Background/Objectives: Traditional autologous bone grafts as a treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal^®, a ceramic bone substitute, may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal^® in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: A single-center, retrospective study, investigating patients treated with PerOssal^® between January 2020 and December 2023. Collected data include patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal^® was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal^® (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal^® demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols.

Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization ($\epsilon <2.9\mathrm{mm}$) and low angulation errors for k-wire instrumentation ($\epsilon <{0.75}^{\circ }$) on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.

Background/Objectives: Traditional autologous bone grafts as treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal^®, a ceramic bone substitute may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal^® in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: Single-center, retrospective study, investigating patients treated with PerOssal® between January 2020 and December 2023. Collected data included patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal^® was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal® (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal^® demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols.

Purpose: To assess the result in orthopedic trauma surgery, usually three-dimensional volume data of the treated region is acquired. With mobile C-arm systems, these acquisitions can be performed intraoperatively, reducing the number of required revision surgeries. However, the acquired volumes are typically not aligned to the anatomical regions. Thus, the multiplanar reconstructed (MPR) planes need to be adjusted manually during the review of the volume. To speed up and ease the workflow, an automatic parameterization of these planes is needed. Approach: We present a detailed study of multitask learning (MTL) regression networks to estimate the parameters of the MPR planes. First, various mathematical descriptions for rotation, including Euler angle, quaternion, and matrix representation, are revised. Then, two different MTL network architectures based on the PoseNet are compared with a single task learning network. Results: Using a matrix description rather than the Euler angle description, the accuracy of the regressed normals improves from 7.7 deg to 7.3 deg in the mean value for single anatomies. The multihead approach improves the regression of the plane position from 7.4 to 6.1 mm, whereas the orientation does not benefit from this approach. Thus, the achieved accuracy meets the reported interrater variance in similarly complex body regions of up to 6.3 deg for the normals and up to 9.3 mm for the plane position. Conclusions: The use of a multihead approach with shared features leads to more accurate plane regression compared with the use of individual networks for each task. It also improves the angle estimation for the ankle region. The reported results are in the same range as manual plane adjustments. The use of a combined network with shared parameters requires less memory, which is a great benefit for the implementation of an application for the surgical environment.

Background: There has been an increasing number of fragility fractures of the sacrum in the recent decade. With rates of up to 28%, the complication rates after surgical treatment are still at an unacceptably high level, and new treatment strategies are urgently needed. Therefore, the purpose of this study was to evaluate the potential of 3D-navigated trans-sacral bar osteosynthesis in the surgical treatment of fragility fractures of the sacrum. Methods: Retrospectively, from 2017 to 2023, all cases with confirmed fragility fractures of the sacrum in patients > 65 years of age that were surgically treated with navigated 3D-navigated trans-sacral bar osteosynthesis were included, and epidemiological data and the course of treatment analyzed in comparison to a matched control group. Results: Finally, 21 patients (18 women and 3 men) were included in this study. The average age of the patients was 82.6 (SD 6.3) in the intervention group and 79.4 (SD 6.7) in the control group. There were postoperatively detected complications in two cases (18%) in the intervention group and in four cases (40%, p = 0.362) in the control group. The postoperative in-hospital stay was 10 days (SD 3.8) vs. 11.4 days (SD 3.8) in the control. None of the patients in the intervention group and two in the control group needed revision surgery. Conclusions: Overall, 3D-navigated trans-sacral bar osteosynthesis seems to be a promising technique, enabling an accurate implant positioning while offering a low complication rate with an excellent short-term outcome in elderly patients with fragility fractures of the sacrum.

Background: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. Objective: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. Methods: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. Results: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer’s intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. Conclusions: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size.