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Background: Hip fractures typically occur in geriatric patients representing an increasing medical as well as socioeconomic challenge., Patients and Methods: In order to reveal the influence of considerable comorbidities and the time of surgery in the treatment of geriatric hip fractures we analysed patients treated between 1993 and 2008 at a level I trauma centre., Results: 654 patients with isolated hip fractures were included. Surgical treatment was performed with osteosynthetic stabilisation in 55.5 % (n = 363) and with endoprosthetic implants in 44.5 % (n = 291). The presence of pulmonary, psychiatric and metabolic/endocrinological comorbidities resulted in delayed treatment. If an early surgical treatment was performed within the first 12 hours after hospital admission, long-term survival was significantly improved (p = 0.02). A regression analysis revealed a statistical trend towards an increased mortality of 0.2 % per hour delay after hospital admission. The presence of considerable comorbidities and surgical treatment with endoprosthetic implants (odds ratio 1.611) were proven as independent mortality factors., Conclusion: The present study supports the guideline of early surgical treatment of geriatric hip fractures. Emphasising the incidence of in-hospital complications and the mortality after endoprosthetic treatment, osteosynthetic fracture stabilisation should be considered in the presence of considerable morbidity and pre-surgical immobilisation., (Georg Thieme Verlag KG Stuttgart · New York.)

Aim: Quads or all-terrain vehicles do not seem to play a major role either in traffic accidents or in hospital admissions in Germany. However, reports about spectacular quad crashes in the press are not that infrequent. In contrast, no scientific survey or study regarding the issue of quad crashes in Germany has been published so far. Thus, this study aims to evaluate the present incidence of quad crashes, accident circumstances and resulting injury patterns, and to discuss possible consequences., Method: At a level I trauma centre, data from accident and hospital records of quad drivers were analysed focusing on the following parameters: injury type, localisation and mechanism, treatment details, abbreviated injury scale (AIS) score, maximum AIS (MAIS) score, delta-v, collision speed, and other technical parameters. Comparisons to motorcycle accidents were performed. RESULT During a five-year period from 2005 to 2009, there were ten admissions of quad drivers out of around 11 000 emergency trauma patients (0.1 %). Five accidents had happened off-road, four were traffic accidents. Eight patients were male; the mean age was 30 years. The mean total hospital stay was 15 days; there was a mean of 1.5 stays per patients with 2.0 surgical procedures needed. One patient died, only two recovered fully. The accident research data bank revealed 14 cases of quad accidents out of 18 990 (0.1 %). The mean impact velocity was 35 km/h (motorcyclists 40.0 km/h). The most frequent injury mechanism was a collision with a car. The upper extremity was the predominant injured region (AIS 0.7), while it was the lower extremity for motorcyclists (AIS0.91). The maximum AIS were 1.4 in quad drivers and 1.49 in motorcyclists., Conclusions: Although the absolute incidence of quad accidents in Germany is low, they pose a relatively high risk for severe injuries. Possible reasons are the comparatively low active and passive safety of quads as well as limited experience with quad driving and the "fun" aspect which might provoke risky driving behaviour. Larger series from the US report a high incidence of drug abuse among quad casualties as well as very limited use of helmets. In Germany, helmet usage has been mandatory since 2006. Possible additional measures to prevent a rise in quad accidents could be the total prohibition of alcohol consumption for quad drivers as well as special courses or driving licenses or an increase of the legal age for driving quads., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements., Method: Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing on the following parameters: injury type, localisation and mechanism, abbreviated injury scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and compared with those of experienced drivers., Results: In 18 352 accidents in the area of Hannover (years 1985-2004), 2602 novice drivers and 18 214 experienced drivers were recorded as having an accident. Novice car drivers were more often and more severely injured whereas on motorcycles the experienced drivers were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % of the novice car drivers were not restrained by seatbelts as compared to 3.7 % of the experienced drivers and 6.1 % of the novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries were sustained in 20 % at collision speeds below 30 km/h and in 80 % at collision speeds above 50 km/h. Novice car drivers drove significantly older cars. The risk profile of novice drivers is similar to that of drivers older than 65., Conclusion: Structural protection and special lectures like skidding courses could be proper measurements next to harder punishment of violations.