[Bouldering: a sport with a high risk of intraarticular fractures]. / Bouldern ­ Trendsport für jedermann mit Potential zu schwerwiegenden Gelenkverletzungen.

Bouldering is a famous new sport with an increasing number of athletes. It became an Olympic sport in 2020. As no major sports equipment is required, everybody can take up bouldering even with little knowledge. However, despite the low climbing height there is a high risk of severe joint injuries, especially in the lower limb. Increasing numbers of climbers have led to an increase in injuries. New floor designs are supposed to reduce these risks. Improved documentation and specific research in bouldering should provide more insight into risks, injury patterns and prevention.

Epidemiology and Injury Pattern of E-Scooter Injuries - Initial Results. / Verletzungen mit E-Scootern ­ erste Ergebnisse zu Epidemiologie und Verletzungsmustern.

AIM: Since the introduction of shared electric scooters in Germany in June 2019, surgeons have been treating injuries caused by these devices. METHODS: In our Institution, we implemented the first registry to examine the pattern of injuries and to gather epidemiological data on persons injured while riding electric scooters. We conducted a prospective analysis of all patients treated in our Emergency Department for an injury sustained while riding an electric scooter between June 2019 and June 2020. All patients were noted in a registry (E-SCORE = E-Scooter Register). The study was approved by the institutional ethics board. Outcomes were first time of use, injuries, imaging, alcohol and helmet use, age, length of hospital stay and surgical therapy. RESULTS: 90 patients were identified. Mean age was 35.6 years (± 15.4); 65.5% were male. We diagnosed 32 fractures and 7 ligament injuries. Injuries to the head were found in 38 patients; 8 had relevant intracerebral or maxillofacial injuries. Alcohol use was noted in 18 (20%) patients, only 2 of whom wore a helmet (2.2%). 29 patients (32.2%) required surgical intervention. CONCLUSION: This study highlights the significant number of head injuries in patients riding electric scooters. Nevertheless, there are also a significant number of injuries to the bones and ligaments, which required surgical treatment. Hardly any of the patients was wearing a helmet and alcohol use was not unusual. In our opinion, scooter related injuries are leading to an growing number of vehicle related injuries and could probably benefit from some legal regulations, such as a blood alcohol limit and recommendation for helmet use. Implementation of a nationwide registry might be useful in evaluating injuries related to electric scooters.

[Arthroscopically Assisted Minimally Invasive Fixation of a Type D2c Scapular Fracture]. / Arthroskopisch gestützte minimalinvasive Schraubenosteosynthese einer Skapulafraktur Typ D2c nach Euler/Rüdi.

Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced glenoid fractures, scapula tilt of more than 40° and injuries to the superior shoulder suspensory complex. We describe a case of a 22 year old man, who while cycling collided with a moving car due to wet roads. After his admission to hospital as a polytraumatised patient, the trauma CT-Scan showed haemothorax with several associated rip fractures, displaced humeral shaft fracture and fractures of the acromion and glenoid, classified as type D2c according to Euler and Rüdi. Following damage control principles, drainage of the haemothorax was already performed in the ER and surgical treatment of the displaced humeral shaft fracture was performed on the day of admission. No peripheral neurological deficits were evident. After pulmonary stabilisation, surgery was performed 6 days later on the glenoid and acromion fracture, which in conjunction may be regarded as an injury to the superior shoulder suspensory complex. We performed an arthroscopically-assisted screw fixation of the glenoid fracture (type D2c according to Euler and Rüdi) and an ORIF procedure at the acromion. Postoperative rehabilitation was performed with passive abduction and elevation up to 90° for the first two weeks and active abduction an elevation up to 90° for weeks 3 to 6. Full ROM was allowed at week 7. CONCLUSION: Articular fractures of the glenoid are rare and mainly seen as rim fractures. The indications for surgery are displaced articular fractures and injury to the superior shoulder suspensory complex. As demonstrated by this article, type D2c fractures according to Euler and Rüdi can be treated effectively as an arthroscopically-assisted screw fixation procedure.

The role of navigation in high tibial osteotomy: a study of 50 patients.

From October 1, 2007, to October 10, 2008, we performed 50 navigated high tibial osteotomies (medial opening wedge). The mean age of the patients was 46.58 years (range, 16-70). Twenty-three osteotomies were performed in women and 27 in men. Two patients received osteotomies on both sites. Average malalignment was 6.4 degrees varus (range, 3 degrees -10.8 degrees ). Sixteen osteotomies were performed on the right side and 34 on the left side. Detailed preoperative planning was performed using the digital MediCad (Hectec GmbH, Niederviehbach, Germany) program based on the malalignment test. Navigation data were compared using full weight-bearing and intraoperative radiographs. Navigation was shown to be an excellent device for intraoperative control of the amount of correction achieved and offers additional information regarding the lateral plain, ligaments, flexion and extension.

Ablation of atrial fibrillation and esophageal injury: effects of energy source and ablation technique.

OBJECTIVE: The aim of this study was the evaluation of histologic changes induced on the esophagus by surgical ablation therapy for atrial fibrillation. METHODS: Experiments were performed on 39 sheep. Circular lesions were created endocardially or epicardially in the left atrium and at the pulmonary veins by using different energy sources: cryoablation, microwave, laser, and unipolar or bipolar radiofrequency. Temperatures inside the esophagus were measured, and esophageal tissue was investigated macroscopically and histopathologically. RESULTS: Esophageal damage was seen histologically in 24 of 39 cases. The epithelium was intact in all cases. Unipolar radiofrequency induced the most intensive esophageal lesions in 4 of 6 cases. The affected areas were small (1.56-3.01 mm) but reached deep into the tissue. Endocardial cryoablation resulted in wider lesions (2.01-8.54 mm), which were intensive in only 2 of 6 cases. Epicardial cryoablation and bipolar radiofrequency induced wide (1.11-6.8 mm) but mainly mild alterations. Endocardial and epicardial microwave energy affected the esophagus in single cases, and lesions were small (0.97-2.81 mm). Only in 1 case did laser energy induce a moderate alteration (5.30 mm) of the esophageal wall. CONCLUSIONS: Esophageal alterations were found in numerous cases. However, marked lesions were especially induced by endocardial unipolar radiofrequency and cryoablation.

Intraoperative left atrial ablation (for atrial fibrillation) using a new argon cryocatheter: early clinical experience.

PURPOSE: Recently surgical treatment of atrial fibrillation has gained more popularity and presently is being performed in large numbers of patients. This report describes our early experience in treatment of patients with chronic or paroxysmal atrial fibrillation with a new tool for left atrial cryoablation. DESCRIPTION: From July 2002 through January 2003, 28 patients underwent left atrial cryoablation with the Surgifrost CryoCath. Patients underwent cryotherapy as an isolated procedure (n = 1), in combination with mitral valve surgery (n = 13), or with other surgical procedures (n = 14). In all patients contiguous lesion lines to the orifices of the pulmonary veins connected to the mitral annulus and the atriotomy were created. Surgery was performed through a conventional sternotomy in 8 patients (29%) and a right lateral minithoracotomy using video-assistance in 20 patients (71%). EVALUATION: Postoperatively sinus rhythm was restored in 27 patients (96%). At discharge 82% (23/28) of patients were in sinus rhythm and 18% (5/28) were in atrial fibrillation. Four patients (14%) required pacemaker implantation. There was no in-hospital mortality. At 6-months follow-up (19/28 patients) all were alive and 74% were in stable sinus rhythm, New York Heart Association functional class was 1.2 +/- 0.4. CONCLUSIONS: As indicated by our small and early patient cohort left atrial cryoablation with the Surgifrost argon cryocatheter is effective for the treatment of atrial fibrillation. This new device is technically easy to handle, it can be applied through a median sternotomy or lateral minithoracotomy. Long-term follow-up is necessary to evaluate further rhythm outcome.