Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity.

Idiopathic genu valgum is a frequently diagnosed growth disorder in adolescence. Whenever the possibilities of conservative therapy have been exhausted, leg straightening by means of hemiepiphysiodesis has become the standard form of treatment. Because of their flexible screw-plate connection, eight-Plates have been reported in the literature to lead to lower complications regarding implant loosening and fracture compared to other implants. The aim of this retrospective survey was to analyse our own patient population who were treated for genu valgum by means of temporary hemiepiphysiodesis near the knee using eight-Plates to modulate growth. Between July 2007 and July 2015, 198 eight-Plates were implanted near the knee in 132 children suffering from genu valgum to modulate growth. Depending on the deformity analysis, an eight-Plate was implanted on the distal medial femur and/or the proximal medial tibia. By December 2015, they had been removed from 105 patients. The etiology of genu valgum was mainly idiopathic or associated withobesity. Evaluation was carried out clinically and radiologically (whole-leg X-ray in standing) including determination of the joint angles. The median follow-up period was about 46 months (12–102 months). The median age at implantation was 12.7 +/−6.76 years. Of the 105 patients, 45.7% (n = 48) were girls. The eight-Plates remained in place for a median period of 13 +/−1.76 months. Irrespective of the location of hemiepiphysiodesis, the intermalleolar distance was corrected to a median of 0 +/−2.1 cm while the anatomical femorotibial angle was corrected by on average 9 +/−2.7 °Mechanical lateral distal femoral angle changed an average 7 +/− 7.72 degrees. Medial proximal tibial angle changed an average 4 +/− 6.02 degrees. Complications necessitating surgery occurred in 2.8% of cases (1 wound infection, 3 corrective osteotomies following overcorrection). Temporary hemiepiphysiodesis using eight-Plates is a gentle, simple and effective procedure used to treat genu valgum by modulating growth. Slight overcorrection is desirable due to the rebound phenomenon, especially in young patients with high growth potential and risk groups such as obese children. In adolescents with only low growth potential (older than 14 years), owing to the low correction potential, the indication should be strictly reviewed and the possible failure of therapy should be discussed with the patient. No differences were observed regarding the location of the implanted eight-Plates (femoral or tibial).

Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS^® polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS^® protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient.

Background: Large language models are increasingly applied in health care for documentation, patient education, and clinical decision support. However, their factual reliability can be compromised by hallucinations and a lack of source traceability. Retrieval-augmented generation (RAG) enhances response accuracy by combining generative models with document retrieval mechanisms. While promising in medical contexts, RAG-based systems remain underexplored in orthopedic and trauma surgery patient education, particularly in non-English settings. Objective: This study aimed to develop and evaluate a RAG-based chatbot that provides German-language, evidence-based information on common orthopedic conditions. We assessed the system’s performance in terms of response accuracy, contextual precision, and alignment with retrieved sources. In addition, we examined user satisfaction, usability, and perceived trustworthiness. Methods: The chatbot integrated OpenAI’s GPT language model with a Qdrant vector database for semantic search. Its corpus consisted of 899 curated German-language documents, including national orthopedic guidelines and patient education content from the Orthinform platform of the German Society of Orthopedics and Trauma Surgery. After preprocessing, the data were segmented into 18,197 retrievable chunks. Evaluation occurred in two phases: (1) human validation by 30 participants (orthopedic specialists, medical students, and nonmedical users), who rated 12 standardized chatbot responses using a 5-point Likert scale, and (2) automated evaluation of 100 synthetic queries using the Retrieval-Augmented Generation Assessment Scale, measuring answer relevancy, contextual precision, and faithfulness. A permanent disclaimer indicated that the chatbot provides general information only and is not intended for diagnosis or treatment decisions. Results: Human ratings indicated high perceived quality for accuracy (mean 4.55, SD 0.45), helpfulness (mean 4.61, SD 0.57), ease of use (), and clarity (mean 4.77, ), while trust scored slightly lower (mean 4.23, ). Retrieval-Augmented Generation Assessment Scale evaluation confirmed strong technical performance for answer relevancy (mean 0.864, SD 0.223), contextual precision (mean 0.891, SD 0.201), and faithfulness (mean 0.853, SD 0.171). Performance was highest for knee and back-related topics and lower for hip-related queries (eg, gluteal tendinopathy), which showed elevated error rates in differential diagnosis. Conclusions: The chatbot demonstrated strong performance in delivering orthopedic patient education through an RAG framework. Its deployment on the national Orthinform platform has led to more than 9500 real-world user interactions, supporting its relevance and acceptance. Future improvements should focus on expanding domain coverage, enhancing retrieval precision, and integrating multimodal content and advanced RAG techniques to improve robustness and safety in patient-facing apps.

Modular mega-endoprosthesis systems are used to bridge very large bone defects and have become a widespread method in orthopaedic surgery for the treatment of tumours and revision arthroplasty. However, the indications for the use of modular mega-endoprostheses must be carefully considered. Implanting modular endoprostheses requires major, complication-prone surgery in which the limited salvage procedures should always be borne in mind. The management of periprosthetic infection is particularly difficult and beset with problems. Given this, the present study was designed to gauge the significance of periprosthetic infections in connection with modular mega-implants in the lower extremities among our own patients. Patients who had been fitted with modular endoprosthesis on a lower extremity at our department between September 1994 and December 2011 were examined retrospectively. A total of 101 patients with 114 modular prostheses were identified. Comprising 30 men (29.7 %) and 71 women (70.3 %), their average age at the time of surgery was 67 years (18–92 years). The average follow-up period was 27 months (5 months and 2 weeks to 14 years and 11 months) and the drop-out rate was about 8.8 %. Altogether, there were 19 (17.7 %) endoprosthesis infections: 3 early infections and 16 late or delayed infections. The pathogen spectrum was dominated by coagulase-negative staphylococci (36 %) and Staphylococcus aureus (16 %), including 26 % multi-resistant pathogens. Reinfection occurred in 37 % of cases of infection. Tumours were followed by significantly fewer infections than the other indications. Infections were twice as likely to occur after previous surgery. In our findings modular endoprostheses (18 %) are much more susceptible to infection than primary endoprostheses (0.5–2,5 %). Infection is the most common complication alongside the dislocation of proximal femur endoprostheses. Consistent, radical surgery is essential – although even with an adequate treatment strategy, the recurrence rate is very high. Unfortunately, the functional results are frequently unsatisfactory, with amputation often being the last resort. Therefore, the indication for implantation must be carefully considered and discussed in great detail, especially in the case of multimorbid patients with previous joint infections.