Transforming growth factor-beta 1(TGF-β1) is a regulatory protein, involved in bone fracture healing. Circulating TGF-β1 levels have been reported to be a predictor of delayed bone healing and non-union, suggesting active relationship between tissue and circulating TGF-β1 in fracture healing. The purpose of this study was to analyse TGF-β1 local and serum concentrations in fracture healing to further contribute to the understanding of molecular regulation of fracture healing. Serum samples of 113 patients with long bone fractures were collected over a period of 6 months following a standardised time schedule. TGF-β1 serum concentrations were measured using ELISA. Patients were assigned to 2 groups: Group 1 contained 103 patients with physiological healing. Group 2 contained 10 patients with impaired healing. Patients in both groups were matched. One patient of the group 2 had to be excluded because of missing match partner. In addition, fracture haematoma from 11 patients of group 1 was obtained to analyse local TGF-β1 concentrations. 33 volunteers donated serum which served as control. TGF-β1 serum concentrations increased during the early healing period and were significantly higher in patients with physiological healing compared to controls (P=0.04). Thereafter, it decreased continuously between weeks 2 and 8 and fell again after week 8. TGF-β1 serum concentrations in patients with physiological healing were significantly higher at week 24 compared to controls (P=0.05). In non-unions, serum concentrations differed significantly from those of controls at week 6 (P=0.01). No significant difference in between patients with physiological and impaired fracture healing was observed. Fracture haematoma contained significantly higher TGF-β1 concentrations than peripheral serum of the patients (P=0.017). Elevated levels of TGF-β1 in haematoma and in serum after bone fracture especially during the entire healing process indicate its importance for fracture healing.

Summary: Objective: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and its associated illness, coronavirus disease 2019 (COVID-19), has led to a global health crisis burdening frontline emergency departments, including orthopedic and trauma units. The aim of this study was to provide an overview of the impact of the lockdown secondary to the pandemic on patient numbers and pattern of injuries at the department of traumatology of the Medical University of Vienna.Methods: This retrospective, descriptive study identified all patients admitted and enrolled onto the trauma registry at a level I trauma center, between 15 March 2020 and 30 April 2020 (lockdown) and compared them to those between 15 March 2019 and 30 April 2019 (baseline). Variables collected included patient age, sex, reason for hospital admission, place of injury, death, injury severity score (ISS), as well as American Society of Anaesthesiologists (ASA) score.Results: A total of 10,938 patient visits to the trauma emergency department were analyzed, 8353 presentations during the baseline period and 2585 during lockdown. Only 1869 acutely injured and 716 follow-up patients presented during lockdown, compared to 6178 and 2175, respectively, during baseline. Throughout the COVID-19 lockdown there were significant reductions in both workplace and traffic accidents, sports injuries, number of hospitalized patients, and overall visits to the trauma emergency department; however, the number of major traumas and hip fractures remained similar. Furthermore, there was a significant increase in the frequency of injuries at home as well as hospital admissions due to attempted suicide.Conclusion: Despite the reduction in total number of patients, trauma departments should continue to provide adequate service during lockdown considering that severe injuries showed no change. Conditions such as breakdown of social networks and limited access to mental health care and support might account for the significant rise in hospital admissions due to suicides. We recommend that more attention and effort should be made to prevent this excess of suicide deaths.

The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3^® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group—20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker’s ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.

One of the most common fractures is that of the intracapsular femoral neck; however, the optimal implant for head-preserving treatment remains controversial. The aim of the study was to compare the outcomes of treating undisplaced intracapsular femoral neck fractures with either the dynamic hip screw (DHS) or the double cannulated screw fixation (CSFN). This retrospective cohort study analysed the data of 453 patients, with a mean age of 76.9 years, whose intracapsular fractures were treated with the DHS or CSFN between 2005 and 2013. The analysis focused on the rates of revision surgeries and complications; however, the impact of confounding exogenous factors, such as smoking and alcohol, were also considered. No significant difference was observed between the revision rates of DHS and CSFN (15.0% vs. 13.1%; p = 0.565). According to the complication rate, the advantage in favour of the CSFN was not significant (20.5% vs. 13.1%, p = 0.038). The use of the DHS was associated with a 13 min longer surgery (p < 0.0001) and a one day longer hospitalization (p = 0.242). Excessive consumption of alcohol was associated with an increased incidence of avascular necrosis (18.6% vs. 8.7%, p = 0.035). The choice of implant showed no significant impact on rates of revision surgery and complications. In terms of socioeconomic factors, the fixation with two cannulated screws was more favourable, making it the more cost-effective and less stressful method.