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Purpose Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed. Methods All operative procedures carried out with intraoperative 3D imaging between August 2001 and December 2016 were included. The scans were assessed intraoperatively and documented thereafter. In case of malreduction or misplaced implants, an immediate revision was performed. The number of scans per case as well as the findings and consequences drawn regarding the anatomical region were analyzed. Results 4721 cases with 7201 3D scans were included in this study. The most common anatomical regions were the ankle (22.3%), the calcaneus (14.8%) and the tibial head (9.5%). In 19.1% of all cases, an intraoperative revision was performed. The highest revision rates were found with 36.0% in calcaneal fractures, 24.8% in fractures of the tibial plateau, 22.3% in injuries of the ankle. In 52.0% of revisions, the reduction was improved regarding intra-articular steps or joint congruency. In 30.5% an implant was corrected. Conclusion Intraoperative revision due to results of 3D imaging was performed in almost one-fifth of cases. This illustrates the improved possibilities to detect malreduction and implant misplacements intraoperatively and thus the abilities to improve surgical outcome. Level of evidence III.

BACKGROUND Medical photography is an integral part of patient care, playing an important role in wound management, in particular, but also in planning surgical therapy or patient and medical education. Smartphones are increasingly used and due to medicolegal reasons, usability, and efficiency, in particular, it may be superior to digital cameras. OBJECTIVE Aim of this panel study was to assess if implementation of a specialized smartphone app for medical photography would lead to an increase usage and efficiency of it. METHODS With the help of weekly questionnaires, this single center panel study compared the use of digital cameras and smartphones with a specialized app for medical photography. The study took place at a level 1 trauma center from June to November 2020. RESULTS 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4±1.9 times/week (95% CI [1.7;9.2]; P=.005) when the smartphone was used. The time it took to upload pictures to the PACS was significantly shorter for the app (1.8±1.2min) than for the camera (14.9±24.0h) (P CONCLUSIONS Specialized smartphone apps offer a secure, fast, and easy way to acquire medical photos and could possibly improve patient education and care in terms of wound management, in particular, while also offering medicolegal and economic benefits.

Previous studies have demonstrated a frequent occurrence of screw/K-wire malpositioning during surgical fracture treatment under 2D fluoroscopy and a correspondingly high revision rate as a result of using intraoperative 3D imaging. In order to facilitate and accelerate the diagnosis of implant malpositioning in 3D data sets, this study investigates two versions of an implant detection software for mobile 3D C-arms in terms of their detection performance based on comparison with manual evaluation. The 3D data sets of patients who had received surgical fracture treatment at five anatomical regions were extracted from the research database. First, manual evaluation of the data sets was performed, and the number of implanted implants was assessed. For 25 data sets, the time required by four investigators to adjust each implant was monitored. Subsequently, the evaluation was performed using both software versions based on the following detection parameters: true-positive-rate, false-negative-rate, false-detection-rate and positive predictive value. Furthermore, the causes of false positive and false negative detected implants depending on the anatomical region were investigated. Two hundred fourteen data sets with overall 1767 implants were included. The detection parameters were significantly improved (ppp=.005). In summary, version 2 of the implant detection software achieved significantly better results. The time saved by using the software could contribute to optimizing the intraoperative workflow.

Patellar maltracking caused by a rupture of the medial patellofemoral ligament (MPFL) can be improved by MPFL reconstruction (MPFL-R) with a tendon graft. Nonresorbable suture tape (FiberTapeIn eight fresh-frozen human knee joint specimens (m/f 4/4; age 75 ± 10 years), the MPFL was identified, and a rupture was placed near the femoral insertion site. In the study group (SG; 4 knees), soft-tissue fixation of the FT was performed at the medial patellar retinaculum; in the control group (CG; 4 knees), FT was fixed at the patella via suture anchors. For native MPFL (nMPFL), ruptured ("injured") MPFL (iMPFL) and reconstructed MPFL (FT-MPFL-SG, respectively, FT-MPFL-CG) cone beam CT scans were performed in 15°, 30°, and 45° of knee joint flexion. Patellar tracking was assessed using the radiological parameters patellar tilt (PT), congruence angle (CA) and posterior patellar edge-trochlear groove ratio (PTR).All recorded radiological parameters increased, respectively, decreased in the CG and SG from the nMPFL to the iMPFL state. After MPFL-R, all parameters normalized when compared to the intact state (nMPFL), regardless of patella-side fixation technique. All investigated parameters of patellotrochlear alignment were positively, respectively, negatively significantly (p 0.05) correlated throughout all evaluated conditions (nMPFL, iMPFL, FT-MPFL-SG, FT-MPFL-CG).MPFL-R with a nonresorbable suture tape can normalize patellar maltracking in fresh-frozen human knee joint specimens in earlier degrees of knee joint flexion independent of patella-side fixation technique. The investigated parameters of patellotrochlear alignment correlate with each other.

To compare outcomes, complications, revisions, and rates of implant removal of superior compared to anteroinferior plating in displaced midshaft clavicle fractures at mid-term follow-up. We retrospectively reviewed 79 patients who underwent operative treatment for displaced midshaft clavicle fractures (Group A: 28 patients with superior plating; Group B: 51 patients with anteroinferior plating) that were at least 2 years postoperatively. Adjusted Constant Score (aCS), Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score were compared. Bone union, implant removal, complications and revision surgeries were assessed. Group A had a significantly higher aCS compared to group B (90, IQR: 85.0–91.0 vs. 91, IQR: 90.0–93.0; P = 0.037). No significant differences between groups were seen in VAS (P = 0.283) and QuickDASH (P = 0.384). Bone union was achieved in 76 patients (96.2%) with no significant differences between groups (Group A: 96.4% vs. Group B: 96.1%; P > 0.999). There were no significant differences in implant removal rates (Group A: 60.7% vs. Group B: 66.7%; P = 0.630), complications (Group A: 46.4% vs. Group B: 31.4%; P = 0.226) and revisions (Group A: 25% vs. Group B: 9.8%; P = 0.102). Superior and anteroinferior plating result in high bone union rates and good clinical outcomes with similar rates of plate removal.

Background Intraoperative imaging is regularly used for intraoperative reduction control and evaluation of the implant position in trauma surgery. 2D imaging is limited, especially in complex anatomical regions such as the pelvis. The introduction of mobile 3D C-arms (CBCT: cone-beam computed tomography) has significantly improved intraoperative assessment. Nevertheless, there are still limitations regarding the field of view and metal artifacts. The purpose of this study was to evaluate the potential of intraoperative computed tomography (iCT) in surgical treatment of sacroiliac (SI) injuries. Methods Twenty-five cases with injuries of the posterior pelvic ring involving the SI region that were surgically treated with navigated SI screws using the mobile iCT Airo (Brainlab, Munich, Germany) were analysed. Subsequently, the data were compared with historical control groups (CBCT with and without navigation; 2D fluoroscopy only). Results The average score for subjective image quality achieved using the Likert scale is significantly higher for the iCT (4.48 ± 0.65) than for the CBCT (3.04 ± 0.69) with p = 0.00. The average duration of surgery using iCT was 189.32 ± 88.64 min, which was not significantly different from the control groups (p = 0.14 - 0.70). The average fluoroscopy time using iCT was 81.96 ± 97.34 s, which was significantly shorter than in all of the control groups (p = 0.00 - 0.03). The rate for postoperatively detected complications after using iCT was 0% (n = 0). Compared with the 2D-only control group (25%; n = 1), there is a significant difference (p = 0.01). The remaining two control groups showed no significant differences (p = 0.09 - 0.19). Conclusions The iCT provides excellent image quality that allows reliable assessment of fracture reduction and implant placement even in complex anatomical regions. The radiation exposure for the medical staff is reduced by decreasing the fluoroscopy time without significantly prolonging the surgical time. Overall, the possibility of intraoperative correction improves clinical outcome and patient treatment in the long term.

BACKGROUND CONTEXT Patients’ outcome following traumatic atlanto-occipital dislocation (AOD) has been poor. In recent years, an increasing number of patients surviving the initial trauma are admitted to hospital. In order to further improve the management of these patients, the knowledge of diagnostics and therapy as well as possible complications should be increased. PURRPOSE The aim of this study was to evaluate diagnostic parameters, therapy, early complications and outcome of patients with traumatic AOD. STUDY DESIGN Monocentric retrospective cohort study. PATIENT SAMPLE A total of 12 patients were included in this study. OUTCOME MEASURES The main outcome measure was functional patient outcome. Furthermore, radiographic and treatment data were analyzed. METHODS All patients suffering from traumatic AOD within an 8-year time period were included. Demographic data, radiological diagnostic parameters (condylar sum, basion dens interval, basion axis interval, power´s ratio, x-line method), as well as treatment data and complications of every patient were analyzed. Radiological parameters were compared with each other. Outcome was analyzed by a follow up examination. RESULTS The accident mechanisms were motor vehicle accidents (MVA), fall from high and low height. Basion dens interval, basion axis interval, power's ratio and x-line method were not reliable in identifying traumatic AOD (only up to 33% of the patients were identified). Twelve patients could be reviewed. Three patients were treated with surgery, five patients were treated nonsurgically. Four patients died before surgical therapy. All seven surviving patients (survival rate: 58.3%) were re-examined (mean follow-up time: 6.7 months). All patients had a GCS of 15. Three surviving patients suffered from persisting neurological deficits. CONCLUSIONS The most reliable way to diagnose AOD in Computer Topography is using the condylar sum. Surgical and nonsurgical measures can be employed with reasonable outcomes. Patient specific injury burden and clinical presentation should be taken into account when making treatment decisions for AOD.

Infection represents probably the most challenging complication in shoulder arthroplasty and all other surgical procedures of the shoulder. A deep infection of the shoulder is often combined with a destruction of the joint and a loss of function. In many cases the arthroplasty is the last resort for these patients to obtain a satisfactory function. The objective of this study was to determine outcome data on microbiota and clinical results of a two-stage shoulder arthroplasty procedure after deep infection of the shoulder. Twenty-six patients with a deep shoulder infection after arthroplasty, osteosynthesis, or rotator-cuff repair were included, while two patients had an empyema without prior surgery. All underwent initial surgical debridement with implantation of an antibiotic-loaded spacer, followed by postoperative systemic antibiotics. The patients obtained definitive shoulder arthroplasty in a second surgery. None of the patients had to undergo more than two surgeries before the arthroplasty. The follow-up analysis including microbiota results, complication rates, and functional outcomes could be determined after at least 1 year in 60% of patients (n = 16). The most frequently detected microorganisms were S. epidermidis (31%, n = 10) and Cutibacterium acnes (19%, n = 6). In 28% (n = 9) of cases multi-drug resistant bacteria were detected and in 35% (n = 8) of cases more than one microorganism was found. The overall revision rate was 42%, 11 of 26 patients, in the first 8 weeks after arthroplasty. Reasons for revision were joint dislocations in 23% (n = 6), 15% (n = 4) postoperative hematomas, one (4%) re-infection and one (4%) periprosthetic fracture. At follow-up after 19.3 ± 5.5 months postoperatively, a mean abduction of 113.4°, anteversion of 122.8° and external rotation of 14° was found, with an average age and gender-adjusted Constant Score of the affected shoulder of 63. The subjects’ pain and impairment in normal life measured by a questionnaire with school grades were significantly reduced (p

In clinical routine, wound documentation is one of the most important contributing factors to treating patients with acute or chronic wounds. The wound documentation process is currently very time-consuming, often examiner-dependent, and therefore imprecise. This study aimed to validate a software-based method for automated segmentation and measurement of wounds on photographic images using the Mask R-CNN (Region-based Convolutional Neural Network). During the validation, five medical experts manually segmented an independent dataset with 35 wound photographs at two different points in time with an interval of 1 month. Simultaneously, the dataset was automatically segmented using the Mask R-CNN. Afterwards, the segmentation results were compared, and intra- and inter-rater analyses performed. In the statistical evaluation, an analysis of variance (ANOVA) was carried out and dice coefficients were calculated. The ANOVA showed no statistically significant differences throughout all raters and the network in the first segmentation round (F = 1.424 and p > 0.228) and the second segmentation round (F = 0.9969 and p > 0.411). The repeated measure analysis demonstrated no statistically significant differences in the segmentation quality of the medical experts over time (F = 6.05 and p > 0.09). However, a certain intra-rater variability was apparent, whereas the Mask R-CNN consistently provided identical segmentations regardless of the point in time. Using the software-based method for segmentation and measurement of wounds on photographs can accelerate the documentation process and improve the consistency of measured values while maintaining quality and precision.

There is a paucity of literature demonstrating which factors are associated with signs of elbow instability on magnetic resonance imaging (MRI) following simple elbow dislocations (SED). This study aimed to evaluate demographic variables and MRI datasets to identify factors associated with elbow instability following SEDs. This retrospective multicenter MRI study included patients who had sustained SED and presented within 21 days of trauma. Measurements included ulnohumeral angle, drop sign, and radiocapitellar and ulnohumeral incongruity. The coronoid tip (Regan Morrey type I), lateral collateral ligament (LCL), common extensor origin (CEO), medial collateral ligament (MCL,) and common flexor origin (CFO) were assessed for injuries. Simple and multiple logistic regression analyses were performed to identify factors associated with signs of elbow instability (e.g., ulnohumeral incongruity > 1 mm) on MRI. A total of 147 patients (68 women, 79 men) with a mean age of 42.9 years (range, 17–85) were included. Of those, 62 patients (42.2%) demonstrated radiocapitellar (> 2 mm) and 36 patients (25.5%) demonstrated ulnohumeral incongruity (> 1 mm); 17 patients (11.6%) had a drop sign (≥ 4 mm). All patients with elbow instability on MRI had injury to the CEO and/or CFO. In multiple logistic regression, an ulnohumeral angle of ≤ 45° (p = 0.005; OR: 4.95), injury to the CEO (p

The aim of the cadaveric study was to determine the effects of an unstable ankle fracture on the position of the fibula in the incisural notch and subsequently to evaluate the alterations resulting from the individual steps of a guideline-based osteosynthesis. In a specimen model with 20 uninjured fresh-frozen lower legs with induced unstable fracture of the fibula (type Weber C), a guideline-based osteosynthesis was performed. The distances between the anterior and posterior edges of the tibia and fibula and in the center of the incisural notch, as well as the rotation angle of the fibula, were measured in the acquired 3D image data sets and were compared with the intact condition of the ankle mortise. The dissection of the syndesmosis and osteotomy of the fibula results in an external rotation the fibula by 3.6° (p = 0.000), while the distance between the anterior edge of the tibia and the fibula widens by 1.86 mm (p = 0.000). After osteosynthesis of the fibula and transfixation of the syndesmotic region using a positioning screw, the posterior distance is no longer substantially increased by 0.22 mm (p = 0.103) but also reduced by 0.1 mm (p = 0.104) in the tibiofibular notch. The external rotation of the fibula remains slightly increased by just 0.45° (p = 0.009). The results indicate that there is a tendency for over-compression when adjusting the tibiofibular distance and that the fibula in the tibiofibular notch tends to remain slightly rotated externally.

Rationale: To our knowledge, no study has investigated concomitant injuries of the sternoclavicular joint (SCJ) in acute clavicle fractures. The purpose of this study was to determine the effect of an ipsilateral clavicle fracture on the SCJ in a systematic computer tomography (CT) morphologic evaluation. Methods: CT scans in the axial and coronal plane of 45 consecutive patients with clavicle fractures were retrospectively analyzed. The scans were assessed regarding anatomic congruence of bilateral SCJs—joint space width (JSW); the position of bilateral medial clavicles (PC); and the non-fusion of epiphyses, arthritis, calcifications, and intra-articular gas. Results: The mean SCJ JSW was significantly different in the coronal (cJSW; 8.70 mm ± 2.61 mm in affected vs. 7.63 mm ± 2.58 mm in non-affected side; p = 0.001) and axial plane (aJSW; 9.40 mm ± 2.76 mm in affected vs. 9.02 ± 2.99 in non-affected SCJs; p = 0.044). The position of the medial clavicle showed a significant difference in the coronal plane (cPC; 14.31 mm ± 3.66 mm in the affected vs. 13.49 ± 3.34 in the non-affected side; p = 0.011), indicating a superior shift. Conclusion: Acute clavicle fractures may be associated with an enlargement of the ipsilateral SCJ space width and a superior shift of the proximal clavicle. Both morphologic alterations could indicate concomitant injuries of the SCJ as well as a potential increase in the risk of SCJ instability.

When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage.To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period.All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation.354 CT-scans were performed in 171 patients (mean 2.07 [1 - 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 - 21.72).Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.Bei der Anwendung mobiler 3-D-C-Bögen bestehen Einschränkungen hinsichtlich der Bildqualität, insbesondere durch Artefaktbildung und die limitierte Größe des 3-D-Volumens. Um diese Limitationen zu umgehen, wurden spezielle mobile intraoperative Computertomografen (iCT) konstruiert, die sowohl eine Verbesserung der Bildqualität sowie ein größeres „Field of View“ bieten als auch den Anforderungen eines intraoperativen Einsatzes gerecht werden sollen.Praktikabilität und Bildqualität eines Systems zur mobilen intraoperativen CT-Diagnostik (Airo, Brainlab, München) werden anhand verschiedener Parameter über einen Zeitraum von 40 Monaten evaluiert.Alle operativen Eingriffe, die im Zeitraum zwischen Januar 2017 und April 2020 unter Anwendung der iCT erfolgten, wurden hinsichtlich der Parameter Operationsgebiet, Anzahl der Scans, Scandauer, Konsequenz aus dem Scan und Verwendung eines Navigationssystems ausgewertet.354 CT-Scans von 171 Patienten wurden ausgewertet (durchschnittlich 2,07 [1 – 6] Scans pro Eingriff). Hierbei erfolgten 47,81% der Eingriffe an der Wirbelsäule und 52,19% am Becken. 83% (42 – 100) der Eingriffe erfolgten navigiert. In 22% der Eingriffe wurde nach einem Scan eine Maßnahme durchgeführt, am häufigsten (55%) erfolgte hierbei die Korrektur eines Führungsdrahts an der Wirbelsäule. Die durchschnittliche Scandauer betrug 10,33 s (3,54 – 21,72).Die Anwendung war zuverlässig und hilfreich. Der Prozess der Integration in die Abläufe ist aufwendiger als bei der Verwendung mobiler 3-D-C-Bögen. Die Bildqualität ist für intraoperative Bedingungen hervorragend und erlaubt in allen Fällen eine sichere und eindeutige Beurteilung der Situation. Aufgrund des hohen intraoperativen Aufwands sowie der hohen Investitionskosten des Systems bei ebenfalls guter Bildqualität mobiler 3-D-C-Bögen in der Extremitätenchirurgie ist die traumatologische Anwendung der iCT hauptsächlich in der operativen Therapie von Körperstammverletzungen in großen Traumazentren zu sehen.

Reconstruction of the medial patellofemoral ligament (MPFL-R) with nonresorbable suture tape (FiberTapeIn ten human, fresh-frozen knee joint specimens (m/f 6/4; age 74 ± 9 a), the MPFL was identified and dissected near the femoral insertion site. In five knee joints, the MPFL-R using FT was performed with soft-tissue fixation at the patella (study group; SG), and in five knee joints, the FT was fixed via suture anchors (control group, CG). All reconstructions were evaluated until load to failure of the patella-side fixation with a displacement rate of 200 mm/min.The mean maximum load to failure in the SG was 395.3 ± 57.9 N. All reconstructions failed by complete tearing off the medial patellar retinaculum from its medial patellar margin, but fixation of the FT remained stable. In the CG, the mean maximum load to failure was 239.4 ± 54.5 N and was significantly different compared to the SG (p = 0.04). All reconstructions failed via pullout of the suture anchors. Stiffness and elongation did not differ between the groups, and no failure of the FT was observed in any of the specimens.Primary stability of soft-tissue MPFL-R using FT was superior to suture-anchor fixation. Both fixation techniques provided sufficient primary stability, superior to previously reported native MPFL tensile strengths. MPFL-R with FT could be a possible alternative procedure for MPFL-R, eliminating potential complications due to autologous tendon graft harvesting.

Background To evaluate reliability, practicability and precision of a novel intraoperative computed tomography(iCT)-based (Airo mobile CT scanner, Brainlab, Munich, Germany) navigated procedure to minimally-invasive positioning of cervical pedicle screws.Methods Ten consecutive patients that suffered from a cervical traumatic instability needing posterior fixation were included in this retrospective analysis. Posterior pedicle screws were positioned iCT-navigated percutaneously. After positioning of the screws, a control scan was performed to assess screw placement and correction if needed. All CT scans were randomly evaluated by two investigators with experience in skeletal CT diagnostics. In the iCT scans, positioning of the screws regarding affection of the medial pedicle cortex as well as the neuroforamina were measured. Additionally, image quality was evaluated with a subjective Likert-Scale (0-5) and a semi-objective Assessability score (0-4).Results 44 screws were placed in an average duration of surgery of 139min [83-209]. The average subjective image quality was 3.9 [2-5], the average assessability score was 3.7 [2-4]. 27 screws (61%) were positioned exactly centered in the pedicle. 4 screws perforated the medial wall by more than 2mm [2.8-2.9]. 9 screws were positioned laterally by more than 2mm [2.5-4.9]. No postoperative neurological deficits were observed.Conclusion iCT-navigated percutaneous placement of pedicle screws is a rather safe and reliable method for posterior fixation of the cervical spine that allows fixation of traumatic cervical instabilities with minimal additional trauma. Even in shallow anatomic structures, visualization of instruments and implants allows for minimally invasive surgery.

Pseudarthrosen konnen als Komplikation einer vorhergegangenen operativen oder konservativen Frakturbehandlung oder nach elektiven Knocheneingriffen entstehen. Ihre Behandlung ist aufwendig und wird noch erschwert, wenn begleitende Weichteildefekte oder Wundheilungsstorungen vorliegen. In diesem Fall sollte bereits fruh eine Abstimmung zwischen Unfallchirurgie/Orthopadie und Plastischer Chirurgie erfolgen und das weitere Vorgehen interdisziplinar geplant werden. Aufgrund der positiven Effekte auf Knochenheilung und Osteomyelitis ist eine zeitnahe Weichteilrekonstruktion durch eine gefasgestielte oder freie Lappenplastik zu favorisieren. Falls erforderlich sollte eine kompromittierte Durchblutung an der betroffenen Extremitat im Vorfeld mithilfe interventioneller oder gefaschirurgischer Masnahmen optimiert werden. Im Fall atropher, aseptischer Pseudarthrosen kann der Defektverschluss einzeitig, im Zuge der definitiven unfallchirurgischen Versorgung erfolgen. Bei positivem Keimnachweis ist die Infektsanierung in jedem Fall vorher sicherzustellen. Die Weichteilrekonstruktion kann dann mit Abschluss der seriellen, radikalen Debridements erfolgen. Beispiele fur zwei haufig durchgefuhrte freie Gewebetransfers sind die muskulare Latissimus- und die fasziokutane anterolaterale Oberschenkel-Lappenplastik („anterolateral thigh [ALT] flap“). Fur beide sind mehrere Varianten beschrieben, das rekonstruktive Portfolio beinhaltet daruber hinaus aber noch viele weitere Optionen. Sind nach Defektverschluss noch weitere unfallchirurgische Revisionen vorgesehen, sollten fasziokutane Lappenplastiken in der Rekonstruktion favorisiert werden.

Background The treatment of fracture- or non-union-related infections has persistently been a major challenge for both patients and treating surgeons. With rising aging of patients and increasing comorbidities, combined with the heterogeneity of germs and any number of multi-resistance against standard antibiotics, a successful treatment is increasingly difficult. One potential solution could be a custom-made individualized antibacterial coating of standard implants with a biphasic degradable biocarrier (Cerament G/V, supplied by Bonesupport AB, Lund, Sweden) that releases high doses of antibiotics around the bone-implant-interface. Here, we describe our technique of coating intramedullary nails, plates and press-fit shoulder endoprostheses which may prevent bacterial adhesion and biofilm formation. So far, there is very limited experience in individual coating of implants in hip or knee endoprostheses to prevent reoccurrence of surgical-site infection. Currently, no reports are available for coating of stems of shoulder prosthesis and nails or plates for fracture fixation. Methods Here, we show our first experiences with a new individualized surgical technique of coating these implants with a resorbable antibiotic-loaded hydroxyapatite/calcium sulphate biocomposite to prevent biofilm formation and thereby recurrence of bone or joint infection. We describe three cases for coating of plates and nails for fracture fixation and coating of stems of a shoulder prosthesis. Results No adverse events of the resorbable bone graft substitute were observed. In all of the cases, no recurrence of the infection was observed and osseointegration was achieved. After implant coating of the shoulder prosthesis, no radiological signs of loosening were detected. Conclusion We present a new surgical approach of a surface coating of plates, intramedullary nails or prostheses. The osteoconductive- and anti-inflammatory effect of the gentamicin- or vancomycin-loaded hydroxyapatite/calcium sulphate bone graft substitutes shows promising results.