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Background: The development of bone marrow edema in body regions adjacent to joints can have many causes and a differentiation is not possible using magnetic resonance imaging (MRI)., Definition: Bone marrow edema is not necessarily an indication for microfractures. The definition of bone marrow edema is a purely radiological description. There is no uniform classification of bone marrow edema. The clinical significance, therapy and course are heterogeneous; therefore, there are no uniform recommendations for therapy., Diagnostics: A bone marrow edema visible in MRI does not always lead to certain inferences regarding the pathogenesis. In order to be able to detect fractures it is necessary to carry out a biopsy and a histological examination., Conclusion: The interpretation of MRI results and the derivation of a therapy in every case need a balanced assessment of the MRI results, medical history, clinical investigations and clinical symptoms.

Operative procedures on the lower limb demand crucial handling of the surrounding soft tissues. Otherwise skin necrosis may develop and in cases of overlapping to the bone there is a risk of osteitis. Therefore the operative treatment requires an approach which reduces operative trauma to a minimum. However, in some cases even a minimal incision is too traumatic. The case we present, describes the use of an expandable nail-system to correct a valgus deformity in a lower limb, years after radiation therapy for synovial sarcoma. The distinctiveness in this case is the dystrophic skin after irradiation and the surgical options for correction.

Bipolar dislocation injury of the forearm is rarely documented. It is a combined forearm injury with trauma on the elbow side and on the side of the wrist joint. We describe two different cases of this complex dislocation. The first patient suffered from a Monteggia-like dislocation fracture with transscaphoid dislocation of the wrist. The second person had an acute longitudinal radioulnar membrane dissociation after elbow dislocation with an additional scapholunate tendon rupture. The difficult management of these injuries is illustrated by these cases.

After repeated failure of osteosynthesis of a subcapital humerus fracture, the humeral joint got infected. Radical surgery, use of a temporary Palacos-Refobacin spacer, and secondary implantation of an inverse prosthesis achieved painlessness and satisfying functional results.

Desmoplastic fibroblastoma ("collagenous fibroma") is a benign fibrous soft tissue tumor. We report a rare case of a "collagenous fibroma" located in the proximal lower leg in 56-year-old man. The clinical, radiological, and pathological-morphological findings are documented. The operative treatment was performed according to general principles of surgical management of benign soft tissue tumors.

In 1997 six patients with posttraumatic ankle arthritis aged 54 (45-71) years were treated with a LINK S.T.A.R. ankle prothesis. The average follow up was 29 (21-36) months. Results were evaluated according to the ankle score of H. Kofoed [7]. Two patients had an excellent outcome and 1 patient had a fair result. In three patients secondary arthrodesis had to be performed, due to loosening of the implant. Based on our experiences we cannot recommend this implant for patients with posttraumatic arthritis at this time.

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P < 0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P < 0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P < 0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P < 0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P < 0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

A solid AO unreamed tibial nail was found to be broken at the revision operation for a pseudoarthrosis following open tibial fracture treatment in a 17-year-old girl. The nail breakage had not been detectable in the roentgenograms. Access to the broken nail was achieved through a longitudinal osteotomy via the tibial tuberosity. A metal drill was used to drill a 5-mm hole proximally into the medial aspect of the nail. There the tip of an elevatorium could be inserted, which allowed force to be applied along the longitudinal axis of the nail. Additionally, another longitudinal osteotomy had to be performed immediately distal to the pseudoarthrosis, and a bone distractor was applied in between. Thus, the nail loosened and could be removed completely. The bony defect was filled with autologous bone graft and a 9-hole AO tibial plate was applied to stabilize the tibia. We report on the breakage of this system and the surgical management of this complication.

From 1977 through 1992 a total of 25 children (age 4 months to 14 years) were hospitalized for pelvic fractures. Clinical outcome and X-ray evaluation had been recorded and were retrieved for 21 children. In 3 patients pelvic fractures required surgery. All pelvic fractures healed uneventfully whether treated by surgery or conservatively. Concomitant injuries, treatment, and types of pelvic fracture are discussed.

The KT-1000 arthrometer was used to measure anterior tibial displacement in patients with acute unilateral anterior cruciate ligament (ACL) disruptions. Measurement revealed 11.5 mm absolute displacement on the injured side and 3.6 mm side-to-side difference with the 89 N test, 15.2 mm absolute displacement and 6.1 mm side-to-side difference with the manual maximum displacement test, and 8.5 mm displacement and 2.0 mm side-to-side difference with the active quadriceps test. Chronic anterior instabilities measured 13.0 mm absolute displacement on the involved side and 5.4 mm side-to-side difference with the 89N test, 17.7 mm displacement and 8.6 mm side-to-side difference with the manual maximum displacement test, 10.8 mm displacement and 4.4 mm side-to-side difference with the active quadriceps test. Testing technique, measurements in control subjects without previous knee injuries, and displacement measurements of other authors and other instrumented testing devices are described.

Two hundred consecutive patients were treated for medial meniscus lesions by partial arthroscopic medial meniscectomy. Only patients with intact cruciate and collateral ligaments prior to surgery and at arthroscopy were accepted for the study. Although all patients denied a new trauma, 12 patients (6%) were found to have increased anterior instability and 43 patients (22%) to have increased medial instability at follow-up 53.5 months after surgery. KT-1000 measurements in knees with increased anterior tibial translation revealed an average side-to-side difference of 4.7 mm.