Evaluation of a deep learning-based reconstruction method for denoising and image enhancement of shoulder MRI in patients with shoulder pain.

OBJECTIVES: To evaluate the diagnostic performance of an automated reconstruction algorithm combining MR imaging acquired using compressed SENSE (CS) with deep learning (DL) in order to reconstruct denoised high-quality images from undersampled MR images in patients with shoulder pain. METHODS: Prospectively, thirty-eight patients (14 women, mean age 40.0 ± 15.2 years) with shoulder pain underwent morphological MRI using a pseudo-random, density-weighted k-space scheme with an acceleration factor of 2.5 using CS only. An automated DL-based algorithm (CS DL) was used to create reconstructions of the same k-space data as used for CS reconstructions. Images were analyzed by two radiologists and assessed for pathologies, image quality, and visibility of anatomical landmarks using a 4-point Likert scale. RESULTS: Overall agreement for the detection of pathologies between the CS DL reconstructions and CS images was substantial to almost perfect (κ 0.95 (95% confidence interval 0.82-1.00)). Image quality and the visibility of the rotator cuff, articular cartilage, and axillary recess were overall rated significantly higher for CS DL images compared to CS (p < 0.03). Contrast-to-noise ratios were significantly higher for cartilage/fluid (CS DL 198 ± 24.3, CS 130 ± 32.2, p = 0.02) and ligament/fluid (CS DL 184 ± 17.3, CS 141 ± 23.5, p = 0.03) and SNR values were significantly higher for ligaments and muscle of the CS DL reconstructions (p < 0.04). CONCLUSION: Evaluation of shoulder pathologies was feasible using a DL-based algorithm for MRI reconstruction and denoising. In clinical routine, CS DL may be beneficial in particular for reducing image noise and may be useful for the detection and better discrimination of discrete pathologies. Assessment of shoulder pathologies was feasible with improved image quality as well as higher SNR using a compressed sensing deep learning-based framework for image reconstructions and denoising. KEY POINTS: • Automated deep learning-based reconstructions showed a significant increase in signal-to-noise ratio and contrast-to-noise ratio (p < 0.04) with only a slight increase of reconstruction time of 40 s compared to CS. • All pathologies were accurately detected with no loss of diagnostic information or prolongation of the scan time. • Significant improvements of the image quality as well as the visibility of the rotator cuff, articular cartilage, and axillary recess were detected.

Diagnostic value of water-fat-separated images and CT-like susceptibility-weighted images extracted from a single ultrashort echo time sequence for the evaluation of vertebral fractures and degenerative changes of the spine.

OBJECTIVES: To evaluate the performance of single-echo Dixon water-fat imaging and computed tomography (CT)-like imaging based on a single ultrashort echo time (sUTE) MR sequence for imaging of vertebral fractures as well as degenerative bone changes of the spine in comparison to conventional CT and MR sequences. METHODS: Thirty patients with suspected acute vertebral fractures were examined using a 3-T MRI, including an sUTE sequence as well as short-tau inversion recovery (STIR) and T1-weighted sequences. During postprocessing, water-fat separation was performed by solving the smoothness-constrained inverse water-fat problem based on a single-complex UTE image. By removing the unwanted low-frequency phase terms, additional MR-based susceptibility-weighted-like (SW-like) images with CT-like contrast were created. Two radiologists evaluated semi-quantitative and quantitative features of fractures and degenerative changes independently and separately on CT and MR images. RESULTS: In total, all 58 fractures were accurately detected of whom 24 were correctly classified as acute fractures with an edema detected on the water-fat-separated UTE images, using STIR and T1w sequences as standard of reference. For the morphological assessment of fractures and degenerative changes, the overall agreement between SW-like images and CT was substantial to excellent (e.g., Genant: κ 0.90 (95% confidence interval 0.54-1.00); AO/Magerl: κ 0.75 (95% confidence interval 0.43-1.00)). Overall inter-reader agreement for water-fat-separated UTE images and SW-like images was substantial to almost perfect. CONCLUSION: Detection and assessment of vertebral fractures and degenerative bone changes of the spine were feasible and accurate using water-fat-separated images as well as SW-like images, both derived from the same sUTE-Dixon sequence. KEY POINTS: • The detection of acute vertebral fractures was feasible using water-fat-separated images and CT-like images reconstructed from one sUTE sequence. • Assessment of the vertebral fractures using SW-like images with CT-like contrast was found to be comparable to conventional CT. • sUTE imaging of the spine can help reduce examination times and radiation exposure.

Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT.

OBJECTIVES: To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies. MATERIALS AND METHODS: Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student's t-test, and Pearson's correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen's κ and intraclass correlation coefficient. RESULTS: All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT. CONCLUSION: Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT. CLINICAL RELEVANCE STATEMENT: In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure. KEY POINTS: • No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images. • Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts. • The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.

Evaluation of MR-derived simulated CT-like images and simulated radiographs compared to conventional radiography in patients with shoulder pain: a proof-of-concept study.

BACKGROUND: To evaluate the diagnostic value of MR-derived CT-like images and simulated radiographs compared with conventional radiographs in patients with suspected shoulder pathology. METHODS: 3 T MRI of the shoulder including a 3D T1-weighted gradient echo sequence was performed in 25 patients (mean age 52.4 ± 18 years, 13 women) with suspected shoulder pathology. Subsequently a cone-beam forward projection algorithm was used to obtain intensity-inverted CT-like images and simulated radiographs. Two radiologists evaluated the simulated images separately and independently using the conventional radiographs as the standard of reference, including measurements of the image quality, acromiohumeral distance, critical shoulder angle, degenerative joint changes and the acromial type. Additionally, the CT-like MR images were evaluated for glenoid defects, subcortical cysts and calcifications. Agreement between the MR-derived simulated radiographs and conventional radiographs was calculated using Cohen's Kappa. RESULTS: Measurements on simulated radiographs and conventional radiographs overall showed a substantial to almost perfect inter- and intra-rater agreement (κ = 0.69-1.00 and κ = 0.65-0.85, respectively). Image quality of the simulated radiographs was rated good to excellent (1.6 ± 0.7 and 1.8 ± 0.6, respectively) by the radiologists. A substantial agreement was found regarding diagnostically relevant features, assessed on Y- and anteroposterior projections (κ = 0.84 and κ = 0.69 for the measurement of the CSA; κ = 0.95 and κ = 0.60 for the measurement of the AHD; κ = 0.77 and κ = 0.77 for grading of the Samilson-Prieto classification; κ = 0.83 and κ = 0.67 for the grading of the Bigliani classification, respectively). CONCLUSION: In this proof-of-concept study, clinically relevant features of the shoulder joint were assessed reliably using MR-derived CT-like images and simulated radiographs with an image quality equivalent to conventional radiographs. MR-derived CT-like images and simulated radiographs may provide useful diagnostic information while reducing the amount of radiation exposure.

Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial.

BACKGROUND: Elective implant removal (IR) accounts for up to 30% of all orthopaedic surgeries. While there is general acceptance about the need of implant removal for obvious reasons, such as infections or implant failure, little is known about the beneficial aspects in cases of minor reasons such as patients' wish for IR. Therefore, we initiated this study to define patients' benefit of elective implant removal following plate osteosynthesis of displaced clavicle fractures. PATIENTS AND METHODS: Prospective evaluation of patients was conducted before implant removal and 6 weeks postoperative. Subjective and objective criteria included pain rating on a visual analogue scale (VAS) and active range of motion (ROM) pre- and 6 weeks postoperative. Functional scoring included Constant-Murley Score, DASH (Disabilities of Arm, Shoulder and Hand Score), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index). RESULTS: 37 patients were prospectively enrolled in this study and implant removal was performed after 16 ± 6.1 months. No re-fractures nor other complications were detected during routine follow up. Functional outcome increased through all scores (Constant score 73.3 ± 14.6 preoperative to 87.4 ± 12.0 postoperative (p = 0.000), MSQ 85.0 ± 7.3 preoperative to 91.8 ± 9.0 postoperative (p = 0.005), DASH Score 7.4 ± 8.2 preoperative to 5.7 ± 9.5 postoperative (p = 0.414), SPADI 93.4 ± 6.6 preoperative to 94.0 ± 10.1 postoperative (p = 0.734). CONCLUSIONS: Discomfort during daily activities or performing sports as well as limited range of motion were the main reasons for patients' wish for implant removal. We found increased functional outcome parameters and decreased irritation after implant removal. Therefore we suggest implant removal in case of patients' wish and completed fracture consolidation. TRIAL REGISTRATION: Trial registration no: NCT04343118, Retrospective registered: www.clinicaltrials.gov .

Is the Use of Segways or E-Scooters in Urban Areas a Potential Health Risk? A Comparison of Trauma Consequences.

Background and objectives: Electromobility has become increasingly popular. In 2001, Segway personal transporters (Segway) were established for tourists, and e-scooters have been in use since their approval in 2019. The aim of this study was to analyze and compare the types of injuries directly related to the use of Segways and e-scooters, respectively, in a German city and to phrase potential safety advice. Materials and Methods: All patients presenting to our emergency department after Segway incidents were retrospectively analyzed and compared with the prospectively collected cohort of patients following e-scooter incidents. Presented injuries were analyzed by body region and injury severity score (ISS). Epidemiological data were collected. Results: Overall, 171 patients were enrolled. The Segway group included 56 patients (mean age 48 years), and the e-scooter group consisted of 115 patients (mean age 33.9 years). Head injuries (HI) occurred in 34% in the Segway group compared to 52% in the e-scooter group. The ISS was approximately equal for both groups (mean ISS Segway group: 6.9/e-scooter group: 5.6). Conclusions: Since the e-scooter group presented a high number of HI along with a higher likelihood and greater severity of HI, mandatory use of helmets is suggested.

CT-like images based on T1 spoiled gradient-echo and ultra-short echo time MRI sequences for the assessment of vertebral fractures and degenerative bone changes of the spine.

OBJECTIVES: To evaluate the performance of 3D T1w spoiled gradient-echo (T1SGRE) and ultra-short echo time (UTE) MRI sequences for the detection and assessment of vertebral fractures and degenerative bone changes compared with conventional CT. METHODS: Fractures (n = 44) and degenerative changes (n = 60 spinal segments) were evaluated in 30 patients (65 ± 14 years, 18 women) on CT and 3-T MRI, including CT-like images derived from T1SGRE and UTE. Two radiologists evaluated morphological features on both modalities: Genant and AO/Magerl classifications, anterior/posterior vertebral height, fracture age; disc height, neuroforaminal diameter, grades of spondylolisthesis, osteophytes, sclerosis, and facet joint degeneration. Diagnostic accuracy and agreement between MRI and CT and between radiologists were assessed using crosstabs, weighted κ, and intraclass correlation coefficients. Image quality was graded on a Likert scale. RESULTS: For fracture detection, sensitivity, specificity, and accuracy were 0.95, 0.98, and 0.97 for T1SGRE and 0.91, 0.96, and 0.95 for UTE. Agreement between T1SGRE and CT was substantial to excellent (e.g., Genant: κ, 0.92 [95% confidence interval, 0.83-1.00]; AO/Magerl: κ, 0.90 [0.76-1.00]; osteophytes: κ, 0.91 [0.82-1.00]; sclerosis: κ, 0.68 [0.48-0.88]; spondylolisthesis: ICCs, 0.99 [0.99-1.00]). Agreement between UTE and CT was lower, ranging from moderate (e.g., sclerosis: κ, 0.43 [0.26-0.60]) to excellent (spondylolisthesis: ICC, 0.99 [0.99-1.00]). Inter-reader agreement was substantial to excellent (0.52-1.00), respectively, for all parameters. Median image quality of T1SGRE was rated significantly higher than that of UTE (p < 0.001). CONCLUSIONS: Morphologic assessment of bone pathologies of the spine using MRI was feasible and comparable to CT, with T1SGRE being more robust than UTE. KEY POINTS: • Vertebral fractures and degenerative bone changes can be assessed on CT-like MR images, with 3D T1w spoiled gradient-echo-based images showing a high diagnostic accuracy and agreement with CT. • This could enable MRI to precisely assess bone morphology, and 3D T1SGRE MRI sequences may substitute additional spinal CT examinations in the future. • Image quality and robustness of T1SGRE sequences are higher than those of UTE MRI for the assessment of bone structures.

Excellent clinical and radiological outcome following locking compression plate fixation of displaced medial clavicle fractures.

BACKGROUND: Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. Aim of this study was to evaluate the clinical and radiological outcome following operative treatment of displaced medial end clavicle fractures. METHODS: Patients who presented with a displaced fracture of the medial clavicle between September 2012 and December 2019 were retrospectively enrolled in this study. All patients were operatively treated with open reduction and internal fixation (ORIF) using an anatomically precontoured locking compression plate (LCP) originally designed for the lateral clavicle (Synthes®, Umkirch, Germany). Functional outcome was recorded using the American Shoulder and Elbow Surgeons (ASES) Score, the Munich Shoulder Questionnaire (MSQ), Shoulder Pain and Disability Index (SPADI) and Constant Score. RESULTS: Overall 18 patients with a mean age of 54.5 ± 23.5 years suffering from a displaced fracture of the medial clavicle were identified. The mean follow-up was 40.9 ± 26.2 months. The mean ASES accounted for 88.3 ± 20.8 points, the mean MSQ was 83.1 ± 21.7 points, the mean SPADI was 85.6 ± 22.5 and a mean normative age- and sex-specific Constant Score of 77.5 ± 19.1 points resulted. No minor or major complications were observed. Radiologic fracture consolidation was achieved in all patients after a mean of 6.4 months. CONCLUSION: Surgical treatment of displaced medial clavicle fractures using an anatomically precontoured locking plate originally designed for the lateral clavicle led to very good to excellent clinical and functional results. TRIAL REGISTRATION: No: DRKS00024813 , retrospectively registered 19.03.2021 ( www.drks.de ).

Is early full weight bearing safe following locking plate ORIF of distal fibula fractures?

BACKGROUND: In the modern western world appraisal of economical points such as treatment and disability after trauma present a financial burden. In this context open reduction internal fixation techniques allowing for early full weight bearing might not only improve the clinical outcome but also shorten the period of disability in working life. The aim of the study was to analyze whether ORIF of ankle fractures using either a standard semitubular plate or a new polyaxial locking plate system result in a better clinical outcome. METHODS: In this prospective study, all patients with distal fibula fractures (AO 44 B1.1, B1.2, B1.3), with indication for surgery were included. Patients were randomized to either the DePuy Synthes® one-third semitubular plate (Group I) or NEWCLIP TECHNICS, Active Ankle® polyaxial locking plate (Group II). Primary outcome parameter was function of the ankle joint, assessed by the Olerud and Molander ankle score, Foot and Ankle outcome score and Karlsson and Peterson Scoring System for Ankle function. Secondary outcome parameter were postoperative complications. Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations were considered as minor and deep wound infection, material loosening, loss of reduction were regarded as major complications requiring revision surgery. Clinical and radiological follow-up were performed 6 and 12 weeks, 6 months and 1 year postoperatively. RESULTS: Fifty-two patients (31 W/21 M) with a mean age of 43 yrs. (range 22-64 yrs.) were enrolled. Seven patients (13.5%) were excluded, so that 45 patients were available for follow up. Twenty-five patients were treated with DePuy Synthes® one-third semitubular plate (55.6%; group I) while 20 patients received an anatomically preformed polyaxial locking plate (44.4%, group II). Four minor complications occurred in Group I (16%) compared to two minor complications in group II (10%). Significant better clinical results regarding OMAS (p < 0.02, < 0.04), KPSS (p < 0.04) and FAOS (p < 0.02, < 0.03) were observed 6 and 12 weeks after surgery in group II. CONCLUSIONS: The results of the presented study demonstrate a significant better clinical functional outcome in the early postoperative follow-up in patients treated with a polyaxial locking plate. Furthermore, our data show that ORIF using polyaxial locking plates in combination with an early postoperative weight bearing presents a safe, stable treatment option for ankle fractures so that patients benefit especially in the early stages of recovery. TRIAL REGISTRATION: Registered 20 April 2020, retrospectively on ClinicalTrails.gov ( NCT04370561 ).

[E-scooter accidents and their consequences : First prospective analysis of the injury rate and injury patterns in the urban area of a German city with over 1 million residents]. / E-Scooter-Unfälle und deren Folgen : Erste prospektive Analyse der Verletzungsrate und Verletzungsmuster im urbanen Raum einer deutschen Millionenstadt.

BACKGROUND: Since their approval in Germany in June 2019 e­scooters have become increasingly more popular; however, with growing popularity and easy access for everybody the number of accidents has increased, sometimes even resulting in severe injuries. OBJECTIVE: The purpose of this study was to collect demographic data and analyze injury patterns of accidents due to e­scooter use in a large German city and to give suggestions on future safety concepts and rules of conduct. METHODS: All patients who presented at the interdisciplinary emergency room of the Klinikum rechts der Isar, University hospital of the Technical University in Munich between 1 July 2019 and 1 April 2020 after suffering an e­scooter accident were included in this study. Demographic data as well as information with respect to the trauma mechanism were prospectively collected. RESULTS: During the study period 60 patients were identified of which 34 (56.7%) were male with an average age of 34.7 years (range 18-73 years) at the time of the accident. Of the patients 22 rode the e­scooter under the influence of alcohol and only 1 wore a helmet. The head was the most injured body region, followed by the upper and lower extremities and 2 (3.3%) patients were severely injured with an injury severity score (ISS) ≥16. CONCLUSION: Due to the growing popularity of e­scooter use more injuries have been registered. The head was the most affected body region, therefore emphasis should be put on wearing a helmet. Furthermore, strict rules and more police controls should take place to identify and reduce the number of accident victims under the influence of alcohol.

Excellent clinical outcome and low complication rate after proximal hamstring tendon repair at mid-term follow up.

PURPOSE: Proximal hamstring tendon avulsions lead to a significant loss of strength and a functional deficit of the respective lower limb and surgery is the recommended treatment. Only little is known about the clinical outcomes and complications when comparing acute and chronic management as well as partial and complete tears. Therefore, the purpose of this study was to investigate the clinical results and the complication rate of patients after surgical treatment of proximal hamstring tendon injuries. It was hypothesized that surgical treatment of an acute proximal hamstring avulsion would lead to a superior clinical outcome with a low complication rate and high return to sports rate compared to chronic cases and partial avulsions. METHODS: Patients who underwent proximal hamstring tendon repair between 2008 and 2015 were retrospectively evaluated with a minimum follow up of 2 years. Outcome measurements were obtained by means of Lysholm score, Harris Hip Score, Visual Analog Scale, and Tegner Activity Scale. Return to sports (RTS) rate was determined. Postoperative adverse events were recorded and complications reported. Patients' outcomes were compared between acute/chronic repair and partial/complete injury patterns. RESULTS: Ninety-four of 120 (78.3%) were available for final assessment at a mean follow-up of 56.2 ± 27.2 months. Clinical outcome measures were excellent and did not differ between the treatment groups or between the different injury patterns. RTS was achieved by 86.2% of the patients and was significantly superior after acute treatment (p < 0.05). The overall complication rate was 8.5% and significantly higher in complete tears compared to partial tears and in delay compared to acute surgery (p < 0.05). CONCLUSION: Surgical treatment of proximal hamstring tendon avulsions results in excellent clinical outcome scores and a high RTS rate. Open surgical treatment has shown to be a safe procedure with a low complication rate. Surgical timing is important, as early surgical intervention provides a higher RTS rate and a lower complication rate than delayed surgery and should therefore be preferred in clinical practice. Repair of partial and complete tears lead to similar clinical outcome, but a higher complication rate in complete avulsions. LEVEL OF EVIDENCE: Level IV.

Correction to: No added value using SPECT/CT to analyze persistent symptoms after anterior cruciate ligament reconstruction.

The shared first authorship of Christian Egloff, MD and Lukas Huber was always planned and correctly acknowledged.

No added value using SPECT/CT to analyze persistent symptoms after anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the diagnostic and clinical value of SPECT/CT compared to the standard algorithm for patients with persistent symptoms after anterior cruciate ligament reconstructions. The standard algorithm uses clinical information, conventional radiographs, MRI and CT scan, while the trial algorithm uses the same information but SPECT/CT in addition. METHODS: In a diagnostic comparative trial three experienced surgeons evaluated 23 consecutive patients with persistent symptoms after ACL reconstruction using first standard and second the trial algorithm with a time interval. Each rater had to establish a diagnosis and therapeutic decision with each algorithm. On MRI, graft continuity, bone marrow edema, chondral and meniscal lesions, femoral notch osteophytes were evaluated. Bone tracer uptake in SPECT/CT was anatomically analyzed and compared with MRI findings. MRI findings and SPECT/CT tracer uptake were correlated using Spearman's rho test. RESULTS: Additional SPECT/CT analysis did not change diagnosis in any case and did not correlate with clinical graft integrity. Treatment decisions remained unchanged as well. Chondral lesions, arthritic changes, meniscal lesions, graft impingement are best visualized in MRI and showed correspondent tracer uptake in SPECT/CT. Tunnel position was well classified with standard CT scan and showed no correlation with SPECT/CT tracer uptake. CONCLUSION: Information derived by SPECT/CT in addition to the standard algorithm using clinical information, X-rays, MRI, and CT scan did not change the diagnosis or treatment plan. There is currently no justification to implement SPECT/CT for patients with persistent symptoms after anterior cruciate ligament reconstructions. LEVEL OF EVIDENCE: Level II: diagnostic comparative study.

Reduction Osteotomy of the Prominent Tibial Tubercle After Osgood-Schlatter Disease.

PURPOSE: To evaluate the functional and clinical outcome of a new closing-wedge osteotomy for the prominent tibial tubercle after Osgood-Schlatter disease. METHODS: Between 2010 and 2014, 7 consecutive adults (mean age, 28.6 years; range, 26-35 years) were treated by closing-wedge reduction osteotomy of a painful tibial tubercle. All patients had prior nonsurgical and surgical treatment. Preoperative and postoperative tubercular prominence, Caton-Deschamps index for patellar height, the Kujala Anterior Knee Pain Scale, Lysholm Knee Score as well as visual analog scale score and Tegner activity scores were recorded. RESULTS: Mean follow-up after reduction osteotomy was 31.3 months (27-41 months). The bony prominence of the tibial tubercle was significantly reduced (mean 8 mm, P < .001) and the Caton-Deschamps index was lowered from 1.29 to 1.09 (P < .001). From preoperative to last follow-up, the Kujala Anterior Knee Pain Scale increased from 54.71 preoperative to 84.71 (P < .001); the Lysholm Knee Score improved from 72.42 to 94.14 (P < .001); the Tegner activity score increased from 3.1 to 5.7 (P < .001), whereas the visual analog scale significantly decreased from 5.8 to 1.2 (P < .001). No complications were recorded, and all patients were satisfied with clinical outcome. CONCLUSIONS: Closing-wedge osteotomy of the tibial tubercle effectively reduced the bony prominence after Osgood-Schlatter disease and consecutively improved the outcome in terms of knee pain and function. Thus, we can recommend this procedure in selected patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Functional Postoperative Outcome for 92 Cases of Radial Head Fractures: A PROM-Based Retrospective Study.

Background: Fractures of the radial head are common injuries, whereas, in the case of displaced fractures, surgical treatment using screw or plate osteosynthesis, excision, or replacement of the radial head is required. However, data about patient-related outcomes (PROM) for different types of radial head fractures is limited in the current literature. Therefore, this study was conducted to evaluate the functional outcome after operatively treated radial head fractures and to further correlate these results with the initial modified Mason classification. Methods: In this retrospective study, all suitable patients with surgical treatment of a radial head fracture were identified. Only patients with Mason II-IV fractures were included. All patients completed the Elbow Self-Assessment Score (ESAS) questionnaire. Data on fracture classification, type of surgery, and revision operations (if needed) were assessed. Results: A total of 92 patients suffering from fractures of the radial head (57 Mason II, 35 Mason III-fractures) who were operatively treated at our institution were enrolled. There were 42 (47.7%) female and 50 (54.3%) male patients with an average age of 47.5 ± 14.1 years. Screw osteosynthesis was performed in 67 patients, plate osteosynthesis in 20 patients, and five patients received radial head arthroplasty. The average ESAS score accounted for 89.7 ± 16.7. Mason II fractures showed significantly better functional results with higher ESAS scores (92.3 ± 13.9 vs. 85.4 ± 20.1) as well as significantly lower rates of necessary implant removal (0 vs. 5 (14.3%) than Mason III fractures. Screw osteosynthesis showed significantly better functional ESAS scores, 91.0 ± 16.5, than plate osteosynthesis, with 85.3 ± 17.6 (p = 0.041), but was predominantly used in Mason II fractures. Conclusions: Surgical treatment using screw- and plate osteosynthesis of radial head fractures provides a good overall outcome. The postoperative function is associated with the initial Mason classification as the patients' reported outcome was worse in Mason III fractures compared to Mason type II fractures. In this context, the ESAS score can be considered a useful tool for the assessment of the patient-based functional outcome.

High return to sports rates after operative treatment of patella fractures.

BACKGROUND: Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. METHODS: This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. RESULTS: Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). CONCLUSION: The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).

Reply to Martetschläger, F.; Wahal, N. Comment on "Feuerriegel et al. Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging. Diagnostics 2022, 12, 2345".

We would like to thank you for your kind letter and thoughtful comments [...].

[Analysis of 6851 foot and ankle injuries from 2010-2017 in an emergency department]. / Analyse von 6581 Fuß- und Sprunggelenkverletzungen einer Notaufnahme im Zeitraum von 2010­2017.

BACKGROUND: Foot and ankle injuries are among the most common lesions in traumatology, accounting for more than one in ten human fractures. The aim of this study was to investigate the demographic changes of patients with foot and ankle injuries, the temporal occurrence and the development over the years in an emergency department. MATERIAL AND METHODS: Retrospective study of patients treated for foot and ankle injuries in the emergency department from 2010-2017. Patients were identified by ICD codes and demographic changes, temporal occurrence and the development over the years were analyzed. Using quantile-quantile plots, continuous variables were tested for normal distribution and, if applicable, tested for significance using t­tests or non-parametric Mann-Whitney U­tests. RESULTS: A total of 6581 foot and ankle injuries were included in the analysis. The mean age of patients with a foot fracture was 39 ± 17.4 years and with an ankle fracture 47 ± 19.2 years (p < 0.001). Ligamentous ankle injuries occurred particularly in younger patients during the summer months. The age distribution of ankle fractures showed a peak incidence between 30-39 years of age for men and an increased occurrence in women over 50 years. In the age group between 65 and 75 years trimalleolar ankle fractures represented the second most common ankle fracture. Fractures of the foot most commonly affected patients aged 20-29 years, with a second peak incidence in women between the ages of 50 and 59 years. CONCLUSION: Ligamentous injuries of the ankle joint are common injuries in the emergency department and affect mainly younger patients. Ankle fractures showed a bimodal age distribution for women and especially bimalleolar and trimalleolar fractures were more common in women aged 65 years and older. Because of the increased prevalence of foot and ankle fractures in older women, further osteoporosis evaluation should be initiated in this patient population.

Standalone Axial Malrotation after Pediatric Supracondylar Fracture Does Not Seem to Be an Indication for Immediate Postoperative Revision Surgery.

Rotational spurs as evidence for post-surgical malrotation are frequently observed when treating pediatric supracondylar humeral fractures (SCHFs). This study aimed to investigate the long-term outcome of a pediatric cohort with unrevised axial malrotation and to discuss the indication for revision surgery. Postoperative radiographs of children treated for SCHFs over eight years were retrospectively analyzed. Children with radiological signs of malrotation (von Laer malrotation quotient) were invited for a follow-up clinical and radiological examination. Among 338 treated children, 39 (11.5%) with a mean age of 5.3 years (range 1.8-11.7 years) showed radiological signs for postoperative malrotation and were not revised and therefore invited to participate in the study. Twelve patients (31%) with a mean age of 11.3 years (range 8.8-13.8 years) took part in the follow-up examination after a mean of 7.1 years (range 5.4 to 11.3 years). The mean postoperative van Laer malrotation quotient was 0.15 (range 0.11-0.2). At follow-up, the range of motion of the elbow joint was not significantly different compared to the contralateral side. Apart from the humeral ulnar angle (p = 0.023), there were no significant differences in the radiological axes. The Flynn criteria were excellent and good in 90% of the cases. The mean was 1.7 points indicating excellent subjective results. Standalone postoperative malrotation did not lead to an adverse long-term outcome in a small cohort of pediatric patients with SCHFs and did not indicate immediate postoperative revision surgery. However, further investigations with larger cohorts should verify whether additional criteria such as stability of the osteosynthesis and signs for increasing valgus or varus displacement in the follow-up radiographs should get more importance in decision making.

Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients.

PURPOSE: Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients' frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. METHODS: A retrospective, multicenter study in the period 2009-2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. RESULTS: A total of 129 patients with a mean age of 79 years (range 43-102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21-10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. CONCLUSION: Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.