Aim: Subsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method. Method: During the literature research, the method of “adaptive monitoring” fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied. Results: Initially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry’s data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry. Discussion: The application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults. Conclusions: The method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry’s data quality and is currently second to none. The resulting transparency of the registry’s data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.

Methodology: In a consecutive retrospective analysis of 190 patients treated with the Masquelet technique at the BG Klinikum Hamburg from January 2012 to January 2022, subgroup analysis for defect-specific features such as the extent and morphology of the defect were recorded, and their influence on the time to reach full weight-bearing of the affected limb was investigated. Results and conclusion A total of 217 defects were treated in 190 patients using the Masquelet technique. 70 % of all defects were in the tibia, followed by 22 % in the femur and only about 7 % in the upper extremity. The average length of all defects was 58 mm (+/- 31 mm), with the largest defect measuring 180 mm and the smallest measuring 20 mm. 89 % of the patients achieved full weight-bearing at the end of therapy. The average time from initiation of therapy to reaching safe full weight-bearing was 589 days. There was a significant correlation between defect length and time to reach full weight-bearing (p = 0.0134). These results could serve as a basis for creating a score for prognostics and evaluation of bone healing after treatment with the Masquelet technique. Additionally, the results could help guide indications for secondary stabilization using internal fixation.

Background: The aim of this study was to systematically explore point-of-care biomarkers as diagnostic indicators for the detection and exclusion of mild traumatic brain injury (mTBI) in an emergency room (ER) setting using Eye-Tracking and Virtual Reality (ET/VR) technology. The primary target group included patients who had suffered an acute trauma to the head and presented within 24 h to the emergency department. Methods: The BG Unfallkrankenhaus Berlin and the BG Klinikum Hamburg participated in this explorative, prospective, single-arm accuracy study. This study included patients who presented to the emergency department with suspected mTBI and were examined using ET/VR glasses. All further steps corresponded to clinical routine (e.g., decision on hospital admission, imaging diagnostics). After the completion of treatment, the patients were divided into mTBI and non-TBI subgroups by consensus between two independent clinical experts, who were blinded to the results of the index test (examination using ET/VR glasses) in the form of a clinical synopsis. The diagnosis was based on all clinical, neurological, neurofunctional, neuropsychological, and imaging findings. Routine trauma and neurological history, examination, and diagnosis were performed in each case. All statistical analyses were performed with exploratory intent. Results: The use of ET/VR glasses was found to be predominantly unproblematic. Two of the fifty-two analyzed parameters can be statistically distinguished from a random decision. No difference in oculomotor function was found between the two subgroups, and no correlations between the parameters recorded by the VR goggles and the detection of mTBI were found. Conclusions: At present, the use of VR goggles for the diagnosis of mTBI in an ER setting cannot be recommended.

PurposeAs part of a fracture treatment registry, a questionnaire was developed to record the general state of health of the patients, the result of fracture treatment and complications. This resulted in the "Fracture Evaluation Since Hospitalization" score, or FRESH- score. The development and validation of the FRESH- score is the subject of this manuscript. MethodsFor validation, the EQ-5D-5L was used as a matching questionnaire. 237 patients were contacted via mail and received both questionnaires. The reliability was determined testing the internal consistency by Cronbach's alpha, convergent validity was tested with the Pearson correlation, construct validity was determined using the Wilcoxon rank sum test, as well as the paired t-test.ResultsCronbach's alpha for reliability was moderate at 0.57. Convergent validity using Pearson's correlation resulted in a moderate correlation with a coefficient of 0.41. Construct validity was determined using the Wilcoxon rank sum test, as well as the paired t-test. Both methods showed a high significance of p=0.0287 and a tendency p=0.0677, which represents a relationship between the two samples. Content validity was tested using missing values, which were low at 8% on average.ConclusionThe FRESH- score proved to be reasonable, reliable and sufficiently valid. Application with a larger samples would strengthen the validity of the questionnaire. The score fills a gap between existing questionnaires in orthopedics. An advantage of the FRESH- score is its concise set up and broad applicability.

Aim Subsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method.Method During the literature research, the method of “adaptive monitoring” fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied.Results Initially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry’s data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry.Discussion The application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults.Conclusions The method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry’s data quality and is currently second to none. The resulting transparency of the registry’s data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.