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An osteochondral transfer of a scaphoid segment into the lunate fossa in proximal row carpectomy was performed in two female patients in stage IV of Kienböck's disease. Clinical and radiological follow-up at 18 and 6 months, respectively, showed results comparable to those of PRC in Lichtman stage III. This technique may serve as another option for salvage operations on the wrist.

Background: Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper., Method: 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated., Results: A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated., Discussion: With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury severity score (ISS) and LOS in ICU could be used for this purpose. In future, data obtained in trauma networks can help optimize reimbursement for the treatment of these patients.

The causes of chronic posttraumatic ankle pain are manifold, ranging from ligament and tendon injuries and fractures to joint degeneration. Calcaneonavicular coalition, a bridge between the calcaneus and navicular bones, is a rare disease with an incidence below 1%. The morphology of this coalition is variable. It can occur as either a fibrous, cartilaginous or bony union of the involved bones. Symptoms usually occur in adolescence with chronic pain around the ankle, mainly lateral and anterior, following distortion trauma. Patients often claim to have a lateral ankle sprain. We report 2 cases of a fracture of the calcaneonavicular coalition as the cause of chronic posttraumatic ankle pain and demonstrate the characteristics of tarsal coalitions with a review of the literature.

Growth factors are in clinical use to stimulate bone growth and regeneration. BMP-2 is used in long bone and spinal surgery, PDGFbb for the treatment of periodontal defects and children with growth hormone receptor deficiency are treated with IGF-I.Aim of the present study was the comparative analysis of the effect of these growth factors released from a local drug delivery system on cells of the osteogenic lineage at differing differentiation stages.The experiments with the mesenchymal cell line C2C12 revealed a proliferating effect of all three growth factors and a differentiating effect of BMP-2 with a dramatic increase in alkaline phosphatase activity. None of the growth factors stimulated cell migration.Human osteoblast like cells showed similar results with an increase in proliferation after stimulation with IGF-I or PDGFbb. The enzymatic activity of alkaline phosphatase was enhanced only in the cells stimulated with BMP-2. This group showed also more mineralized matrix compared to the other groups.In conclusion, the growth factors IGF-I and PDGFbb delivered with a local drug delivery system stimulated cell proliferation, whereas BMP-2 showed a dramatic effect on differentiation on osteoblast precursor cells and osteoblast like cells.

Osseous graft healing at the tendon bone interface after anterior cruciate ligament (ACL) reconstruction is unsatisfactory in 10-25%, depending on the evaluation criteria or the kind of graft used for reconstruction. Mechanical as well as biological aspects are currently discussed. Since osteoblasts play an important role in the osseous integration of an ACL graft, we hypothesize that synovial fluid (SF), when entering the bone tunnel, has an inhibitory effect on osteoblasts. In order to verify this hypothesis, human osteoblasts (p3) were incubated in the presence of SF or partially purified SF. Proliferation was assayed using MTT or BrdU assay. Gene expression of osteoblast markers (alkaline phosphatase, collagen I, and osteocalcin) were determined by TaqMan analysis. In the control group, SF was exchanged by fetal calf serum (FCS). The results showed osteoblast proliferation in the presence of SF as well as in partially purified heat-pretreated synovial fluid. Native SF induced alkaline phosphatase and collagen I gene expression. No induction of the osteocalcin gene was observed in the experiment. These results were comparable to that obtained with FCS. These findings suggest that SF stimulated proliferation of osteoblasts in vitro. This effect is mediated, in part, by heat-stable components of SF. In addition, the expression of osteoblast marker genes alkaline phosphatase and collagen I, but not osteocalcin, was induced by SF. Therefore, problems associated with cruciate ligament reconstruction might be due to the inhibition of osteoblast differentiation. If so, this is not a specific attribute of SF, but also applies to serum.

Objective: The aim of this retrospective study was to analyze the long-term results of primary repair of median and ulnar nerve lesions. Clinical influence factors for nerve reconstruction were investigated. Furthermore, current score systems were inquired and evaluated on their effectiveness to illustrate the success of repair., Patients and Method: Sixty-five patients with 71 lesions of the median and ulnar nerve were assessed on average 8.2 years after reconstruction. The results were classified according to the DASH (disability of arm, shoulder, and hand) Score, the Rosen's hand protocol and the Highet Scale., Results: On average the patients regained 70% of their original hand function (evaluated by Rosen Score: median nerve 2.2/for ulnar nerve 1.92 out of 3.0). Although we noticed inferior motor recovery in ulnar nerve lesions, no significant differences between the overall results of both nerves were observed. Neither accompanying artery and flexor tendon injuries nor the suture technique influenced the recovery. The age of the patient was confirmed as an important influence factor. The results of the DASH Score, Rosen Score and Highet Score correlated significantly., Conclusion: For a sufficient outcome measurement we underline the importance of evaluation of patient's estimation of their impact on their activities of daily living. For this a combination of the functional Rosen Score and the DASH Score is suggested.

Intraosseous lipomas represent a small number of benign bone tumors with incidence rates of approximately 0.1%. In about 15% these neoplasias are localized within the calcaneus, mostly at Ward's triangle. The tumors usually remain clinically inapparent and diagnosis is often obtained incidentally. Although CT scan and MRI provide specific and sensitive diagnostic tools that can distinguish morphology and dignity, surgical treatment is not standardized yet. In conjunction with a case report, we summarize and critically compare current treatment strategies.

Isolated fractures of the os triquetrum are a very rare condition, since they are usually combined with other fractures of the carpus. An undetected isolated fracture of the os triquetrum in a 28-year-old pieceworker revealed an osseous consolidation with a misalignment of the joint surface on presentation 6 months after his primary injury. During the whole time he was unable to work due to the severely painful restricted range of movement of his wrist. There are no general guidelines for treatment. Instead of correction of the anatomy of the os triquetrum, we decided to perform a subperiosteal pisiform excision according to Palmieri. As early as 6 weeks later, the patient was able to go back to work and demonstrated a pain-free full range of movement of his wrist. We encourage this procedure not only for degenerated joint disease but also for posttraumatic lesions in the early onset of painful blocking of the joint between the os triquetrum and os pisiforme.