Background: Ruptures of the anterior cruciate ligament (ACL) are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage. This might at least in part depend on the method of graft fixation in the bony tunnels. Whereas resorbable screws are easy to handle, pins may better preserve graft tension. The objective of this study is to determine whether pinning of ACL grafts reduces residual anterior laxity six months after surgery as compared to screw fixation. Design/ Methods: SPOT is a randomised, controlled, patient and investigator blinded trial conducted at a single academic institution. Eligible patients are scheduled to arthroscopic ACL repair with triple-stranded hamstring grafts, conducted by a single, experienced surgeon. Intraoperatively, subjects willing to engage in this study will be randomised to transplant tethering with either resorbable screws or resorbable pins. No other changes apply to locally established treatment protocols. Patients and clinical investigators will remain blinded to the assigned fixation method until the six-month follow-up examination. The primary outcome is the side-to-side (repaired to healthy knee) difference in anterior translation as measured by the KT-1000 arthrometer at a defined load (89 N) six months after surgery. A sample size of 54 patients will yield a power of 80% to detect a difference of 1.0 mm ± standard deviation 1.2 mm at a two-sided alpha of 5% with a t-test for independent samples. Secondary outcomes (generic and disease-specific measures of quality of life, magnetic resonance imaging morphology of transplants and devices) will be handled in an exploratory fashion. Conclusion: SPOT aims at showing a reduction in anterior knee laxity after fixing ACL grafts by pins compared to screws.

Pedestrians are at a high risk for crash and injury. This study aims at comparing data from real world crashes with data gathered from experimental settings.

Zusammenfassung: Hintergrund und Fragestellung: Eine hochwertige Weiterbildung ist ein Schlüsselfaktor für gute und sichere Patienten- und Patientinnenversorgung. In Deutschland werden derzeit Weiterbildungsordnungen und Logbücher mit dem Ziel überarbeitet, die Weiterbildung in eine kompetenzbasierte Weiterbildung zu überführen. Ziel der Studie ist die Analyse der täglichen Realität der orthopädisch-chirurgischen Weiterbildung in Deutschland anhand der Elemente der Weiterbildung. Methoden: Im März 2020 wurde eine Onlinebefragung von Weiterzubildenden mit 44 Fragen zu den Themen Weiterbildungsordnung, Logbuch, Bildungsressourcen, Evaluation, Weiterbildungsbefugte und Arbeitszeitverteilung durchgeführt. Ergebnisse: Insgesamt 237 Personen beantworteten die Umfrage, 208 erfüllten die Einschlusskriterien. Die Weiterzubildenden empfinden einen Mangel an klaren Standards in der Weiterbildungsordnung. 25 % der Weiterzubildenden erhalten keine strukturierten Lernressourcen wie beispielsweise Simulationen oder Kurse. Weiterbildungsgespräche werden in 58 % der Fälle durchgeführt. Die meisten Weiterzubildenden schätzen die Expertise ihrer Weiterbildenden in der Orthopädie/Unfallchirurgie, während sie deren Kompetenz in Supervision und Feedbackgeben als unterdurchschnittlich bewerten. Administratives Arbeiten umfasst 220 min der täglichen Arbeitszeit, im Schnitt verbleiben 60 min pro Tag und Weiterzubildenden, um operative Tätigkeiten zu erlernen. Diskussion: Die Studie deckt Inkonsistenzen mit der aktuellen Weiterbildungsordnung und ein Defizit an Supervision und Evaluation auf. Die Überführung in kompetenzbasierte Weiterbildung sollte daher nicht ausschließlich auf einer Anpassung der Weiterbildungsordnung beruhen, sondern auf allen Ebenen der Weiterbildung anvisiert werden (Lernressourcen Ausbildung der Weiterbildenden, Evaluation).

Architectural division of aseptic and septic operating theatres is a distinct structural feature of surgical departments in Germany. Internationally, hygienists and microbiologists mainly recommend functional separation (i.e. aseptic procedures first) without calling for separate operating floors and rooms. However, patients with severe musculoskeletal infections (e.g. joint empyema, spondylodiscitis, deep implant-associated infections) may benefit from the permanent availability of septic operating capacities without delay caused by an ongoing aseptic surgical program. A systematic literature review on the influence of a structural separation of septic and aseptic operating theatres on process and/or outcome quality has not yet been conducted. Systematic literature search in PubMed MEDLINE, Ovid Embase, CINAHL and the Cochrane Library, screening of referenced citations, and assessment of grey literature. A total of 572 articles were found through the systematic literature search. No head-to-head studies (neither randomised, quasi-randomised nor observational) were identified which examined the impact of structural separation of septic and aseptic operating theatres on process and/or outcome quality. This review did not identify evidence in favour nor against architectural separation of septic or aseptic operating theatre. Specifically, there is no evidence of a harmful effect of architectural separation. Unless prospective studies, ideally randomised trials, will be available, it is unjustified to call for abolishing established hospital structures. Future investigations must address patient-centered endpoints, surgical site infections, process quality and hospital economy. PROSPERO (International prospective register of systematic reviews): CRD42018086568.

Background: In the past ten years, the number of publications on injuries associated with electric scooters (e-scooters) has been increasing continuously. The aim of this systematic review and meta-analysis was to synthesize the original study results on injury types, injury severity, clinical care, accident mechanisms, risk factors, and patient characteristics associated with e-scooter accidents. Methods: The literature search was conducted in PubMed, EMBASE and Medline. We included quantitative clinical studies published between 07/2019 and 07/2024 that report e-scooter-associated injuries in patients who presented to an emergency department. Variables that were reported as proportions (e.g., frequency of extremity fractures) were summarized using a proportional meta-analysis. Parameters on a continuous scale were combined using a meta-analysis of the arithmetic means. Results: Among 524 unique records, 149 articles met the inclusion criteria, and 68 were eligible for quantitative analyses. Most e-scooter patients sustained injuries to the head and face with a pooled frequency of 42.1% (95% CI 38.7–45.4). Injuries of the upper extremities were estimated at 40.1% of patients (95% CI 35.8–44.4). Fractures of the extremities occurred with a pooled frequency of 25.7% (95% CI 22.5–28.9). An estimated proportion of 2.3% (95% CI 1.6–3.0) sustained severe traumatic brain injuries. Determined by the Injury Severity Score (ISS), 2.8% (95% CI 1.5–4.1) of the e-scooter patients were severely injured (ISS ≥ 16). Conclusions: Injuries to the head and face as well as the upper extremities are the most common causes for emergency department visits following e-scooter accidents. One in four patients presented with extremity fractures. Severe injuries, however, affect less than three percent of e-scooter patients.