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Patients with long-segment cervical spinal fusion resulting from spinal ankylosing disorders (SADs) are at high risk for highly unstable cervical spine fractures necessitating surgery as the treatment of choice; however, without an existing gold standard. Specifically, patients without concomitant myelo- pathy, representing a rare entity, may benefit from a minimized surgical approach of a single-stage posterior stabilization without bone grafting for posterolateral fusion. This retrospective monocenter study in a Level I trauma center included all patients treated with navigated posterior stabilization without posterolateral bone grafting between January 2013 and January 2019 for cervical spine fractures in preexisting SADs without myelopathy. The outcomes were analyzed based on complication rates, revision frequency, neurologic deficits, and fusion times and rates. Fusion was evaluated by X-ray and computed tomography. 14 patients (11 male, 3 female) with a mean age of 72.7 ± 17.6 years were included. Five fractures were at the upper and nine at the subaxial cervical spine (predominantly C5-7). There was one surgery-specific complication of postoperative paresthesia. There was no infection, implant loosening, or dislocation, and no revision surgery necessary. All fractures healed after a median time of 4 months and 12 months being the latest time of fusion in one patient. Single-stage posterior stabilization without posterolateral fusion is an alternative for patients with SADs and cervical spine fractures without myelopathy. They can benefit from a minimization of surgical trauma while having equal times of fusion and no increased rate of complications.

In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints.21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality.With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points.The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.In Zeiten einer pandemischen Bedrohungslage, wie bei COVID-19, und der Notwendigkeit reduzierter direkter Arzt-Patienten-Kontakte rückte die internetbasierte Videotelefonie mehr und mehr als Ersatzserviceleistung in den Fokus. Um individuellen oder gesamtwirtschaftlichen Problemen entgegenzuwirken, darf die Erkennung und Behandlung anderer Erkrankungen keine längerfristige Unterbrechung erfahren. In kurzer Zeit stieg der Bedarf alternativer Methoden zur Patientenbetreuung. Bisherige telemedizinische Einsatzgebiete lagen vor allem im Bereich der radiologischen Befundung, der Nachsorge und des Monitorings psychiatrischer und internistischer Erkrankungen sowie geriatrischer Patientenbetreuung. Studien zur Einsatzmöglichkeit für eine orthopädisch-unfallchirurgische Untersuchung des Kniegelenks existieren nach Autoreninformationen bislang nicht. Wie sich der Einsatz einer Videosprechstunde in der speziellen Anwendung für die Anamnese und Untersuchung bei Beschwerden des Kniegelenks konzipieren und umsetzen lässt, soll im Rahmen dieser Machbarkeitsstudie erarbeitet werden.21 Schauspielpatienten (SP) mit simulierten Beschwerden des Kniegelenks wurden für jede Diagnose einzeln zunächst über Videotelefonie und anschließend im direkten Kontakt durch einen Facharzt (FA) untersucht. Eine Gruppe der SP war medizinisch vorgebildet, die andere bestand aus Laien. Von beiden Untersuchungseinheiten wurde die Zeit gemessen. Die erkannten Symptome, die patientenseitige Durchführungsqualität der Eigenuntersuchungsschritte und die abgeleitete Diagnose wurde auf einem Bewertungsbogen durch den Arzt dokumentiert. Die SPs erhielten zum Abschluss beider Untersuchungseinheiten einen Bewertungsbogen zur jeweiligen Untersuchungsmethodik.Die Untersuchungseinheit der Videosprechstunde dauerte im Mittel 8,63 (± 2,5) min, die der normalen Sprechstunde 5,63 (± 1,7) min (p 0,001). Die Dauer der Videountersuchung zeigte für die Gruppe mit medizinischem Vorwissen einen Wert von 7,67 (± 1,4) min, wohingegen die Untersuchung der Laiengruppe im Mittel 9,7 (± 3,1) min dauerte (p = 0,049). Ein höheres Alter verlängerte die Dauer der Videountersuchung (p = 0,032; r = 0,47). Im Mittel wurden 9,32 (± 0,4) von 10 Punkten für die Eigenuntersuchungen der Beinachse, des Gangbildes und der Freiheitsgrade erreicht. Niedrigere Mittelwerte erreichten die Funktionstests: Payr-Test 7,2 (± 2,3) Punkte, Merke-Test 5,9 (± 2,8) Punkte, No-touch-Lachmann-Test 6,4 (± 2,7) Punkte, Gravity-Sign-Recurvatum-Test 6,7 (± 2,4) Punkte. Die Durchführbarkeit der Eigenuntersuchungen bewerteten die SP im Mittel mit 2,43 (± 0,98) von 5 Punkten.Die Videosprechstunde für muskuloskelettale Beschwerden des Kniegelenks ermöglicht eine orientierende Fernuntersuchung und hilft, das Patientenaufkommen in Kliniken und Praxen zu minimieren. Sie geht mit einem zeitlichen Mehraufwand für den Arzt einher und findet ihre Limitierung in den Funktionstests der Kniebinnenstrukturen. Die telemedizinische Untersuchung ersetzt in der heutigen Form keine persönliche Sprechstunde.

Wiederherstellung der Kniegelenkfunktion bei endoprothetischen Revisionseingriffen mit fortgeschrittenen Knochendefekten durch Verwendung tibialer metaphysarer Komponenten. Metaphysare Defekte entsprechend AORI(Anderson Orthopaedic Research Institute)-II- (a und b) und -III-Defekten in der Revisionsendoprothetik des Kniegelenks. Persistierender oder aktueller Gelenkinfekt, genereller Infekt (Pneumonie, Harnwegsinfekt [HWI]), fehlende Metaphyse, insuffizienter Streckapparat. Standardzugang uber bestehende Hautnarbe, Arthrotomie, Entfernung Zementspacer, wenn notwendig, und Entnahme multipler Gewebeproben; Praparation Femur first; anschliesend Praparation Tibia. Referenzierung der Rotation und Gelenklinienhohe mit entsprechender Entscheidung zur Verwendung von Augmenten. Tibiale Osteotomie intramedullar referenziert. Bestimmung der metaphysaren Defektgrose und dementsprechend Wahl der Komponentengrose. Positionierung der Raspelfuhrung fur die metaphysare Komponente (Sleeve); stufenweise Praparation des Bettes fur die metaphysare Komponente. Belassen der Komponente in der gewunschten Tiefe (bei Verwendung von Augmenten +5 oder +10 mm dementsprechend 5 bzw. 10 mm oberhalb des Tibiaplateaus). Montage des Tibiaplateaus auf dem liegenden Sleeve und Reposition. Probekopplung, Kontrolle der Implantatlage und der Gelenklinienhohe rontgenradiologisch. Verwendung der definitiven Implantate. Vollbelastung; regelmasige Wundkontrolle; Limitation des Flexionsgrades nur bei Augmentation oder geschwachtem Streckapparat. Zwischen Mai 2018 und August 2019 wurden 14 metaphysare Komponenten bei 14 Patienten tibial implantiert. Der mittlere Nachuntersuchungszeitraum betrug 10,4 Monate. Die Nachuntersuchung umfasste die klinische Untersuchung, den KSS (Knee Society Score) sowie eine Rontgen- und Versagensanalyse. Eine signifikante Verbesserung der ROM („range of movement“) von 75 ± 16° auf 100 ± 14° (p 200 m) nach 6 Monaten; tibiale Schaftschmerzen wurden von allen Patienten verneint. Das nachuntersuchte Kollektiv zeigt im Beobachtungsintervall eine Implantatuberlebensrate von 100 %.

BACKGROUND Ankle arthropathy is a frequent complication of haemophilia, reducing the patients' quality of life. Despite intensive conservative therapy, end-stage arthropathy requires surgical treatment, either by ankle fusion (AF) or total ankle replacement (TAR). METHODS Eleven consecutive AFs were performed in nine patients and 11 TARs were implemented in 10 patients. Outcomes were assessed clinically by AOFAS score and radiologically by the Pettersson and Gilbert scores. RESULTS The mean age of the patients in these groups were 35.7 years and 49.4 years, respectively. Of the 11 ankles that underwent fusion, 10 showed bony consolidation not later than 12 weeks after surgery, whereas one still showed non-union after 6 months. VAS pain scores decreased significantly in both groups. Mean AOFAS scores also improved significantly, from 28.1 before to 80.3 after AF and from 21.5 before to 68.0 after ankle replacement. No perioperative complications were observed in either group. Late deep infection was observed in two patients that underwent TAR, which required removal of the implant. CONCLUSION Our data indicate that both AF and TAR result in significantly reduced pain in patients with haemophilia with end-stage haemophilic arthropathy. While TAR is associated with a higher risk of deep infection and minimal persistent pain, it preserves the pre-operative range of motion. AF on the other hand is associated with the risk of non-union and a longer post-operative recovery period but results in greater pain reduction.

BACKGROUND The marginal mandibular branch (MMB) of the facial nerve provides lower lip symmetry apparent during human smile or crying and is mandatory for vocal phonation. In treating facial palsy patients, so far, little attention is directed at the MMB in facial reanimation surgery. However, isolated paralysis may occur congenital, in Bell's palsy or iatrogenic during surgery, prone to its anatomical course. A variety of therapies address symmetry with either weakening of the functional side or reconstruction of the paralyzed side. To further clarify the histoanatomic basis of facial reanimation procedures using nerve transfers, we conducted a human cadaver study examining macroanatomical and microanatomical features of the MMB including its axonal capacity. METHODS Nerve biopsies of the MMB were available from 96 facial halves. Histological processing, digitalization, nerve morphometry investigation, and semiautomated axonal quantification were performed. Statistical analysis was conducted with P < 0.05 as level of significance. RESULTS The main branch of 96 specimens contained an average of 3.72 fascicles 1 to 12, and the axonal capacity was 1603 ± 849 (398-5110, n = 85). Differences were found for sex (P = 0.018), not for facial sides (P = 0.687). Diameters were measured with 1130 ± 327 μm (643-2139, n = 79). A significant difference was noted between sexes (P = 0.029), not for facial sides (P = 0.512.) One millimeter in diameter corresponded to 1480 ± 630 axons (n = 71). A number of 900 axons was correlated with 0.97 mm (specificity, 90%; sensitivity, 72%). CONCLUSIONS Our morphometric results for the MMB provide basic information for further investigations, among dealing with functional reconstructive procedures such as nerve transfers, nerve grafting for direct neurotization or babysitter procedures, and neurectomies to provide ideal power and authenticity.

Soft tissue sarcomas are a heterogeneous group of neoplasias that due to their often clinically silent appearance often remain undetected or experience delayed treatment. Especially soft tissue swelling is often misinterpreted by patients and doctors and trivialized or verified with an incorrect biopsy technique. The hereby evoked complications for the patients are serious and may be reduced by simply following the available guidelines. The treatment of soft tissue sarcomas requires a close interdisciplinary coordination between specialists in tumor orthopedics, oncology, radiology, pathology and radiotherapy. On the basis of a selective literature review, the following article points out the current evidence on the treatment and illustrates a treatment algorithm.Weichteilsarkome sind eine heterogene Gruppe von seltenen Neoplasien, die aufgrund ihrer anatomischen Lage und ihres oft inapparenten klinischen Erscheinungsbildes eine häufig zu spät diagnostizierte Tumorentität darstellen. Gerade weichteilige Schwellungen werden initial oft fehlinterpretiert und im Gegensatz zu den gängigen Behandlungsleitlinien bagatellisiert oder inkorrekt biopsiert. Die daraus resultierenden Komplikationen sind für den Patienten gravierend und können durch Befolgen gewisser Behandlungsgrundsätze minimiert werden. Die Behandlung der Weichteilsarkome kann nur im interdisziplinären Kontext unter Einbeziehung von chirurgischen Fächern, Onkologie, Pathologie und Strahlentherapie gelingen und sollte beginnend mit der Biopsie an Tumorzentren durchgeführt werden. Dieser Übersichtsartikel versucht, anhand einer selektiven Literaturrecherche eine Übersicht über die aktuelle Evidenzlage zur Behandlung dieser Tumorentität aufzuzeigen und einen Behandlungsalgorithmus darzustellen.

The second part of this review deals with the several options for the surgical therapy of bone metastases according to their anatomical site and the patient's individual prognosis. Although metastases to the bone - with few exceptions - are normally given palliative therapy, patients nowadays reach survival times of several months to years, depending on the underlying tumour entity. Scoring systems are suitable to estimate the patient's prognosis and fracture risk. The indication for operation has to be adapted to these parameters. In order to preserve a high quality of life, a limb saving procedure has to be aimed at. The options include the resection of the metastasis with stabilisation, the sole stabilisation of the affected bone, and wide resection with limb reconstruction using a modular tumor endoprosthesis. With today's anaesthesiological peri- and intraoperative care, a vast number of surgical implants and bone augmentations are available. However, what is important is not the practicability of the procedure, but the oncological justification and patient-adapted selection of surgical therapy.Der vorliegende 2. Teil dieser Übersichtsarbeit befasst sich mit den unterschiedlichen operativen Therapiemöglichkeiten von Skelettmetastasen in Abhängigkeit von deren Lokalisation und der individuellen Prognose des Patienten. Obwohl im Falle der ossären Metastasierung mit wenigen Ausnahmen von einem palliativen Therapieschema ausgegangen wird, erreichen die Patienten dennoch Überlebensraten von mehreren Monaten bis Jahren in Abhängigkeit von der zugrunde liegenden Tumorentität. Zur Abschätzung der Prognose und Frakturgefährdung stehen verschiedene Scores zur Verfügung. Die Operationsindikation ist immer im Zusammenhang mit der Prognose und patientenindividuell zu stellen. Im Sinne des Erhaltens einer hohen Lebensqualität ist prinzipiell eine extremitätenerhaltende Therapie anzustreben. Diese lässt sich unterteilen in eine Resektion der Metastase mit Stabilisierung der Extremität, der alleinigen Stabilisierung sowie der weiten Resektion mit ossärer und funktioneller Defektrekonstruktion mittels einer Tumorendoprothese. Mit den heutigen Möglichkeiten der intra- und perioperativen Patientenversorgung ist eine Vielzahl von Implantaten und Möglichkeiten der Augmentation von metastatischen Knochendefekten verfügbar. Im Vordergrund steht jedoch nicht die chirurgische Durchführbarkeit, sondern die onkologisch sinnvolle und patientengerechte Wahl der Therapie und des operativen Vorgehens.

Secondary cleft nose rhinoplasty remains a challenging procedure. Cartilage memory and scar contraction are problematic factors. The need for more detailed procedures for secondary reconstruction in this patient population has arisen. Contemporary refinements demonstrate a highly structured approach. We conducted a retrospective study evaluating the aesthetic results of cleft patients who underwent secondary rhinoplasty.In a retrospective study, a photometric analysis of cleft patients operated in the period 2003-2011 was conducted. Reconstructive methods were documented. Pre- and postoperative photographs of cleft rhinoplasty patients were evaluated using a standardized protocol. Nostril width ratio, columellar angle, tip projection ratio, and nasolabial angle served as objective instruments. The Unilateral Cleft Lip Surgical Outcomes Evaluation score was chosen for external photometric rating and rated blindly by 2 external individual plastic surgeons as independent nonbiased reviewers. The interrater and intrarater reliabilities were calculated using the Cohen kappa coefficient (κ).A total of 120 secondary rhinoplasties in 85 uni- and bilateral cleft patients could be included. Mean follow-up was 20 months. A total of 60 (71%) patients needed additional bone grafting (chin/pelvis), and 23 (27%) patients a LeFort I osteotomy. In one third of the secondary rhinoplasties, a medial and/or lateral osteotomy was performed (34%). In one fourth (24%), an external septoplasty was considered necessary. In 55% (47 patients) of the cases, a columellar strut was used. Excluding bone grafts, a total of 173 other grafts (mean of 2 grafts/patient) were applied. Postoperative measurements for nostril width ratio and columellar angle were statistically significant. A structured approach with contemporary refinements is described in detail. Intra- and interrater reliabilities for photometric assessment according to the Unilateral Cleft Lip Surgical Outcomes Evaluation score are shown.A structured approach for secondary cleft rhinoplasty yields satisfying, reproducible, and stable results.

BACKGROUND AND OBJECTIVES: Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS: From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS: An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684 +/- 1884 axons (range, 2655-12457) were counted for the entire group (n = 87). Right facial halves showed 6364 +/- 1904 axons (n = 43). Left facial halves demonstrated 6996 +/- 1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247 +/- 2230 (n = 22), male showed 6769 +/- 1809 axons (n= 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933 +/- 424 mu m (range, 975 to 3012). CONCLUSIONS: No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen.

The zygomaticus major (ZM) is important for the human smile. There are conflicting data about whether the zygomatic or buccal branches of the facial nerve are responsible for its motor innervation. The literature provides no precise distinction of the transition zone between these two branch systems. In this study, a definition to distinguish the facial nerve branches at the level of the body of the zygoma is proposed. In the light of this definition, we conducted an anatomical study to determine how the source of innervation of the ZM was distributed. A total of 96 fresh-frozen cadaveric facial halves were dissected under loupe magnification. A hemiparotidectomy was followed by antegrade microsurgical dissection. Any branch topographically lying superficial to the zygoma or touching it was classed as zygomatic, and any neighboring inferior branch was considered buccal. The arborization of the facial nerve was diffuse in all cases. In 64 out of 96 specimens (67%, 95% CI: 56% to 76%), zygomatic branches innervated the ZM. Buccal branches innervated ZM in the other 32 facial halves (33%, 95% CI: 24% to 44%). There were no differences in respect of sex or facial side. All facial halves displayed additional branches, which crossed the muscle on its inner surface without supplying it. In 31 specimens, a nerve branch ran superficial to ZM in its cranial third. According to our classification, the zygomaticus major is innervated by zygomatic branches in 67% of cases and by buccal branches in 33%. Clin. Anat. 31:560-565, 2018. © 2018 Wiley Periodicals, Inc.

ZusammenfassungMaligne Neoplasien sind in Deutschland nach den kardiovaskulären Erkrankungen weiterhin die zweithäufigste Todesursache. Obwohl sich die 5-Jahres-Überlebensraten der meisten malignen Tumoren in Deutschland in den letzten 30 Jahren signifikant verbessert haben, gilt eine ossäre Metastasierung mit wenigen Ausnahmen weiterhin als Zeichen der Inkurabilität. Neben den seltenen primären Knochentumoren macht die Behandlung von ossären Absiedlungen von Karzinomen einen großen Teil der tumororthopädischen Tätigkeit aus, die zudem eine enge interdisziplinäre Abstimmung mit der inneren Medizin, Radiologie und der entsprechenden Fachdisziplin der zugrunde liegenden Entität erfordert. Durch die Fortschritte in der onkologischen Therapie des Primärtumors wird z. T. ein sehr langes Überleben erreicht, sodass das Management von SRE („skeletal related events“) auch bei palliativen Situationen an Relevanz gewinnt. Die vorliegende Übersichtsarbeit geht in ihrem 1. Teil auf der Grundlage einer aktuellen selektiven Literaturübersicht auf die zuvor erwähnten pathophysiologischen Zusammenhänge der ossären Metastasierung ein und stellt im Folgenden einzelne Diagnostika und deren Relevanz dar.

Zusammenfassung Hintergrund Das multiple Myelom (MM) ist als maligne hämatologische Systemerkrankung nach Einteilung der Weltgesundheitsorganisation (WHO) dem Formenkreis der Plasmazellneoplasien zuzuordnen. Die weltweite Inzidenzrate des MM liegt etwa bei 6 – 7/100 000 Einwohnern/Jahr und macht somit etwa 1% aller Krebserkrankungen der Welt aus. In Deutschland sind ca. 6000 Neuerkrankungen pro Jahr zu verzeichnen. Im Zeitalter der sog. neuen Therapiesubstanzen wie Immunmodulatoren, Proteasomeninhibitoren und Antikörpern haben sich in der Behandlung des MM enorme Fortschritte ergeben. Auf dem Fachgebiet der Orthopädie und Unfallchirurgie ist es von großer Bedeutung, die Leitsymptome des MM im klinischen Alltag sicher zu erkennen und durch eine zielgerichtete Basisdiagnostik weiter abzuklären. Die operative Versorgung von myelomassoziierten Skelettläsionen, wie etwa die Stabilisierung von pathologischen Frakturen, ist Aufgabe der orthopädischen Chirurgie. Methoden Auf Grundlage einer umfassenden Literaturrecherche, die selektiv in PubMed mit den Stichworten „multiple myeloma“ and „diagnostic“ or „therapy“ erfolgte, wurde die verfügbare Primär- und Sekundärliteratur zu aktuellen Standards in der Diagnostik und Therapie des MM beurteilt. Eingeschlossen wurden systematische Reviews, Metaanalysen, klinischen Studien und internationale Therapieempfehlungen bis Frühjahr 2016. Ergebnisse Es existieren heute sehr sensitive Nachweismethoden in der Diagnostik des MM, die neben der bildgebenden Skelettdiagnostik und histologischen Knochenmarkuntersuchung insbesondere die klinisch-chemische Serum- und Urindiagnostik, einschließlich eines 24-h-Sammelurins umfassen. Nach heutigem Kenntnisstand besteht das therapeutische Grundkonzept aus der Kombination einer Hochdosischemotherapie (HDT) und einer autologen Blutstammzelltransplantation (ASCT). Die einzelnen Therapiesäulen der meist multimodalen Behandlungsstrategie sind in enger fachübergreifender Zusammenarbeit patientengerecht abzuwägen. Hierbei ist für die Bewertung des Risikoprofils des Patienten das Lebensalter, die Komorbiditäten sowie der individuelle Krankheitsverlauf (Rezidivneigung oder therapierefraktäre Krankheitsprogression) zu berücksichtigen. Bei Patienten > 70. – 75. Lebensjahr und/oder schweren Komorbiditäten, für die eine HDT und ASCT i. d. R. ungeeignet ist, müssen Indikationen für konventionelle Therapieoptionen gestellt werden. Darüber hinaus sind supportive Behandlungsmaßnahmen wie die Gabe von Bisphosphonaten zur Knochenprotektion, stabilisierende Operationen von pathologischen Frakturen oder eine lokale Strahlenbehandlung von schmerzhaften Osteolysen in das gesamtheitliche Therapiekonzept des MM einzubinden. Schlussfolgerung In aktuellen Studienuntersuchungen konnte gezeigt werden, dass neue Wirkstoffgruppen wie Proteasomenhemmer, immunmodulatorische Substanzen und Antikörper bereits vielversprechend in der Behandlung des MM eingesetzt werden können, um die Prognose und Lebensqualität von Myelompatienten in Zukunft weiter zu verbessern. Hierbei werden die Therapiealgorithmen komplexer und kostenintensiver.

Periprosthetic joint infection is among the most common and severe complications in total joint arthroplasty. Today, a combination of different methods is used for diagnosis because no single method with sufficient sensitivity and specificity is available. In this study, we explored the usability of single-molecule microscopy to characterize synovial fluid samples from periprosthetic joint infections. Patients (n = 27) that needed revision arthroplasty underwent the routine diagnostic procedures for periprosthetic joint infection of the University Hospital in Bonn. Additionally, the diffusion rate of two probes, dextran and hyaluronan, was measured in small volumes of periprosthetic synovial fluid samples using single-molecule microscopy. To evaluate the suitability of single-molecule microscopy to detect PJI the AUC for both markers was calculated. The diffusion rate of hyaluronan in periprosthetic synovial fluid from patients with septic loosening was faster than in samples from patients with aseptic loosening. Single-molecule microscopy showed excellent diagnostic performance, with an area under the receiver operating characteristic curve of 0.93, and allowed the detection of periprosthetic joint infection in patients that would be challenging to diagnose with current methods. For the first time, single-molecule microscopy was used to detect periprosthetic joint infection. Our results are encouraging to study the value of single-molecule microscopy in a larger patient cohort. The speed and accuracy of single-molecule microscopy can be used to further characterize synovial fluid, potentially allowing intraoperative diagnosis of periprosthetic joint infections in the future.

Presenting the implantation of the PediatrOS™ FlexTack™ (Merete, Berlin, Germany) for growth guidance and a modified explantation procedure to facilitate explantation and prevent bone and soft tissue damage. Implantation: Genua vara and valga, coxa vara, varus and valgus deviation of the ankle joint, the elbow joint and the wrist Modified Explantation: Removal of the implant after successful limb correction or dislocation of the implant. Implantation: Closed growth plates, insufficient remaining growth potential, acute or chronic infection, insufficient osseous structures, severe muscular, nervous or vessel diseases endangering the respective limb Explantation: General inoperability of the patient. Implantation: Localization of the growth plate. Insertion of K‑wire parallel to joint line on the joint side. Setting of the implant. Insertion of second K‑wire and insertion with the implantation instrument and hammer. Modified Explantation: Cutting of the implant bridging part. Both ends of the bridging part are bent vertically to prevent soft tissue damage. Dissection of both implant arms from the bone with the chisel. Extraction in 360° motion using tooth extraction pliers. Implantation: Full weight bearing. X‑ray controls every 3 months to control growth correction. Explantation: Full weight bearing. Complications such as breaking of the k‑wires, breaking of the chisel or extraction of adhering bone tissue occurred in 14 of the 64 (21.9%) explanted FlexTack implants. Complication-free removal using the original instruments provided by the manufacturer was possible for five implants. The modified explantation procedure as described above was applied in 45 explanted implants (70.3%) with complete removal of the implant without further complications within the follow up period.

The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube. Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube. In 15 further cases the use of a trevira tube was not necessary. The mean follow-up time was 26 months (range: 24 months to 84 months). Both, Enneking score and range of motion (ROM), was evaluated. Further radiographs were obtained in two planes. The survival rate one year after surgery was 83 % and 63 % after two years. We recorded a 96 % survival of the limb two years after surgery. We also observed only one case of periprosthetic joint infection (PJI) in the entire follow-up period in one patient who received treatment with a trevira tube. The mean Enneking score was 20 points (range 8 to 26 points). ROM was equal in both study groups. In total 20 % of the treated patients (n = 6) suffered complications. Replacement of the proximal humerus by using a trevira tube in combination with a modular tumour endoprosthesis is a safe and viable treatment option for both, bone tumours and metastases. There is no statistically significant increased risk of infection by using trevira tube even among immunosuppressed patients. Level 3, retrospective comparative study

Contains fulltext : 79856.pdf (Publisher’s version ) (Closed access) BACKGROUND: The k(e)(0) value is the first order rate constant determining the equilibration of drugs between plasma or end-tidal concentration and effect-site (e.g., brain) concentration. Parametric and semiparametric approaches have been used for estimating individual k(e)(0) values and describing the drug-response curve. In this study, we introduce a new semiparametric approach calculating k(e)(0) values for isoflurane, sevoflurane, and desflurane by maximizing the prediction probability P(K). METHODS: Data from 45 patients scheduled for a radical prostatectomy were analyzed. After lumbar epidural catheterization, patients received remifentanil and propofol solely for induction of anesthesia. Thereafter, epidural analgesia was initiated, and isoflurane, sevoflurane, or desflurane (15 patients each) was added to maintain unconsciousness. At least 45 min later, end-tidal concentrations were varied between 0.5 and 2 minimum alveolar anesthetic concentration. We estimated an individual k(e)(0) value for each patient by optimizing the prediction probability P(K) (P(K)-based k(e)(0)) or by minimizing the area within the hysteresis loop (area-based k(e)(0)). Data are mean +/- sd. RESULTS: Both semiparametric approaches led to comparable k(e)(0) values with 0.18 +/- 0.06 min(-1) (P(K) based) and 0.15 +/- 0.04 min(-1) (area based) for isoflurane and 0.17 +/- 0.08 min(-1) (P(K) based) and 0.16 +/- 0.11 min(-1) (area based) for sevoflurane. k(e)(0) values for desflurane (P(K) based: 0.30 +/- 0.17min(-1); area based: 0.32 +/- 0.25 min(-1)) were significantly higher than for isoflurane and sevoflurane. CONCLUSION: Maximizing the prediction probability P(K) for estimating k(e)(0) seems to be a promising method that researchers could use on an exploratory basis.