Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation.

PURPOSE: The treatment of comminuted patellar fractures remains a challenge for orthopedic surgeons. The aim of this study was to assess the clinical, functional, and radiological outcome after treatment of comminuted patellar fractures using an anatomically contoured plating system. METHODS: Between January 2015 and December 2019 (5 years), 29 patients with complex C3 fractures according to AO classification (18 female, 11 male; mean age: 53 years) were treated using an anatomically contoured plating system (patella SuturePlate™, Arthrex®, Naples, USA). Indication for surgery was based on instability and/or initial fragment dislocation (> 2 mm). After a minimum follow-up of 12 months, patients were examined using a standardized clinical examination and functional outcome was assessed using specific knee scores (Lysholm, WOMAC, IKDC, Kujala, and Tegner score). In addition, complications were recorded and all available radiographs were evaluated regarding osteoarthritis and reduction quality. RESULTS: All patients returned for follow-up investigation after an average of 19 months (range: 12-48 months). A mean range of motion (ROM) of 131° (range: 100-150) was recorded. Overall good functional outcome parameters could be reported, with a mean Lysholm score of 84.7 (range: 100-45), a WOMAC of 5.1 (range: 0-19.2), a Kujala scale of 85.5 (range: 100-48), an IKDC of 76.6 (range: 100-44.8), and a Tegner score of 4.3 (range: 10-3) with a difference of 0.62 to pre-operative. Patient satisfaction was rated 8.4 (range: 4-10) using a VAS. No loss of reduction, mechanical failure, or implant complications were detected. Radiological follow-up showed no evidence of relevant post-traumatic retropatellar osteoarthritis. In 7 cases, implants were removed due to subjective mechanical irritation. CONCLUSION: Anatomically contoured patellar plates allow secure fixation of the fracture fragments even in comminuted cases. Especially when tension-band wiring is prone to early failure, locking plate fixation represents a viable option leading to good functional results and low complication rates.

[With structure to successful further education : Presentation of curriculum, checklists and compendium for career entrants]. / Mit Struktur zur erfolgreichen Weiterbildung : Vorstellung von Curriculum, Checklisten und Berufseinsteigerheft.

The further training to a medical specialist in orthopedics and trauma surgery is in a state of continuous development. This is underlined by numerous amendments from previous and coming years, including recently the implementation of the eLogbook, which is presently being implemented nationwide by the individual State Chambers of Physicians; however, in addition to the legally regulated conditions of the further education regulations the focus on the quality of the content of further training should not be neglected. This could be achieved by a structural approach. As the Young Forum for Orthopedics and Trauma Surgery (JFOU) we would like to promote the exchange of ideas and policy engagement and directly contribute to the topic of further training in orthopedics and trauma surgery by facilitating a successful further training in numerous projects. This article presents the following projects on the topic of further training: checklists on diverse topics which are relevant for the clinical routine and further training, a comprehensive compendium for career entrants to facilitate the start of the career on the threshold from studying to routine daily work, a guide on further training for structured training even during the period of training for medical specialists and beyond, interactive spreadsheets for the progress in fulfilling the required benchmarks and a structured curriculum for further training in the medical specialist examination for orthopedics and trauma surgery in cooperation with Thieme eREF. Additionally, further projects on the topics of mentoring and specialization in orthopedics and trauma surgery can be found on our platform.

[Patalla Fractures]. / Patellafrakturen.

Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.

Obstructive sleep apnoea but not central sleep apnoea is associated with left ventricular remodelling after acute myocardial infarction.

OBEJCTIVE: Obstructive sleep apnoea (OSA) increases left ventricular transmural pressure more than central sleep apnoea (CSA) owing to negative intrathoracic pressure swings. We tested the hypothesis that the severity of OSA, and not CSA, is therefore associated with spheric cardiac remodelling after acute myocardial infarction. METHODS: This sub-analysis of a prospective observational study included 24 patients with acute myocardial infarction who underwent primary percutaneous coronary intervention. Spheric remodelling, calculated according to the sphericity index, was assessed by cardiac magnetic resonance imaging at baseline and 12 weeks after acute myocardial infarction. OSA and CSA [apnoea-hypopnoea index (AHI) ≥ 5/hour] were diagnosed by polysomnography. RESULTS: Within 12 weeks after acute myocardial infarction, patients with OSA exhibited a significant increase in systolic sphericity index compared to patients without sleep-disordered breathing (no SDB) and patients with CSA (OSA vs. CSA vs. no SDB: 0.05 ± 0.04 vs. 0.01 ± 0.04 vs. - 0.03 ± 0.03, p = 0.002). In contrast to CSA, the severity of OSA was associated with an increase in systolic sphericity index after accounting for TIMI-flow before percutaneous coronary intervention, infarct size, pain-to-balloon-time and systolic blood pressure [OSA: B (95% CI) 0.443 (0.021; 0.816), p = 0.040; CSA: 0.193 (- 0.134; 0.300), p = 0.385]. CONCLUSION: In contrast to CSA and no SDB, OSA is associated with spheric cardiac remodelling within the first 12 weeks after acute myocardial infarction. Data suggest that OSA-related negative intrathoracic pressure swings may contribute to this remodelling after acute myocardial infaction.

Improving early language and literacy skills: differential effects of an oral language versus a phonology with reading intervention.

BACKGROUND: This study compares the efficacy of two school-based intervention programmes (Phonology with Reading (P + R) and Oral Language (OL)) for children with poor oral language at school entry. METHODS: Following screening of 960 children, 152 children (mean age 4;09) were selected from 19 schools on the basis of poor vocabulary and verbal reasoning skills and randomly allocated to either the P + R programme or the OL programme. Both groups of children received 20 weeks of daily intervention alternating between small group and individual sessions, delivered by trained teaching assistants. Children in the P + R group received training in letter-sound knowledge, phonological awareness and book level reading skills. Children in the OL group received instruction in vocabulary, comprehension, inference generation and narrative skills. The children's progress was monitored at four time points: pre-, mid- and post-intervention, and after a 5-month delay, using measures of literacy, language and phonological awareness. RESULTS: The data are clustered (children within schools) and robust confidence intervals are reported. At the end of the 20-week intervention programme, children in the P + R group showed an advantage over the OL group on literacy and phonological measures, while children in the OL group showed an advantage over the P + R group on measures of vocabulary and grammatical skills. These gains were maintained over a 5-month period. CONCLUSIONS: Intervention programmes designed to develop oral language skills can be delivered successfully by trained teaching assistants to children at school entry. Training using P + R fostered decoding ability whereas the OL programme improved vocabulary and grammatical skills that are foundations for reading comprehension. However, at the end of the intervention, more than 50% of at-risk children remain in need of literacy support.