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In der modernen Unfallchirurgie und Orthopadie wird die Anwendung allogener Knochentransplantate durch das mogliche Ubertragungsrisiko von Infektionserkrankungen erheblich eingeschrankt. Eine Losungsmoglichkeit bietet die Anwendung eines thermischen Desinfektionssystems (Lobator SD-1), welches mit einer Inaktivierungstemperatur von 80 °C arbeitet und in der Lage ist, zahlreiche bakterielle und virale Infektionserreger abzutoten. In dieser Studie wurde die Inaktivierungskinetik von HIV durch Warmebehandlung im Lobator SD-1 untersucht. Dabei wurden humane Femurkopfe mit 100 µl einer hochangereicherten Suspension von freiem und zellgebundenem HIV (1010) beladen und dem Desinfektionsprozes fur 5, 10, 20, 30, 40, 50 bzw. 62 min ausgesetzt. Die anschliesende Rekultivierung erfolgte mit Hilfe von HUT-78 Zellen durch Titration der Virussuspension in 10facher Verdunnung uber 10 Verdunnungsstufen und Inkubation bis maximal 21 Tage. Der Virusnachweis wurde durch Beobachtung von Riesenzellformationen und quantitativem p24-Antigennachweis im ELISA-Test durchgefuhrt. Dabei konnte eine lineare Virusinaktivierung in Abhangigkeit von der Erwarmungszeit gefunden werden. Ab einer 40minutigen Behandlung im Desinfektionssystem (Normalprozeszeit 92 min, Zieltemperatur 80 °C) war eine vollstandige Virusinaktivierung zu verzeichnen. Die Ergebnisse zeigen, das durch eine Behandlung humaner Femurkopfe im thermischen Desinfektionssystem eine sichere Inaktivierung von HIV erreicht wird.

The use of allogenic bone transplants in surgery has been greatly diminished owing to the risk of transmitting infectious diseases. This risk can be reduced by the use of a thermal disinfection system (Lobator SD-1). This is achieved by increasing the temperature to 80 degrees C, inactivating a number of bacterial and viral agents. In this study the decay of HIV at high temperature in the Lobator SD-1 was researched. In the center of human femoral heads 100 microliters of a highly concentrated suspension of free and cell-bound HIV (10(10)) was exposed to the thermal process at intervals of 5, 10, 20, 30, 40, 50 and 62 min. For the recultivation HUT-78 cells were used through titration of the virus suspension in ten-fold dilutions over ten dilution steps and incubation up to a maximum of 21 days. Evidence of the virus was checked through observing giant cell formations and quantitative determination of p24 antigen using an Elisa test. Linear virus inactivation was found based upon the time the virus was exposed to heat. After a treatment of 40 min in the disinfection system, total virus inactivation was achieved. The normal disinfection process time using Lobator SD-1 is 92 min. A temperature of 80 degrees C is reached after approximately 45 min. The results prove that this system totally inactivates HIV in human femoral heads.

Thermal energy (80 degrees) for the disinfection of cancellous allogenic bone grafts was employed, and it proved to be an advantageous, safe and easily accessible method. The effects of this treatment on biological values were examined in terms of biomechanical and biodynamic (graft incorporation) loss of the treated grafts versus the autoclaved and untreated samples. Given the thermolability of the pathogens in question, the thermal approach presented here has the advantage of being readily controllable. The lack of toxic or mutagenic risks through this method and its accessibility represent further advantages. In thermal treatment of bone allografts, it is essential that one knows the thermoconductivity of the bone sample and that one can demonstrate pathogen inactivation through the entire graft volume. All of the parameters in the 80 degrees C group that were measured in this study indicate clear biological superiority over the autoclaved group. A newly developed thermoincubator is introduced for gentler disinfection of allogenic bone grafts and it inactivates common vegetative pathogens as well as HIV. It is still necessary to conduct serological screening for hepatitis antigens in the donor pool, however. Based on these results, we conclude that the clinical use of autoclaved allogenic bone grafts needs to be reviewed and possibly limited.

Fractures of the sternum often are not discernable on X-rays. The standard lateral X-ray of the sternum may allow the diagnosis. The aim of this study was to find out whether sternal fractures can be visualized by ultrasound. The flat, plane and broad bone provides an ideal rest for a linear scanner; the one used in our study had 5 MHz. We show that sternal fractures can easily be diagnosed by means of ultrasound, and because of an interruption of the cortical reflex, possibly better than on radiographs. We also wanted to show whether sonography, which is in widespread use for the diagnosis of blunt abdominal trauma, can also be used in an emergency situation of blunt thoracic injury (e.g. seat belt injury). In 16 cases of fractures of the sternum already diagnosed by X-ray, an examiner unacquainted with the X-ray results was able to locate and diagnose all fractures by ultrasound within 1 min.

After amputation of the thumb good functional results can be achieved by lengthening the first metacarpal bone, if a suitable technique is used. Since 1987 we have treated six patients in this way. In all of our patients the thumb was mechanically stable and sensitive after lengthening, thus improving the patients' ability to use their hands for grasping. Other advantages include the relative simplicity of the method, the fact that no experience of microsurgery is necessary and that the surgery does not result in soft tissue damage. In most cases treatment is on an outpatient basis. Between the various operations the patient can be reintegrated into his professional and social life. The period of absence from work (about 12 weeks) is relatively short when the severity of the injury is taken into consideration. Distraction of the first metacarpal bone cannot be considered an alternative to replantation but represents a complementary procedure in accordance with the modern management of severe hand injuries.