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Die Spondylodiszitis ist eine schwere infektiöse Erkrankung der Bandscheibe und der angrenzenden Wirbelkörperanteile, die zu einer Destruktion des Bewegungssegmentes führt und mit einer Letalität von etwa 15 % einhergeht. Schwere Verlaufsformen können zudem zur Abszedierung und septischen Streuung führen. Aber auch Fehlstellungen des Achsenorgans und neurologische Funktionseinbußen bis hin zum Querschnitt sind mögliche Komplikationen. Eine frühzeitige Diagnostik und gezielte Therapie tragen zur Minderung des Risikos einer signifikanten Gesundheitsstörung bei. Die vorliegende Übersichtsarbeit fasst wichtige Algorithmen in der Diagnostik und Therapie zusammen und diskutiert diese vor dem Hintergrund der aktuellen Literatur. Nach aktuellem Wissenstand bietet die operative Behandlung der Spondylodiszitis viele Vorteile und ist daher die Methode der Wahl, wenn in ausgesuchten Fällen ein konservatives Vorgehen zur Heilung führt. Endpunkte der Behandlung sind die Infektsanierung mit Normalisierung der laborchemischen Entzündungsparameter und der knöcherne Durchbau des Bewegungssegments. Spondylodiscitis is a severe infectious disease of the intervertebral discs and of the adjacent parts of the vertebral bodies, culminating in destruction of the mobile segment. It is accompanied by a mortality rate of approximately 15%. Severe courses of the disease can also lead to abscess formation and dispersal of sepsis. Malpositioning of the axis organ and deficits in neurological function up to paraplegia are also possible complications. Timely diagnostics and targeted therapy contribute to minimizing the risk of significant health disorders. This review article gives a summary of important algorithms in the diagnostics and treatment and discusses them against the background of currently available literature. According to the current state of knowledge the surgical treatment of spondylodiscitis provides many advantages and is therefore the method choice, even if a conservative approach can be successful in selected cases. The endpoints of treatment are cleansing of the infection with normalization of laboratory parameters of inflammation and the osseous fusion of the mobile segment. more...

27 cemented stems were implanted in fresh-frozen human cadaver femora with third generation antegrade cementing technique and with prechilled vacuum-mixed and pre-pressurized Palacos R bone cement. 3 groups with different implantation techniques were compared according to the achieved cement mantle thickness distribution. Group 1 (modified stem fixation): 7 canulated stems inserted over guidetubes that were fixed in distal synthetic plugs (3 Willert CF-30 and 4 flanged Charnley stems). The guidetubes served simultaneously for stem centralization and evacuation of the intramedullary cavity. Group 2: 12 stems with distal centralizers with fins (4 flanged Charnley, 8 anatomic cemented AC), and Group 3: 8 stems without centralizer (4 Willert CF-30 and 4 flanged Charnley). For analysis, each femur was cut into mean 25 cross-sections (range, 22 - 31). Contact radiographs were taken and digitized with a sampling distance of 0.12mm (204.8 dpi). Using a custom-made computer program (FemStat 1.001), the cement mantle thickness was determined at mean 650 implant surface points per cross section. Results: The percentage of critical cement mantle thickness was lower for the canulated stems with guidetube. Here 14.1 % of the measurements were smaller than 2mm. For the stems with distal centralizer and without centralizer this was 28.3 % and 28.2 % (p = 0.003 and p = 0.002, U-test). Cement mantles smaller than 1mm were also reduced for group 1 (2.8 % compared with 4.7 % and 7.5 %) but this was not significant (p = 0.384 and p = 0.094). The stems without centralizers had only slightly inferior cement mantles if compared to stems with distal centralizers with fins (for < 2mm p = 0.571, for < 1mm p = 0.305). Comparing different cementing techniques for one constant type of prosthesis (Charnley) the canulated stems with guide tubes provided a significantly better cement mantle thickness than the stems with distal centralizers (for < 2mm 10.3 % compared with 26.6 %, p = 0.029; for < 1mm 1.5 % compared with 3.4 %, p = 0.343). Distal centralizers failed, as the intramedullary cavity is elliptic in cross section and the gaps between the wings caused malposition. For all stems in group 3 improvement of the cement mantle thickness was predominantly achieved in the distal and middle third of the femur. Conclusion: The implantation technique with canulated stems inserted over a guidetube allows superior stem positioning leading to a more favourable cement mantle. more...

We describe the mid-term clinical results of the surgical treatment of primary degenerative arthritis of the sternoclavicular joint in eight women. They had not responded to conservative treatment and underwent a limited resection arthroplasty. For pre-and postoperative clinical evaluation we used the Rockwood score for the sternoclavicular joint. Postoperatively, the Constant score was also determined. The mean follow-up was 31 months (10 to 82).The median Rockwood score increased from 6 to 12.5 points. The median postoperative Constant score was 87 (65 to 91). Four patients had an excellent, three a good, and one a poor result. All patients were pleased with the cosmetic result.Resection arthroplasty is an effective and safe treatment for chronic, symptomatic degenerative arthritis of the sternoclavicular joint with a high degree of patient satisfaction. more...

We have carried out an electromyographical examination of the activity of five different regions of the deltoid muscle during abduction/adduction in various body postures with different biomechanical actions of arm gravity. The results show that the deltoid action is highly differentiated in its different regions and is not restricted only to the generation of an abducting moment in the shoulder joint. There is obviously a biomechanical contribution, mainly by its spinal and clavicular regions, to the stabilization of the glenohumeral joint and to the control of the selected plane of abduction. more...

Osteochondritis dissecans (OD) of the lateral tibial condyle is a rare condition. A review of the literature revealed only nine cases in seven patients. We report about a new case. It is widely accepted that this form of OD originates from an accessory center of ossification. Our case supports this theory. Although comparative roentgenograms of the left knee, taken because of complaints in the right one, were interpreted to be normal, retrospective analysis clearly revealed the lateral intercondylar eminence of the left knee to have been irregular many years before the onset of symptoms. Association with a classical OD in the contralateral knee is striking in most of the reported cases. more...