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After operating on the injured cruciate ligaments, immediate mobilization and protection of the healing ligament are indispensible. However, no approach has yet been shown to safely provide both. Therefore, in 1984 we introduced a new technique: the repaired or reconstructed cruciate ligaments are augmented with a biodegradable material - a doubled-over PDS cord, 1.5 mm in diameter. It allows for immediate and safe mobilization. Because of its appropriate elasticity it does not cause "stress shielding." Postoperatively, the patients are mobilized on a motorized frame for 2 weeks. Subsequently, we have used a limited mobilization cast (LMC). Forty-nine out of 63 patients (78%) have now been reexamined for this follow-up study, using the score from the Hospital for Special Surgery and stress X-rays in the Lachmann, position (30 degrees flexion). The results compare favorably with a prior follow-up study of patients from our hospital without PDS augmentation and without early mobilization. The knees in the present study are more stable and have a better range of motion, particularly when the LMC was used.

The infection rate of open lower leg fracture is extremely high. Surgical treatment guarantees a reduced risk of infection when compared with conservative treatments. But even osteosynthetic methods such as screw or compression plate fixation show unsatisfactory results because of the additional traumatization of the primarily injured soft tissue combined with a reduction of blood circulation. From July 1973 till September 1976 we treated 57 2nd and 3rd degree open shank fractures with osteosynthetic methods: 46 with compression plate osteosynthesis and 11 primarily or secondarily with external fixation. The osteitis-rate was 14%, in addition to that there was a soft-tissue infection rate of 5%. In order to change our therapeutical procedure we stabilized 2nd and 3rd degree open lower limb fractures and lower leg fractures complicated by soft-tissue damages consequently by external fixation. From October 1976 till May 1978 we treated 39 open shank fractures; 24 of them were 2nd and 3rd degree open fractures. They were treated by external fixation. This change in our surgical treatment resulted in an osteitis-rate of 2.6%, there was no case of soft-tissue inflammation. These results underline the superiority of treating 2nd and 3rd degree open lower leg fractures and fractures combined with soft-tissue injuries consequently and chiefly with AO external fixation.

For chest X-ray in the ward and for intraoperative cholangiography the registered doses were low. A limitation of the exposures or the operations was not necessary. For osteosynthesis operations the doses for the patient and the staff could be kept low by preparing the operation adequately, by using modern image-intensifer units with grid and automatic regulation in fluoroscopy, and with discipline in using fluoroscopy. During one week a surgeon could do eight osteosynthesis operations without reaching legally imposed dose limit. The control area could be restricted to a space around the patient with a radius of two meters.

Our results and experience with computer tomography (CT) were analyzed with respect to 41 patients with fresh bone injuries in both the cervicothoracic and the lumbar region of the vertebral column. Besides differentiated representation of the involvement of various parts of the vertebral body, the arch, transverse and spinous processes in 46 fractures, and four luxation fractures, bone fragments were found in the spinal cavity in 12 patients. Two patients displayed spinal bleeding and 3 showed a traumatic vertebral disc protrusion; 5 patients had paravertebral hematomas. Comparison of the CT-verified computer-tomographic fractures with the results of conventional X-ray diagnosis in two planes, as well as partial a.p. or lateral tomography (n = 12), revealed that in 13 patients even the detection of the fracture remained uncertain. Post-traumatic CT investigation (n = 9) showed syringomyelia in 3 patients, dense necrosis in 1 patient, and spinal channel stenoses as well as radicular irritations which could be explained by overshoot bone neogenesis at the intervertebral foramina. New technological developments in CT instruments of the most recent generation (digital radiography, sagittal and coronary image reconstruction) have made CT the most effective method in the diagnosis of spinal trauma. This necessitates a reorientation in the diagnostic procedure in patients with traumatic lesions of the spine.

Ectopic ossifications occassionally occur after stable osteosyntheses. The literature and our own observations indicate that osseous bore-chips probably favour these ossifications, especially after intermedullary nailing. Experiments determined the weight of osseous bore-chips which occur in intermedullary nailing of femur and in plate osteosynthesis of radius and ulna. Conclusions drawn from these findings should be considered when performing osteosynthesis.