Objective: Spine trauma occurs frequently in multiple injured patients. Pre-hospital diagnosis is difficult. Clinical management depends on associated injuries and neurologic status.

To evaluate epidemiology and influence of recent therapeutic regimens on outcome we analyzed the data of the German Trauma Registry (German Trauma Society, DGU).

Methods: Out of 8057 patients in the German Trauma Registry 772 patients (28 % women, 72 % men; mean age 37 +/− 17 yrs.; mean ISS: 29 +/− 15 (range 9–75) points) with severe spine trauma (AIS> 2) were investigated in a retrospective analysis.

Results: MVAs were the most frequent cause for severe spine trauma (49%). The age group 25–34 years was most affected (26%). About half of all severe spine injuries were not expected in the prehospital setting. Neurologic deficit was observed in 47%. 41% of the patients with severe C-spine lesion had an initial GCS < 9 points. 89% of the patients had no preexisting comorbidity. Mortality rate (90 days) amounted to 22%. Sepsis occurred in 9%. Respiratory failure was the most common organ dysfunction (18%). Median ICU stay was 8 days. Thoracic spine lesions were almost always associated with thoracic trauma (96%; other locations 37%). Lumbar spine injuries were highly related to abdominal injuries (93%).

Conclusion: Almost 10% of all documented cases in the German Trauma Registry showed severe vertebral injuries. The extend of injury was often underestimated in the preclinical setting. Due to the high incidence of thoracic injuries in thoracic spine trauma a well balanced surgical and critical care regimen is warranted especially in this group.

Introduction: Throughout known medical literature the proximal humeral fracture is mentioned with an approximately 5% contribution to all fractures. The optimal operative strategy regarding proximal humeral fractures is still being discussed controversely. This study was conducted to show implant associated problems and their clinical relevance.

Materials and methods: Of a total 198 patients with proximal humeral fractures 166 patients, 98 females and 68 males at a mean age of 74,7 years were treated operatively from 2000 to 2004 in our clinic with an angle-stabile plate osteosynthesis and underwent a clinical and radiological follow-up. Retrospectively we characterised the fractures by using the most common classification of NEER and assessed the functional results with the CONSTANT score.

Results: The 166 evaluated patients with 8 cases of a type I fracture, 13 patients with type II fracture, 34 patients with type III fracture, 47 cases with type IV fracture, 42 patients with type V fracture and 22 cases with type VI were all operatively treated with an angle-stabile plate osteosynthesis. 142 patients underwent early assisted physical therapy. Of all assessed patients the average CONSTANT score was 79,7 points. Among the 8 patients with type I fracture the average CONSTANT score was 84,4 points, among the 13 patients with type II fracture it reached an average 87,4 points. The average score of the 34 patients with type III fracture was 78,8 points. The more complex fractures, according to NEER’s classification, reached average scores of 71,2 points among the 47 cases with type IV fractures, 69,8 points (42 patients, type V) and 61,6 points (22 patients, type VI). The presence of avascular necrosis of the humeral head in 18 cases resulted in a significantly worse functional outcome and therefore a lower average score of 48,1 points. For 36 patients the follow-up revealed intraarticular dislocation of the proximal locking screws which required operative revision in 15 cases.

Conclusion: Even in the complex proximal humeral fracture one can achieve good clinical results for the patients by using an angle-stabile plate osteosynthesis and therefore establishing a secure and rigid situation for an optimized consecutive physical therapy, especially in the elderly. To prevent from intraarticular screw placement the proximal locking screws should be chosen shorter, if possible, then initially measured.

Introduction: Infection following arthroplasty is a rare but significant and threatening complication. The incidence is about 2%. Treatment of an infected joint replacement may be demanding, time consuming and expensive. The aim was to evaluate the average cost of an infected arthroplastic in our own department under the given reimbursement system in Germany.

Material and Methods: During 3 month 20 consecutive cases of infected joint refered to our institution were monitored for treatment costs and final reimbursement by the health insurances.

Results: In 65% of the included cases the amount of reimbursement by the health insurance organisations did not cover the costs of the treatment in our department. The amount of financial loss in total was 48.142 € with more than 9.000 € in some cases.

Conclusions: For the treating institution there is a risk of substantial financial losses due to inadequate reimbursement. Calculated on the basis of ~ 150.000 implanted joint protheses / a, an infection rate of 2% and treatment costs of ~50.000 € / infected case the economic burden is an estimated 150 million € / a in Germany. This amount should justifie a sound evaluation of costs related to infection in arthroplasty, which should be the effort of the health insurance organisations. Additionally specific research in the field of infection prevention must be sponsored. The system of reimbursement should be adeaquately adopted and corrected.