Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures.

INTRODUCTION: Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. MATERIALS AND METHODS: Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning. RESULTS: The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44). The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61 min) and estimated complexity of fracture treatment (+ 0.65 min). CONCLUSION: The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.

Promoting bone callus formation by taking advantage of the time-dependent fracture gap strain modulation.

Delayed union and non-union of fractures continue to be a major problem in trauma and orthopedic surgery. These cases are challenging for the surgeon. In addition, these patients suffer from multiple surgeries, pain and disability. Furthermore, these cases are a major burden on healthcare systems. The scientific community widely agrees that the stability of fixation plays a crucial role in determining the outcome of osteosynthesis. The extent of stabilization affects factors like fracture gap strain and fluid flow, which, in turn, influence the regenerative processes positively or negatively. Nonetheless, a growing body of literature suggests that during the fracture healing process, there exists a critical time frame where intervention can stimulate the bone's return to its original form and function. This article provides a summary of existing evidence in the literature regarding the impact of different levels of fixation stability on the strain experienced by newly forming tissues. We will also discuss the timing and nature of this "window of opportunity" and explore how current knowledge is driving the development of new technologies with design enhancements rooted in mechanobiological principles.

Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU®.

(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care.