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Schmerzreduktion und Verbesserung der Lebensqualitat durch ISG-Fusion. Chronische Iliosakralgelenk-assoziierte Schmerzen. Positive ISG-Testinfiltration mit Lokalanasthetikum. Positive ISG-Provokationstests. Erfolglose konservative Therapie uber 6 Monate. Nicht ISG-assoziierte Beschwerden. Tumor/Infektion/instabile Fraktur im Implantationsareal. Fehlbildungen, Tumor oder Osteolyse des Sakrum- oder Iliumknochens. Aktive Infektion an der Behandlungsstelle. Allergie gegen Metallkomponenten. Sekundarer Krankheitsgewinn, Rentenbegehren. Unzureichend behandelte Osteoporose. Uber einen lateralen minimal-invasiven Zugang bildwandlergesteuertes Einbringen von Kirschner-Drahten transartikular durch das ISG in das Sakrum. Aufmeiseln des Implantatlagers uber die Kirschner-Drahte und Einbringen von insgesamt 3 triangularen Titanimplantaten zur ISG-Arthrodese. Thromboseprophylaxe. Drei Wochen Teilbelastung und anschliesend schrittweise Aufbelastung. Rontgenkontrollen in definierten Intervallen. Physiotherapie. Es wurden 26 konsekutive Patienten nach 48 Monaten untersucht. Die evaluierten Endpunkte waren tieflumbale Schmerzen entsprechend der visuellen Analogskala (VAS 0–10), Funktionseinschrankungen entsprechend Oswestry Disability Index (ODI) und Lebensqualitat entsprechend EuroQOL-5D (EQ-5D). Nach 4 Jahren zeigte sich der Ruckenschmerz im Vergleich zu praoperativ deutlich verbessert (VAS praoperativ 8,4, VAS 4 Jahre postoperativ 4,6). Die Funktionseinschrankungen zeigten sich rucklaufig (ODI praoperativ 58,1, ODI 4 Jahre postoperativ 32,1), und ein Anstieg der Gesundheitsbewertung im EQ-5D war zu verzeichnen (praoperativ 0,5, nach 4 Jahren 0,7). Die Rate an Patienten, welche Opiate zur Schmerztherapie einnahmen, konnte deutlich gesenkt werden (praoperativ 82 %, postoperativ 39 %). Es zeigte sich keine Implantatlockerung im untersuchten Zeitraum.

Osteoporotic vertebral fractures without prior adequate traumatization are frequent diagnosed in orthopedics because of the increasing life expectancy and incidence of osteoporosis. The associated high mortality is caused by reduced mobilization which leads to a higher risk of infection and a bedridden state. On the other hand the diagnosis of sacral insufficiency fractures is often prolonged because of unspecific symptoms while being associated with similar risks. This article presents an overview of the present scientific literature and a retrospective analysis of patients treated via balloon-assisted sacroplasty. In 8 years, ten patients (three men and seven women) were treated. The average age was 78.4 years and the average time until the diagnosis 4.6 weeks. In most patients a significant pain reduction after the failure of conservative treatment thanks to operative treatment as well as increased mobility was observed. Only one experienced a minor surgical complication being cement leakage with nerval impaction which did not compromise her clinical outcome or satisfaction with the procedure. Balloon-assisted sacroplasty can possibly be seen as an effective symptomatic therapy in osteoporotic insufficiency fractures.

Objective Infantile scurvy or Moller-Barlow's disease appears to be of no further importance in Western countries; however, this is a careless assumption. In severely disabled children especially, this malady manifests itself in a broad range of symptoms such as delayed or suppressed bone healing, minor traumatization leading to bruises or fractures, and epiphysiolysis. Methods: The aim of this article was to present the required daily uptake of vitamin C and the biochemical pathways in the human body leading to the typical symptoms of scurvy. Two cases of chronic scurvy with prolonged bone healing and bleeding, epiphysiolysis, and gingival hyperplasia are presented. Both patients were chronically ill with one having cerebral palsy and the other a neuroblastoma of the adrenal gland. Results After diagnosis, the substitution of vitamin C via percutaneous endoscopic gastrostomy in both patients was necessary to treat them. Both patients quickly achieved a full recovery. Conclusion: The two patients presented show the importance of infantile scurvy in daily medical care. The prevalence of scurvy is often underestimated in severely disabled or chronically ill children.

For a significant period of time, B-ISDN will coexist with the 64-kb/s-based (narrowband) ISDN. The specification of a concept and the mapping functions employed for interworking between the two networks, in particular for voice services, is a major factor for the success of B-ISDN.