Melissa Paraskevaidis

Background/Objectives: Acetabular fractures, traditionally linked to high-impact trauma in younger adults, are increasingly observed in the elderly due to falls and poor bone quality. This demographic shift necessitates updated treatment approaches. This study analyzes demographic trends and treatment evolution over a decade using the German pelvic fracture registry. Methods: Data on acetabular fractures were analyzed from the German pelvic fracture registry of the German Trauma Society. Parameters included classification, demographics, treatment methods, and surgical details. Trends were assessed by grouping patients based on treatment intervals and age, comparing treatment methods, surgical approaches, and reduction quality across these groups, considering fracture types and treatment volume. Results: The study included 2853 unilateral acetabular fractures with a mean patient age of 61.5 years, showing an increasing age trend. A shift from simple to complex fractures involving the anterior acetabular column was observed. Operative treatment was performed in 62.5% of cases, more common in non-geriatric patients and those with posterior column involvement. The use of anterior intrapelvic approaches increased over time, replacing the Ilioinguinal extrapelvic approach. Anatomical reduction was achieved in 47.4% of cases, with 31.7% having imperfect reductions and 20.9% poor reductions. High-volume centers had significantly better reduction outcomes, particularly for simple fractures. Geriatric patients exhibited worse reduction quality compared to younger patients. In-hospital mortality was stable at 3.3%. Conclusions: The study highlights a demographic shift towards an older patient population, leading to more complex fracture patterns. Despite advancements in surgical techniques and new implant technologies, these demographic changes have resulted in lower reduction quality for complex fractures. Emphasis is placed on careful patient selection for reconstructive surgery or endoprosthetic replacement to ensure high-quality outcomes.

Soft tissue sarcomas (STSs) are a diverse group of rare malignant soft tissue tumors with a high disease burden. Treatment protocols are complex and, to this day, a precise recommendation for the surgical margin width is lacking. The present study aims to analyze the width of the surgical margins in STS resection specimens and analyze them for local and systemic disease-free survival as well as for most frequent histologic STS subtypes. A total of 169 consecutive patients diagnosed and treated in curative intent in our institution following a primary and localized STS of the extremities or trunk from January 2010 to December 2020 were included in this study regardless of age. Our data reveal that low-grade STSs are best controlled locally by a surgical margin ≥2 mm and in this way also preventing distant metastases effectively. Local recurrence-free survival and metastasis-free survival in high-grade STS were improved by intact muscle fascia or periosteum at the margin when compared only to soft tissue. However, the outcome was independent of the surgical margin width, suggesting a close but negative margin may be safe in high-grade STS subtypes with less invasive growth patterns when combined with adjunct radiochemotherapy.

(1) Background: Clinical approaches have depicted interconnectivity between the Achilles tendon and the plantar fascia. This concept has been applied in rehabilitation, prevention, and in conservative management plans, yet potential anatomical and histological connection is not fully understood. (2) Objective: To explore the possible explanation that the calcaneus acts as a hypomochlion. (3) Methods: 2 databases (Pubmed and Livivo) were searched and studies, including those that examined the relationship of the calcaneus to the Achilles tendon and plantar fascia and its biomechanical role. The included studies highlighted either the anatomical, histological, or biomechanical aspect of the lower limb. (4) Results: Seventeen studies were included. Some studies depicted an anatomical connection that slowly declines with age. Others mention a histological similarity and continuity via the paratenon, while a few papers have brought forward mechanical reasoning. (5) Conclusion: The concept of the calcaneus acting as a fulcrum in the lower limb can partially be supported by anatomical, histological, and biomechanical concepts. Despite the plethora of research, a comprehensive understanding is yet to be investigated. Further research exploring the precise interaction is necessary.

Zusammenfassung: Der menschliche Gang als Methode der Fortbewegung ist eines der individuellsten Charakteristika eines jeden Menschen. Die ersten Durchführungen einer Ganganalyse waren visuell und wurden durch den jeweiligen Arzt durchgeführt, um frühzeitig klinische Entscheidungen bei Gangdysfunktionen treffen zu können. Mit der Entwicklung neuer Technologien und der Verwendung von kinetischen Belastungsplatten sowie der Kombination mit der elektromyografischen Untersuchung kam es zu rapiden Fortschritten bei der Analyse des menschlichen Ganges. Der Gangzyklus wird aufgeteilt in eine Stand- und eine Schwungphase, die jeweils 60 – 65% bzw. 35 – 40% des Gangzyklus ausmachen. Diese 2 Phasen werden in weitere Untereinheiten aufgegliedert. Es erfolgen Messungen bezüglich der temporalen Aspekte wie z. B. Geschwindigkeit, Zeit-Distanz-Parameter sowie der räumlichen Parameter, z. B. Schrittlänge des Ganges. Die Anwendung neuester Methoden wie z. B. die 3-D-Analyse des Gangzyklus in Kombination mit der Elektromyografie und der Anwendung von Kraftmessplatten spielen bei orthopädisch-unfallchirurgischen Patienten eine bedeutende Rolle. Die Limitierung dieser Messungen durch die Ortsgebundenheit und die mangelnde Flexibilität der Platten wird durch die Verwendung von Laufbändern mit integrierten Druck- und Kraftmessplatten überwunden. Neueste Entwicklungen moderner Belastungssohlen erleichtern durch die alltägliche Praktikabilität die Anwendung der Ganganalyse bei Alltagsaktivitäten. In Kombination mit der WLAN-Technik erschließen sich durch die schnelle Datenübertragung neue zukunftsweisende Anwendungsfelder. Die benutzerfreundliche Anwendung der Belastungssohlen wird zukünftig im Hochleistungssport, in der Prothesenanpassung, der Planung von Amputationen, bei der Evaluierung neuropädiatrischer Erkrankungen und sogar der forensischen Medizin breite Anwendung finden.