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A case of surgical reconstruction of the lateral tibial plateau after impression fracture (Type 41-B3.1) of an 47-year-old female is presented. Joint reconstruction was performed by using a free patellar graft. The 16-year follow-up shows a very good functional outcome without subjective complaints. This case underlines that performing patellar autografting for surgical reconstruction of severe injury of the tibial plateau seems to be a promising alternative especially considering young patients in spite of avoiding total knee replacement.

We report 3 individually different cases of primary chronic osteomyelitis. Neither the plasmacellular nor the sclerosing forms caused diagnostic or therapeutic difficulties whereas the case of a 40-year old male patient with a Brodie abscess in the tibial head could not be diagnosed unless the untreated abscess had perforated into the knee itself and empyema of the knee leaded to operative treatment and finally diagnosis of the Brodie abscess. Follow-up X-rays in weekly periods or MRT could have been helpful to avoid delayed diagnosis.

Cultivation and transplantation of autologous keratinocytes has been used in the last 15 years to treat complicated wounds of different origin. In spite of excellent technical advancements and clinical experiences cultured keratinocyte grafting still is associated with practical limitations. Application of hyaluronic acid ester membranes as carrier substrate for the transfer of keratinocytes allows improved graft handling: reduces total time required for tissue cultivation and furthermore enhances vitality of the keratinocytes because of possible grafting at semiconfluence.

Despite the application of data processing in medicine beginning almost 40 years ago and then employing the Hollerith-method until now no consent has been achieved to solve the problems that arise from the demands of jurisdiction concerning methodical proceedings and procedures in data processing in hospitals. Concerning this the hospitals' administrations are overstrained as are the clinical departments. The paper presented recalls empirical knowledge that has already been gathered long ago.

The study presented investigates prospectively the clinical value of the PMN-elastase as a sequel parameter in 954 patients of a surgical intensive care unit. The elastase-values measured discriminate highly significant between patients with and without complications (p < 0.001) as well as between survivors and non-survivors (p < 0.001). Furthermore in patients underlying shock-phases in the course of treatment significantly higher elastase values are measured as in the patients remaining (p < 0.001). The highest prognostic evidence is determined by the elastase at the 9th day of course of disease concerning the prediction of a patient's death (sensitivity 78%, specificity 75%, positive predictive value 63%, respectively negative predictive value 87%).

Acquisition, storage and processing of any images relevant in trauma surgery together or in combination with (alpha) numeric data nowadays are possible employing a personal computer. The computing speed that is achieved with 486 cpu's "inside" is sufficient to process images in motion as well as single images to be filtered. The display and process-resolutions required for processing of X-ray-images can be achieved with the PC's hardware as well as with the software available. That is why there is no need any longer for special configurations for X-ray-departments. Calculating the price of the process-environment proposed, about 25,000 DM should be enough including the video tape recorders and the CD-ROM-recorder that are required.

Intensive care treatment of elderly patients is discussed controversially. Especially the success of maximal therapeutic efforts is questioned in this group. Therefore, this paper analyses prospective data of 1572 patients of a surgical intensive care unit with respect to age-related outcome. Besides the anticipated high proportion of concomitant diseases and an associated increased mortality of aged patients, there are no specific age-dependent differences. Old patients benefit from maximal therapeutic efforts to the same extent like younger patients. The authors conclude from the data that the patient's age per se should not influence the indication for intensive therapeutic interventions.

Following the proposal of Oedekoven we investigated the method of continuous and rapid skin enlargement by dynamic traction (which we named the CORSET-method) at the border of wounds, applied through elastic silicon rubber bands. Since March 1992 we operated more than 20 patients. By means of the "rubber bands" mentioned above soft tissues can be stimulated to grow, that is to say increase the area of skin that had to be treated with transplants priorily in order to close soft tissue defects following a compartment-syndrome or septic complications in the abdomic wall following operations in the abdomen. Applying the CORSET-method there is no risk of inflammation or soft tissue damage caused by the operation itself.

Adjust preclinical treatment is an inevitable compound of polytrauma-management. Instantaneously applied expert therapy of the traumatic shock and acutely performed diagnosis of the pattern and dignity of injuries often are crucial for the patients' outcome. Precise documentation of the first phase of treatment thus gains importance for clinical investigations to come and for questions put scientifically. Applying data processing with data input through an optical mark reader a standardized encounter sheet, that proved to be usable as a checklist, has been developed in our hospital for the emergency-rescue-team. Being simple to use and handy to fill out it serves as a clinical record as well as a means for direct data input to a personal computer. The encounter sheet is presented in this paper together with first results of the application in daily routine.

The multi-center study presented reveals that 76% of the conventionally performed X-ray investigations of the skull can be avoided without any relevance concerning the non-diagnosis of severe injuries. Only in 3.2% of all patients investigated a skull X-ray had instantaneous therapeutically consequences. Thus routinely performed skull X-rays are no longer acceptable in the light of cost reduction and radiation load. The clinical-neurological investigations however are inevitable to perform the state of the art treatment of patients with head injuries today, leading to computerized tomography if necessary. A check-list of clinical findings is presented to get the indications for conventional X-rays of the skull and to manage an effective use of such investigations in appropriate clinical situations.

Data management in hospitals used to be the data management of the hospital-management in the last 15 years, not however the data management the doctors performed. The acceptance for electronic means slowly rising more software is used in the clinics today but still by the doctors privately. Software specialists have registered the growing market available for their products. That is why the danger to accept even unusuable software rises every day, as unexperienced software-beginners as doctors mostly are often relied on offers without being told about their dignity and usefulness.

Problems of calculations and predictions on more than two particles moving are known in mathematics and physics since a long time already. However in medicine as there is lack of knowledge about the complexity of the pathophysiological behaviour of "systems" doctors tend to invent scores, scales and indices to make parameters more intelligible to them without concern on underlying interdependencies and redundancies. There is nothing to say against this kind of proceeding as long as the resulting data are not processed statistically. However, since the personal computer was invented there was and especially today is no need to summarize data any longer to gain the degree of understanding, in the contrary, the only data that really count are those that are processed correctly according to statistics, and thus doctors do not have to keep an eye any longer on incomplete intermediate results.

Depending on the individual skill of doctors the results of clinical investigations and laboratory findings are weighted differently according to their reliability today. Dealing with medical data the statistical way they have to be handled differently as well depending on the degree of reproducability and thus reliability. The problem of safety and quality of data in medicine is known to every experienced doctor as long as he himself "processes" them, nevertheless data tend to be treated uncritically when "automatically" processed by a computer. A way out of this pitfall is given by standardization of data using check-lists without transfer to any kind of coding-system or thesauri because none of those systems exists today that is capable of regaining the input-informations as they were from the codes.

To assure quality and progression of surgical intensive-care therapy appropriate equipment is mandatory to ensure documentation and quality-control. In our hospital data processing of any information concerning the patients treated in the intensive-care unit has become part of the daily routine. This paper presents and discusses the underlying concept.

From January 1st, 1984 until December 31st, 1988 586 employees of the University Clinic of Frankfurt, West-Germany, were treated after occupational accidents with potentially HIV-contaminated materials. The majority of the patients were admitted because of lacerations that occurred with used injection needles. Up to now the sero-conversion of a patient after this special kind of trauma has not been documented in West-Germany. In our clinic we found an infection in one employee, which is due to an occupationally acquired injury.

The digital computerarthrometry (DCAM) was developed as a very cost-effective device to calculate the pathologic angles of injured joints. The joint's data are captured by a frame grabber-board installed in a personal computer after takeover from the X-rays by a video camera. Measurements are performed using a commercially available software package which displays the X-ray-photograph on a separate screen besides the one used to manipulate the computer. With this system the calculations of angles and distances of the injured joints are performed with considerably higher precision as it could be done before. As a further possibility bone density measurements may be done from the X-rays as it had been tried to before computers could be used. Our first results seem to present our system as an alternative to the costly workstations, that had to be used until now.

The efficacy and efficiency of 5874 diagnostic X-rays at the Department of Traumatology, University Clinics of Frankfurt, West-Germany, were reviewed. Efficiency of the method was extremely high with false results in only 0.00017%. The efficacy of the diagnostic traumatologic X-ray procedures could be markedly increased with a more critical approach in indications and the avoidance of routine diagnostic X-rays mainly of the skull. This study shows an optional reduction of traumatologic X-rays of 16% and a concomitant reduction in costs of 17.2%.