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IntroductionProximal humerus fractures are common injuries of the elderly. Different treatment options, depending on fracture complexity and stability, have been recommended in the literature. Particularly for varus displaced fractures with a lack of medial support, and patients suffering from osteoporosis, structural allografts can be used to enhance the stability of the construct. An individually shaped allograft has been suggested in the literature and investigated in a clinical setting. However, biomechanical properties have yet to be evaluated.Materials and methodsTwenty-four fresh-frozen humeri and 12 femoral heads were obtained, and an unstable three-part fracture of the humeral head was simulated. Fracture fixation was achieved by using a locking plate in both groups. In the test group, a mushroom-shaped allograft was tailored out of a femoral head to individually fit the void inside the humeral head. Specimens were fitted with a 3D motion analysis system and cyclically loaded with a stepwise increasing load magnitude in a varus-valgus bending test until failure or up to a maximum of 10,000 load cycles.ResultsThe mushroom group reached a significantly higher number of load cycles (8342; SD 1,902; CI 7133–9550) compared to the control group (3475; SD 1488; CI 2530–4420; p < 0.001). Additionally, the test group showed significantly higher stiffness values concerning all observational points (p < 0.001).ConclusionThis mushroom-shaped allograft in combination with a locking plate significantly increased load to failure as well as stiffness of the construct when exposed to varus-valgus bending forces. Therefore, it might be a viable option for surgical treatment of unstable and varus displaced proximal humerus fractures to superiorly prevent loss of reduction and varus collapse.

Trams are widely used for urban public transportation. The aim of this study was to identify the total number of accidents and common injury patterns of tram-system-related cycling injuries. All patients attending the traumatology emergency department of University Hospital of Innsbruck between January 2010 and December 2019 due to tram-track-related bike crashes were identified. Patient demographics; date, time, and mechanism of the accident; type of injury; exact diagnosis and subsequent treatment; as well as direct treatment costs were evaluated and analyzed. A total of 378 patients (56.1% female; mean age: 38.4 years) were identified. Bike tire wedging was the most frequent accident mechanism (95.2%). A total of 108 patients (28.7%) sustained a total number of 135 fractures, predominately of the upper limb. Twenty-six patients (7.0%) required surgical treatment. No patient in this collective died as a result of the injuries sustained in the accident. During the time of this analysis, the city government implemented several measures to increase cyclists’ safety. For the main injury site, a sharp reduction in injuries was observed. Urban tram tracks are a significant risk factor for cycling-related injuries. Injuries might be reduced with the implementation of cyclist-friendly safety measures.

SARS-CoV-2 has had a measurable impact on the field of orthopedic and traumatological surgery. To date, scarce data on intramural SARS-CoV-2 infections in orthopedic and traumatological patients have been reported. Therefore, the aim of our study was to investigate the effect of nosocomial SARS-CoV-2 infections in orthopedic and traumatological inpatients regarding symptoms of infection, mortality, duration of hospitalization, and other relevant patient-dependent factors. Patients admitted to hospital for an orthopedic or traumatological indication were screened retrospectively for nosocomial SARS-CoV-2 infections and included in this study. An age-, sex-, and ICD 10-matched control group was assigned and demographic data, clinical symptoms of a SARS-CoV-2 infection as well as mortality, length of hospital stays, time to surgery, pre-existing conditions, LKF-points representing the financial effort, and the Charlson Comorbidity Index were collected. A significantly higher length of stay was observed in the SARS-CoV-2 group (25 days; 4–60; SD 12.5) when compared to the control group (11 days; 2–36; SD 7; p < 0.05). LKF points were significantly higher in the SARS-CoV-2 group (13,939 points vs. 8542 points). No significant difference in mortality could be observed. An infection with SARS-CoV-2 in inpatients significantly increases length of hospital stay and cost of treatment. Although no significant difference in mortality was found, care should be taken to avoid intramural SARS-CoV-2 infections, resulting in prolonged hospitalization, higher costs, and potentially further individual risks.

Bone defects can be filled with autografts, allografts and artificial bone-materials. The aim of this study was to evaluate whether the digitization of known defect models with a navigation system is a reliable measurement method for estimating the size of a bone defect. Six preformed, cylindrical and cone-shaped defects on an artificial hip-bone were digitalized by six different observers. Reference volumes were gathered by measuring the depth of the defects, using an alginate impression material to fill out the defects and calculating the volumes from a CT scan. One out of the six preformed defects showed a statistically significant difference between the digitalization and the calculation, four showed a significant difference between the digitalization and the mould as well as between the digitalization and the CT calculation. This technique offers satisfactory results and consistent reproducibility when digitalizing big defects with relatively simple shape. Decreasing size and increasing complexity of the defects leads to more imprecise measurements. •Digitalization of bone defects is possible using navigation systems.•This technique shows good results and reproducibility when measuring big defects.•The known size of a defect can be used to determine further treatment.

Aims COVID‐19, a respiratory viral disease causing severe pneumonia, also affects the heart and other organs. Whether its cardiac involvement is a specific feature consisting of myocarditis, or simply due to microvascular injury and systemic inflammation, is yet unclear and presently debated. Because myocardial injury is also common in other kinds of pneumonias, we investigated and compared such occurrence in severe pneumonias due to COVID‐19 and other causes. Methods and results We analysed data from 156 critically ill patients requiring mechanical ventilation in four European tertiary hospitals, including all n = 76 COVID‐19 patients with severe disease course requiring at least ventilatory support, matched to n = 76 from a retrospective consecutive patient cohort of severe pneumonias of other origin (matched for age, gender, and type of ventilator therapy). When compared to the non‐COVID‐19, mortality (COVID‐19 = 38.2% vs. non‐COVID‐19 = 51.3%, P = 0.142) and impairment of systolic function were not significantly different. Surprisingly, myocardial injury was even more frequent in non‐COVID‐19 (96.4% vs. 78.1% P = 0.004). Although inflammatory activity [C‐reactive protein (CRP) and interleukin‐6] was indifferent, d‐dimer and thromboembolic incidence (COVID‐19 = 23.7% vs. non‐COVID‐19 = 5.3%, P = 0.002) driven by pulmonary embolism rates (COVID‐19 = 17.1% vs. non‐COVID‐19 = 2.6%, P = 0.005) were higher. Conclusions Myocardial injury was frequent in severe COVID‐19 requiring mechanical ventilation, but still less frequent than in similarly severe pneumonias of other origin, indicating that cardiac involvement may not be a specific feature of COVID‐19. While mortality was also similar, COVID‐19 is characterized with increased thrombogenicity and high pulmonary embolism rates.

Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive. In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9-10). Sixty five patients (36.5%) constituted the non-dexamethasone control group. While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group. In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.