Purpose: Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. Patients and methods: Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher − 1, n = 26) was compared with a group with impaired bone density (T-score lower − 1, n = 24). Results: A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. Conclusions: HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. Level of evidence: III. Graphic These slides can be retrieved under Electronic Supplementary Material.

To compare the radiological and functional outcome after fixation of intertrochanteric fractures (IF) using either an integrated 2-screw cephalomedullary nail [InterTan (IT); Smith & Nephew] or a single-screw device [Gamma3 (G3); Stryker] with a 5-year follow-up. Prospective, randomized. A single-center study. One hundred four patients with a mean age of 81.2 ± 9.2 years were included, 33 patients were available for the final 5-year follow-up, 63 patients died, and 8 patients were lost for follow-up. Internal fixation of intertrochaneteric femur fractures using a cephalomedullary nail with either a single screw or an integrated 2-screw system. Length of hospital stay, SF-36-questionnaire, Harris-Hip-Score, radiographs. SF-36 index at 6 months indicated that 93% of the IT group returned to their prefracture status compared with only 80% in the G3 group. For the mental health SF-36 index, the IT patients showed a significant increased level 6 months after the index procedure (IT: P = 0.02; G3: P = 0.20). The length of hospital stay was significantly (P = 0.03) shorter in the IT group. After 5 years however, neither group had significant implant-related complications or differences in terms of functional outcome. Regarding functional outcome and hospital stay, the IT collective performed better in the 6-month follow-up. After 5 years, no significant differences were recorded. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background: The role of pelvic circumferential compression devices (PCCD) is to temporarily stabilize the pelvic ring, reduce its volume and to tamponade bleeding. The purpose of this study was to evaluate the effect of PCCDs on mortality and bleeding in severely injured trauma patients, using a large registry database. Methods: We performed a retrospective analysis of all patients registered in the Trauma Register DGU® between 2015 and 2016. The study was limited to directly admitted patients who were alive on admission, with an injury severity score (ISS) of 9 or higher, with an Abbreviated Injury Scale AIS_pelvis of 3-5, aged at least 16, and with complete status documentation on pelvic circular compression devices (PCCD) and mortality. A cohort analysis was undertaken of patients suffering from relevant pelvic fractures. Data were collected on mortality and requirements for blood transfusion. The observed outcome was compared with the expected outcome as derived from version II of the Revised Injury Severity Classification (RISC II) and adjusted accordingly . A Standardized Mortality Ratio (SMR) was also calculated. Results: A total of 9,910 patients were included. 1,103 of 9,910 patients suffered from a relevant pelvic trauma (AIS_pelvis=3-5). Only 41% (454 cases) of these received a PCCD. PCCD application had no significant effect on mortality and did not decrease the need for blood transfusion in the multivariate regression analysis. However, in this cohort, the application of a PCCD is a general indicator for a critical patient with increased mortality (12.0% no PCCD applied vs. 23.2% PCCD applied prehospital vs. 27.1% PCCD applied in the emergency department). The ISS was higher in patients with PCCD (34.12 ± 16.4 vs. 27.9 ± 13.8; p < 0.001). Conclusion: PCCD was applied more often in patients with severe pelvic trauma according to ISS and AIS_pelvis as well with deterioration in circulatory status. PCCDs did not reduce mortality or reduce the need for blood transfusion. Trial registration: TR-DGU ID 2017-003, March 2017; German clinical trial register DRKS00024948

The use of smartphone apps is an essential part of everyday life. Mobile applications offer enormous opportunities for dealing with challenges in public health, and their number increases every day. This paper aims to review the existing literature on mobile applications in orthopaedic oncology and to summarize the current mobile applications for musculoskeletal tumors. A systematic literature review was conducted regarding articles on mobile applications in orthopaedic and trauma surgery. The focus was on identifying mobile applications that can be used in the treatment of patients with musculoskeletal tumors. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality. In addition, the Apple App Store and Google Play Store were searched for suitable mobile applications. Ninety-one articles describing a mobile application in orthopaedic and trauma surgery were identified. Three articles focused on a mobile application for musculoskeletal tumors. Additionally, seven mobile applications were available in the App/Play Stores dealing with bone or soft tissue tumors in orthopaedic oncology without corresponding scientific articles. Increasing numbers of mobile applications are being developed in orthopaedic and trauma surgery. Currently, only three scientific articles on mobile applications in orthopaedic oncology are present, yet several more applications are available without scientific medical evaluation. Since mobile applications can facilitate the everyday life of orthopaedic and trauma surgeons, it is worthwhile to be aware of new developments in this field. A regular scientific evaluation of the subject is important in order to classify the significance of these applications.