such as total hip arthroplasty for the treatment of hip arthritis.

A cost-effectiveness analysis of reverse total shoulder arthroplasty versus hemiarthroplasty for the management of complex proximal humeral fractures in the elderly

To investigate, whether hyperspectral imaging (HSI) is able to reliably differentiate between healthy and damaged cartilage tissue. A prospective diagnostic study was performed including 21 patients undergoing open knee surgery. HSI data were acquired during surgery, and the joint surface's cartilage was assessed according to the ICRS cartilage injury score. The HSI system records light spectra from 500 to 1000 nm and generates several parameters including tissue water index (TWI) and the absorbance at 960 nm and 540 nm. Receiver operating characteristic curves were calculated to assess test parameters for threshold values of HSI. Areas with a cartilage defect ICRS grade ≥ 3 showed a significantly lower TWI (p = 0.026) and higher values for 540 nm (p < 0.001). No difference was seen for 960 nm (p = 0.244). For a threshold of 540 nm > 0.74, a cartilage defect ICRS grade ≥ 3 could be detected with a sensitivity of 0.81 and a specificity of 0.81. TWI was not suitable for cartilage defect detection. HSI can provide reliable parameters to differentiate healthy and damaged cartilage. Our data clearly suggest that the difference in absorbance at 540 nm would be the best parameter to achieve accurate identification of damaged cartilage. 

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Intraoperative hyperspectral imaging (HSI) as a new diagnostic tool for the detection of cartilage degeneration

The purpose of this study was to investigate whether the addition of computed tomography (CT) to magnetic resonance imaging (MRI) improves the accuracy of classifying osteoporotic vertebral body fractures (OVBF).A retrospective analysis of a prospective single-center database has been performed. All consecutive patients who had suffered an acute thoracolumbar OVBF in one level II spine center between 2017 and 2019 were analyzed. Thereby, fractures of type OF 1 and OF 5 were excluded. All fractures were initially classified by 5 board-certified orthopaedic surgeons based on MRI and conventional radiographs. Afterwards a reclassification including CT scans were performed. Differences in OF classification and OF score values between both measurements were analyzed.A total of 61 patients were analyzed with a mean age 75.8 years (SD: 8.8 years). In 82.9% of the cases, there was no difference in OF classification comparing classification based only on MRI versus MRI + CT. A difference of more than two OF types was observed in less than 1% of all ratings. The inter-rater reliabilities of the OF classification based on CT + MRI and MRI alone were 0.63 and 0.49, respectively. In 97.5% of the cases there was no therapy-relevant difference of the treatment recommendation with respect of a surgical or nonoperative treatment recommendation based on the OF score.In terms of the OF classification and the OF score, the addition of CT add limited value compared to conventional radiographs and MRI only. Additionally, there is only a minor rate of disagreement in treatment recommendations when adding a CT. 

https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-022-06056-4

OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score

Georg Osterhoff

Papers

Die Videosprechstunde in einer unfallchirurgisch/orthopädischen Spezialsprechstunde

Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating

A cost-effectiveness analysis of reverse total shoulder arthroplasty versus hemiarthroplasty for the management of complex proximal humeral fractures in the elderly

Intraoperative hyperspectral imaging (HSI) as a new diagnostic tool for the detection of cartilage degeneration

OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score