Benjamin Bücking

The influence of hip rotation on femoral offset in plain radiographs.

Background and purpose — Adequate restoration of femoral offset (FO) is critical for successful outcome after hip arthroplasty or fixation of hip fracture. Previous studies have identified that hip rotation influences the projected femoral offset (FOP) on plain anteroposterior (AP) radiographs, but the precise effect of rotation is unknown. Patients and methods — We developed a novel method of assessing rotation-corrected femoral offset (FORC), tested its clinical application in 222 AP hip radiographs following proximal femoral nailing, and validated it in 25 cases with corresponding computed tomography (CT) scans. Results — The mean FORC was 57 (29–93) mm, which differed significantly (p < 0.001) from the mean FOP 49 (22–65) mm and from the mean femoral offset determined by the standard method: 49 (23–66) mm. FORC correlated closely with femoral offset assessed by CT (FOCT); the Spearman correlation coefficient was 0.94 (95% CI: 0.88–0.97). The intraclass correlation coefficient for the assessment of FORC by AP hip radiographs correlating the repeated measurements of 1 observer and of 2 independent blinded observers was 1.0 and 1.0, respectively. Interpretation — Hip rotation affects the FOP on plain AP radiographs of the hip in a predictable way and should be adequately accounted for.

Numbers of Severely Injured Patients in Germany. A Retrospective Analysis From the DGU (German Society for Trauma Surgery) Trauma Registry.

BACKGROUND Persons who sustain severe traumatic injury, i.e., those with an Injury Severity Score (ISS) of 16 or above, go on to suffer major physical, emotional, and socio-economic consequences. It is important to know the incidence of severe trauma so that these patients can be cared for optimally. METHODS Data from the year 2012 on severely injured persons with an ISS of 16 or above were obtained from the trauma registry of the German Society for Trauma Surgery (DGU) and analyzed. Further information was obtained from the database of the DGU trauma network. The annual incidence of severe trauma was estimated from these data in three different ways. RESULTS An extrapolation of hospital-based data to the German population yielded a figure of 16 742 severely injured persons per year. A population-based estimate from the German federal state of Bavaria yielded a figure of 16 514/year, while an area-based extrapolation using data from 17 established networks yielded a figure of 16 554/year. We added 10% to each of these figures as a correction for assumed underreporting. We conclude that the number of persons who sustained a severe traumatic injury in Germany in 2012 lay between 18 209 (95% confidence interval [CI]: 17 751-18 646) and 18 416 (95% CI: 18 156-18 695). This corresponds to an incidence of 0.02% per year. CONCLUSION Data from a prospectively maintained nationwide trauma registry were used for the first time to calculate the annual incidence of severe traumatic injury in Germany: the expected number of severely injured persons per year is 18 200-18 400. Previous extrapolations yielded values in the range of 32 500-35 300. A high variability of documentation practices among supraregional trauma centers may have distorted the estimate, along with other factors. The figures were not normalized for age or sex.

Two-Incision Minimally Invasive Approach for the Treatment of Anterior Column Acetabular Fractures

Overview Introduction We describe an alternative to the Letournel ilioinguinal approach for anterior column acetabular fractures that is performed with a unique retraction device that decreases the rate of soft-tissue complications. Step 1: Position the Patient and Identify the Sites for the Incisions Identify the sites for both incisions with the help of an image intensifier. Step 2: Make the First Incision to Expose the Anterior Column and the Linea Terminalis (Pelvic Brim) Make the first incision to expose the central area of the fracture. Step 3: Make the Second Incision to Expose the Symphysis and the Ipsilateral Pubic Bone Make the second incision to expose the area for the distal plate fixation. Step 4: Maintain Exposure of the Linea Terminalis Using a Soft-Tissue Retraction System For better visualization, use a soft-tissue retraction system. Step 5: Reduce the Fracture Clean and reduce the fracture through the first incision. Step 6: Fix the Fracture Perform temporary and definitive fixation according to the standards for anterior acetabular fracture fixation. Step 7: Close the Wound After radiographic documentation in three views, close the wound. Results We reported the results of a case-control study of the first twenty-six patients operated on with the two-incision minimally invasive technique. Indications Contraindications Pitfalls & Challenges

Anästhesie in der Orthopädie /Unfallchirurgie – Die Versorgung proximaler Femurfrakturen des alten Patienten

Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program.

Response to “Comments on mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis”

1. Recent clinical studies identified patient-specific characteristics like old age, male sex or comorbidities as predictive factors for increased mortality after hip fracture. The aim of our study was to identify these and further risk factors for in-hospital mortality as cardio-respiratory complications after treatment of trochanteric factures to define high-risk subgroups and make future preventive actions possible [2]. We agree with the authors’ comment that predictors which are not known are measured imprecisely or unmeasured may lead to residual confounding. While it is impossible for unknown or unmeasured predictors to be included in the statistical model, the problem may persist with imprecisely measured predictors. No specific approach for confounder identification can generally be recommended. We used a univariate pre-selection approach to identify important factors for our multivariate models. This approach leads to the inclusion of ASA grade in our final model for cardio-respiratory complications, even if the differences between crude and adjusted estimates of the OR for ASA grade are negligibly small. 2. To determine potential predictive factors, first a univariate binary logistic regression analysis was performed to study