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Prevention of rotatory impairment and radial head dislocation in the forearm is an important aspect when treating children with osteochondromas. Various studies tried to determine the best treatment, describing different surgical techniques. No consensus has been reached yet. This retrospective study compares the treatment outcome of patients with osteochondroma of the radius and ulna after surgical or conservative treatment. Seventeen forearms treated over a period of 20 years were analysed. Outcome parameters were the prospectively collected clinical data and the radiological findings: “relative shortening” of ulna/radius, the “radial articular angle” (RAA) and the “carpal slip” (CS). Our study shows an improvement of the range of motion and cosmetic appearance of the forearm after an operative procedure, with or without bone lengthening. We observed an increase in wrist and elbow mobility with a decrease in pain scores and a confirmed high cosmetic satisfaction in almost 70% of the patients after bone lengthening and up to 85% after simple excision. For patients suffering from functional impairment or pain, an operative approach is beneficial. Multiple and repetitive osteochondroma excisions are recommended during growth to prevent deformity and rotatory motion restriction. Lengthening procedures require a careful indication.

Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs’ implication. In addition, K. kingae’s OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.

Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children

AimsWe aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae.MethodsThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed.ResultsK. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot.ConclusionK. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578–583.

Objective The purpose of this study was to investigate the incidence of complications in pediatric spastic cerebral palsy (CP) patients weighing less than 20 kg at the time of intrathecal baclofen (ITB) pump implantation and to compare it with spastic CP patients heavier than 20 kg. Material and methods Twenty-seven patients with spastic CP (14 males) treated with ITB implantation at our institution between January 2002 and January 2018 were retrospectively reviewed. Eight of the 27 patients had a bodyweight below 20 kg (group A) and 19 had weight above 20 kg (group B). Results Group A had a significantly more important proportion of patients with the Gross Motor Function Classification System V compared to group B (88 vs. 42%). The median follow-up was respectively 2.5 (1.8-4.6) and 4.6 (1.9-10.0) years in groups A and B. Median age at the time of ITB implantation was 7.4 (2.8-12.8) and 13.7 (6.5-16.8) years in groups A and B (P = 0.002). The proportion of patients with complications or reoperation was NS between groups A and B (P > 0.05). No postoperative infections were recorded in any of the groups. During follow-up, five patients died (63%) in group A and three (16%) in group B (P = 0.049) within 3.8 years on average after ITB implantation. Conclusions ITB therapy in spastic CP patients weighing less than 20 kg seems to be as well tolerated and effective as it is in heavier (>20 kg) pediatric patients.

BACKGROUND Horse-related activities are increasingly popular among young people but are frequently associated with severe injuries requiring hospital treatment. There are few data on the incidence of equestrian injuries, especially in child populations, or on means of prevention. Thus, this study's purpose was to highlight the epidemiological data on specific injuries due to equestrianism and serve as the groundwork for future studies on the prevention of equestrian accidents. METHODS A retrospective study collected data on all children younger than 16 years old who attended our regional emergency department after involvement in an equestrian accident. The study covered the periods from 1990 to 2003 and 2011 to 2018. Twenty-two years of data on trauma circumstances, injury patterns (mechanism, anatomic site, and severity), treatment protocols, and hospital lengths of stay were analyzed. RESULTS This study confirmed that more young females participating in equestrian sports attended our emergency department than males. The leading cause of equestrian injury was falling from a horse (80.2%). Orthopaedic injuries represented around 60% of all reported lesions, far ahead of head injuries (30%). More than half of the injured children required hospitalization for inpatient medical care, and almost 50% of these underwent a surgical procedure, especially for upper extremity fractures (72% of all fractures). One patient died due to severe cerebral injury. CONCLUSIONS Horse riding injuries occur more frequently and are more serious than in many other sporting activities. There is an urgent need to reassess preventive measures to reduce the incidence and severity of equestrian injuries. LEVEL OF EVIDENCE Level IV.

The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned to Kingella kingae in a 21-month-old girl. The reported case demonstrated that primary pyomyositis may be encountered during invasive infection due to K. kingae even if this manifestation remains rare. This bacterial etiology must, therefore, be evoked when a primary pyomyositis is observed, and this is in particular in children under 4 years of age.

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.

Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mononeuropathy are either infectious, immune mediated, toxic, or infiltrative (tumoral). In this article, we presented the case of a 7.5-year-old male child who presented to the emergency department with a painful right lower limb. Magnetic resonance imaging confirmed the diagnosis of subacute osteomyelitis of the ischium, which extended toward the external hip rotators and infiltrated the tissues around the sciatic nerve. Treatment with intravenous antibiotics (flucloxacillin 50 mg/kg/d and gentamicin 10 mg/kg/d) rapidly improved the child's condition and relieved neurological symptoms within a few days. Traumatic and iatrogenic injuries are the most common causes for SN. To our knowledge, this presented case is the first to describe SN due to an infectious process following subacute osteomyelitis.

We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused byThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

Case Although congenital nonunion of the clavicle is a well-known pathology in children, posttraumatic nonunion is a rare entity. Nonunion after open reduction and internal fixation of a clavicle fracture is exceptional in the pediatric population. We report on a patient presenting posttraumatic pseudarthrosis of the clavicle after surgical treatment. Pseudarthrosis was resected, and the defect was bridged with an iliac crest autograft, supplemented with bone morphogenetic protein, and fixed with an elastic stable intramedullary nail. Conclusion This procedure offered enough stability for achieving fracture consolidation and is a safe alternative to plating in clavicle nonunion.

Objective: To develop a clinical decision guide for the diagnosis and treatment of hyperextension injuries of long fingers.Study design: Consecutive patients age : location of pain; swelling and bruising, stability, and mobility. Pathological radiographic findings were compiled, and the risk of late complications was analyzed. The predictive value of the clinical examination in the identification of low-risk injuries was assessed.Results: The majority (67%) of children consulting for a hyperextension finger trauma did not have a fracture. No child with a low-risk clinical examination had a subsequent high-risk diagnosis (eg, relevant intra-articular fracture, dislocation). Among 64 clinical high-risk diagnoses only 12 significant fractures were found.Conclusion: Treatment decisions after PIP hyperextension injuries can be based on a clinical examination using a standardized evaluation protocol. Application of the clinical decision guide presented here has a sensitivity of 100% to rule out a significant injury. Present results showed that the majority of radiographs currently performed are avoidable. Once the decision rule is validated, its clinical application will improve patient care, reduce waiting times in emergency departments, avoid unnecessary radiation exposure, and possibly reduce costs.

Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.

Case: A 14-year-old girl sustained a posterior elbow dislocation and presented with a proximal radioulnar translocation (PRUT) and a displaced fracture of the radial head. Reduction of the elbow dislocation and the proximal radioulnar translocation were achieved by external manipulation in the operating room. The radial head was not amenable to closed reduction and remained entrapped in the anteromedial compartment of the elbow. So open reduction and internal stabilization was carried out.Conclusions: In PRUT, closed reduction should be attempted. The radial head should be preserved even if it is fully dislocated from metaphysis. Retrograde intramedullary radial nailing provides enough stability of the fracture to promote early mobilization and facilitate union.

BACKGROUND Femoral fracture is a significant major trauma in children and adolescents, sometimes resulting in serious complications. This study aimed to determine the epidemiology of femoral fractures and to define associated injuries and mortality incidence in a pediatric population below 16 years old. METHODS The medical records of all patients with a femoral fracture treated in our hospital from 1997–2016 were reviewed retrospectively. Age, gender, mechanism of the trauma, month and season of fracture occurrence, fracture type, associated injuries, and mortality data were collected. Patients were divided into four age groups and compared. RESULTS The study included 348 children with 353 femoral fractures. The mean annual prevalence of femoral fracture during the study period was 22.7 per 100,000 children. Except for children less than 1 year old, most fractures occurred in male patients (69%), with a male-to-female ratio of 2.2:1. Road accidents were the most common mechanism at all ages. Femoral fractures were mainly due to low-energy trauma in neonates and infants, to road accidents and low-energy trauma in preschool children, to sports accidents in school-age children, and to road traffic accidents in teenagers. February was the month with the most occurrences of femoral fractures. Winter was the peak season for femoral fractures in children aged

Purpose Intramedullary lengthening nails are an accepted alternative to external fixators but are limited by anatomical preconditions. Therefore, to date the use of external fixators is sometimes inevitable. We report on a new technique for correction of combined limb length discrepancies and complex axis deformities using solely internal devices - a lengthening nail and a locking plate. Methods Between October 2008 and November 2011 five patients (two femora, three tibias) with a mean leg length discrepancy of 36 mm (25 to 50) and a complex angular deformity were treated with a fully implantable motorized lengthening nail (Fitbone) and a locking plate. All patients were evaluated with regards to the pre- and postoperative leg length as well as axis alignment, functional outcome, lengthening indices and complications. Results A successful leg length equalization was achieved in all cases and physiological joint orientation angles in all but one case. The mean distraction index was 1.2 mm/day, the maturation index 24 days/cm and the consolidation index 35 days/cm. The functional outcome was very encouraging in all cases with bilateral free range of movement. In total, two complications were observed, one nonunion and one loss of leg length after an early locking bolt removal in a peripheral hospital. Conclusion The combination of a fully implantable motorized lengthening nail and a locking plate is a valuable alternative option for treating selected cases with limb length discrepancies in combination with a complex deformity of the lower leg. However, the reported technique puts high demands on the preoperative planning, operative technique as well as surgeon's skills. Level of evidence IV (retrospective series)

ObjectiveThe optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.MethodsWe conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.ResultsWe enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.ConclusionsAfter initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.Trial registration numberNCT03615781.

Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infections. It may also have an affinity for bone and joint tissue. We report on 1 case of subacute osteomyelitis of the patella due to M. lacunata that presented as an osteolytic bone lesion in a child.

Purpose This study aimed to elucidate whether levels of physical activity (PA) return to normal after bone healing or whether long-term behavioural changes in PA are to be expected in children and teenagers who have sustained limb fractures. Methods In all, 100 children and teenagers with a first episode of limb fracture and 100 sex- and age-matched healthy controls (CTRL) were recruited for a prospective study. PA in limb fracture patients was assessed at 18-month follow-up using accelerometer measurements, and values were compared with those of CTRL. Time spent in PA at different levels of intensity was determined for each participant and expressed in minutes and as a percentage of total validly measured time. Results Mean levels of PA at different levels of intensity by previously injured children and teenagers were similar than CTRL (42 sets of paired data). However, time spent in moderate-to-vigorous PA (MVPA) was lower than 60 minutes among limb-fracture patients at 18-month follow-up. Conclusion The amount of skeletal loading in children and teenagers returns to normal values by 18 months after limb fracture. Even if time spent in MVPA is not significantly lower in children and teenagers with limb fractures, it no longer reached the international recommendations for school-aged children (MVPA > 60 minutes), which may be interpreted as a lifestyle modification or a behavioural change to avoid new trauma. Level of Evidence II

Pyogenic tenosynovitis is an uncommon condition in children, and there are few published case reports. We present a series of 11 cases who were treated in the Geneva Children Hospital in the last 10 years. Kingella kingae was the main pathogen, and the characteristics of infection (inflammatory indices, clinical findings and severity) are similar to other osteoarticular K. kingae infections in infants.

Background Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up. Methods We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients. Results At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group's ultradistal radius and whole wrists (+4.8% to +5.2%). Conclusions A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.

Proximal tibial epiphysiolysis (PTE) can have debilitating consequences for young athletes. The mechanism and predisposing factors for this lesion have yet to be determined. To find a common denominator and a biomechanical explanation for PTE, we were using a retrospective analysis of 15 cases in combination with a systematic review of literature. A retrospective review of medical charts was performed to identify all PTE between 2003 and 2012. Records were screened for patient age and gender, sports activity, mechanism of injury, and treatment protocols. Additionally, a literature review (MEDLINE/PubMed database, the Cochrane Library, online search engines) was conducted. Medical charts of 14 adolescents (15 Salter-Harris I and II fractures) were analyzed. The literature review revealed additional 75 fractures. The predominant mechanisms were landing from a jump, takeoff for a jump, stop and go movements, and eccentric muscle contraction with the knee in flexion. The main sports-activities implicated in these injuries were basketball. Landing from a jump with a decreased knee and hip flexion movement increases tensile forces on the proximal tibia epiphysis. During physiological epiphysiodesis, the growth plate displays an increased vulnerability and such increased tensile forces can lead to a growth plate failure. Neuromuscular fatigue can alter coordination and proprioceptive accuracy during landing from a vertical jump and thus perturbs sagittal shock absorption. In our opinion, trainers should instruct young athletes in techniques that help avoiding uncontrolled high impact landings. Level of evidence: Level IV.

Case We report the case of an 11-year-old girl who developed osteonecrosis of the femoral head in the radiographically normal, asymptomatic left hip that had been fixed prophylactically in the context of a slipped capital femoral epiphysis (SCFE) that had been detected on the contralateral hip. The etiology of the osteonecrosis remains unknown. Conclusion This case report demonstrates that prophylactic fixation of a radiographically normal, asymptomatic hip in the context of an SCFE on the contralateral side has the potential for substantial complications. Therefore, the risk of osteonecrosis in the prophylactically pinned hip should be carefully considered because this complication may have devastating functional consequences.

Isolated osteomyelitis of the patella is a rare condition mainly occurring in the pediatric population. Diagnosis is often delayed as clinical presentation manifests with vague anterior knee pain, sometimes with mild local signs of inflammation but frequently without any local signs at all. While falls on the knee can explain mild knee pain, erythema, swelling and persistent peripatellar pain should raise a high index of suspicion for local infection. We present two cases of subacute osteomyelitis of the patella in young children. In both cases bone lesions presented as an osteolytic lesion of the patella. After open biopsy of the lesion, bacteriological analysis confirmed infection with Kingella kingae.

Background Following resection of large benign bone tumors surgeons are confronted with bone defects severely affecting the stability of a limb. To restore the mechanical continuity of the bone different treatment methods using bone grafts have been described. In pediatric patients the thick periosteal sleeve is thought to contribute to bone formation. Hypothesis An intact periosteal sleeve is crucial in bone remodelling around a non-vascularised fibular graft used to bridge large bone defects. Methods We present a treatment technique applied in 6 cases comprising of subperiosteal tumor resection at the diaphyseal or metaphyseal level of long bones followed by defect bridging with a non-vascularised fibula graft inserted into the periosteal sleeve of the resection zone. Elastic intramedullary nails or plates were used for stabilisation. Results Due to the intact periosteum at the resection site bone integration occurred quickly and full remodelling was seen in all but one case. Tumor location in this case was at the metaphyseal level resulting in tumor resection at the growth plate. Although bone healing at the distal resection site was seen after a few weeks proximal consolidation was only partial. Full reconstitution of the fibula in the remaining periosteal sleeve was seen in 5 cases, partial reconstitution in 1 case. Discussion In the pediatric patient, the described technique is an effective and reliable treatment method for large benign bone tumors requiring resection. However, great diameter discrepancy of the donor and recipient site and a thin periosteum can be a limiting factor for its application. Level of evidence Level IV clinical study.

Summary Osteoarthrosis - a degenerative joint disease - has a high prevalence in the elderly. 70-80% of people older than 70 years of age display radiological signs of joint degeneration but only 10-30% become symptomatic. The ability to practice sport is important for people of almost all age groups. However, depending on the type of sport high joint loading forces can occur increasing the risk of injury to the articular cartilage. Thus, determining the impact of different sports on the onset and progression of osteoarthritis is of particular importance to the sports physician. While excessive joint loading forces during certain sports can promote the onset of early arthritis a chondroprotective effect has been found upon moderately intense exercise indicating that certain sports might be effective in preventing the onset of disease.

Human rhinoviruses (HRVs) are composed of 60 identical subunits, each comprising one copy of the viral capsid proteins VP1, 2, 3, and 4. Consequently, 60 symmetry-related epitopes are available for binding of antibodies or receptors. The minor receptor group of HRVs uses members of the low-density lipoprotein receptor family for cell entry. The ligand binding domains of these receptors are composed of various numbers of ligand binding repeats, and several of these modules within a single molecule are believed to attach simultaneously to the star-shaped dome at the 5-fold symmetry axis of the virus. Using fluorescence correlation spectroscopy (FCS), we have now determined the equilibrium binding constants and the mode of attachment of recombinant concatemers of ligand binding module 3 of the human very-low-density lipoprotein receptor to HRV2. We demonstrate that the avidity of the interaction drastically increases with the number of concatenated modules. For the trimer, the binding isotherm was biphasic, indicating that attachment of two and of three modules within the same molecule was resolved. The receptor consisting of seven repeats was found to bind most strongly, but a complete binding isotherm could not be established due to cross-linking of virions. The values of the dissociation constants were about 1 order of magnitude higher than those previously determined by using surface plasmon resonance techniques reflecting the different presentation of the binding partners. As compared to the concatemers, the natural receptors are composed of similar but not identical repeats; thus, cooperativity and different specificity of the ligand-binding modules allow for recognition of many ligands and viral serotypes. Due to the low concentrations and amounts of sample required, FCS is ideally suited for the determination of receptor binding parameters of viruses difficult to produce in high quantities and/or concentrations.

BACKGROUND: Meningitis or cerebrospinal fluid rhinorrhoea can occur years or even decades after trauma or operation and can be the first indication of a previously unidentified dural lesion. Preventing cerebrospinal fluid (CSF) leakage with a fibrinogen-based collagen fleece (TachoComb®) was the interest of our clinical study. METHODS: In the present study, we examined the watertightness and effectiveness of TachoComb® following supratentorial/infratentorial as well as skull-base operations. The dura was closed primarily by sutures and covered with a fibrinogen-based collagen fleece to prevent CSF leakage. RESULTS: Twelve patients developed a subcutaneous CSF collection requiring no further treatment, seven patients were managed by lumbar CSF drainages, and three patients had to be reoperated. CONCLUSIONS: Based on these results, we proved the watertightness and effectiveness of this fibrinogen-based collagen fleece.

Surgical treatment of highly comminuted distal radius fractures in elderly patients with poor bone quality or in polytrauma patients is a technical challenge. Aim: The aim of this study was to evaluate the results of temporary bridge plating in these patients. Method: A retrospective review using data from 21 patients undergoing temporary bridge plating in our department was performed. All patients had fractures classified as type C3 by AO classification. To achieve optimal joint surface reduction, supplementary fixation was necessary in all cases. Data was evaluated for clinical and radiological parameters. Results: Radiological results showed a mean post-operative positive ulnar variance of 1.2 mm, mean radial inclination of 18° and a mean radial length of 10 mm. Furthermore, correlations between fracture patterns and ligament injuries were analyzed. Conclusion: Temporary bridge plating is indicated in the treatment of highly comminuted distal radius fractures in elderly patients with poor bone quality and young polytrauma patients. (Level of evidence: Level 4) [Hand Microsurg 2017; 6(3.000): 110-119]

Purpose Post-traumatic injury of the triangular fibrocartilagineus complex (TFCC) can result in debilitating wrist problems. Although diagnosis and treatment of these lesions is well described for the adult population, hardly any data exists for this type of injury in young adolescents. Methods Between 2011 and 2014 seven patients between 10 and 14 years of age have consulted our department for posttraumatic ulnar-sided wrist pain. Previous trauma included distal radial fractures with a concomitant fracture of the ulnar styloid, multiple micro-traumas of the wrist and an overuse injury. Clinical evaluation showed tenderness over the TFCC complex, pain on movement and in most cases instability of the distal radio-ulnar joint (DRUJ) with episodes of sub/dislocation in two patients. Pre-operative arthro-MRIs were conducted confirming the pathology in only 3 cases. Therefore, all patients underwent diagnostic arthroscopy of the wrist followed by surgical treatment according to the discovered lesion. The mean age at the time of surgery was 12.9 years. Results Arthroscopy of the wrist confirmed a TFCC lesion in all patients. In 5 cases the injury was classified as Palmer type 1B, once as a combined type 1A/1B and once as type 1A. All 6 patients with a type 1B injury underwent arthroscopically assisted mini-open reconstruction of the TFCC. Treatment of the type 1A injury consisted of arthroscopic shaving of the central lesion. Postoperative clinical examination revealed stable wrists with a normal range of motion in all cases. Patients reported a decrease in pain-level during daily activities or were entirely pain-free. Conclusion TFCC lesions in the adolescent population are difficult to evaluate on an arthro-MRI and results are often inconclusive. Diagnostic arthroscopy is thus the preferred method of diagnosis for this type of injury. The arthroscopic assisted mini-open TFCC reconstruction is a reliable technique to achieve DRUJ stability and good clinical outcomes.

Purpose: Muscle atrophy is a commonly encountered problem in osteoarthritis (OA). The aim of this study was to estimate the amount of muscle atrophy and fatty degeneration of the lower leg muscles related to ankle OA by magnetic resonance imaging (MRI). Methods: Twenty-one patients with unilateral ankle OA were included in this cohort study. Calf circumference of the affected and healthy lower leg was documented. The degree of OA was classified in conventional radiographs. The cross-sectional areas and fatty degeneration of the muscles of the lower leg were measured in bilateral MRI. Results: We found a significantly reduced calf circumference of the affected vs. healthy leg (p = 0.016). MRI showed a significantly lower cross-sectional area of the entire lower leg musculature in OA (p = 0.013). Sub-analysis of muscle groups revealed that only the M. soleus had a significant cross-sectional area decrease (p