Increased Demand for Pharmaceutical Drugs Containing Potassium Iodide In Connection with the Russia-Ukraine Conflict.

The current conflict between Russia and Ukraine increased concerns in the German population of a release of radioactive substances, e.g.radioactive iodine. A high dose of potassium iodide (PI) may prevent accumulation of radioactive iodine in the thyroid gland. Therefore, the German government keeps a sufficient quantity of PI in stock for public supply in case of an emergency. We investigated ambulatory drug dispensing rates of PI and found that the total dispensing of PI (statutory health insurance (SHI), private health insurance (PHI), and overthe-counter (OTC)) increased by 106% from February to March 2022. Changes in PI dispensing were mainly due to an increase in OTC sales, where PI as an antidote showed a sevenfold increase from around 930 packages (February 2022) to 6,500 packages (March 2022), while SHI and PHI dispensing remained relatively low. Furthermore, we investigated whether these changes in dispensing raised the number of suspected adverse drug reactions (ADR). We found no increase of ADR reports related to the use of PI-containing medicinal products between February and September 2022, neither in our national pharmacovigilance nor in the European EudraVigilance database. The data suggest that the mere possibility of a nuclear disaster in Ukraine raised the demand of PI in Germany. Thus, timely and proactive information and reassurance of the public of supply reliability by the Government in a case of a nuclear emergency could be helpful in preventing potential drug shortages and unfounded concern.

The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature.

BACKGROUND: Drug-induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side-effect of systemic drugs, reliable data on its actual incidence are lacking so far. OBJECTIVES: A possible approach to evaluate the real-life extent of drug-induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical 'heatmap' of photosensitivity. METHODS: The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance-based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature. RESULTS: This analysis includes means of 632 826 944 (+/-14 894 918) drug dispensings per year in DE and 113 270 754 (+/-1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side-effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.

Post-mortem analysis of prescription opioids-A follow-up examination by LC-MS/MS with focus on fentanyl.

Our aim was to investigate the reason for relatively low detection rates for opioids and fentanyl in particular in post-mortem cases in the State of Hamburg. We re-analysed 822 blood samples from two different time periods, 2011/12 and 2016. These samples had been previously analysed in accordance with post-mortem routine by a case selected strategy. All samples were re-analysed with an LC-MS/MS method specific for prescription opioids. The main point in the evaluation was to determine whether the previous analysis strategy had led to underreporting of drug-related deaths (DRD), especially with regard to fentanyl. Another aim was to evaluate changes in prescribing prevalence of opiates and opioids. We compared pharmacy claims data in Hamburg with Germany. The analyses showed that the number of DRD remained unaffected by the new analytical strategy. Detection rates in DRD, however, increased for fentanyl 3.4-fold from 1.2% to 4.1%, buprenorphine from 5.9% to 7.6%, oxycodone from 0% to 1.8%, tilidine from 1.8% to 2.4%. The most frequently detected opioids in DRD cases were methadone (39.4%) and heroin (20%). Prescription rates between 2011-2017 decreased in Hamburg for nearly all opioids, morphine by - 43.5%, buprenorphine - 43%, codeine - 57%, fentanyl - 25%, tilidine -17%, tramadol - 31%, and hydromorphone -6%. Oxycodone, tapentadol, and piritramide prescription rates increased. For Germany, a decrease in the prescription rates for fentanyl was also found during this period (-12.9 %), although not as pronounced as in Hamburg. Prescription rates for methadone were three to greater than five times higher in Hamburg as compared to the German average due to the higher number of substituted persons per inhabitant. Conclusion: Despite the global problem of opioid abuse, there are significant regional differences in the nature and extent of opioid abuse. It is necessary to collect data at the national level to develop appropriate prevention strategies.

Posterolateral plate fixation with Talarlock® is more stable than screw fixation in ankle arthrodesis in a biomechanical cadaver study.

BACKGROUND: A number of studies report on limitations of the screw arthrodesis in severe malalignment of the hindfoot, neuropathic deformity, poor bone quality and osteoporosis. METHODS: Fourteen anatomically correct polyurethane foam models of the right leg (Sawbones Europe, Malmö, Sweden) and eighteen fresh-frozen human lower leg specimens (9 pairs) were used for the comparative biomechanical testing. RESULTS: The statistical analysis of the stiffness of the fixation developed a significant difference in favor of the plate in all test directions. CONCLUSIONS: The excellent biomechanical results are very promising and we hope for a reduction of the pseudarthrosis rate and shorten the postoperative treatment phase.

[Bootcamp: longitudinal gender-based surgical and clinical skills training]. / Bootcamp ­ Longitudinaler "Skills-Kurs" zur Vermittlung klinischer und operativer Fertigkeiten : Unter Berücksichtigung geschlechtsspezifischer Unterschiede.

BACKGROUND: Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented. OBJECTIVES: Description of an innovative longitudinal gender-based surgical and clinical skills training course. METHODS: An elective 5-day modular skills course is offered for third to fifth year medical students. Module 1 aims at teaching basic surgical and communication skills involving local and regional anesthesia, initial experience with arthroscopy, fracture fixation, emergency measures as well as communication skills training using standardized patients. The subsequent modules cover surgical knowledge and skills of increasing complexity. The main goals are to increase the interest in orthopedic trauma surgery and to reduce concerns regarding discrimination and gender-related issues. Learning outcomes are assessed using a 6-item multiple choice questionnaire (MCQ) and a 3-stage objective structured clinical examination (OSCE) regarding induction of anesthesia, arthroscopy simulation and communication skills. RESULTS: A total of 52 second year medical students (39 females, 13 males) completed module I. There were no differences between men and women with regard to the MCQ and anesthesia and communication skills; however, male students scored significantly higher in the arthroscopy test. All students rated the course as being highly effective in terms of acquisition of knowledge and skills. Almost all participants would recommend the course to fellow students and 70 % of participants stated they would participate in the advanced courses. Female participants in particular reported a marked increase in interest in orthopedic trauma surgery and less concerns regarding discrimination and gender-related issues. CONCLUSION: The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.

[Manifestation of Dupuytren nodules following fracture of the distal radius]. / Dupuytrenknotenbildung nach Operation einer distalen Radiusfraktur.

PURPOSE: The aim of this study is to evaluate the incidence of post-traumatic development of Dupuytren nodules in distal radius fractures treated operatively. PATIENTS AND METHODS: In 2 prospective randomised studies for operative treatment of distal radius fractures, the formation of Dupuytren nodules was registered. One of the exclusion criteria was a pre-existing Dupuytren's disease at the date of trauma. In addition to the notification of the development of Dupuytren nodules, signs of a complex regional pain syndrome were registered as well as the wrist function, level of pain and grip strength. The Castaing and the Gartland and Werley scores were assessed. The clinical outcomes of patients with and without Dupuytren nodules were compared. 239 of 275 (87%) of the patients could be examined 1 year after the operation, consisting of 32 men and 207 women with a median age of 64.2 years. The patients with Dupuytren nodules were re-evaluated after 16-60 months (median 41.8) for progression of the disease. RESULTS: 21 patients (8.7%) developed changes of the palmar aponeurosis. In 20 patients nodules were stated, one patient showed a cord at the fourth ray of the injured hand. 19 out of 21 patients were female (90.5%). At re-evaluation after 41.8 months (16-60) progression could not be noted nor could similar changes be seen on the contralateral side. Patients with Dupuytren nodules were not handicapped in their hand function. 3 patients (14.3%) revealed a positive family history for Dupuytren's disease. Abuse of alcohol or diabetes was not present in any of the patients with Dupuytren nodules, 7 (33%) were smokers. CONCLUSION: The occurrence of Dupyutren nodules can be triggered by a trauma or operation. It may be speculated that these nodules are an entity of their own as no progression of the contracture could be seen during the follow-up period.

[Biaxial reconstruction nail for pertrochanteric femoral fractures. Osteosynthesis]. / Biaxialer Rekonstruktionsnagel für pertrochantäre Femurfrakturen. Osteosynthese.

BACKGROUND: The steady rise in life expectancy of our population leads to an exponential increase in proximal femoral fractures. The growing increase of comorbidities in these patients requires continuous development of modern implant systems for internal fixation of proximal femoral fractures. MATERIALS AND METHODS: In this study we enrolled 116 patients with pertrochanteric femoral fractures who were treated with a proximal femoral nail (Targon PF, Aesculap) over a period of 1 year. The indications for this implant system were set at unstable fracture types. Data of the operative and postoperative course were collected prospectively. RESULTS: The average age of the 116 predominantly female subjects was 77±14 years and the most commonly observed fracture subtype was 31-A1.2. The follow-up rate was 55 %. We observed a decrease in the postoperative modified Harris hip score of 22.7 %. The 1-year mortality was 21.6 %. CONCLUSIONS: The results of this study showed a low rate of perioperative complications and implant loss anda decline in patient mobility was typically observed within 1 year.

[Fractures of the proximal humerus in the elderly : Osteosynthesis versus joint replacement]. / Frakturen des proximalen Humerus im hohen Lebensalter : Osteosynthese versus Gelenkersatz.

BACKGROUND: Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly. OBJECTIVES: This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations. METHODS: The published scientific data were reviewed and current opinion available to guide patient care are presented. RESULTS: The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis. CONCLUSION: Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.

[Malunion of the distal radius - long-term results after extraarticular corrective osteotomy]. / Die fehlverheilte distale Radiusfraktur - Langzeit-ergebnisse nach extraartikulärer Korrekturosteotomie.

BACKGROUND AND PURPOSE: Numerous reports on short- and mid-term results demonstrate the value of corrective osteotomies for malunion of the distal radius. However, only long-term results can show whether a procedure has stood the test of time. Therefore the main questions to be answered in this article are: (i) are clinical and radiological improvements, recorded at short- and mid-term follow-up, long lasting? (ii) are consecutive procedures required, especially salvage procedures?; and (iii) what about the development of post-traumatic osteoarthritis? PATIENTS AND METHODS: The study is based on the prospective data of 17 patients who underwent an extraarticular corrective osteotomy of the distal radius for symptomatic malunion (13 dorsal and 4 palmar malunions) between August 1992 and August 2003. The corrective osteotomy was performed as an opening wedge osteotomy filling the gap with an iliac crest bone graft and stabilisation of the radius with a plate. In 16 patients the radius was approached from palmar, in one patient the approach was dorsal. Preoperative, at short-term and at long-term postoperative follow-up clinical and radiological examinations were performed. In dorsal malunion the mean short-term follow-up was 17±10 (range: 7-44) months, and the mean long-term follow-up was 157±51 (120-254) months. In palmar malunion, the short-term follow-up averaged 13±6 (7-20) months, and the long-term follow-up 150±10 (138-166) months. RESULTS: All osteotomies showed bony union. One patient had to be excluded from the long-term evaluation due to wrist fusion and ulnar head hemiresection after 15 years. After dorsal malunion the long-term results showed a lasting improvement for all parameters. A comparison of short-term and long-term results revealed no deterioration of the results but a further statistically significant improvement in grip strength. 7 patients had no osteoarthritis, 3 osteoarthritis 1°, 1 osteoarthritis 2°, and 1 osteoarthritis 3°. After palmar malunion improvements occurred and lasted in the long-term run, but were not statistically significant. In this group no osteoarthritis was present. CONCLUSION: Corrective osteotomy for malunion of the distal radius has stood the test of time even in the long-term course. Even from this point of view, it can be recommended.

Osseofix® system for percutaneous stabilization of osteoporotic and tumorous vertebral compression fractures - clinical and radiological results after 12 months.

PURPOSE: Determining whether implantation of an expandable titanium mesh cage (Osseofix® system) is a successful and safe minimally invasive therapy for osteoporotic and tumorous vertebral compression fractures (VCFs). MATERIALS AND METHODS: 32 patients (25 women, 7 men, mean age 71) with 46 osteoporotic or tumorous VCFs (T6 to L4) from June 2010 to January 2012 were included. All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). The clinical and radiological results were evaluated preop, postop and 12 months postop based on the visual analog scale (VAS) and the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT. RESULTS: There was a significant improvement in pain intensity (VAS) (7.8 to 1.6) as well as a significant reduction in the mean ODI (71.36 % to 30.4 %) after 12 months. The mean kyphotic angle according to Cobb showed significant improvements (12.3° to 10.8°) after 12 months. Postinterventional imaging showed one case of loss of height in a stabilized lumbar vertebral body (2.2 %) in osteoporosis and one case with adjacent fracture (2.2 %) in osteoporosis. We saw no changes in the posterior vertebral wall. Except for one pronounced postoperative hematoma, we saw no surgical complications including no cement leakage. CONCLUSION: The clinical mid-term results are good at a low complication rate. The stabilization of symptomatic osteoporotic and tumorous VCFs with the Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation. KEY POINTS: • The Osseofix® system is well suited for stabilizing osteoporotic and tumorous VCFs.• It is a safe and effective procedure without cement leakage and with a low complication rate.• The procedure is an interesting alternative to established cement augmentation procedures.

Fracture near press-on interlocking enhances callus mineralisation in a sheep midshaft tibia osteotomy model.

INTRODUCTION: Factors which impair fracture healing after intramedullary (IM) nailing of long bone fractures range from surgical and biological factors to mechanical parameters. Mechanical parameters known to prolong bony consolidation are share forces at the site of the fracture. Fracture near press-on interlocking reduces share forces directly at the fracture site and is hypothesised to enhance callus mineralisation. A sheep model of midshaft tibia osteotomies evaluates the technique. MATERIALS AND METHODS: Fracture near interlocking was achieved by surfacing a custom made nail with special hutches that enable firm screw seating on top of the nail ("golf ball" structure). Virtual (fine element analysis (FEA)) and biomechanical pilot tests were completed before in vivo application in 12 adult female German black sheep. Midshaft tibia osteotomy was performed creating a subcritical 7 mm gap for delay in union. One group (n=6) was treated with reamed IM nailing employing the custom made nail and in addition to proximal and distal standard interlocking a fracture near press on interlocking was employed. A second group of six sheep without additional press on interlocking served as control. 10 weeks after operation the quality of fracture healing was determined by micro-CT. RESULTS: The FEA showed that axial loading up to 4000N did not lead to implant fatigue. Fracture near press on interlocking led to significantly more callus mineralisation compared to the conventional interlocking procedure (0.567 g/cm(3) ± 0.106 g/cm(3) versus 0.434 g/cm(3) ± 0.0836 g/cm(3), p=0.043). CONCLUSIONS: Fracture near press on interlocking increases callus mineralisation in a subcritical osteotomy model in sheep. The results indicate that the reduction of share forces at the fracture site after nailing procedures may be effective in reducing the time until bony consolidation.

[Ankle arthrodesis with an posterolateral approach using a polyaxial angle stable Talarlock® plate]. / OSG-Arthrodese über einen posterolateralen Zugang mit der polyaxial-winkelstabilen Talarlock®-Platte.

OBJECTIVE: Safe arthrodesis of the ankle as well as load carrying capacity free of pain. INDICATION: Painful arthritis of the ankle joint occurring idiopathic or posttraumatic, resulting from rheumatoid arthritis or neuromuscular diseases. Extensive bony defects in varus or valgus ankle deformities and after failed prosthesis. Complex hindfoot deformities in neurological disease, paralysis and instabilities. Joint destruction after infection. CONTRAINDICATIONS: Active osteitis, extensive skin ulcers in the approach area, periphery artery occlusive disease. SURGICAL TECHNIQUE: Posterolateral skin incision. Sparing cartilage resection. Penetrating sclerosis zones. Reorientating anatomic positioning of the talus thereby correcting axis deformities. Talarlock(®) plate positioning and tibiotalar arthrodesis. POSTOPERATIVE MANAGEMENT: Full weight bearing in an arthodesis boot for 6 weeks. After bone grafting partial weight bearing (20 kg) in an arthrodesis boot for 8 weeks. Full weight bearing after 10weeks. RESULTS: Ten patients were operated on using this procedure. The follow-up time was 1 year. There were no complications requiring further surgical procedures. Ankle fusion and a good clinical outcome could be achieved in all cases.

Transplantation of bone: prerequisites for immunologic and inflammatory conditions - an overview.

In this review we have summarized the conditions under which bone grafts have a suitable environment for ingrowth into surrounding bone. Among the topics discussed are the immunological properties of bone and differences between bone grafting and organ transplants. Local osteogenic immune changes following fracture and bone graft transplants are outlined. Moreover, techniques of bone graft harvesting are summarized.

[The role of psycho-oncology in orthopedic tumor centers]. / Stellenwert der Psychoonkologie und ihre Versorgungslage an Zentren für Tumororthopädie.

INTRODUCTION: Psychosocial screening has not been implemented into diagnosis-related guidelines for the treatment of orthopedic tumor patients. The aim of the study was to evaluate the significance of psycho-oncology in orthopedic institutions specialized in musculoskeletal tumors as well as the opinion and clinical experience of the treating physicians. METHODS: In total 60 orthopedic institutions were recruited. Data were assessed and analyzed by a newly developed, standardized questionnaire. To detect specific, demographic differences results were additionally analyzed according to gender, age and professional experience. RESULTS: A total of 118 physicians from 47 institutions participated. Significant differences between professional experience groups were obtained regarding the wish for psychosocial treatment in cases of own illness (p=0.032) and the difficulty of addressing patient feelings (p=0.05). CONCLUSIONS: The majority of orthopedic physicians deemed psycho-oncology important. To ensure a holistic approach to the treatment of orthopedic tumor patients, psycho-oncological aspects should be implemented in diagnosis-related guidelines.

Current concepts review - fractures in the region of the elbow.

Elbow injuries continue to rise with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in specific diagnosis, and therapy. The surgical treatment of trauma to the adult elbow has evolved rapidly in recent years and many useful concepts and techniques have been established. This paper reviews the published scientific data and current opinion available to guide patient care.

[Antibiotic prophylaxis in primary and revision hip arthroplasty: what is the evidence?]. / Antibiotische Infektionsprophylaxe in der Primär- und Revisionsendoprothetik der Hüfte: Was ist erwiesen?

Advances in the perioperative and postoperative management of total joint replacement have led to a steady decrease in the infection rate, which in the case of total hip replacement presently lies between 0.25 and 1%. Unfortunately there is disparity in current practice nationally and internationally, regarding duration, time of application and choice of antibiotics. Currently there are only Level 1a recommendations for primary hip arthroplasty, whereas, due to the heterogeneity and complexity of most revision cases as well as a lack of randomized controlled trials, antibiotic prophylaxis for hip revision arthroplasty is mostly based on the surgeon's preference. In this article the current literature is reviewed and scientifically sound data and recommendations are summarized.

[Undergraduate curricular training in musculoskeletal ultrasound: the impact of preexisting anatomic knowledge]. / Kurrikulare Ultraschallausbildung am Bewegungsapparat: Einfluss der anatomischen Vorbildung auf die Weitergabe von Basis-Skills an der Schulter.

OBJECTIVE: The aim of this study was to evaluate the impact of students preexisting anatomic proficiency to address the fundamental problems related to musculoskeletal ultrasound (MSUS) training by assessing the peer-assisted learning (PAL) system. METHODS: Students without anatomic knowledge (first semester, n = 38) and students in their fourth semester of medical school (n = 49) were randomly assigned to two groups: 1) The PAL group - teaching by a group of three minimally trained student-teachers and 2) the Staff group - students were taught by a group of three ultrasound-experienced operators. Sessions included both a theoretical and a praxis component (DEGUM/EULAR, Toshiba Nemio™ XG, 10 MHz). A multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE) were performed. Qualitative differences were evaluated by the Likert scale. RESULTS: Exposure included three separate lessons (each 120 minutes, 65 minutes of active scanning). The results of the MCQ were better among the fourth semester students than among those without anatomic knowledge (p < 0.001). Among first semester students, the MCQ results were better for those who had been taught by medical staff than for those who had been instructed by means of PAL (4.3 vs. 3.1; p = 0.045). At no point during the practical evaluation did significant differences arise between students of fourth and first semesters after medical staff tutoring (19.6 vs. 19.7 points; p = 0.978). PAL did result in worse results with regard to practical MSUS competence levels in the students possessing no previous knowledge (OSCE score 16.1; p = 0.042). CONCLUSIONS: Although deficits in theoretical knowledge cannot be compensated for, basic MSUS content appears to be adequately transferable to students with limited anatomic knowledge. Thus, an early implementation of MSUS during medical school education would be prudent, provided that the training is performed by an experienced MSUS operator.

Which is the ideal point of time to perform intraoperative 3D imaging in dorsal stabilisation of thoracolumbar spine fractures? A matched pair analysis.

INTRODUCTION: After dorsal stabilisation of vertebral fractures by an internal fixateur the postoperative computed tomography is a standard procedure to control the positions of the pedicle screws, the success of the reposition, the clearance of the spinal canal and to plane an additive secondary ventral stabilisation. An intraoperative scan with a 3D image intensifier may clarify these questions directly after the implantation with the possibility of an immediate correction of the implants. The aim of this study was to find out the optimal point of time to perform an intraoperative 3D scan and if a postoperative computed tomography is dispensable. PATIENTS AND METHODS: Intraoperative 3D scans were carried out on 33 patients with thoracolumbar spine fractures (T11-L5) after bi-segmental fixateur interne montage (Group 1). A matched pair group of 33 patients (Group 2) with a 3D scan after implantation of pedicle screws was built. A postoperative computed tomography of the instrumented spinal section was done in all patients. The following measurements were done in sagittal and axial reconstruction planes and were compared: classification of screw positions, maximal axial diameter of pedicles, cortical perforation of the screws. Additionally in Group 1 the distance between the upper and lower end plates of the injured section, the height of posterior vertebral body wall, the dislocation of the posterior wall and the minimal diameter of the spinal canal were measured. RESULTS: The intraoperative scoring of pedicle screws positions and the measurement of pedicle width showed in both groups a significant accordance with the computed tomography determinations. The measurements "posterior wall dislocation" and "diameter of spinal canal" were only possible in 24 3D scans and showed a significant difference compared with the CT data. The picture quality in Group 2 was scored significantly better than for Group 1 with the complete assembly of the fixateur. CONCLUSION: The ideal point of time for an intraoperative 3D imaging with the present intensifier generation is directly after pedicle screw insertion. The reliable determination of the spinal canal diameter, of posterior wall fragments and of the exact fracture morphology is only possible by postoperative computed tomography.

Is locking nailing of humeral head fractures superior to locking plate fixation?

UNLABELLED: The optimal surgical treatment of displaced proximal humeral fractures is controversial. New implants providing angular stability have been introduced to maintain the intraoperative reduction. In a multi-institutional study, we prospectively enrolled and followed 152 patients with unilateral displaced and unstable proximal humeral fractures treated either with an antegrade angular and sliding stable proximal interlocking nail or an angular stable plate. Fractures were classified according to the Neer four-segment classification. Clinical, functional, and radiographic followups were performed 3, 6, and 12 months after surgery. Absolute and relative (to the contralateral shoulder) Constant-Murley scores were used to assess postoperative shoulder function. Using age, gender, and fracture type, we identified 76 pairs (152 patients) for a matched-pairs analysis. Relative Constant-Murley scores 12 months after treatment with an angular and sliding stable nail and after plate fixation were 81% and 77%, respectively. We observed no differences between the two groups. Stabilization of displaced proximal humeral fractures with either an angular stable intramedullary or an extramedullary implant seems suitable with both surgical treatment options. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.