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The aim of this study was to determine the difference between real age (RA) and dental age (DA) in boys and girls from the Autonomous City of Buenos Aires (C.A.B.A.) by analyzing digital panoramic radiographs from the database of the Imaging Department at the Buenos Aires University School of Dentistry, using the Demirjian Method (DM). The sample consisted of 508 panoramic radiographs of 6- to 14-year old Argentines (268 female and 240 male). The Demirjian method was used to estimate dental age from each panoramic radiograph, and the Wilcoxon test was applied to perform a comparative analysis with the real age recorded in the image database. Average RA was 9.36 years (SD 2.11), and average DA according to the Demirjian method was 10.45 years (SD 2.31). For females, RA was 9.25 (SD 2.12), and DA according to the DM was 10.40 years (SD 2.41). For males, RA was 9.46 (SD 2.10), and DA according to the DM was 10.50 years (SD 2.22). An inter-classcorrelationcoefficient(ICC) calculated as a correlation measure between dental age and real age was ICC = 1.09%. The ICC was 1.04% for the males and 1.15% for females. Significant differences were found between DA and RA (p0.01) in general and according to sex. Real age was found to be lower than dental age in the study population from Buenos Aires City.El objetivo del presente trabajo fue determinar la diferencia entre la edad real (ER) y la edad dental (ED) en niños y niñas de la Ciudad de Buenos Aires analizando radiografías panorámicas digitales de la base de datos de la Cátedra de Diagnóstico por imágenes FOUBA, utilizando el Método Demirjian (MD). La muestra consistió en 508 radiografías panorámicas (268 del sexo femenino y 240 del sexo masculino) en una población argentina de 6 a 14 años de edad. Se realizó el cálculo de la edad dental en cada una de ellas, conforme el método de Demirjian. Se efectuó un análisis comparativo con la ER proveniente de la base de datos, utilizando la prueba de Wilcoxon. En las 508 panorámicas se estimó la ED. Se pudo establecer que la ER en promedio es 9.36 años con un desviación estándar (DS) de 2,11 y que la edad según el método de Demirjian es 10,45 años con una DS de 2,31. Para el sexo femenino se obtuvo una ER de 9,25 y una DS de 2,12 y según MD es de10,40años con una DSde 2,41. Para el sexo masculino se obtuvo una ER de 9,46 y una DS de 2,10 y según MD es de 10,50 años con una DS de 2,22. Se obtuvo un coeficiente de correlación inter-clase (CCI), como medida de correlación entre edad dental y real, de (CCI 1,09%). El CCI para el sexo masculino fue de (CCI 1,04 %) y en el caso del sexo femenino fue de (CCI 1,15%). Se hallaron diferencias significativas entre ED y ER (p0,01) en general y también para ambos sexos. Se pudo evidenciar que la edad real es menor que la edad dental en la población de la Ciudad de Buenos Aires.

Dieser Artikel soll einen Uberblick uber die Moglichkeiten navigierter Operationsverfahren bei der Versorgung von Beckenring- und Azetabulumfrakturen anhand unserer experimentellen und klinischen Erfahrungen geben. Initial wurden zunachst verschiedene Navigationsverfahren zur Verschraubung des Sakroiliakalgelenks (SI) im Vergleich zur konventionellen Technik an Spenderleichen (80 Schrauben) untersucht. Danach wurde die 2D-fluoroskopische Navigation in der Klinik (35 Schrauben) mit der konventionellen Technik (n=23) verglichen und retrospektiv alle SI-Schrauben aus einem 7-Jahres-Intervall (n=139) analysiert. An Azetabula wurde experimentell die 3D-fluoroskopisch navigierte supraazetabulare Verschraubung am Leichenpraparat (10 Schrauben) durchgefuhrt und mit klinischen Fallbeispielen verglichen. In der Zusammenschau lasst sich fur die navigierte SI-Fugen-Verschraubung eine signifikante Eingriffsverlangerung gegenuber der konventionellen Technik konstatieren. Allerdings wurde die intraoperative Durchleuchtungszeit um 50% reduziert. Weiterhin wies die konventionelle Verschraubung gegenuber der Navigation eine etwa 4-mal hohere Fehlplatzierungsrate auf, die bei Operateuren mit groser Vorerfahrung signifikant niedriger war. Am Azetabulum ist die Nutzung der Navigation im 2D-Modus hilfreich, der Einsatz der Navigation im 3D-Modus ist mit einer hohen Lernkurve verbunden. Zusammenfassend stellen wir fest, dass die navigierte SI-Fugen-Verschraubung weitgehend etabliert ist. In der Azetabulumchirurgie wird die Anwendung der Navigation dagegen (vorerst) auf wenige Einzelfalle beschrankt bleiben.

Die Insuffizienzfraktur des Sakrums stellt eine potentielle Ursache fur Ruckenschmerzen im hoheren Lebensalter dar. Am haufigsten werden sakrale Insuffizienzfrakturen im Rahmen der Osteoporose beobachtet, wahrend die Strahlennekrose oder maligne Prozesse seltenere Ursachen dieser Frakturen sind. Im eigenen Krankengut war zuletzt eine deutliche steigende Inzidenz zu verzeichnen. Anhand eines Fallbeispiels soll daher uber Klinik, Diagnostik und Therapie der sakralen Insuffizienzfraktur berichtet werden.

Background Epidemiological data suggest that chronic hepatitis C virus (HCV) infection may contribute to the development of diabetes mellitus. Therapy of HCV infection with recombinant interferon-α (r-IFN-α) can also impair of glucose metabolism. Methods To investigate the impact of HCV infection and the therapy with r-IFN-α on glucose metabolism we measured insulin sensitivity, glucose effectiveness, and first and second phase insulin secretion, using the minimal modelling analysis of frequently sampled intravenous glucose tolerance tests in 13 nondiabetic patients with HCV-induced liver disease before and after therapy with r-INF-α (6 × 106 U, subcutaneously, three times a week over 4 months). Liver biopsy was performed to evaluate and score liver fibrosis as a marker of HCV-induced cell injury. Results Insulin sensitivity (r = − 0.59, P

Background/Aims: To investigate the link between hepatitis C infection and glucose intolerance, we measured insulin sensitivity, glucose effectiveness and β-cell secretion in noncirrhotic HCV-infected patients with normal glucose tolerance according to WHO criteria as assessed by oral glucose tolerance tests. Methods: Glucose, insulin and C-peptide data from frequently sampled intravenous glucose tolerance tests were analyzed using the minimal modeling technique for glucose and C-peptide to determine insulin sensitivity, glucose effectiveness, first and second phase insulin secretion in noncirrhotic HCV-infected patients (n = 10) and in healthy control subjects (n = 10). Histological activity index (HAI) as well as the extent of fibrosis were evaluated by scoring liver biopsies. Results: Insulin sensitivity (2.72 ± 1.63 vs. 6.84 ± 1.20 10–4 min–1 per µU/ml, p < 0.01) and glucose effectiveness (2.29 ± 0.45 vs. 2.89 ± 0.39 10–2 min–1, p < 0.05) ere significantly lower in patients with HCV-induced liver disease. Insulin sensitivity was negatively related to serum alanine aminotransferase (r = –0.47, p < 0.05) and aspartate aminotransferase concentrations (r = –0.65, p < 0.05). Multiple linear regression analysis revealed a strong relation of insulin sensitivity with fibrosis score and HAI (r = –0.82, p < 0.02 for both). Second phase insulin secretion was significantly enhanced in HCV-infected patients (14.30 ± 2.04 vs. 8.29 ± 1.65 min–1, p < 0.05). Conclusions: HCV-infected patients with normal glucose tolerance are insulin and glucose resistant. The impairment of glucose tolerance appears to be closely related with the severity of HCV-induced liver damage.

Posterior dislocations of the shoulder represent a rare injury with frequently occurring soft tissue and/or bony concomitant lesions such as the reverse Hill-Sachs lesion and the dorsal labrum tear. For the combination of these injuries, no evidence-based therapeutic recommendations exist.Reflecting on two clinical cases and the current literature data, options for the treatment of combined osseous and soft tissue injuries due to posterior dislocation of the shoulder are presented.We report two cases of fresh traumatic first-time posterior dislocations that were each explored arthroscopically and subsequently operated using an open technique. In the first case, we performed refixation of the labrum, followed by open osteosynthesis with bone substitution. Treatment of the second case included diagnostic arthroscopy and - after a frustrating attempt to elevate the defect in an arthroscopically assisted retrograde technique - open reconstruction of the humeral head with an allograft.In both cases good clinical outcomes with Constant scores of 79 and 86 points at the 16- and 12-month follow-ups, respectively, were achieved. Radiologically complete integration of the used materials was found.These cases show that for the operative treatment of fresh, traumatic posterior shoulder dislocation, it is useful to explore the joint arthroscopically to identify concomitant injuries of the labrum and if necessary treat them. The bony pathology of the humeral head can subsequently be addressed in an open technique, whereby the appropriate treatment should be chosen based on the size of the defect.

Entre las pericias de identificacion odontologica forense, los analisis de huellas de mordedura han representado un topico actual, relevante y controvertido pues la unicidad de la denticion, la confiabilidad de la piel como soporte y sus tecnicas de analisis, han visto un fuerte cuestionamiento a partir de una relevante casuistica de condenas injustas. Mientras la literatura especializada y mas actual ofrece una permanente revision sobre protocolos y normas para la cualificacion de pericias y peritos, la literatura de habla hispana no sostiene un ritmo similar, con una escasa o nula actualizacion de contenidos adecuados en procedimientos, investigacion o reportes de casos. Dado que estos analisis ha sufrido cambios absolutos de base, y que una conveniente actualizacion al habla hispana permitiria la adaptacion, modificacion o reemplazo de sus postulados axiologicos, se presenta una revision cronologica sobre casos y topicos de inferencia en el analisis de huellas de mordeduras como evidencia juridica, y se proponen y discuten nuevos postulados epistemologicos para el abordaje forense de este tipo de evidencias.

Due to the increasing age of patients and the rising number of joint replacements, the incidence of periprosthetic fractures (PPF) is also increasing. The treatment should be selected with knowledge of the prefracture interface status and the type of fracture involved. The aim of this study was to evaluate our treatment of PPF with long-term follow-up.From 1988 to 2006, 99 patients with PPF were treated in our department. In 86 cases a plate osteosynthesis was used. After a mean time of 7.3+/-2.8 years, we studied 56 patients and monitored their complications.The most diagnosed fracture was Johansson type III (44%). Seventy-one patients were treated with a conventional and 15 with locking-plate osteosynthesis. In 15 cases (17.5%) we found severe complications (3 breaks and 3 dislocations of the plates, 6 cases of pseudarthrosis, 2 deep wound infections, and 1 case of postoperative bleeding).Due to the minor frequency of severe complications, plate osteosynthesis of a periprosthetic fracture with a loosened interface is a good therapeutic option for individual patients, particularly for geriatric patients and those without disorders specific to a loosened interface.

Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion.This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86+/-8 (65-110) years. All patients were treated operatively. After a mean of 12+/-9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27+/-13 (4-103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index.With discharge from the acute care hospital, the Barthel index was 42+/-20 points and it increased during rehabilitation to 65+/-26 points. One year later the Barthel index was 67+/-28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75+/-24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52+/-27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome.Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.

The procedure of sacroplasty was introduced recently and involves the percutaneous application of cement to the sacral bone. Currently there are no standardized data available reflecting clinical results such as leakage rates or other complications. The aim of this study was to evaluate the feasibility and results of a balloon-assisted, CT-guided cement application in a controlled experimental approach.The trials were conducted on preserved human cadaveric specimens (n=6). The cement application was supported by kyphoplasty balloons (Kyphon) on the right hand side, and was performed without balloons on the opposite side. CT scans were obtained for preoperative planning and postoperative assessment, while CT fluoroscopy was used for intraoperative guidance (Philips Brilliance 64).The procedure revealed a good feasibility with an average procedure time of 36.9+/-2.4 min (range 33.1-38.9). The chosen scan protocol produced the following effective doses: 0.99 mSv in females and 0.63 mSv in males per scan and 0.33 mSv (females) and 0.25 mSv (males) per CT fluoroscopy image. Extraosseous cement spreading was not observed after both balloon-assisted and conventional application.The CT-guided technique presented in this study enables surgeons to perform sacroplasty with high precision and moderate radiation exposure. Further clinical studies are necessary to show if the balloon-assisted cement application can promote lower leakage rates than the conventional technique in patients with sacral fractures.

Independently of lacerated anatomic structures, the ensuing fracture type, concomitant injuries around the joint, the primary aim in treating distal humeral fractures is the restoration of a painfree, mechanically loadable elbow that has a free range of motion. To achieve these goals the fracture and its associated injuries have to be adequately diagnosed, adequately surgically treated, and after reconstruction must undergo an early physical therapy (PT) protocol. Adequate diagnostics, except for standard X-ray films, include in most cases an additional preoperative CT for evaluation and planning of the surgical approach. Adequate surgical treatment entails anatomic reconstruction and stable fixation via an approach that causes a minimum of additional iatrogenic injury to the adjacent soft tissues. Adequate PT is synonymous with early onset of movement, i.e. as early as the 1st postoperative day if the fixation is stable enough. However, a demanding problem is the increasing number of osteoporosis-associated distal humeral fractures in the elderly population with the development of complex fracture types, partly due to poor bone quality, that are not easily addressed and might lead to unsatisfactory results even after applying standardized protocols including anatomically contoured angular stable plates.

Low back pain disorders of the elderly can potentially be caused by sacral insufficiency fractures due to osteoporosis, radiation necrosis or seldom malignant processes. In our institution an increasing numbers of patients suffering from osteoporotic sacral insufficiency fractures could recently be observed. In a case report study clinical symptoms, diagnostic procedures as well as therapeutic options are discussed.

In Germany more than 40,000 patients suffer from osteoporotic vertebral fractures every year. Most of these fractures do not require operative stabilisation. However, if surgical stabilisation is necessary, stable fixation of transpedicular implants will be difficult to obtain. In a case study we report on the possibility of a kyphoplasty-guided technique for stable pedicle screw fixation.

In pelvic surgery, computer-assisted procedures are currently used predominantly for percutaneous iliosacral screw placement. The aim of this study was to evaluate the possibilities and limits of a 2D-fluoroscopic navigated procedure used for this indication.A consecutive series of patients with non or slightly displaced injuries of the posterior pelvic ring were prospectively investigated. Cannulated cancellous screws of 7.3 mm were percutaneously implanted in the supine position. The navigated procedure was performed using an active optoelectronical system and a 2D C-arm. Target parameters were practicability, precision and intraoperative radiation exposure time compared to patients treated using a non-navigated technique.In a 15 month period, 35 screws were implanted in 20 patients. The average procedure took 36.2+/-12.5 min (range 18-62 min), with a fluoroscopic time of 0.9+/-0.3 min (range 0.6-1.8 min) per screw. The displacement rate was 8% (n=3/35, CI 1.8-23.0). Compared to retrospectively selected patients treated using a non-navigated technique (n=13), a significant increase in procedure time (P=0.01), a significant decrease of radiation exposure time (P0.001) and a decreased displacement rate (P0.05) were observed in the navigated group.The 2D-fluoroscopic navigated procedure used in this study can be recommended for percutaneous stabilisation of non or minor displaced injuries of the posterior pelvis. This procedure reduces intraoperative radiation exposure and improves intraoperative orientation but does not crucially enhance the precision of screw placement compared to the non-navigated technique. Finally, it is limited by its poor image resolution and lack of three-dimensionality.

The study was performed to assess the necessity of dose adjustment (kV or mAs (eff.)) in 16-slice CT (MDCT) in postoperative controls of iliosacrally inserted osteosynthetic screws (OS) on preserved human cadaver specimens. The minimal tube settings for diagnostic imaging of the pelvic bone were analyzed and the effective doses and important organ doses were calculated.16 preserved human cadaver specimens with transiliac osteosynthetic screws were scanned on a 16-slice CT (collimation 16 x 0.75 mm, pitch 0.7) with 10 different tube settings (35, 50, 75, 100, 150 mAs (eff.) and 120 and 140 kV). 32 datasets (blinded for name and scan parameters) with and without OS were independently evaluated by four observers. The 10 series were sorted by subjective image quality (image noise, contours, artifacts), and the series with the lowest but still diagnostic quality was selected. The statistical analysis included multi-rater-kappa-test and Wilcoxon test for paired samples.The multi-reader agreements for sorting the series were fair (kappa = 0.38). The agreements in comparing the lowest diagnostic image qualities were slight to fair (kappa = 0.08-0.23). The paired sample test comparing the lowest diagnostic image quality with and without OS showed no statistical significance (p = 0.29). 87.5 % of the readouts (n = 64 [16 examinations, 4 readers]) with OS and 78.1 % of those without OS could be adequately diagnosed using the three series with the lowest effective doses (0.9-1.4 mSv for men, 1.4-2.0 mSv for women; 120 kV-35 mAs (eff.), 120-50, 140-35).MSCT scans of the pelvic bone can be performed with very low effective doses. It is not necessary to adjust tube settings when imaging bones with osteosynthetic screws. If the concept for the control of the pelvic osteosynthetic screw position includes more than 2 conventional films (for example anterioposterior view with additional inlet and outlet views), a low dose CT is preferable to conventional radiography.

Fractures of the proximal humerus represent a typical injury of the elderly. Additional lesions of nerves or arteries are rare and there is only little information in the literature on the co-occurrence of proximal humerus fractures and compromised peripheral circulation which could lead to the loss of the upper extremity. To prevent damage to the injured limb, it is necessary to invent and initiate a standardized algorithm involving trauma care matching the special needs of this combined injury.

Computer-assisted procedures have recently been introduced for navigated iliosacral screw placement. Currently there are only few data available reflecting results and outcome of the different navigated procedures which may be used for this indication. We therefore evaluated the features of a new 3D image intensifier used for navigated iliosacral screw placement compared to 2D fluoroscopic and CT navigation.Twenty fixed human cadavers were used in this trial. Cannulated cancellous screws were percutaneously implanted in the supine position in four treatment groups. An optoelectronic system was used for the navigated procedures. Screw placement was postoperatively assessed by fluoroscopic 3D scan and CT. The target parameters of this investigation were practicability, precision as well as procedure and fluoroscopic time per screw.All navigated procedures revealed a significant loss of time compared to non-navigated screw placement (2D: p0.001, 3D: p0.05, CT: p0.001). Simultaneously a significant decrease of radiation exposure time was observed in the navigated groups (p0.001 each). The misplacement rate was 20% in the non-navigated and the 2D fluoroscopic navigated group each. Procedures providing 3D imaging of the posterior pelvis did not produce any screw misplacement (p0.05). However, the CT procedure was associated with time-consuming registration and high rates of failed matching procedures.Our data show a clear benefit of using C-arm navigation for iliosacral screw placement compared with the CT-based procedure. While both fluoroscopy-based navigation procedures decrease intraoperative radiation exposure times, only 3D fluoroscopic navigation seems to improve the precision compared to non-navigated screw placement.

The treatment of unstable cervical spine injuries with the halo vest represents an established procedure. So far no data reflecting the quality of life of patients following a halo vest treatment are available. Elderly people make up a large part of the inpatients in our hospital. Therefore special attention is payed to this group of patients in this study.In this study 41 patients (average age of 51.8 +/- 23.5 years) with an unstable injury of the upper cervical spine were investigated. All of them underwent a halo vest therapy in our hospital during 1988-2003. The health-related quality of life was assessed in the mean 8.0 years after the trauma by using the SF-36 Health Survey. Additionally, the incidence of complications and the union rate over time were observed.The evaluation of the data obtained from the SF-36 revealed a reduced quality of life in the patient group in comparison to the reference population. This was particularly apparent in patients older than 60 years. The fracture healing under halo vest treatment was comparably slow. In 17% of the cases no fracture union was obtained after 12 weeks. This was only seen for patients older than 60 years. The complication rate associated to the halo vest amounted to 43% and was independent of age.The treatment of unstable fractures of the upper cervical spine with a halo vest results in a prolongated fracture healing for elderly people. Furthermore a halo vest therapy reduces the health related quality of life. Therefore, even for elderly patients an internal osteosynthetic stabilization of an unstable injury of the upper cervical spine should be considered if indicated.

MRI is a sensitive diagnostic tool, which is especially suited for the diagnosis of vertebral injuries in children since no radiation has to be applied to gonads or blood-producing organs. An indirect sign of vertebral injury is the presence of "bone bruise," an edema of the vertebral body without other bony lesions. The purpose of this study was to elucidate the clinical significance of "bone bruise" following vertebral trauma in children.Between 1998 and 2003 a total of 66 children with vertebral injuries were treated at our institution; 34 of these patients initially underwent MRI. In this retrospective study 20 of these children who were diagnosed with a vertebral injury based on the presence of a "bone bruise" in an MRI on admission were examined clinically as well as by follow-up MRI.All 20 patients stated they felt no limitations in daily activities. On examination there were no significant pathologic findings. We did not note persistence of a "bone bruise" or a collapse of the affected bone in the follow-up MRI.If a "bone bruise" is detected in the MRI after vertebral trauma in children, it usually has a good prognosis. With adequate therapy, which in our regimen consists of bedrest and early mobilization, we did not note any secondary collapse of the affected vertebrae.

Cervical spine injuries are rare in children. They tend to occur predominantly in the region of atlanto-axial articulation. Even traumatic rotatory atlanto-axial subluxation (AAD) has been described in the literature, however, there is no consistent therapeutic protocol. We report on a 4 year old girl with an acute traumatic rotatory atlanto-axial subluxation treated with closed reduction and retention in a hard-collar. Control CT scans and physical examination after 6 weeks revealed an excellent outcome without any signs of recurrence. As there is a correlation between outcome and increasing length of the dislocation-therapy interval, optimal management of acute rotatory atlanto-axial subluxation depends on early diagnosis with plain radiography and CT scans. Timely diagnosed cases may be treated successfully with closed reduction and cervical immobilisation in a hard-collar. Failure to obtain reduction and recurrence are an appropriate indication for surgical intervention.

The application of autogenous bone grafts represents the golden standard for reconstruction of the load-bearing anterior column in the thoracolumbar spine. However, the osseous integration of the implanted grafts is demanding and delayed union or pseudarthrosis may occur. There are no standardized data available yet indicating the further course in such cases. The aim of this study was to evaluate the incorporation of endoscopically applied grafts and to develop therapeutic strategies for delayed or non-fusions. Twenty patients suffering from unstable injuries of the thoracolumbar spine were studied in a prospective clinical trial. After primary dorsal stabilization, the anterior column was thoracoscopically reconstructed with an autogenous iliac crest graft and a fixed-angle implant (MACS). The osseous integration of the bone grafts was detected by MSCT 1 year postoperatively. Complete integration of the transplanted bone grafts was observed in only 65% of the cases. In 25% partial integration was detected and in two cases a fracture of the transplanted iliac crest graft occurred. Despite the incomplete integration of the bone grafts, the further course without surgical intervention revealed no clinical or radiological evidence of a concomitant implant loosening or a relevant secondary loss of correction. Similar to the open technique, endoscopic reconstruction of the anterior column with autogenous bone grafts may lead to disadvantageous results concerning the integration and healing of the applied bone grafts. Decision making in such cases depends on the individual clinical and radiological findings (i.e., evidence of implant loosening and concomitant loss of correction).

We report about a 6-year-old female patient who sustained a cervical spine (C7) burst fracture with initial neurological impairment. The treatment in our department on the day of the trauma included corporectomy and replacement of the C7 body with a tricortical iliac bone graft. One year after the trauma we were able to see the patient again. The functional outcome was good. Due to the rare entity of this case and the difficulty of predicting progress we would like to present our treatment regime and the 1-year follow-up results.

The treatment of osseous defects is widely established in the elderly. The number of positive reports on the successful application of bovine as well as coralline hydroxyapatite ceramics has continuously increased during the last few years. In trauma surgery hydroxyapatite ceramics are most commonly applied in metaphyseal defects evoked by traumatic fractures of the long bones. The bovine and coralline materials applied are biocompatible and exhibit an interconnecting porous system. Good osteoconductive properties of such materials have repeatedly been demonstrated. Due to possible harmful effects caused by abrasion of the material, intra-articular application should be strictly avoided. Biological degradation of the materials does not occur even during long-term follow-up. The application of hydroxyapatite ceramics was introduced at our institution in 1992. Since then, no adverse events have been observed and only a few relevant complications were described in the literature. We report on a patient revealing a mechanical failure of a bovine hydroxyapatite (Endobon) 7.5 years after implantation into a metaphyseal defect of the proximal tibia caused by a traumatic fracture.

Verletzungen der Wirbelsaule sind bei Kindern ausgesprochen selten. In der Literatur wird der Anteil kindlicher Wirbelsaulenverletzungen unter allen wirbelsaulenverletzten Patienten mit unter 2% angegeben [4], [12], [21]. Jungen sind dabei etwa doppelt so haufig betroffen wie Madchen. Vorwiegend treten Wirbelsaulenverletzungen bei Kindern unter 5 sowie uber 10 Jahren auf. Zu den fuhrenden Unfallursachen zahlen Sturze aus groser Hohe (50%) und Verkehrsunfalle (25%), gefolgt von Sportverletzungen und in seltenen Fallen dem „battered child syndrome“ [17], [21], [22], [26].

Combined dorsoventral stabilization provides superior mechanical stability in the operative treatment of thoracolumbar spine fractures. Currently, there are no data available reflecting the quality of life in trauma patients following the combined procedure. The aim of this investigation was to study the health-related quality of life after dorsoventral stabilization of the thoracolumbar junction using the SF-36 Health Survey.In order to assess the quality of life, 30 patients from a consecutive series with unstable fractures of the thoracolumbar junction were investigated in a clinical study. After posterior stabilization with an internal fixator (USS, Synthes),anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with osteosynthesis (MACS, Aesculap; VentroFix, Synthes). The quality of life was investigated 2 years after surgery. Additionally, plain X-rays were obtained and the degree of kyphotic deformation was measured.The evaluation of the data obtained from the SF-36 revealed a reduced quality of life, especially regarding the "physical functioning index", the "bodily pain index", and the "emotional functioning index". Of the patients, 42% still suffered from moderate to severe pain. Measurement of the Cobb angle showed a slight loss of correction without occurrence of a relevant kyphotic deformity. Our statistical analyses did not show any correlation between the data obtained from the SF-36 and the clinical results. Especially there was no correlation between the "bodily pain index" and the Cobb angle ( r=0.112, Spearman's rank order correlation).The patients studied here showed a reduced quality of life 2 years after dorsoventral stabilization of the thoracolumbar junction predominantly resulting in long-term pain symptoms. As these findings could not be related to the radiological results (i.e., the occurrence of a kyphotic deformation), other factors such as injury of the motion segment of the spine and the major surgical procedure have to be considered as the main reasons for the reduced quality of life. In summary, it can be concluded that the SF-36 is a suitable tool for the investigation of the postoperative outcome following dorsoventral stabilization of the thoracolumbar junction in trauma patients.

Since 1998 the calcium-phosphate cement BIOBON has been an established tool for the operative treatment of metaphyseal bone defects. No data are currently available in the literature on the clinical results of employing BIOBON:For the evaluation of the mediumterm outcome in the therapy of metaphyseal bone defects after distal radial fractures, we examined 29 patients in a retrospective study. These patients with unstable radial fractures were treated between 1998 and 2001 with BIOBON and additional osteosynthesis.We performed a clinical and radiological examination of 20 patients (69.0%) after an average period of 18.35 months (9-40 months). In all patients parts of the bone replacement material were still visible radiologically. The average outcome using the Gartland and Werley score was 7.5 points (2-21) and therefore a good result.Calcium-phosphate cements represent a good alternative to autogenous bone transplantation, especially in elderly patients.

It is widely believed that combined dorso-ventral stabilization provides superior mechanic stability in the operative treatment of thoracolumbar spine fractures. Currently there are no data available reflecting the fusion rates in trauma patients following the combined procedure. Aim of this investigation was to study the fusion rates following dorso-ventral stabilization of thoracolumbar spine fractures and the rates of local complications at the donor site.In order to assess fusion and complication rates 30 patients with unstable fractures of the thoracolumbar spine were selected from a consecutive series and investigated in a prospective study. After posterior stabilization with a fixateur interne (USS, Synthes) anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with an osteosynthesis (MACS,Aesculap;VentroFix, Synthes). The osseous integration of the autogenous transplants was measured by CT-scan 12+/-2.4 months after surgery.The evaluation of the radiographic and CT data revealed a fusion rate of 77% (23/30) one year after surgery. These findings were accompanied by minor complications at the donor site in 37% (11/30).Our experiences with autogenous spine grafting gave evidence that a reliable osseus integration can not be expected in all of the cases. Furthermore one has to consider a high rate of local complications. Therefore alternative procedures such as the use of cages will be of increasing influence in the surgical treatment of thoracolumbar spine fractures.

Cervical spine trauma most commonly involves the lower parts in adults. In children lesions of the cervical spine can predominantly be found in the region of C1/C2 including ligament injuries at this level. However such injuries are difficult to detect and only few data are available concerning therapy and prognosis of atlantoxial ligament lesions. We report on two children suffering from isolated rupture of the alar ligaments. Both injuries were proven by magnetic resonance imaging which is recommended as the resource of choice for the evaluation of the cervical spine soft tissues in children. Although the biomechanic properties of the alar ligaments remain unclear non-operative treatment for the rupture of these ligaments seems to be adequate. In order to avoid neurologic symptoms or long term complications an immediate diagnosis is indispensable.

Endobon is a porous hydroxyapatite ceramic which has been used as a bone replacement substitute since 1989. Currently there are no data available reflecting long-term effects of Endobon in human bone grafting. In order to assess such effects 35 patients with fractures of the proximal tibia were studied retrospectively over a period up to 91 months. The metaphyseal defects were filled by Endobon and fractures were stabilized by internal plate fixation subsequently. A secondary loss of reduction due to mechanical failure of the bone replacement material did not occur even after removal of metal implants. No histological signs of resorption or degradation could be found 18 months after application. Our data show that Endobon provides good mechanical properties during a long term follow-up and can be recommended as a suitable therapeutic option versus cancellous bone graft.

Atlantoaxial subluxation is predominantly found in trisomy 21. While neurological symptoms occur less frequently, fatal atlantoaxial instability with spinal cord compression has been described in trisomy 21 after minor trauma of the cervical spine. Presenting a special case we could demonstrate that atlantoaxial instability has to be ruled out in patients with trisomy 21 suffering from acute cervical spine trauma. We further recommend primary posterior fusion if the biomechanical stability of the atlantoaxial complex remains unclear after clinical and radiological exploration.

Epidemiological data suggest that chronic hepatitis C virus (HCV) infection may contribute to the development of diabetes mellitus. Therapy of HCV infection with recombinant interferon-alpha (r-IFN-alpha) can also impair of glucose metabolism.To investigate the impact of HCV infection and the therapy with r-IFN-alpha on glucose metabolism we measured insulin sensitivity, glucose effectiveness, and first and second phase insulin secretion, using the minimal modelling analysis of frequently sampled intravenous glucose tolerance tests in 13 nondiabetic patients with HCV-induced liver disease before and after therapy with r-INF-alpha (6 x 106 U, subcutaneously, three times a week over 4 months). Liver biopsy was performed to evaluate and score liver fibrosis as a marker of HCV-induced cell injury.Insulin sensitivity (r = - 0.59, P0.05) and first phase insulin secretion (r = - 0.66, P0.03) were negatively related to the fibrosis score. Insulin sensitivity rose from 1.96 (SEM 0.37, n = 8) to 5.69 (SEM 0.99, n = 8) 10-4 min-1 per microU mL-1 (P0.01) in responders and from 2.51 (SEM 0.61, n = 5) to 6.95 (SEM 1.99, n = 5) in nonresponders after 4 months r-INF-alpha therapy. Fasting free fatty acids decreased significantly to about 50% (P0.01) in patients with and without therapy response after 4 months, whereas first phase insulin secretion did not change.HCV-induced liver injury is related to the deterioration of insulin sensitivity and first phase insulin response, thus impairing glucose homeostasis in these HCV-infected patients. The administration of r-INF-alpha three times a week over 4 months is not associated with an impairment of glucose homeostasis.

This pilot study was initiated to evaluate factors controlling glucose tolerance in patients with hepatitis C virus-induced liver disease before and after therapy with recombinant interferon-alpha (r-INF-alpha). Fifteen patients with histologically and serologically proven hepatitis C infection underwent oral and frequently sampled intravenous glucose tolerance tests (FSIGTT) before and after four months of therapy (6 x 106 U r-INF-alpha, subcutaneously, three times a week). Glucose, insulin and C-peptide data from FSIGTT were analysed using the minimal modeling technique to determine insulin sensitivity, glucose effectiveness and first and second phase insulin secretion. According to the WHO criteria 13 patients, had normal glucose tolerance; diabetes mellitus was diagnosed in 2 patients. In the morning following the last r-INF-alpha injection four months later, insulin sensitivity improved significantly in hepatitis C virus-infected patients with normal glucose tolerance (2.17 +/- 0.37 vs. 6.18 +/- 0.94 10(-4) min(-1) per microU/ml, p < 0.001) and with diabetes mellitus (0.86 to 2.61; 0.46 to 1.06 10(-4) min(-1) per microU/ml). This effect was independent of the extent of fibrosis, virus load before treatment and therapy response. First phase insulin secretion increased in non-diabetic (139.2 +/- 17.1 vs. 200.0 +/- 32.7, p < 0.05) and diabetic patients with HCV infection (55.24 to 118.5; 84.23 to 261.1). Moreover, free fatty acid concentrations in all HCV-infected patients were significantly reduced (0.48 +/- 0.01 vs 0.21 +/- 0.03 mmol/l, p < 0.01). Therapy with recombinant interferon-alpha is associated with an amelioration of glucose tolerance in non-diabetic and diabetic HCV-infected patients.