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Purpose Searching for quick determinable biomarkers with high sensitivity and specificity is necessary to improve and optimise the early diagnosis of periprosthetic elbow infection (PEI). Therefore, this study's objective was to evaluate the diagnostic value of synovial fluid interleukin-6 (IL-6) levels for diagnosing PEI in total elbow arthroplasty. Method Twelve prospective enrolled patients underwent total elbow arthroplasty revision surgery, during which synovial fluid was obtained. Between the initial implantation and the revision procedure were 33.5 ± 41 months (range, 2–144 months). Synovial fluid was collected for immediate IL-6 analysis parallel to the revision surgery. Furthermore, microbiological samples were obtained and analysed. Two groups were defined based on the microbiological results: non-infection and infection group. The ability of synovial fluid IL-6 analysis to predict infection status was explored using receiver operating characteristic curves and further statistical analysis. Results Synovial fluid IL-6 analysis had a good diagnostic accuracy of 83% for PEI with an area under the curve of 0,79 and an ideal cutoff value (determined using Youden’s criterion) of 15244 pg/mL. Discussion This is the first study to clinically evaluate IL-6 as a diagnostical marker for periprosthetic joint infection (PJI) in total elbow arthroplasty. Our results suggest a good accuracy and high sensitivity for IL-6 to identify a PEI. The analysis of IL-6 can improve surgical decision-making regarding managing total elbow arthroplasty in terms of one- or two-staged revision. Conclusion IL-6 can play an important role in the perioperative differentiation of infected and non-infected situations.

Introduction Over the last decades, arthroscopic surgery has become increasingly relevant as its minimally invasive approach offers many benefits. To investigate the risks of orthoscopic surgery at the elbow, this study aimed to investigate the development of temperatures in elbow joints while performing radiofrequency ablation in arthroscopic surgery. Materials and methods We performed standard arthroscopic surgeries with posterolateral, transtricipital and anterolateral approaches on seven cadaveric elbows and performed ablation on predefined locations with or without irrigation. Two temperature probes were positioned into the olecranon fossa and between the ulnar nerve and the medial joint capsule. The temperature data were recorded using a real-time data logger. A bipolar radiofrequency ablation (bRFA) device was used at the medial and lateral recess and in the fossa olecrani over a defined period. Data was then analyzed using Matlab. Results Using bRFA without irrigation results in rapidly increasing temperature within the joint. A significant temperature increase was found within only 5 s without irrigation ( p  = 0.0052) in the fossa olecrani. We did not observe critical temperatures above 41 °C close to the ulnar nerve within 30 s under constant irrigation ( p  = 0.0747). Conclusions Radiofrequency ablation (RFA) can be safely used in elbow arthroscopy with irrigation. The continuous use without irrigation should be limited to 3 s. Despite the anatomical proximity of the ulnar nerve and capsule, we were able to show that a possible rise in temperature most likely does not affect the ulnar nerve.

Purpose Ligamentous elbow dislocations often affect young patients with high functional and athletic demands. After reduction and clinical examination of joint stability, further treatment options are, therefore, the subject of controversial debate. In order to be able to advise patients adequately, an assessment of the possible return-to-sport based on experience is necessary. This study examines the medium to long-term return-to-sports after conservative treatment of a ligamentous elbow dislocation. Methods In this clinical study, 42 patients (47.6% female, 52.4% male) who were treated conservatively for a ligamentous elbow dislocation at our clinic were surveyed. Conservative treatment was carried out for at least 6 weeks. Exclusion criteria were concomitant bony lesions requiring surgery, a tendency to dislocate between 30 and 130° of flexion after reduction, a positive apprehension test after reduction, and athletes with medial pop-up/instability and high valgus stress as part of their sporting activities. The Disabilities of the arm, shoulder and hand (DASH), the sport-DASH and the subjective elbow value (SEV) were tested. The sport-DASH was correlated with gender, age, arm dominance, and the type of sport practiced. Descriptive statistics and significant differences were determined using statistical analyses. Results The average age was 42.7 years (range 22–75). After an average follow-up after 4.5 years, the mean value of DASH was 2.44 (SD 4.77), the mean value of sports DASH was 4.17 (SD 11.04) and the mean value of SEV was 94.93% (SD 6.40). There were no significant differences in sports DASH depending on gender ( p  = 0.81), age ( p  = 0.68), dislocation side in relation to the dominant arm ( p  = 0.54) or the type of sport practiced ( p  = 0.94, p  = 0.65, p  = 0.71). 2 patients (4.8%) underwent surgery after 6 and 8 weeks of conservative treatment due to persistent elbow stiffness. Conclusion In our patient cohort, a very good return-to-sports after conservative treatment of ligamentous elbow dislocation was demonstrated, taking into account the above exclusion criteria. Factors such as age, gender, the side of the dislocation in relation to the arm dominance, and the type of sport had no influence on the outcome of our study. The data help practitioners to advise patients better when deciding on treatment and the question of a possible return to sport.

PurposeAfter major COVID-19 lockdown measures were suspended in 2021, E-scooter mobility regrew rapidly. In the meantime, multiple studies were published on the potential risks for e-scooter drivers and the necessity for wearing protective equipment. But did the drivers learn their lessons?MethodsWe observed data of E-scooter-related accidents admitted to the emergency department of a level 1 German trauma center in the year 2021 and compared the data with our previous report (July 2019-July 2020).ResultsN = 97 E-scooter-related accidents were included, marking a 50% increase when compared to the previous observation. Most patients were young adults (28.18 ± 1.13 years) with a notable shift towards a male population (25 vs. 63, p = 0.007). While the injury pattern remained unchanged, injury severity, reflected by a significant increase in shock room treatments (p = 0.005), hospital admissions (p = 0.45), and ICU admissions (p = 0.028), increased. Lastly, we report a higher injury severity of patients driving under the influence of alcohol, expressed by significant differences in hospital admissions, shock room treatments, ICU admissions, intracerebral bleeding (p < 0.0001), and injuries requiring surgery (p = 0.0017).ConclusionThe increase in injury severity and especially the substantial number of accidents due to driving under the influence of alcohol, are alarming for both trauma- and neurosurgeons. As the controversy surrounding the general use of E-scooters will continue, we urge representatives to intensify their efforts regarding prevention campaigns focusing on the potential dangers of E-scooters, especially when driving under the influence of alcohol.

This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA’s total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.

BackgroundThe aim of the present study was to describe the prevalence and topography of the dominant nutrient foramen at the clavicle.Methods317 macerated human clavicles (167 right and 150 left) were available for the study. After detecting the dominant nutrient foramen, the total distance from the sternal surface to the examined nutrient foramen was measured. A foramen index (FI) was used for further data processing.ResultsWe detected a dominant foramen in 300/317 (94.64%) clavicles, which was located in the middle third in 287/300 (95.7%) clavicles. The average clavicular length was measured at 14.9 cm ± 1.0 cm (range 11.6–17.5 cm) with an average foraminal distance from the sternoclavicular joint surface of 7.9 cm ± 1.3 cm (range 0.9–12.6 cm) in total. The mean FI was 53.2% ± SD 7.4% (range 5.5–79.3%).ConclusionThe present study provides a topographic mapping of the foraminal area (46–60% of the total clavicular length). The findings help to assess clavicular fracture patterns, which pass through the foraminal area.

Genetic factors undoubtedly affect the development of congenital heart disease (CHD) but still remain ill defined. We sought to identify genetic risk factors associated with CHD and to accomplish a functional analysis of SNP-carrying genes. We performed a genome-wide association study (GWAS) of 4034 White patients with CHD and 8486 healthy controls. One SNP on chromosome 5q22.2 reached genome-wide significance across all CHD phenotypes and was also indicative for septal defects. One region on chromosome 20p12.1 pointing to the MACROD2 locus identified 4 highly significant SNPs in patients with transposition of the great arteries (TGA). Three highly significant risk variants on chromosome 17q21.32 within the GOSR2 locus were detected in patients with anomalies of thoracic arteries and veins (ATAV). Genetic variants associated with ATAV are suggested to influence the expression of WNT3, and the variant rs870142 related to septal defects is proposed to influence the expression of MSX1. We analyzed the expression of all 4 genes during cardiac differentiation of human and murine induced pluripotent stem cells in vitro and by single-cell RNA-Seq analyses of developing murine and human hearts. Our data show that MACROD2, GOSR2, WNT3, and MSX1 play an essential functional role in heart development at the embryonic and newborn stages.

Cardiosphere-derived cells (CDCs) generated from human cardiac biopsies have been shown to have disease-modifying bioactivity in clinical trials. Paradoxically, CDCs’ cellular origin in the heart remains elusive. We studied the molecular identity of CDCs using single-cell RNA sequencing (sc-RNAseq) in comparison to cardiac non-myocyte and non-hematopoietic cells (cardiac fibroblasts/CFs, smooth muscle cells/SMCs and endothelial cells/ECs). We identified CDCs as a distinct and mitochondria-rich cell type that shared biological similarities with non-myocyte cells but not with cardiac progenitor cells derived from human-induced pluripotent stem cells. CXCL6 emerged as a new specific marker for CDCs. By analysis of sc-RNAseq data from human right atrial biopsies in comparison with CDCs we uncovered transcriptomic similarities between CDCs and CFs. By direct comparison of infant and adult CDC sc-RNAseq data, infant CDCs revealed GO-terms associated with cardiac development. To analyze the beneficial effects of CDCs (pro-angiogenic, anti-fibrotic, anti-apoptotic), we performed functional in vitro assays with CDC-derived extracellular vesicles (EVs). CDC EVs augmented in vitro angiogenesis and did not stimulate scarring. They also reduced the expression of pro-apoptotic Bax in NRCMs. In conclusion, CDCs were disclosed as mitochondria-rich cells with unique properties but also with similarities to right atrial CFs. CDCs displayed highly proliferative, secretory and immunomodulatory properties, characteristics that can also be found in activated or inflammatory cell types. By special culture conditions, CDCs earn some bioactivities, including angiogenic potential, which might modify disease in certain disorders.

Background/Objectives: In the presence of porcelain aorta (PA), transcatheter aortic valve replacement (TAVR) has become a class I therapeutic indication for the treatment of severe aortic valve stenosis. To date, few studies have analyzed the clinical outcomes of TAVR in PA patients. We aim to analyze the calcification patterns of the thoracic aorta in PA patients and to evaluate their clinical implications for TAVR procedures. Methods: This study included 161 patients who had PA confirmed through pre-operative CT and underwent TAVR between 11/2014 and 12/2022. The primary outcome was to perform a multi-slice CT (MSCT) analysis assessing the calcification in the proximal, middle, and distal thoracic aortic segments. Each segment was divided into quadrants for scoring calcifications on a scale from 1 (<25%) to 4 (>75%). The cohort was categorized into circular or noncircular calcification group. The secondary clinical outcomes were defined according to VARC-3 criteria. Results: The study cohort included 161 patients (median age, 77.2 years; IQR, 70.1–82.6 years). The median EuroSCORE II and STS predicted risk of mortality were 3.10% [1.80–5.58] and 2.70% [1.70–4.30], respectively. In 75% of patients (n = 121/161), TAVR was performed via transfemoral access. Circular calcifications were found in 8.1% of patients, while noncircular calcifications were present in 91.9%. Significant calcifications were primarily in the right quadrant of the proximal segment (33.54%), superior quadrant of the middle segment (39.75%), and left quadrant of the distal segment (73.29%). The 30-day mortality rate was 3.11% and periprocedural ischemic stroke rate 3.38%. Conclusions: Most TAVR patients with PA exhibited noncircular calcification. The most extensive calcifications were primarily in areas relevant to surgical manipulation. Patients with PA displayed low short-term mortality and relatively few stroke events. In view of these findings, TAVR constitutes a valid treatment option for patients with PA and aortic stenosis.

Background: The novel Navitor intra-annular self-expandable transcatheter aortic valve prosthesis is designed to improve coronary access, reduce paravalvular leaks, and enhance hemodynamic performance. Comparative data with the established Evolut platform (R, Pro, FX) are still lacking. This study aimed to evaluate the short-term clinical outcomes of Navitor (NAV) versus Evolut transcatheter heart valves. Methods: We conducted a single-center analysis of patients undergoing transfemoral TAVR between January 2015 and May 2024. A propensity score matching protocol including 18 baseline variables was used to balance baseline characteristics. Clinical outcomes were assessed using VARC-3 criteria. Results: Of 1067 TAVR patients, 210 were analyzed after matching—70 with the Nav valve and 140 with the Evolut valve. Baseline characteristics were comparable between groups, with a mean age of 80.9 ± 6.5 years in the NAV group and 80.7 ± 6.7 years in the Evolut group (p = 0.9). Both groups had an intermediate STS predicted risk of mortality, 3.9 ± 3.4% for NAV and 3.9 ± 3.2% for Evolut (p = 1.0). The effective aortic annulus diameter was comparable between the NAV (23.9 ± 1.5 mm) and Evolut group (23.9 ± 2.4 mm, p = 0.8). Hemodynamic performance at discharge was similar, with mean gradients of 7.5 ± 2.8 mmHg (NAV) vs. 7.4 ± 3.7 mmHg (Evolut, p = 0.9). Valve orifice areas and paravalvular leak rates showed no difference between the groups. Device success rates at discharge were good for both THVs: 89.3% for Evolut and 91.4% for NAV (p = 0.8). Disabling stroke occurred less frequently in the NAV group (0.0% vs. 7.1%, p = 0.033), while other early safety outcomes and 30-day mortalities were similar. Conclusions: The Navitor valve offers comparable hemodynamic performance, paravalvular leak rates, and procedural success to the Evolut platform. While early safety outcomes were largely similar, the Navitor valve was associated with a lower 30-day disabling stroke rate.