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Aim: Zirconium-89 has gained great interest for PET, when imaging at late time points is required. Desferrioxamine B (DFO), is mostly used for this radionuclide as bifunctional chelator (BFC) and w ...

Hintergrund Der Entwicklung von Knochenmarkodemen in gelenknahen Korperabschnitten liegen viele Ursachen zugrunde, deren Differenzierung durch die MRT nicht moglich ist.

This study describes the prevalence of pain in trauma patients 1 year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain.Patients were contacted 12 months after admission in order to complete the following questionnaires: Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Trauma Outcome Profile (TOP), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and additional questions concerning satisfaction, work and financial status. Relevant pain at follow-up was defined as80 points on the pain subscale of the TOP.Two hundred and twenty patients were included. The Injury Severity Score (ISS) ranged from 1 to 41. Fifty-three percent (53 %) of patients suffered a severe trauma (ISS 15). One year after injury, 55 % of patients had relevant pain according to the TOP. Patients with pain were older (41.4 vs. 34.4 years, p = 0.003) and had slightly more severe injuries (ISS 17.1 vs. 14.9, p = 0.115). There were significant differences between pain and no-pain patients on all domains of QoL (p 0.001) and on the BDI, STAI and IES-R (p 0.001). Pain patients more often experienced a stressful event and job-related and financial difficulties. Multivariate logistic regression analysis revealed post-traumatic stress disorder (PTSD) as the strongest predictor for pain [odds ratio (OR): 4.38, p = 0.015], followed by a stressful life event (OR: 4.08, p = 0.001).Pain is strongly associated with psychosocial complaints 1 year after trauma. For the treatment of pain following a traumatic event, social reintegration and emotional regulation by means of occupational rehabilitation and psychotherapy should receive more attention.

Background: Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion. Patients and Methods: Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results. Results: In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred. Conclusion: Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

In up to 31% of cases, conservative treatment of mid-clavicular fractures leads to unsatisfactory results. The aim of this study was to define the value of minimally invasive elastic stable intramedullary nailing (ESIN) of mid-clavicular fractures with titanium elastic nails.Within 5 years, ESIN was performed in 45 patients. We studied the functional results and complications.Retrospectively we analysed the results of all patients at a mean follow-up of 24.7+/-2.4 months. Iatrogenic perforation of the lateral cortex occurred twice and medial migration in eight patients. Superficial skin infection developed in one. Nail breakage after fracture healing was observed twice. Twelve patients sustained clavicular shortening ofor =5 mm in relation to the intact contralateral side. After 6 months the mean constant score was 94.3+/-2 points, and the mean DASH score was 5.4+/-2.2 points.Intramedullary stabilisation of mid-clavicular fractures with titanium elastic nails is a minimally invasive technique with good functional results. Patients must be informed about the possibility of open reduction in about half of the cases as well as shoulder asymmetry, migration of the nail, and iatrogenic nerve and vessel injury.

Aim of the present study was to evaluate migration rates of cementless primary hemiarthroplasty in acute femoral neck fractures. In a longitudinal, prospective study 46 patients were treated by cementless hemiarthroplasty. Clinical follow up was correlated with the EBRA-FCA method. In 30% of all patients stem migration amounted to more than 2 mm; further, these patients were seen to have a high level of activity. A high degree of migration in more than 30% of all patients requires critical scepticism toward further use of the investigated cementless stem as hemiarthroplasty. According to literature, migration of more than 2 mm suggests a high probability of early aseptic loosening. In patients with a low degree of activity good results could be observed; nevertheless, in patients with a high level of activity the combination of the investigated cementless stem with a solid fracture head cannot be recommended.

Nicht dislozierte unkomplizierte Bruche ohne Gelenkbeteiligung konnen zum Teil konservativ versorgt werden. Doch der Vorteil einer operativen Behandlung nach einer Fraktur ist, dass der Patient nicht wochenlang mit dem Gips liegt, sondern ohne ausere Fixation rasch wieder mobil ist. Gerade bei alteren Patienten lassen sich so das Thromboembolie risiko und der Pflegeaufwand erheblich reduzieren.

Background/Aims: In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. Methods: A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls). Results: Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05). Conclusion: Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

Nach mehrfachem Versagen der Osteosynthese bei subkapitaler Humerusfraktur kam es zu einer Infektion. Durch konsequentes chirurgisches Debridement, Verwendung eines temporar implantierten Palacos-Refobacin-Spacers und sekundarem Einbau einer inversen Schulterprothese konnten Schmerzfreiheit und ein befriedigendes funktionelles Ergebnis erzielt werden.

Peridurale Anasthesieverfahren werden zur Vermeidung operativer, postoperativer oder chronischer Schmerzen insbesondere in der Extremitatenchirurgie, Gynakologie und Urologie eingesetzt. Komplikationen sind selten, konnen allerdings schwere lokale und systemische Folgen haben. Es werden 3 Falle vorgestellt, bei denen es nach der Verwendung von Periduralkathetern zu einer Spondylitis oder einer Spondylodiszitis kam. In 2 Fallen fuhrte eine verspatete Diagnosestellung zu einer verzogerten Therapie. Eine gezielte antibiotische und in 2 Fallen chirurgische Therapie fuhrte bei allen Patienten zur vollstandigen Ausheilung. Chirurgisch wird nach radikalem Debridement eine ventrale und fakultativ dorsale Stabilisierung der Wirbelsaule durchgefuhrt. Das Auftreten einer Spondylodiszitis nach der Verwendung von Periduralkathetern ist in den meisten Fallen eine Spatkomplikation. Die lange Latenz zwischen Katheteranlage und Ausbildung entsprechender Keimabsiedlungen in der Wirbelsaule kann zu einer erheblichen Diagnose- und Therapieverzogerung fuhren. Insbesondere bei unspezifischen, teilweise verspatet auftretenden Wirbelsaulenbeschwerden und reizlosem Hautbefund uber der Punktionsstelle sollte diese Spatkomplikation in Erwagung gezogen werden.

Bei dem desmoplastischen Fibroblastom („Kollagenfibrom“) handelt es sich um einen benignen, kollagenfaserreichen Bindegewebetumor. Es wird uber den seltenen Fall eines Kollagenfibroms bei einem 56-jahrigen Patienten am linken proximalen Unterschenkel berichtet. Die klinischen, radiologischen und pathologisch-anatomischen Befunde werden dargestellt. Das operative Vorgehen erfolgte gemas den allgemeinen Prinzipien der chirurgischen Therapie von Weichgewebetumoren.

In einer retrospektiven Studie wurde die Sportfahigkeit von 79 Patienten mit frischen zweit- und drittgradigen Luxationen des Schultereckgelenks durchschnittlich 32 Monate nach der Verletzung untersucht. Nach dem Ausmas der Luxation wurden die Patienten in 2 Gruppen unterteilt. Gruppe I umfasste 29 Patienten mit zweitgradiger Luxation des Akromioklavikulargelenks nach Tossy. Von diesen wurden 14 Patienten operativ (Gruppe Ia) und 15 Patienten konservativ (Gruppe Ib) behandelt. In Gruppe II (Tossy III) waren 50 Patienten. Davon wurden 41 operativ (Gruppe IIa) und 9 Patienten konservativ (Gruppe IIb) behandelt.

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.

Fractures of the distal radius are frequent and often complicated. Conventional X-ray images are the first choice method of diagnostic. Magnetic resonance imaging is important for evidence of occult fractures and early detection of complications which are often associated with soft tissue injuries or fracture healing disorders. The knowledge of the typical signal change of the different regions (fracture line, bone marrow, soft tissue) during the physiological fracture healing leads to the recognition of pathological changes. A prospective study was performed by magnetic resonance imaging examinations of eight patients with conservatively treated uncomplicated distal radius fractures. A typical signal change could be demonstrated in the different MRI-sequences during the fracture healing. The changes of the MRI-signal correlated to the well-known pathophysiological and histological changes in that time. Further the most qualified MRI-sequences could be shown. These results are not only basically necessary for the already known indications for magnetic resonance imaging in the distal radius fracture but also increase the indications in the acute osseous injury (early detection of fracture healing disorders).

Einleitung: Ziel dieser retrospektiven Studie ist es, den Einflus von Alter, Begleiterkrankungen, Frakturform, Operationszeitpunkt, Wahl des Implantats (kurzer oder langer Gammanagel) und Operationsverfahren auf Mobilisationsgrad, radiologischen Heilungsverlauf und mogliche Komplikationen nach operativer Stabilisierung von per- und subtrochantaren Oberschenkelbruchen mittels Gammanagel zu analysieren. Patienten und Methoden: Von 1992 bis 1997 wurden 96 Patienten mit isolierter per- oder subtrochantarer Oberschenkelfraktur mittels Gammanagel (Howmedica) operiert. Das Durchschnittsalter der Patienten zum Zeitpunkt der Verletzung betrug 72,5 (27–101) Jahre. 27 Patienten waren Manner, und 69 waren Frauen. Die Operation erfolgte durchschnittlich 1,19 (0–10) Tage nach dem Unfall. Die postoperativen Kontrollen erfolgten nach 3, 6 und 12 Monaten. Hierbei wurden jeweils Rontgenaufnahmen des Oberschenkels mit Huftgelenk in 2 Ebenen durchgefuhrt und der Mobilisationsgrad der Patienten beurteilt. Ergebnisse: Begleiterkrankungen, Operationszeitpunkt, Frakturtyp, Operationsverfahren und Wahl des Implantats (kurzer oder langer Gammanagel) hatten keinen Einflus auf den Grad der Mobilisation, auf den radiologischen Heilungsverlauf oder auf aufgetretene Komplikationen. Altere Patienten ( > 70 Jahre) waren schlechter mobilisierbar (p < 0,001). Ein Jahr nach dem Unfall waren 97 % der Frakturen radiologisch geheilt. Bei 15 Patienten (18 %) kam es zu technischen Komplikationen bei der Verwendung des Gammanagels. Schlusfolgerungen: Per- und subtrochantare Oberschenkelfrakturen konnen mit Hilfe des Gammanagels bei richtiger Handhabung stabil versorgt und die Patienten fruhzeitig mobilisiert werden.

Osteosynthesis of clavicular fractures is sometimes indicated. Since plate fixation may lead to complications, we have used elastic stable intramedullary nailing and report our experience of midclavicular fractures in 32 adults.From 2000 to 2005, we treated 32 adults (26 men), median age 40 (19-66) years, by intramedullary nailing with a titanium elastic nail (TEN). All patients were re-examined after median 27 (12-59) months.Nonunion was not observed. 20 clavicles healed without shortening. 12 clavicles healed with shortening of more than 5 mm. Migration of the TEN in 8 patients required secondary shortening of the nail in 5 of them. Nail breakage after fracture healing was observed twice. The nails were removed in 29 patients after a median of 6 (1.3-15) months postoperatively. No patient sustained a re-fracture after TEN removal. The mean Constant score was 95 (SD 1.9) points and the mean DASH score was 5 (SD 2.3) points.Intramedullary stabilization of midclavicular fractures with a titanium elastic nail is a minimally invasive technique with good cosmetic and functional results. Intramedullary fixation can be seen as an alternative to plate fixation and nonoperative treatment.

Es wurden 63 Patienten mit einer Oberarmschaftfraktur durchschnittlich 18 Monate nach Unfall sowohl klinisch als auch radiologisch nachuntersucht. 27 Patienten (Gruppe A) wurden operativ und 36 Patienten (Gruppe B) konservativ behandelt. Die Analyse der Ergebnisse nach einem Punktescore nach Kwasny ergab durchschnittlich 6,7 Punkte fur Gruppe A und 2,2 Punkte fur Gruppe B zu Gunsten des konservativen Vorgehens (p < 0,0001; F = 46,9). In den 2 miteinander vergleichbaren Gruppen war die konservative Therapie der chirurgischen Versorgung von Oberarmschaftbruchen sowohl bzgl. Beweglichkeit von Schulter- und Ellbogengelenk, Kraftminderung, dem Auftreten neurologischer Storungen und von Schmerzen sowie der subjektiven Bewertung der Behandlung und der Kosmetik durch die Patienten uberlegen. Die Auswertung der radiologischen Ergebnisse ergab keine Unterschiede (p = 0,48).

Die funktionelle Untersuchung mittels des Score nach Constant und Murley ergab durchschnittlich 97 von 100 moglichen Punkten (Minimum 72, Maximum 100) in beiden Gruppen, sowohl nach konservativer als auch nach operativer Therapie. Bei der Nachuntersuchung wiesen 9 von 10 konservativ (90%) behandelten Patienten nach drittgradiger AC-Luxation ein positives Klaviertastenphanomen und eine vermehrte Horizontalverschieblichkeit der Klavikula im Gegensatz zu 18 (44%) von 41 operierten Patienten auf (p

The KT-1000 was used to measure anterior tibial displacement in three populations: normal subjects (n = 120), patients with unilateral acute anterior cruciate ligament (ACL) disruptions (n = 105), and patients with chronic unilateral ACL disruptions who were scheduled for ACL reconstructions (n = 159). All patients with ACL disruptions were measured with and without anesthesia. Tibial displacement under three loading conditions was measured: 89-N anterior displacement force, manual maximum displacement force, and quadriceps contraction to lift the leg. The measurements of the normal knee in the injured populations were not significantly different from those of the knees in the normal population on any test. The injured knee tested with and without anesthesia was significantly different from the normal knee on all tests. The right-left difference in the normal population as less than 3 mm in 98% of patients in the 89-N test, 97% in the manual maximum test, and 99% in the quadriceps active test. The largest amount of displacement and the greatest difference in displacement between the injured and the normal knee was produced by the manual maximum test. The manual maximum injured-minus-normal knee displacement was 3 mm or more in 99% of patients with chronic ACL disruptions and in 95% of patients with acute ACL disruptions.

The purpose of this study was to analyse cartilage changes after traumatic meniscal lesions and to provide a detailed description of the model used with a view to reducing the number of animals used in future studies. The sheep's knee was chosen, as ovine biomechanics are similar to that of humans. In two groups of 10 animals each, a radial tear in the medial meniscus was either sutured with polydioxanone (PDS) or left untreated (sham-operated). Half of the animals in each group were sacrificed after six months, the other half after one year. The time periods to achieve weight bearing, meniscus healing, joint effusion (magnetic resonance imaging scan) and knee cartilage in the medial, lateral and patellofemoral compartments were evaluated in comparison to the opposite knee (control). Osteoarthritis (OA) was assessed by a modified Outerbridge classification and confirmed by scanning electron microscopy. Only one sutured meniscus remained completely adapted. In all other meniscus lesions, the rupture healed with a scar. In the PDS and sham-operated groups, OA was significantly higher in the medial knee compartment than in the lateral compartment and in controls ( P < 0.001). In the operated groups, joint effusion was higher in the right hindlimb knee than in the normal left hindlimb knee (control) after six and 12 months ( P < 0.001). Non-treated, displaced and even adapted sutured radial ovine meniscus tears produced intense OA within less than six months. Therefore, this animal model is suitable for assessment of new therapeutic regimens in meniscal surgery.

Wir beschreiben 2 Falle einer ungewohnlichen Kombination von Unterarmverletzungen mit Handwurzelverletzungen. Unseres Wissens nach ist diese bipolare Verletzung bisher sehr selten dokumentiert. Bei dem 1. Patient lag neben einer komplexen Monteggia-aquivalenten Verletzung auch eine transskaphoidale perilunare Luxation des Karpus vor. Der 2. Patient hatte sich eine longitudinale radioulnare Dissoziation im Unterarm mit einer skapholunaren (SL-)Bandruptur der Handwurzel zugezogen. Anhand dieser Fallvorstellungen werden die diagnostischen Probleme und therapeutischen Masnahmen dieser schweren Kombinationsverletzung im Unterarmbereich und der Handwurzel diskutiert.

The goal of this study was to determine functional results of hemiarthroplasty for 3- and 4-part proximal humeral fractures in elderly patients and to analyze factors affecting the outcome. Thirty-eight consecutive shoulders were treated with hemiarthroplasty after proximal humeral fracture. Two groups of patients with different health status were classified. Group I consisted of patients with 2 or less comorbidities and a maximum of 2 medications at the time of injury. Patients in group II had 3 or more comorbidities with a minimum of 3 medications at the time of injury. The mean of the absolute Constant score in group I was 41, compared to 27 in group II (P.05). Furthermore, compliance of the patient and regular physiotherapy proved to be important prognostic factors. If primary hemiarthroplasty is not likely to be successful with a low functional score, this surgical procedure should be reconsidered especially in patients with more than three comorbidities.

Cancellous bone grafting is currently the most frequent method for replacement of bone material. In recent years, several alternative methods came into practice. However, up to now it remains unclear whether cancellous bone grafting is cheaper as compared to these new methods. Therefore, the aim of this study was to calculate the direct costs of cancellous bone grafting. For calculation of the direct costs operation time needed in addition to the main surgical intervention was measured and the material used recorded in a consecutive series of 50 interventions including bone grafting at the Department of Trauma Surgery at the University Hospital of Bonn Medical School. Surgical staff costs were calculated on the basis of a standard team consisting of one surgical attendant, surgical resident, surgical nurse, and nurse’s service. Cost of anaesthesia was calculated on a per minute base. Mean additional operation time was 26.3 min (range 17–35 min). Surgical staff costs per operation minute were 2.70 Euro, costs for anaesthesiological service were 4.18 Euro/min. Material additional used consisted of sutures and sterilization costs. Material costs summed up to 32.01 Euro. The total direct costs of bone grafting were 212.95 Euro. The direct costs of harvesting cancellous bone graft and the use of bone replacement material are comparable. Due to the high complication rate at the donor site the total-cost-of-illness might be higher when using autologous bone graft.

Incidence of meniscus injury has increased in today's active society. Arthroscopical refixation yields better results than partial meniscectomy. The best healing rates are achieved by sutures. As non-degradable sutures are permanent foreign bodies, slow absorbable materials are needed. A slow degradable suture with high concentration of polylactide acid, the so-called "long-term suture" (LTS, Panacryl), has been suggested to produce a higher inflammatory response than conventional polymer sutures [Vicryl, Dexon or polydioxanone (PDS)]. The aim of the study was to assess LTS for meniscus repair after a traumatic lesion and to evaluate immunological response, biodegradation and healing.In 24 randomised sheep, a radial tear of the medial meniscus was sutured by either PDS or LTS. Twelve sham-operated animals served as control. Half of the sheep were killed after 6 months, the other half after 12 months. The medial and lateral meniscus, synovial membrane, articular cartilage and ascendant lymph nodes up to the kidney were examined. Joint effusion was evaluated by MRI.The synovial membrane was significantly thinner in the LTS group (6 months 85 +/- 10 microm, 1 year 100 +/- 28 microm) than in the PDS group (6 months 165 +/- 10 microm, 1 year 175 +/- 23 microm, P0.001) and the controls (6 months 150 +/- 17 microm, 12 months 192 +/- 21 microm, P0.001). The joint effusion was higher in the PDS than in the LTS group after 6 months, and tended to be higher in controls. In controls, effusion tended to be higher than in the LTS group. In all medial departments, osteoarthritis evolved much more intensely than in the lateral knee departments (P0.01). Bilateral lymph nodes from the groin up to the kidneys were larger (crosscut area) after 6 months in the controls (2.28 +/- 0.7 mm(2)) and PDS treated animals (2.3 +/- 0.7 mm(2)) than in the LTS group (1.3 +/- 0.3 mm(2), P0.001). After 1 year, node size differed significantly between controls and animals from the LTS group (1.98 +/- 0.4 mm(2) vs. 1.5 +/- 0.2 mm(2), P0.05), and between animals from the PDS and the LTS group (2.5 +/- 0.1 mm(2) vs. 1.5 +/- 0.2 mm(2), P0.001).The polylactide thread LTS causes less immunological reaction and synovitis than a polydioxanone suture (PDS).LTS may serve as an alternative to PDS for repair of slow healing structures such as tendons and menisci.

The aim of this prospective cohort study was to address the feasibility of measuring cytokines in serum and urine as early predictor tests for the identification of septic Intensive Care Unit (ICU) patients. The study group consisted of 10 septic and 5 non-septic patients at the onset of sepsis according to modified definitions by the American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM). Serum and urine samples were taken from septic patients at the onset of sepsis and from non-septic patients, every 12 h for 3 days and thereafter every 24 h until day 10. Levels of TNF-alpha, IL-1beta, IL-6, IL-10, IL-18, IFN-gamma, MCP-1, and PCT (procalcitonin) were measured by ELISA. Apart from serum IL-18 and PCT levels, which were elevated in septic patients (p

Die Erstversorgung eines Bruches ubernimmt meist der Hausarzt. Danach muss er abwagen, ob er den Patienten zu einem niedergelassenen Unfallchirurgen uberweisen oder gleich ins Krankenhaus schicken soll. Unsere Autoren haben fur Sie die typischen Frakturzeichen, ein Diagnoseschema sowie die wichtigsten Punkte bei der Erstversorgung eines Patienten mit einer Extremitatenfraktur zusammengefasst.

Follow-up evaluations were carried out in 84 patients examined 5–8 years after sustaining an acute traumatic hemarthrosis of the knee. The initial examination performed within 2 weeks of injury had revealed 18 patients with a stable knee and 66 with anterior instability. Twelve of the patients underwent anterior cruciate ligament reconstruction within 3 months of injury and 11 more did so between 1 and 3 years after injury. To document joint deterioration at follow-up, bone scintigraphy and conventional anteroposterior, lateral, and tunnel X-rays were taken. Medial, lateral, patellofemoral and patellar uptake in bone seintigraphy was graded from 0 to 4. Six radiological variables were graded at eight different sites. Sixty-three patients (75%) had a positive bone scan and 69 patients (82%) showed radiological changes. Bone scan and X-ray scores were both significantly higher in the reconstructed knees.

We report outside protrusion of resorbable Biofix arrows after repair of a medial meniscus tear in a 10-year-old boy. One arrow protruded spontaneously. At surgery the other partially resorbed arrow was found subcutaneously. The tear of the medial meniscus had healed.

Grundlagen: MRI-Untersuchungen nach Trauma ergeben haufig die Diagnose von „bone bruise injuries“. Bisher fehlten allerdings histopathologische und morphologische Untersuchungen uber diese Verletzung.