One Year of Experience in the Orthopaedic and Trauma Surgical Care of War Refugees and Soldiers from Ukraine in a Maximum Care Trauma Centre. / Herausforderungen bei der orthopädisch-unfallchirurgischen Versorgung von Kriegsflüchtlingen und Soldaten aus der Ukraine in einem Trauma Zentrum der Maximalversorgung.

According to the United Nations, around 8,400 people have been injured and over 5,800 killed on the Ukrainian side in the Ukraine war, which has been going on for over 14 months. Extensive humanitarian aid operations were carried out to support Ukraine, so that war-wounded people from Ukraine were also cared for in Germany. In a retrospective cohort study, 10 patients were examined who were treated in the department between February 24th 2022 and February 24th 2023, using the cloverleaf system from Ukraine.The average duration of inpatient treatment was 53.10 days. The average ISS was 23.7. The patients were operated on an average of 3.3 times in our institution. All patients received consultative psychological care. All patients were initially put into protective isolation until the results of a corona test and microbiological swabs were available. After preliminary protective isolation, further isolation had to be carried out in 5 cases due to germs requiring isolation. Eight patients were released to state accommodation. Three patients were transferred back to Ukraine at their own request.The treatment of war-injured patients from Ukraine represents a particular challenge. It absolutely requires an interdisciplinary treatment concept that, in addition to special trauma surgery and orthopaedic expertise, also requires plastic-reconstructive, microbiological and, last but not least, psychological care. Due to the high rate of infections requiring isolation, long, costly therapy with multiple revision operations is often necessary.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

BACKGROUND: Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. MATERIAL AND METHODS: A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. RESULTS: The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. CONCLUSIONS: This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

Look for the POLESTAR (POsteroLateral Engagement of Soft Tissue And Radial head) while navigating around elbow dislocation.

BACKGROUND: Elbow dislocation is frequently associated with bony and osteochondral posterolateral capitellar lesions that are often under-reported. We aim to examine the radiologic signs of posterolateral lesions on computed tomography (CT). METHODS: A retrospective analysis of CT scans was performed. Patients were classified into 4 groups: (1) simple elbow dislocation, (2) elbow dislocation with a fracture of the coronoid tip, (3) elbow dislocation with coronoid tip fracture and a radial head fracture inferior or equal to the anterior third, and (4) terrible triad defined as elbow dislocation with concomitant coronoid and radial head fracture with a more important involvement. Patients with a more complex fracture pattern were excluded. The presence of POsteroLateral Engagement of Soft Tissue And Radial head (POLESTAR) patterns was analyzed and subclassified as impaction type or fragmentation type. RESULTS: Fifty-one CT scans met the inclusion criteria. POLESTAR lesions were identified in 48 cases (94%): 46% impaction-type and 54% fragmentation-type POLESTAR. Analyzing patients from grade 1 to 4, impaction-type POLESTAR was found, respectively, from 40% to 57%, whereas fragmentation type was present from 60% to 43%. CONCLUSIONS: This study shows a high incidence of POLESTAR lesions (94%) that can be present as impaction type or fragmentation type. Based on our preliminary results, impaction type is more common in grades 3 and 4, whereas fragmentation type is more frequent in grades 1 and 2.

Periprosthetic joint infection caused by kytococcus schroeteri: The first reported case and a review of the literature.

Oftentimes, Gram-positive cocci are the cause for periprosthetic joint infections (PJI). Most of these infections include bacteria such as Staphylococcus aureus, Staphylococcus epidermidis or other coagulase-negative staphylococci. We here present the first case of a PJI caused by Kytococcus schroeteri. While being a Gram-positive coccus, it is very rarely the cause for infections in the human body. K. schroeteri is part of the micrococcus branch and often encountered as a symbiotic bacterium living on the skin. Regarding its pathogenic potential, not a lot is known since less than a few dozen human infections have been reported worldwide. Furthermore, many of the cases reported are either associated with implanted material, especially heart valves, or associated with patients whose immune response is deficient. Only 3 reports of osteoarticular infections are described so far.