Do We Need a Strictly Lateral Radiograph for Fracture Management of Forearm Buckle Fractures in Children?

OBJECTIVES: Buckle fractures of the distal forearm are a common fracture entity in children treated conservatively. Diagnostics primarily include radiographs in 2 planes. Inadequate images may occur in the mostly very young patients. Therefore, additional lateral radiographs are often obtained to assess a possible angular tilt. The aim of this study is to investigate whether a strictly lateral x-ray image has an influence on fracture management. METHODS: Seventy-three children with buckle fractures of the distal forearm were included in this retrospective analysis. All cases were analyzed by quality of radiographs, necessity to obtain an additional lateral radiograph, and what influence on fracture management resulted. Follow-up was performed 2 to 4 weeks after immobilization. RESULTS: Thirty-five girls and 38 boys with a mean age of 7.16 years were included; 40 had fractured right and 33 had fractured left arms, respectively. Isolated distal radius fractures occurred in 48 cases, isolated distal ulna fractures in 6 cases, and both bones in 19 cases. Initial radiographic images were evaluated as inadequate in 25 cases. In each of those cases, an additional lateral image was obtained by fluoroscopy without resulting in an alternated fracture management protocol, which was chosen conservatively in each case and resulted in excellent clinical outcome at follow-up examination. CONCLUSIONS: Based on our results, the acquisition of additional lateral radiographs seems to be unnecessary in the diagnostic procedure of buckle fractures of the distal forearm, in case a possible palmar or dorsal angulation cannot be entirely assessed on the initial set of radiographs. An additional lateral image had no influence on fracture management, which was chosen conservatively in every case and led to excellent clinical results.Level of evidence: level III.

Evaluation of interleukin-6 in synovial fluid in periprosthetic joint infection of the elbow.

PURPOSE: Searching for quick determinable biomarkers with high sensitivity and specificity is necessary to improve and optimise the early diagnosis of periprosthetic elbow infection (PEI). Therefore, this study's objective was to evaluate the diagnostic value of synovial fluid interleukin-6 (IL-6) levels for diagnosing PEI in total elbow arthroplasty. METHOD: Twelve prospective enrolled patients underwent total elbow arthroplasty revision surgery, during which synovial fluid was obtained. Between the initial implantation and the revision procedure were 33.5 ± 41 months (range, 2-144 months). Synovial fluid was collected for immediate IL-6 analysis parallel to the revision surgery. Furthermore, microbiological samples were obtained and analysed. Two groups were defined based on the microbiological results: non-infection and infection group. The ability of synovial fluid IL-6 analysis to predict infection status was explored using receiver operating characteristic curves and further statistical analysis. RESULTS: Synovial fluid IL-6 analysis had a good diagnostic accuracy of 83% for PEI with an area under the curve of 0,79 and an ideal cutoff value (determined using Youden's criterion) of 15244 pg/mL. DISCUSSION: This is the first study to clinically evaluate IL-6 as a diagnostical marker for periprosthetic joint infection (PJI) in total elbow arthroplasty. Our results suggest a good accuracy and high sensitivity for IL-6 to identify a PEI. The analysis of IL-6 can improve surgical decision-making regarding managing total elbow arthroplasty in terms of one- or two-staged revision. CONCLUSION: IL-6 can play an important role in the perioperative differentiation of infected and non-infected situations.

The temperature profile in elbow arthroscopy using radiofrequency ablation.

INTRODUCTION: Over the last decades, arthroscopic surgery has become increasingly relevant as its minimally invasive approach offers many benefits. To investigate the risks of orthoscopic surgery at the elbow, this study aimed to investigate the development of temperatures in elbow joints while performing radiofrequency ablation in arthroscopic surgery. MATERIALS AND METHODS: We performed standard arthroscopic surgeries with posterolateral, transtricipital and anterolateral approaches on seven cadaveric elbows and performed ablation on predefined locations with or without irrigation. Two temperature probes were positioned into the olecranon fossa and between the ulnar nerve and the medial joint capsule. The temperature data were recorded using a real-time data logger. A bipolar radiofrequency ablation (bRFA) device was used at the medial and lateral recess and in the fossa olecrani over a defined period. Data was then analyzed using Matlab. RESULTS: Using bRFA without irrigation results in rapidly increasing temperature within the joint. A significant temperature increase was found within only 5 s without irrigation (p = 0.0052) in the fossa olecrani. We did not observe critical temperatures above 41 °C close to the ulnar nerve within 30 s under constant irrigation (p = 0.0747). CONCLUSIONS: Radiofrequency ablation (RFA) can be safely used in elbow arthroscopy with irrigation. The continuous use without irrigation should be limited to 3 s. Despite the anatomical proximity of the ulnar nerve and capsule, we were able to show that a possible rise in temperature most likely does not affect the ulnar nerve.

Lessons learned? Increasing injury severity of electric-scooter accidents over a period of one year: a monocentric follow-up study at a level 1 trauma center.

PURPOSE: After major COVID-19 lockdown measures were suspended in 2021, E-scooter mobility regrew rapidly. In the meantime, multiple studies were published on the potential risks for e-scooter drivers and the necessity for wearing protective equipment. But did the drivers learn their lessons? METHODS: We observed data of E-scooter-related accidents admitted to the emergency department of a level 1 German trauma center in the year 2021 and compared the data with our previous report (July 2019-July 2020). RESULTS: N = 97 E-scooter-related accidents were included, marking a 50% increase when compared to the previous observation. Most patients were young adults (28.18 ± 1.13 years) with a notable shift towards a male population (25 vs. 63, p = 0.007). While the injury pattern remained unchanged, injury severity, reflected by a significant increase in shock room treatments (p = 0.005), hospital admissions (p = 0.45), and ICU admissions (p = 0.028), increased. Lastly, we report a higher injury severity of patients driving under the influence of alcohol, expressed by significant differences in hospital admissions, shock room treatments, ICU admissions, intracerebral bleeding (p < 0.0001), and injuries requiring surgery (p = 0.0017). CONCLUSION: The increase in injury severity and especially the substantial number of accidents due to driving under the influence of alcohol, are alarming for both trauma- and neurosurgeons. As the controversy surrounding the general use of E-scooters will continue, we urge representatives to intensify their efforts regarding prevention campaigns focusing on the potential dangers of E-scooters, especially when driving under the influence of alcohol.

The dominant nutrient foramen at the clavicular midshaft: an anatomical study.

BACKGROUND: The aim of the present study was to describe the prevalence and topography of the dominant nutrient foramen at the clavicle. METHODS: 317 macerated human clavicles (167 right and 150 left) were available for the study. After detecting the dominant nutrient foramen, the total distance from the sternal surface to the examined nutrient foramen was measured. A foramen index (FI) was used for further data processing. RESULTS: We detected a dominant foramen in 300/317 (94.64%) clavicles, which was located in the middle third in 287/300 (95.7%) clavicles. The average clavicular length was measured at 14.9 cm ± 1.0 cm (range 11.6-17.5 cm) with an average foraminal distance from the sternoclavicular joint surface of 7.9 cm ± 1.3 cm (range 0.9-12.6 cm) in total. The mean FI was 53.2% ± SD 7.4% (range 5.5-79.3%). CONCLUSION: The present study provides a topographic mapping of the foraminal area (46-60% of the total clavicular length). The findings help to assess clavicular fracture patterns, which pass through the foraminal area.

In Which Cases Do We Operate? Posterior Malleolar Fractures-Intraobserver and Interobserver Reliability of the Bartonícek/Rammelt Classification and Corresponding Surgery Rates.

INTRODUCTION: The Bartonícek/Rammelt classification is established for posterior malleolar fractures. It subdivides the fractures into 5 types and outlines treatment recommendations. This study aims to determine the intraobserver and interobserver reliability of the Bartonícek/Rammelt classification and investigates its applicability regarding treatment recommendations. MATERIALS AND METHODS: Computed tomography (CT) scans of 80 ankle fractures with a posterior malleolar fracture were analyzed by four observers at two different time points 30 days apart (d1 and d2). Intrarater and interrater reliability was measured using kappa values. The corresponding surgery rates of the fracture subtypes were analyzed, and the surgery rates were correlated with fragment sizes and displacements. RESULTS: A moderate interobserver reliability for d1 0.41 (CI 0.35-0.47) and d2 0.42 (CI 0.36-0.48) was detected. Intraobserver reliability was documented as perfect, with a mean kappa of 0.83. Type II fractures were operated on in 50% of cases. In 50% of type II cases, a nonoperative treatment was chosen. Fragment size correlated strongly with the chosen therapy, and osteosynthesis was performed significantly more often when the fragment size exceeded 3 cm3 (P < .01). CONCLUSIONS: The Bartonícek/Rammelt classification system showed moderate interobserver reliability and perfect to substantial intraobserver reliability. In clinical practice of this study cohort, the size of the posterior malleolar fragment rather than the dislocation and joint impaction seemed to have the decision to operate on type II or III fractures. Existing treatment recommendations based on the Bartonícek/Rammelt classification correspond to the therapy algorithm carried out in this cohort of patients.Levels of Evidence: Level III: Retrospective study.

The Future of Total Elbow Arthroplasty: A Statistical Forecast Model for Germany.

This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.