Background: Demographic changes led to an increasingly ageing population in Germany and thus to possible changes in the frequency of fractures. The primary aim of this study was to report changes in fracture rates of the lower extremities in Germany in 2002 compared to 2017 and to evaluate those changes. Methods: Inpatient data from the German National Hospital Discharge Registry (ICD10) for 2002 and 2017 were evaluated. Changes in total counts and incidence rates were analysed for fractures in the following locations: femoral neck, pertrochanteric, subtrochanteric, distal femur, femoral shaft, proximal and distal tibia, tibial shaft, medial and lateral malleolus, and other parts of the lower leg (including bi- and trimalleolar fractures), calcaneus, talus, other tarsal bones, metatarsal bones, greater toe, lesser toe, other fractures of foot or unspecific fractures of foot and toe. Patients were classed into age groups by sex: 15–24, 25–34,35–44, 45–54, 55–64, 65–74, 75–84, 85–90 and > 90 years. Results: The total count for lower extremity fractures in men and women increased slightly by 4.5% from 305,764 in 2002 to 319,422 in 2017. Hip and femur fractures increased by 23.5% from 150,565 in 2002 to 185,979 in 2017. The number of these fractures among men increased by 46% and among women by 15.3%. The total count of lower leg fractures decreased by 15.4% from 131,162 in 2002 to 110,924 in 2017. Especially, younger age groups showed a decline for all tibial segments and ankle fractures. For both sexes, the number of lower leg fractures in those 75 years or older increased in all lower leg fracture locations. Most femur and lower leg fractures occurred in women. The incidence of fractures rose sharply from 2002 to 2017, especially for older cohorts. Conclusion: The total numbers of lower extremity fractures increased slightly in 2017 compared to 2002 – especially hip and femur fractures among men. The incidence of almost all lower extremity fracture types among older people increased during this time. Women were particularly affected. Therefore, focused prevention programmes should be considered including an extended fracture spectrum in the elderly.

In eukaryotes, cellular functions are tightly controlled by diverse post-translational modifications (PTMs) of proteins. One such PTM affecting many proteins is the deimination of arginine to citrulline. This process, called citrullination is catalyzed by a group of hydrolases called protein arginine deiminases (PADs), of which five isoforms have been identified. Hypercitrullination, as a result of increased PAD expression or activity, is associated with autoimmune diseases e.g., rheumatoid arthritis, lupus, Alzheimer’s disease, ulcerative colitis, multiple sclerosis, and certain cancers. Three common single nucleotide polymorphisms (SNPs) in the PADI4 gene have been described, namely rs874881, rs11203366, and rs11203367, which are thought to affect PAD4 expression and activity. We here compared the suitability of four methods for the screening of SNPs in the PADI4 gene: (i) SYBR-green based real-time polymerase chain reaction followed by high resolution melting curve analysis (HRM-PCR); (ii) PCR followed by detection of restriction fragment length polymorphisms (PCR-RFLP); (iii) conventional tetra-primer amplification refractory mutation system PCR (ARMS-PCR); and (iv) real-time PCR based on the one-step ARMS-PCR. Of these, ARMS-PCR proved to be the most suitable method regarding handling, duration, and cost of experiments. Using the method with SYBR-green based real-time PCR reagents further diminished handling steps and thus potential sources of error.

Background: Recent studies investigating fracture development in Germany are not available especially with regard to demographic change. The primary aim of this study was to report trends in fracture development of the upper extremity in Germany between 2002 and 2017 and to evaluate changes over time. Methods: Evaluating inpatient data from the German National Hospital Discharge Registry (International Classification of Diseases, ICD-10) between 2002 and 2017. Total count, incidences and percentage changes of the following fracture localizations were analysed: proximal humerus, distal humerus, proximal ulna, proximal radius, ulna diaphysis (including Monteggia lesion) and distal radius. Ten age groups for men and women were formed: 35–44, 45–54, 55–64, 65–74; 75–84; 85–90, and > 90 (years). Results: The total count of proximal humeral fractures increased from 40,839 (2002, men/women 9967/30,872) to 59,545 (2017, men/women 14,484/45,061). Distal humeral fractures increased from 5912 (2002, men/women 1559/4353) to 6493 (2017, men/women1840/4653). The total count of forearm fractures increased from 68,636 (2002, men/women 17,186/51,450) to 89,040 (2017, men/women 20,185/68,855). Women were affected in 70–75% of all cases with rising incidences among nearly every age group in female patients. Conclusion: Total count of nearly every evaluated fracture increased. Also, incidences increased especially in the older female age groups. Fracture development already seems to reflect demographic changes in Germany.

Although the benefits of hand orthoses were shown in previous studies, they have not been able to establish themselves in clinical routines. With a focus on patient satisfaction, this study aimed to evaluate the latest generation of hand orthoses after palmar plate osteosynthesis for isolated distal radius fractures in comparison with circular plaster casts. 50 patients (16% dropout rate) were randomly assigned to an orthotic group (immobilization by orthosis, OG) or a control group (immobilization by a plaster cast, CG). Intra-articular fractures were present in 74% of the cases, and unstable AO C3 fractures in 26%. Questionnaires on patient satisfaction, documentation of the time required, clinical scores (DASH, SF-36), range of motion, grip measurements and radiographs were used for evaluation. The OG proved to be equivalent to the plaster treatment in terms of patient satisfaction, and stability of the reduction, as well as clinical scores DASH and SF-36. The OG was even superior in terms of personal hygiene (p = 0.011), handling (p = 0.008) and better adaptability (p = 0.013). Significantly less time was required to apply the orthosis (p < 0.001). In addition to the good results achieved so far, the study showed that the latest generation of orthoses has several advantages over plaster cast therapy, and could therefore become established in everyday clinical practice.

Objective: The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA. Materials and methods: A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson’s correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen. Results: A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA. Conclusion: The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.