Study Design:Expert opinion.Objectives:Osteoporotic vertebral fractures are of increasing medical importance. For an adequate treatment strategy, an easy and reliable classification is needed.Methods:The working group “Osteoporotic Fractures” of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) has developed a classification system (OF classification) for osteoporotic thoracolumbar fractures. The consensus decision followed an established pathway including review of the current literature.Results:The OF classification consists of 5 groups: OF 1, no vertebral deformation (vertebral edema); OF 2, deformation with no or minor (<1/5) involvement of the posterior wall; OF 3, deformation with distinct involvement (>1/5) of the posterior wall; OF 4, loss of integrity of the vertebral frame or vertebral body collapse or pincer-type fracture; OF 5, injuries with distraction or rotation. The interobserver reliability was substantial (κ = .63).Conclusions:The proposed OF classification is easy to use and provides superior clinical differentiation of the typical osteoporotic fracture morphologies.

Introduction The prevalence of osteoporotic fractures is continuously on the rise. The adequate treatment of the predominantly geriatric patients is quite challenging. Osteoporosis can either be the cause of thoracolumbar fractures (nontraumatic fracture) or act as a contributing factor in traumatic fractures. No commonly accepted classification for osteoporotic fractures currently exists. The goal of the “osteoporotic fracture” working group was to develop a classification system and a score to aid therapeutic decision-making process for patients with osteoporotic thoracolumbar fractures. Material and Methods The development of both the classification and the score followed an established methodological pathway. Extensive literature research followed by in-depth discussions in nine consecutive sessions of expert meetings resulted in the proposed classification and scoring system. Between the sessions the classification and the score were applied by the group members in daily practice. The radiological and clinical data of 707 consecutive patients were subsequently collected in 16 clinics and evaluated. Interobserver reliability was calculated after evaluation of 146 fractures by 6 raters. Results The OF-classification consists of five subgroups: OF 1—no deformation (edema in MRI STIR-sequence); OF 2—deformation without or with only minor involvement of the posterior wall (< 1/5); OF 3—deformation with distinct involvement of the posterior wall (> 1/5); OF 4—loss of vertebral frame structure, vertebral body collapse, or pincer type fracture; OF 5—injuries with distraction or rotation. Interobserver reliability showed substantial agreement (Kappa 0.63). The OF-score contains the following parameters: fracture morphology (OF-classification), bone mineral density, potential sintering of the fracture, pain, neurological deficit, potential mobilization, and general health status of the patient (ASA grading), respectively. According to the OF-score, 29% of patients should have received conservative treatment and 49% surgical treatment, respectively. The final choice of treatment in the participating clinics correlated in 85% of cases with the OF-score. Conclusion The OF-classification consists of five subgroups and shows substantial interobserver reliability. In comparison to other classifications, the OF-classification is easy to use and provides a superior differentiation of the typical osteoporotic fracture morphologies. The OF-score takes the clinical status of the predominantly geriatric patients into account to aid the decision-making process in adequate therapeutic strategies. The generated treatment recommendations reflect the actual treatment strategies of specialized clinical centers.

Intraoperative 3D imaging navigation for posterior spinal stabilisations is technically feasible and reliable in clinical use. The image quality depends on the individual bone density. With undisturbed visibility of the vertebral body, the reliability of 3D-based navigation is comparable to that of CT-based procedures. Additionally, it has the advantage of skipping the preoperative acquisition of data as well as the matching process, with reduced radiation doses.

Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss’ kappa (κF) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall’s tau (τK). The presence of a modifier was calculated with κF for interRR and Cohen’s kappa (κC) for intraRR. Results The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κF = 0.764 (Survey 1) and κF = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κF Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κF min.–max. Survey 1/Survey 2: 0.708–0.827/0.747–0.852). The existence of at least one modifier was rated with substantial agreement (κF Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τK = 0.894, DR: τK = 0.901, UR: τK = 0.889). The modifier had an intraRR of κC = 0.684 (DR: κC = 0.723, UR: κC = 0.651), which is also considered substantial. Conclusion The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.

Background Odontoid fractures in geriatric patients represent an entity of increasing incidence with a high rate of morbidity and mortality. The optimal diagnostic and therapeutic management is being controversially discussed in the literature. Methods In a consensus process and based on the current literature, the members of the working groups “Osteoporotic Fractures” and “Upper Cervical Spine” of the German Society for Orthopaedics and Trauma Surgery (DGOU) defined recommendations for the diagnostics and treatment of odontoid fractures in geriatric patients. Results For the diagnosis of odontoid fractures in symptomatic patients, computed tomography represents the gold standard, along with conventional radiographs. Magnetic resonance and dynamic imaging can be used as ancillary imaging modalities. With regard to fracture classification, the systems described by Anderson/DʼAlonzo and by Eysel/Roosen have proved to be of value. A treatment algorithm was developed based on these classifications. Anderson/DʼAlonzo type 1, type 3, and non-displaced type 2 fractures usually can be treated non-operatively. However, a close clinical and radiological follow-up is essential. In Anderson/DʼAlonzo type 2 fractures, operative treatment is associated with better fracture healing. Displaced type 2 and type 3 fractures should be stabilized operatively. Type 2 fractures with suitable fracture patterns (Eysel/Roosen 2A/B) can be stabilized anteriorly. Posterior C I/II-stabilization procedures are well established and suitable for all fracture patterns.