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Die Osteoporose ist eine Volkskrankheit und betrifft Frauen und Manner. Mit abnehmender Knochendichte und zunehmendem Lebensalter steigt das Risiko, atraumatische Frakturen zu erleiden. Diese Frakturen haben neben den Beschwerden durch die Fraktur selbst weitreichende Folgen auf nahezu alle Lebensbereiche des Patienten. Diese Arbeit soll die Folgen von osteoporotischen Frakturen aus Patientensicht darstellen bzw. die Bedeutung der Osteoporose fur den Patienten untersuchen. Es soll die Notwendigkeit der zeitnahen Diagnostik und Therapie nach dem Frakturereignis verdeutlicht werden. Zu den jeweiligen Begriffen wurden Literaturrecherchen durchgefuhrt. Die mithilfe themenbezogener Schlusselbegriffe gefundenen Literaturquellen werden in einer narrativen Ubersicht dargestellt. Verschiedene Teilbereiche mit Bedeutung fur den Patienten wurden identifiziert. Eine unmittelbare Patientensicht findet sich in der Literatur nicht, allerdings konnten Studien mit Befragung der Patienten identifiziert und somit die Patientensicht integriert werden. Fur die Teilbereiche Schmerz, Psyche und kognitive Fahigkeiten, Mortalitat und Pflegebedurftigkeit konnten Angaben in der Literatur erfasst werden. Die Auswirkungen von Osteoporose und Frakturen sind vielschichtig und fur den Patienten gravierend. Masnahmen zur Pravention von osteoporotischen Frakturen sollten konsequent umgesetzt und nach einer Fraktur sollten die notwendige Diagnostik und Therapie schnell eingeleitet werden.

Die Knochenheilung nach Frakturen wird durch eine Vielzahl verschiedener Faktoren beeinflusst. Neben patientenseitigen Parametern, wie Alter, Geschlecht oder Nebenerkrankungen, haben auch die eingenommenen Medikamente einen wesentlichen Einfluss auf die Knochenheilung. Ziel der vorliegenden Arbeit ist es, einen Uberblick uber die Auswirkungen von haufig verwendeten Medikamenten, auser spezifischen Osteoporosemedikamenten und Hormonpraparaten, auf die Knochenheilung zu geben. Der Uberblick wurde auf der Basis einer MEDLINE-Recherche zu den jeweiligen Stichworten durchgefuhrt. Es wurden verschiedene haufig verwendete Medikamente identifiziert, darunter Kortikosteroide, Antihypertensiva, Diuretika, Antidepressiva, Antiepileptika, Statine, Antibiotika, nichtsteroidale Antirheumatika, Antikoagulanzien und andere. Mit Ausnahme der Antihypertensiva, Thiaziddiuretika und Statine wurden in tierexperimentellen und praklinischen Studien negative Effekte auf die Knochenheilung nachgewiesen. Fur die 3 genannten Substanzklassen wurden osteoprotektive Wirkungen publiziert. Klinische Daten beim Menschen sind nur vereinzelt zu finden. Die in praklinischen Studien gewonnenen Daten zur Beeinflussung der Frakturheilung belegen Effekte der im Folgenden betrachteten Medikamente. Dabei sind die Wirkungen beim Menschen teilweise noch nicht durch Studien gesichert. Vor dem Hintergrund der im vorliegenden Beitrag zusammengefassten Ergebnisse sollte in kritischen Fallen die weitere Einnahme der Medikamente diskutiert werden.

Study Design Retrospective study. Purpose To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. Overview of Literature Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. Methods In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiographic parameters were evaluated and correlated. Results The average age of the patients was 51.8 years. There were 225 type A3/A4 and 89 type B2 fractures; 39 of the type B2 fractures (43.8%) had been misdiagnosed as type A fractures. Type B fractures presented with a significantly higher kyphotic wedge angle and Cobb angle and a lower sagittal index (SI) than type A fractures. In addition, the normalized interspinous distance was higher in type B2 fractures. The significant mathematical indicators for PLC injuries were as follows: Cobb angle+kyphotic wedge angle >29°; Cobb angle2 >170°; and vertebral angle/SI >25. Conclusions The results demonstrated that PLC injuries are frequently misdiagnosed. Correlations between certain radiological parameters associated with PLC injuries can be useful indicators of the presence of such injuries requiring surgery.

Zusammenfassung Hintergrund Methicillin-resistente Staphylococcus aureus (MRSA) stellen eine erhebliche Gesundheitsgefährdung dar. Lange Zeit standen die sog. „healthcare-associated (HA)“ und „community-acquired (CA)“ MRSA-Stämme im Augenmerk der medizinischen Forschung. In den letzten 10 Jahren rückte jedoch zunehmend die Gruppe der „livestock-associated MRSA“ (LA-MRSA) in den wissenschaftlichen Fokus. Epidemiologische Studien zeigten, dass LA-MRSA CC398 die Speziesbarriere durchbrachen und im Zuge dessen Menschen kolonisierten und zu Infektionen führten. Bislang liegen jedoch noch keine Daten zur Kolonisierung orthopädischer Patienten mit LA-MRSA vor. Ziel dieser Studie ist es, die Prävalenz einer LA-MRSA-Besiedelung des durchschnittlichen orthopädischen Patienten einer orthopädischen Fachklinik zu bestimmen und im zeitlichen Verlauf zu betrachten. Des Weiteren soll ein Risikoprofil der typischen LA-MRSA-Träger bestimmt werden. Patienten und Methoden Die vorliegende prospektive Untersuchung schloss insgesamt 1544 Personen ein, die im Zeitraum 01.01.2009 bis 30.06.2009 und 01.04.2012 bis 31.03.2013 untersucht worden waren. Dabei handelte es sich um Patienten, die wegen einer elektiven orthopädischen Behandlung im St.-Antonius-Stift in Emstek, Niedersachsen, stationär aufgenommen worden waren. Bei Aufnahme erfolgte ein Nasenabstrich sowie die Abfrage potenzieller Risikofaktoren mittels Fragebogen. Bei positivem Abstrichbefund wurde eine MRSA-Typisierung durchgeführt, um das Vorliegen einer Infektion mit Hospital-acquired MRSA (HA-MRSA) oder einer Lifestock-associated MRSA (LA-MRSA) zu bestimmen. Die Daten der Fragebögen sowie der mikrobiologischen Untersuchung wurden mittels SPSS Version 16.0 übertragen und ausgewertet. Ergebnisse An der Studie nahmen insgesamt 1544 Probanden teil. Es handelte sich um 726 männliche (47%) und 818 weibliche (53%) Studienteilnehmer mit einem mittleren Alter von 58,3 ± 0,73 Jahren (Median: 61,3 Jahre). In diesem Gesamtkollektiv wurde nach der mikrobiologischen Untersuchung der Nasenabstriche bei 51 Probanden (3,3%) eine MRSA-Besiedelung nachgewiesen, während 371 Probanden (24%) eine nasale MSSA-Besiedelung (MSSA: Methicillin-sensibler Staphylococcus aureus) aufwiesen. Dabei ergab sich, dass Studienteilnehmer mit nasaler MRSA-Besiedelung signifikant häufiger direkten Kontakt zu Nutztieren aufwiesen als Probanden ohne nasale MRSA-Besiedelung (59 vs. 11%, p = 0,001). Von den untersuchten 1544 Probanden hatten 30% (n = 463) einen Kontakt zu einer Person mit Nutztieren binnen der letzten 6 Monate. Von den 51 Studienteilnehmern mit nasaler MRSA-Besiedelung hatten 91% Kontakt zu einer Person mit Nutztieren, entsprechend einer statistischen Signifikanz von p Schlussfolgerung Dies ist unseres Wissens die erste Studie, die sich mit der Durchseuchung orthopädischer Patienten und LA-MRSA beschäftigt. Wir konnten zeigen, dass LA-MRSA in Hochrisikogebieten eine zunehmende Rolle bei der Versorgung orthopädischer Patienten spielt. Hierbei zeigte sich, dass keine Verdrängung der CA- und HA-MRSA stattfindet, sondern LA-MRSA eine zusätzliche Besiedelungsquelle darstellt. Patienten, die in der Viehzucht beschäftigt sind oder Kontakt zu Nutztieren haben, sowie deren Familienmitglieder, sollten regelhaft vor orthopädischen Eingriffen gescreent werden. Nur so können die Gefahren einer LA-MRSA-Infektion kontrolliert werden.

Background The present study aimed to evaluate the functional, radiological and histological outcome of a customized focal implant for the treatment of focal full-thickness cartilage defects in sheep. Methods The study used magnetic resonance imaging data as the basis for construction of the titanium implant using a three-dimensional printing technique. This was then placed on the medial condyle of the knee joint in eight sheep and left in place in vivo over a period of six months. Following euthanasia, the local biological response was analyzed using micro-computed tomography, light microscopy and histological evaluation (International Cartilage Repair Society (ICRS) score). The variables were analyzed using a generalized linear mixed model. Odds ratios were given with 95% confidence intervals. Results The osseointegration rate was 62.1% (SD 3.9%). All implants were prone to the neighboring cartilage bed (4.4–1096.1 μm). Using the IRCS score, the elements ‘surface’, ‘matrix’, ‘cell distribution’ and ‘cell population’ all showed pathological changes on the operated side, although these did not correlate with implant elevation. On average, a difference of 0.7 mm (± 2 mm) was found between the digitally planned implant and the real implant. Conclusions As a result of imprecise segmentation and difficult preparation conditions at the prosthesis bed, as well as changes at the surface of the implant over the operational lifetime of the prosthesis, it must be stated that the approach implemented here of using a customized implant for the treatment of focal full-thickness cartilage defects at the knee did not meet our expectations.

An intramedullary device has some advantages over external fixation in callus distraction for bone defect reconstruction. There are difficulties controlling motorized intramedullary devices and monitoring the distraction rate which may lead to poor results. The aim of this study was to design a fully implantable and non-motorized simple distraction nail for the treatment of bone defects. The fully implantable device comprises a tube-in-tube system and a wire pulling mechanism for callus distraction. For the treatment of femoral bone defects, a traction wire, attached to the device at one end, is fixed to the tibial tubercle at its other end. Flexion of the knee joint over a predetermined angle generates a traction force on the wire triggering bone segment transport. This callus distraction system was implanted into the femur of four human cadavers (total 8 femora), and bone segment transport was conducted over 60-mm defects with radiographic monitoring. All bone segments were transported reliably to the docking site. From these preliminary results, we conclude that this callus distraction system offers an alternative to the current intramedullary systems for the treatment of bone defects.

Objective. In patients scheduled to undergo total joint arthroplasty of the hip, the bone quality around the joint affects the safety of prosthetic implantation. Bone strength is clinically assessed by measuring bone mineral density (BMD); therefore we asked if BMD is important to orthopaedic surgeons performing hip arthroplasty. Methods. In a 14-question survey, we asked about treatment patterns with respect to BMD, osteoporosis work-up, and treatment for patients with low BMD scheduled to undergo hip arthroplasty. Results. 72% of all asked orthopaedics reported to use cementless implants as a standard in hip arthroplasty. Over 60% reported that low BMD is a reason to reconsider operation strategies, but only 4% performed BMD measurement preoperatively. 26% would change their treatment strategy in case of a BMD (T-Score) between −1.5 and −2 and 40% in case of a T-score between −2 and −2.5, and 29% would change their intraoperative strategy if a T-score smaller than −2.5 was measured. Conclusion. The majority of orthopaedic surgeons who responded to the survey reported that they do not perform routine measurement of BMD before arthroplasty. However, most surgeons commented that low bone mineral density will influence their surgical plan and the implant design.

Background Recent minimal-invasive posterior fusion devices are supposed to provide stability and obtain fusion in combination with interbody cages in the instrumented segment. The aim of the present study is to evaluate the primary stability of two minimal-invasive posterior prototypes compared to an established spinous process plate and standard pedicle screw instrumentation. Methods Seven fresh frozen human cadaver lumbar spines (L2–L5) were tested in a spinal testing device with a moment of 7.5 Nm. Spinal stability was determined as mean range of motion (RoM) in the segment L3/L4 during extension-flexion, lateral bending and axial rotation. The RoM was measured during five conditions: 1. intact; 2. working prototype composed of an interspinous device and process plates; 3. an established spinous process fixation device 4. working prototype of facet fixation and 5. pedicle screw fixation. Findings All devices caused a significant reduction of RoM during extension-flexion. The RoM during lateral bending was significantly reduced to 37% (of intact) by pedicle screws and 68% by facet fixation prototype. During axial rotation the RoM was significantly reduced to 52% by pedicle screws and to 86% by facet fixation prototype. The other devices had no significant influence on RoM during lateral bending and axial rotation. Interpretation The facet fixation prototype provided less primary stability compared to pedicle screws, but had significant advantages over spinous process fixation techniques. The results encourage further testing of this implant as a minimal-invasive approach for posterior fixation.

Hypovitaminosis D has been identified as a common risk factor for fragility fractures and poor fracture healing. Epidemiological data on vitamin D deficiency have been gathered in various populations, but the association between vertebral fragility fractures and hypovitaminosis D, especially in males, remains unclear. The purpose of this study was to evaluate serum levels of 25-hydroxyvitamin D (25-OH D) in patients presenting with vertebral fragility fractures and to determine whether patients with a vertebral fracture were at greater risk of hypovitaminosis D than a control population. Furthermore, we studied the seasonal variations in the serum vitamin D levels of tested patients in order to clarify the relationship between other known risk factors for osteoporosis and vitamin D levels. We measured the serum 25-OH D levels of 246 patients admitted with vertebral fractures (105 men, 141 female, mean age 69 years, sd 8.5), and in 392 orthopaedic patients with back pain and no fractures (219 men, 173 female, mean age 63 years, sd 11) to evaluate the prevalence of vitamin D insufficiency. Statistical analysis found a significant difference in vitamin D levels between patients with vertebral fragility fracture and the control group (p = 0.036). In addition, there was a significant main effect of the tested variables: obesity (p < 0.001), nicotine abuse (p = 0.002) and diabetes mellitus (p < 0.001). No statistical difference was found between vitamin D levels and gender (p = 0.34). Vitamin D insufficiency was shown to be a risk factor for vertebral fragility fractures in both men and women. Cite this article: Bone Joint J 2015;97-B:89–93.

Aseptic loosening is a serious complication after total joint arthroplasty. Plain radiography, along with clinical signs of prosthesis loosening, is the technique of first choice to evaluate loosening of joint replacements. Nevertheless, radiographical signs of osteolysis may not be apparent until progressed stages of loosening. Thus the search for alternative diagnostic methods is of great importance. The purpose of the present study was to evaluate the potential diagnostic significance of TRAP 5b, Osteocalcin, CrossLaps and Bone ALP for aseptic loosening of total joint replacements.Thirty-seven patients (25 women, 12 men, mean age 65 years, age range 54-76 years) treated with revision surgery due to clinically and radiologically confirmed late aseptic prosthesis loosening were examined prospectively. Serum levels of TRAP 5b, Osteocalcin, CrossLaps and Bone ALP were compared with a matched control group (n = 39).We found a significant decrease in TRAP 5B level in patients with aseptic loosening. Bone ALP and Osteocalcin as markers of osteoblast activity, and CrossLaps as another resorption marker did not allow any prediction of bone remodeling in this late phase of loosening.In the "late" phase of aseptic joint replacement loosening, no increase of TRAP 5b and therefore no increase of osteoclast number and activity was measurable. Thus, in this situation an anti-osteolytic therapy with a bisphosphonate or denosumab would not gain any further benefit.

Vitamin D plays an essential role in bone health and muscle function. Some studies have shown a widespread rate of vitamin D deficiency in the general population, but few have reported on the vitamin D status of orthopaedic patients.We investigated (1) the extent of hypovitaminosis D in orthopaedic patients, (2) seasonal variations in vitamin D levels, and (3) possible risk factors for insufficient vitamin D levels.Vitamin D levels in 1119 patients consecutively admitted to an orthopaedic surgery department in 2011 were measured. To investigate the correlation between climate factors and vitamin D levels, the sunshine hours for each month in 2011 were collected by Deutscher Wetterdienst (the German weather service) in the region where most tested patients lived. The prevalence of normal (30 ng/mL), insufficient (20-30 ng/mL), and deficient (20 ng/mL) 25-hydroxyvitamin D levels was determined. Univariate and multivariate analyses were used to assess risk factors for insufficient vitamin D levels.Overall, 84% of patients had insufficient levels of vitamin D and 60% were vitamin D deficient. Only 15% were in the target range of 30 to 60 ng/mL. The prevalence of low vitamin D levels was greater during winter and months with fewer sunshine hours. Vitamin D levels did not vary according to age, sex, and disease. Individuals with obesity, hypertension, and osteoporosis were more likely to have low vitamin D levels compared with their healthy counterparts.There is an alarmingly high rate of hypovitaminosis D and vitamin D deficiency among orthopaedic patients in this region of Germany, whose latitude (50° N) is approximately the same as those of Vancouver (49°, 15' N) and Paris (48°, 51' N). Given the well-known effects on bone metabolism and muscle health, low vitamin D levels may negatively affect patients. Screening and treating hypovitaminosis D appears to be important in this patient population.

Background The purpose of this observational study was to evaluate serum levels of 25-OH-D in patients scheduled to undergo elective hip or knee arthroplasty. We hypothesised that 25-OH-D level is an independent risk factor for length of stay in orthopaedic patients after elective hip or knee arthoplasty. Materials and methods 25-OH-D levels were measured in 1083 patients admitted to an orthopaedic surgery department to undergo elective hip or knee arthroplasty. Comparisons were performed using Chi square or Student’s t test, followed by univariate and multiple linear regression analysis examining the correlation between the length of stay in the orthopaedic department and 25-OH-D level while adjusting for possible confounders. Results Overall, 86 % of patients had insufficient serum levels of 25-OH-D, and over 60 % were vitamin D deficient. The mean length of stay was 13.2 ± 8.3 days. In patients with hypovitaminosis D, the length of stay was significantly longer compared to patients with normal serum 25-OH-D levels (15.6 ± 7.2 compared to 11.3 ± 7.9 days, P = 0.014). In univariate analyses, serum 25-OH-D level was inversely related to the length of stay in our orthopaedic department compared to patients with normal vitamin D levels (r = −0.16; P = 0.008). In multivariate analyses, the length of stay remained significantly associated with low 25-OH-D levels (P = 0.002), indicating that low vitamin D levels increase the length of stay. Conclusions We found a high frequency of hypovitaminosis D among orthopaedic patients scheduled to undergo elective arthroplastic surgery. Low vitamin D levels showed a significant inverse association to the length of stay in our orthopaedic department. Patients with vitamin D levels in the target range were hospitalised 4.3 days less than patients with hypovitaminosis D. Level 3 of evidence according to “The Oxford 2011 levels of evidence”.

Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (30 ng/ml), insufficient (20-30 ng/ml), and deficient (20 ng/ml) 25OHD levels was determined.All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p0.001). In addition, we found a significant difference (p0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.

Callus distraction using bone segment transport systems is an applied process in the treatment of bone defects. However, complications such as muscle contractures, axial deviation and pin track infections occur in the treatment process using the currently available devices. Since successful treatment is influenced by the applied distraction force, knowledge of the biomechanical properties of the involved soft tissues is essential to improve clinical outcome and treatment strategies. To date, little data on distraction forces and the role of soft-tissue traction forces are available. The aim of this study was to assess traction forces generated by soft tissues during bone segment transport using a novel intramedullary callus distraction system on eight human femora. For traction force measurements, bone segment transport over 60-mm femoral defects was conducted under constant load measurement using 40- and 60-mm bone segments. The required traction forces for 60-mm bone segments were higher than forces for 40-mm bone segments. This study demonstrates that soft tissues are of relevance biomechanically in bone segment transport. The size of the bone segment and the selection of the region for osteotomy are of utmost importance in defining the treatment procedure.