Background E-scooters have emerged as a frequently used vehicle in German cities due to their high availability and easy access. However, investigations about the causes and mechanisms of E-scooter incidents and their trauma-specific consequences are rare. Methods We analysed all patients involved in E-scooter incidents from June to December 2019 who presented to four inner-city EDs in Berlin. The prospective data included patient-related and incident-related data, information on injury patterns and therapy, responses in a voluntary questionnaire concerning E-scooter use and general traffic experience. Results 248 patients (129 males; median age 29 years (5–81)) were included: 41% were tourists and 4% were children. Most incidents (71%) occurred between July and September 2019, the majority occurring at weekends (58%). The injury pattern was mostly multifocal, affecting the lower (42%) and upper limbs (37%) and the head (40%). Traumatic brain injury was associated with alcohol consumption. Inpatient admission was recorded in 25%, surgery in 23%. Conclusion This study has defined the incidence of injury related to E-scooter use in a major European city. Stricter laws governing the use of E-scooters, the wearing of helmets and technical modifications to the E-scooter platforms might decrease E-scooter-associated incidents and resulting injuries in the future. Trial registration number German Clinical Trials Registry (DRKS00018061).

https://emj.bmj.com/content/emermed/early/2021/06/10/emermed-2020-210268.full.pdf

E-scooter incidents in Berlin: an evaluation of risk factors and injury patterns.

The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient’s age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon’s preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.

/pdf/the-concept-of-scaffold-guided-bone-regeneration-for-the-lzpz8ceo.pdf

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

E-scooters are a new type of urban transportation utilized in Germany since June 2019, primarily in larger cities in the context of sharing offers. Such electrically operated standing scooters can be driven at a maximum speed of 20 km/h. A helmet is not mandatory. The aim of this prospective study is to document the injury patterns over the period of 1 year and compare our findings with already available data. Over a period of 1 year (July 2019–July 2020), data on E-scooter-related accidents treated at a level 1 trauma center of a major German city were prospectively documented. Injury patterns were analyzed, and epidemiological data evaluated. Fifty-nine (35 female, 24 male) accidents were included in the observation period. Mean age of accident victims was 30.03 years (± 9.32). Alcohol influence at the time of accident was detected in 9 cases (15.25%). Many of the accident victims suffered multiple injuries. Most of the injuries were upper (50.84%) and lower extremity (47.45%) as well as craniofacial injuries (62.71%). A helmet was not worn in any of the cases. In the year following their introduction, E-scooter-related accidents have led to an additional burden on the emergency capacities of the involved University Hospital, especially in the summer months of 2019. Protective equipment is de facto not worn. Injuries to the extremities, head, and face were most common. None of the accident victims died. This coincides with results from other major cities in national and international comparison. A more intensive education about injury consequences of unprotected E-scooter use and the discussion of a possible obligation to wear a helmet and further protection equipment for the extremities should take place.

/pdf/what-to-expect-injury-patterns-of-electric-scooter-accidents-2jlgzuap2i.pdf

What to expect? Injury patterns of Electric-Scooter accidents over a period of one year - A prospective monocentric study at a Level 1 Trauma Center

https://depositonce.tu-berlin.de/bitstream/11303/13900/1/siebert_etal_2021.pdf

Braking bad – Ergonomic design and implications for the safe use of shared E-scooters

Study Design:Retrospective study of all patients presented at our emergency department after an accident while riding an e-scooter between 15 June 2019 and 15 December 2019. Out of this group, we s...

Impact of the Rising Number of Rentable E-scooter Accidents on Emergency Care in Berlin 6 Months After the Introduction: A Maxillofacial Perspective.

Seit ihrer Zulassung erfreuen sich E‑Scooter einer grosen Beliebtheit im Zentrum deutscher Grosstadte. Sie sind leicht zuganglich, schnell und verleiten oft zu einem riskanten Fahrstil, sodass vermehrt mit Unfallen zu rechnen ist. In dieser Fallserie beschreiben wir erste Erkenntnisse uber Unfallmechanismen und Verletzungsmuster nach E‑Scooter-Unfallen. Alle Patienten, die aufgrund von E‑Scooter-Unfallen in den zentralen Notaufnahmen der Charite, Campus Mitte und Virchow-Klinikum, behandelt wurden, wurden prospektiv in die Fallserie aufgenommen. Ein zusatzlicher Fragebogen erlaubte die Erfassung von Daten uber Fuhrerscheinbesitz, Erfahrung im Strasenverkehr und mit E‑Scootern, Unfallhergang und Fahrverhalten. 24 Patienten (13 mannlich, 11 weiblich, medianes Alter 29,9 Jahre [12–62]) wurden erfasst. Unfallmechanismen waren meist Sturze vom E‑Scooter (75 %) oder Verletzungen am E‑Scooter selbst. Es wurden hauptsachlich Kopfverletzungen (54 %), Weichteilverletzungen der Extremitaten (25 %) und Frakturen (21 %) festgestellt. Die maximale Krankenhausverweildauer war 3 Tage. Unachtsamkeit, Verstose gegen Verkehrsregeln und eine eingeschrankte Verkehrstauglichkeit sind ursachlich fur die beschriebenen Verletzungsmuster nach E‑Scooter-Unfallen. In Bezug auf Haufigkeit und Schwere der Verletzungen ist die Benutzung von E‑Scootern im Risikoprofil den Fahrradern gleichwertig.

E-Scooter: erste Erkenntnisse über Unfallursachen und Verletzungsmuster

Zusammenfassung Hintergrund Trotz Errungenschaften wie der Entwicklung der Hüftprothese ist die wissenschaftliche Produktivität im Bereich der Orthopädie und Unfallchirurgie kaum untersucht. Ziel unserer Studie war es, den Zusammenhang zwischen dem H-Index und dem akademischen Rang von Ärzten/-innen in Führungspositionen in der Orthopädie und Unfallchirurgie in Deutschland, Österreich und der Schweiz (DACH-Region) zu ermitteln, um festzustellen, inwieweit dieser objektive Maßstab der wissenschaftlichen Leistung mit der klinischen Position korreliert. Material und Methoden Alle Ärzte/-innen in leitender Funktion an einem Universitätsklinikum für Orthopädie und Unfallchirurgie in der DACH-Region wurden eingeschlossen. Im Zeitraum September bis November 2020 wurden das Jahr der Habilitation, die Anzahl der Publikationen und Zitationen sowie der H-Index erhoben. Ergebnisse Insgesamt wurden 844 leitende Ärzte/-innen aus 46 Universitätskliniken eingeschlossen. Professoren/-innen publizierten mit 117,4 ± 124,8 die größte Anzahl an Artikeln und wiesen mit 20,1 ± 10,1 den größten H-Index auf (p < 0,001). Zwischen den Ländern zeigten sich signifikante Unterschiede in der Gesamtanzahl an Publikationen (p = 0,001), den Publikationen in den letzten 3 Jahren (p < 0,001) und dem H-Index (p < 0,001), wobei alle Parameter jeweils in der Schweiz am höchsten waren. Schlussfolgerung Unsere Arbeit zeigt, dass eine hohe wissenschaftliche Produktivität mit akademischem Erfolg assoziiert ist. Die aufgezeigten Unterschiede in der DACH-Region legen den Rückschluss nahe, dass die Bedeutung der wissenschaftlichen Arbeit im klinischen Alltag signifikant variiert. Abstract Background Despite major achievements, such as the development of hip prostheses, scientific productivity in orthopaedics and trauma surgery has hardly been investigated. Our study’s aim therefore was to analyse the correlation between the leading physicians’ h-index and their academic rang, in order to determine whether this objective measure of scientific accomplishments correlates with clinical position. Methods All physicians in leading positions at university hospitals’ orthopaedics or trauma surgery departments in Germany, Austria, and Switzerland were included. Year of habilitation, number of publications and citations as well as h-index were collected from September to November 2020. Results A total of 844 leading physicians at 46 university hospitals were included. Professors had the highest number of total publications (117.4 ± 124.8, p < 0.001) and highest h-index (20.1 ± 10.1, p < 0.001). We found significant differences in the total number of publications (p = 0.001), publications in the last three years (p < 0.001), and h-index (p < 0.001) between the three investigated nations, with all parameters being highest in Switzerland. Conclusion Our study shows that increasing scientific productivity is correlated with academic success. The country-specific differences indicate significant differences in the value of scientific activity in daily clinical routine.

Wissenschaftliche Produktivität der universitären Orthopädie und Unfallchirurgie in der DACH-Region

Sehnenentnahme der Patellasehne für die Rekonstruktion des vorderen Kreuzbandes

Correction to: Wissenschaftliche Produktivität der universitären Orthopädie und Unfallchirurgie in der DACH-RegionZ Orthop Unfall eFirstDOI: 10.1055/a-1956-5413 

Erratum: Wissenschaftliche Produktivität der universitären Orthopädie und Unfallchirurgie in der DACH-Region

The aim of this study was to examine the influence of the COVID-19(coronavirus disease 2019) pandemic on the medical and physiotherapeutic follow-up care after reconstructions of the anterior cruciate ligament.116 patients (72 men and 44 women) who had received a reconstruction of the anterior cruciate ligament between September 2019 and December 2020 were included in this study. These patients were divided into two groups depending on the date of surgery: one group that had received surgery in 2019 before the COVID-19 pandemic and one group that had undergone surgery in 2020 and was directly affected by the COVID-19 pandemic. All patients were interviewed using a standardized questionnaire regarding the influence of the coronavirus pandemic on the medical and physiotherapeutic follow-up care, as well as the moment of return to work. In addition, the range of motion of the respective knee 3 months postoperatively was analysed based on physical examination.At 3 months postoperatively, patients who had undergone surgery in 2020 showed a clear trend towards a higher frequency of extension deficits of ≥ 5° (18.8% vs. 4.3%, p = 0.097) or an inability to bend the knee ≥ 120° (23.3% vs. 10%, p = 0.197) compared to those who had received surgery in 2019. Patients who had undergone surgery in 2020 reported significantly longer delays for appointments, a higher number of futile attempts to get an appointment and a higher number of cancelled appointments, regarding both medical and physiotherapeutic follow-up care. 34.9% of the patients who received surgery in 2020 indicated that they were able to reduce the duration of their sick leave due to the increased possibilities of working in a home-office situation during the pandemic. Alternative treatment options due to the pandemic were offered by 13.3% of the physiotherapists and 12.2% of the physicians.Although the physiotherapeutic and medical follow-up care was not directly affected by a "lockdown", the pandemic led to significant restrictions, which are also reflected in a clear trend towards worse clinical outcomes. Consequently, a further expansion of alternative treatment options, which were only offered by 12-13% of practices and that are presumably of comparable relevance for various other diseases, is needed.HINTERGRUND: Ziel der Studie war es, den Einfluss der COVID-19-Pandemie auf die physiotherapeutische und ärztliche Nachsorge nach Rekonstruktion des vorderen Kreuzbandes (VKB) zu untersuchen.Insgesamt wurden 116 Patienten (72 Männer und 44 Frauen) eingeschlossen, die zwischen September 2019 und Dezember 2020 eine Rekonstruktion des VKB erhalten hatten. Die Patienten wurden in eine 2019 vor der COVID-19(„coronavirus disease“ 2019)-Pandemie operierte Patientengruppe sowie eine 2020 operierte, von der COVID-19-Pandemie unmittelbar betroffene Patientengruppe eingeteilt. Anhand eines standardisierten Fragebogens wurden die Auswirkungen der Pandemie auf die ärztliche und physiotherapeutische Nachsorge sowie auf die Dauer der postoperativen Arbeitsunfähigkeit erhoben. Ergänzend erfolgte eine Auswertung des Bewegungsumfanges des operierten Knies 3 Monate postoperativ.Es zeigte sich bei den 2020 operierten Patienten eine deutliche Tendenz zu einem höheren Anteil an Streckdefiziten ≥ 5° (18,8 % vs. 4,3 %, p = 0,097) oder einer maximalen Beugefähigkeit von < 120° (23,3 % vs. 10 %, p = 0,197) 3 Monate postoperativ, die allerdings nicht signifikant war. In der physiotherapeutischen und ärztlichen Nachsorge berichteten die 2020 operierten Patienten von signifikant längeren Wartezeiten auf Termine, späteren Zeitpunkten des ersten postoperativen Termins, einer höheren Anzahl vergeblicher Terminanfragen sowie einer höheren Anzahl abgesagter Termine. 34,9 % der 2020 operierten Patienten gaben an, die Dauer ihrer postoperativen Arbeitsunfähigkeit durch die Möglichkeiten zur Arbeit im Homeoffice verkürzt haben zu können. Pandemiebedingte alternative Behandlungsangebote wurden den Patienten von 13,3 % der Physiotherapeuten sowie 12,2 % der Ärzte angeboten.Obwohl die physiotherapeutische und ärztliche Behandlung von keinem „Lockdown“ betroffen war, kam es aufgrund der Pandemie zu signifikanten Einschränkungen, welche sich auch in einer deutlichen Tendenz zu schlechteren klinischen Ergebnissen niederschlagen. Es besteht daher Bedarf an einem weiteren Ausbau alternativer Therapieoptionen, die bislang nur von 12–13 % der Praxen zur Verfügung gestellt werden und mutmaßlich auch für andere Erkrankungen von ähnlicher Bedeutung sind. 

/pdf/einfluss-der-covid-19-pandemie-auf-die-physiotherapeutische-mttpyed6.pdf

Einfluss der COVID-19-Pandemie auf die physiotherapeutische und ärztliche Nachsorge nach Rekonstruktionen des vorderen Kreuzbandes

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