A computed tomography-based morphometric analysis of thoracic pedicles in a European population.

PURPOSE: The goal of this retrospective study was to perform a CT imaging assessment of thoracic pedicles to provide a representative understanding of pedicle morphology for pedicle-based fixation systems commonly used in orthopedics, trauma and neurosurgery. This study aimed to better understand the morphology of the spine and give spine surgeons a better understanding of thoracic spine anatomy. METHODS: In this study, we retrospectively measured the thoracic spine pedicles of a total of 16 males and 16 females, totaling in 768 individual pedicles. For the measurements, we used standardized planes in computed tomography imaging with a maximum slice thickness of 1 mm. RESULTS: In brief, we identified significant differences in various measurements of male and female pedicle morphology. The medial cortical wall of the pedicles was significantly thicker than the lateral wall, and, in both sexes, the thoracic vertebral body number four was the vertebra with the least amount of cortical bone in the pedicle. CONCLUSIONS: Surgeons performing operations involving pedicle screw placement should be aware of the sex-specific differences in thoracic spine pedicle morphology noted in this research.

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.

Does the Information Quality of ChatGPT Meet the Requirements of Orthopedics and Trauma Surgery?

BACKGROUND: The integration of artificial intelligence (AI) in medicine, particularly through AI-based language models like ChatGPT, offers a promising avenue for enhancing patient education and healthcare delivery. This study aims to evaluate the quality of medical information provided by Chat Generative Pre-trained Transformer (ChatGPT) regarding common orthopedic and trauma surgical procedures, assess its limitations, and explore its potential as a supplementary source for patient education. METHODS: Using the GPT-3.5-Turbo version of ChatGPT, simulated patient information was generated for 20 orthopedic and trauma surgical procedures. The study utilized standardized information forms as a reference for evaluating ChatGPT's responses. The accuracy and quality of the provided information were assessed using a modified DISCERN instrument, and a global medical assessment was conducted to categorize the information's usefulness and reliability. RESULTS: ChatGPT mentioned an average of 47% of relevant keywords across procedures, with a variance in the mention rate between 30.5% and 68.6%. The average modified DISCERN (mDISCERN) score was 2.4 out of 5, indicating a moderate to low quality of information. None of the ChatGPT-generated fact sheets were rated as "very useful," with 45% deemed "somewhat useful," 35% "not useful," and 20% classified as "dangerous." A positive correlation was found between higher mDISCERN scores and better physician ratings, suggesting that information quality directly impacts perceived utility. CONCLUSION: While AI-based language models like ChatGPT hold significant promise for medical education and patient care, the current quality of information provided in the field of orthopedics and trauma surgery is suboptimal. Further development and refinement of AI sources and algorithms are necessary to improve the accuracy and reliability of medical information. This study underscores the need for ongoing research and development in AI applications in healthcare, emphasizing the critical role of accurate, high-quality information in patient education and informed consent processes.

Recent Trends in Plastic Surgery: A Network Analysis of the Abstract Titles of the Largest German Plastic Surgery Congress 2023.

BACKGROUND: Every year, German-speaking experts in plastic, reconstructive, and aesthetic surgery gather to discuss the latest developments at Germany's largest conference for plastic surgery, the joint annual meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) and the Association of German Aesthetic Plastic Surgeons (VDÄPC). Since the topics of the conference have a lasting impact on the practice and research of plastic surgery, an examination of the presented content provides insight into the driving developments in plastic surgery in Germany. MATERIALS AND METHODS: We conducted a retrospective network analysis of all abstract titles from the DGPRÄC and VDÄPC annual meeting in 2023. Data were extracted regarding titles, language, author, and place of origin, and the titles were categorized into the four pillars of the specialty. The titles were standardized and subjected to network analysis. RESULTS: A total of 299 titles from 281 lectures and 18 instructional courses were analyzed. After preprocessing the data, 2463 words with 9384 connections qualified for network analysis. The most frequently mentioned keywords throughout the congress were 'Surgery', 'Breast', 'Reconstruction', 'Flap', 'Patient', 'Tissue', and 'Therapy'. Locations contributing the highest number of abstracts were Ludwigshafen, Hanover, Leipzig, and Munich. CONCLUSION: In the era of big data, network analysis provides the ability to identify underlying structures and nodes in multidimensional, complex datasets. This study demonstrates the useful application of network analysis to identify thematic focuses and connections at the current DGPRÄC and VDÄPC annual meeting. Sites of intensified research could thus be identified.

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.

Robotic-assisted plate fixation of the anterior acetabulum - clinical description of a new technique.

INTRODUCTION: We present a detailed procedure for the robotic-assisted plate osteosynthesis of an anterior acetabular fracture. The purpose of this work was to describe a robotic-assisted minimally invasive technique as a possible method for reducing complications, pain, and hospitalization. Another goal was to present technical recommendations and to assess potential pitfalls and problems of the new surgical approach. METHODS: Surgery was performed in an interdisciplinary setting by an experienced orthopedic surgeon and a urologist. The DaVinci System with standard instruments was used. Reduction was achieved through indirect traction of a pin that was introduced into the femoral neck and direct manipulation via the plate. The plate position and fixation were achieved through 7 additional minimally invasive incisions. RESULTS: The technique has multiple advantages, such as no detachment of the rectus abdominal muscle, a small skin incision, and minimal blood loss. Furthermore, this approach might lower the incidence of hernia formation, infection, and postoperative pain. DISCUSSION: We see the presented technique as a demanding yet progressive and innovative surgical method for treating acetabular fractures with indications for anterior plate fixation. TRIAL REGISTRATION: The study was approved by the local institutional review board (Nr. 248/18).

It is (not) always on Friday: inter-hospital patient transfers in orthopedic and trauma surgery.

BACKGROUND: While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future. MATERIALS AND METHODS: In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed. RESULTS: A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001. CONCLUSION: There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.

COVID-19 measures as an opportunity to reduce the environmental footprint in orthopaedic and trauma surgery.

Background: Climate change and its consequences on our everyday life have also tremendous impacts on public health and the health of each individual. The healthcare sector currently accounts for 4.4% of global greenhouse gas emissions. The share of the emissions in the health care system caused by the transportation sector is 7%. The study analyses the effect of video consultation on the CO2 emissions during the Covid-19 pandemic in an outpatient clinic of the department of orthopaedics and traumatology surgery at a German university hospital. Methods: The study participants were patients who obtained a video consultation in the period from June to December 2020 and voluntarily completed a questionnaire after the consultation. The type of transport, travel time and waiting time as well as patient satisfaction were recorded by questionnaire. Results: The study comprised 51 consultations. About 70% of respondents would have travelled to the clinic by car. The reduction in greenhouse gas emissions of video consultations compared to a face-to-face presentation was 97% in our model investigation. Conclusion: The video consultation can be a very important part of the reduction of greenhouse gas emissions in the health care system. It also saves time for the doctor and patient and can form an essential part of individual patient care.

Sonication in Patients With Spinal Cord Stimulation: A New Approach for Infection Diagnostics.

INTRODUCTION: Spinal cord stimulation (SCS) offers improvement in pain and function for several chronic pain conditions. There are concerns regarding bacterial colonization of the temporary lead extensions and subsequent infection risk in a two-session implantation procedure. Although there is no standardized evaluation of SCS lead contamination, this study evaluates the infection rate and microbial colonization of SCS lead extensions with sonication, a method that is established in implant-related infection diagnostics. MATERIALS AND METHODS: This prospective observational study comprised 32 patients with a two-stage SCS implantation procedure. Microbial colonization of the lead extensions was assessed with sonication. The presence of organisms in the subcutaneous tissue was evaluated separately. Surgical-site infections were recorded. Patient demographics and risk factors including diabetes, tobacco use, obesity, trial length, and infection parameters in serum were recorded and analyzed. RESULTS: The mean age of the patients was 55 years. On average, the trial length was 13 days. In seven cases (21.9%), a microbial lead colonization was found with sonication. In contrast, there was one positive culture (3.1%) from the subcutaneous tissue samples. The C-reactive protein and leukocyte count remained at the preoperative level. One early surgical-site infection (3.1%) occurred. No other late infections occurred six months after surgery. CONCLUSIONS: There is a discrepancy between the presence of microbial colonization and the occurrence of clinically relevant infections. Although the rate of microbial colonization of the lead extensions is high (21.9%), the surgical-site infection rate remained low (3.1%). Therefore, we can conclude that the two-session procedure is a safe approach that is not associated with a higher incidence of infection. Although the sonication method cannot be used as the sole tool for detecting infections in patients with SCS, it can provide additional value in microbial diagnostics in combination with clinical and laboratory parameters and conventional microbiological methods.

Are orthopaedic surgeons prepared? An analysis of severe casualties from the 2021 flash flood and mudslide disaster in Germany.

BACKGROUND: The purpose of this study was to describe and analyse the most severe casualties from the flash flood and mudslides occurring on 14 July 2021 in Germany, focusing on patients who were treated in the closest and largest level I trauma centre in the region the disaster occurred. METHODS: A single-centre retrospective study design was employed, and all patients treated because of the flooding and mudslides who needed inpatient treatment were documented. Data on each patient's demographic characteristics, type of injury, number of surgeries, duration of hospitalisation, operation time, revision rate, injury severity score (ISS), and complications were collected. The primary outcome measure was status at discharge. RESULTS: Within the first week after the flood, a total of 63 patients were documented. Forty-one patients were treated on an outpatient basis in the emergency unit, and 22 patients were hospitalised. Of those hospitalised, 15 patients needed surgical treatment in the operation theatre. The most common injuries were fractures of the lower extremity (n = 7) and soft tissue wounds (n = 4). Overall, 20 surgeries were performed; the mean hospital stay was 7.2 ± 6.4 days, and the mean ISS was 5.7 ± 2.7. CONCLUSION: The July 2021 flood disaster was one of the largest in German history. The included patients showed complex injuries of various types. Because of the effects of climate change, orthopaedic surgeons might face higher numbers of casualties affected by natural disasters. Learning more about the management and profile of these injuries can become a future challenge for orthopaedic and trauma surgeons.

APACHE-Anterior Plating of the Acetabulum in Hemi-Endoscopic Technique: An Alternative Method for Internal Fixation of the Acetabulum.

Injuries of the acetabulum are often challenging in treatment and aftercare. One reason is the required surgical approach, which has high complication rates, including vascular lesion, hernias, and wound infection. We present an alternative endoscopic-assisted approach for the internal fixation of acetabular fractures to avoid the Pfannenstiel incision. An endoscopic approach similar to that used for endoscopic hernia surgery was used. The ilioinguinal approach's lateral window was used to achieve reduction and insertion of a reconstruction plate. The purpose of this study is to describe a minimally invasive technique as a possible method to reduce hospitalization and complications. Another goal is to give detailed technical recommendations and to assess the potential pitfalls of this surgical approach. The APACHE technique is a safe and suitable minimally-invasive approach for the successful treatment of complex acetabular fractures and can be considered in similar cases.