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DNA-protein crosslinks (DPCs) are pervasive DNA lesions that are induced by reactive metabolites and various chemotherapeutic agents. Here, we develop a technique for the Purification of x-linked Proteins (PxP), which allows identification and tracking of diverse DPCs in mammalian cells. Using PxP, we investigate DPC repair in cells genetically-engineered to express variants of the SPRTN protease that cause premature ageing and early-onset liver cancer in Ruijs-Aalfs syndrome patients. We find an unexpected role for SPRTN in global-genome DPC repair, that does not rely on replication-coupled detection of the lesion. Mechanistically, we demonstrate that replication-independent DPC cleavage by SPRTN requires SUMO-targeted ubiquitylation of the protein adduct and occurs in addition to proteasomal DPC degradation. Defective ubiquitin binding of SPRTN patient variants compromises global-genome DPC repair and causes synthetic lethality in combination with a reduction in proteasomal DPC repair capacity.

Total hip arthroplasty (THA) is reported to be one of the most painful surgical procedures. Perioperative management and rehabilitation patterns are of great importance for the success of the procedure. The aim of this cohort study was the evaluation of function, mobilization and pain scores during the inpatient stay (6 days postoperatively) and 4 weeks after fast-track THA.A total of 102 consecutive patients were included in this retrospective cohort trial after minimally invasive cementless total hip arthroplasty under spinal anesthesia in a fast-track setup. The extent of mobilization under full-weight-bearing with crutches (walking distance in meters and necessity of nurse aid) and pain values using a numerical rating scale (NRS) were measured. Function was evaluated measuring the range of motion (ROM) and the ability of sitting on a chair, walking and personal hygiene. Furthermore, circumferences of thighs were measured to evaluate the extent of postoperative swelling. The widespread Harris Hip Score (HHS) was used to compare results pre- and 4 weeks postoperatively.Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (days 1-6 postoperatively). The pain scores before surgery were significantly higher than surgery (day 6), during mobilization (p 0.001), at rest (p 0.001) and at night (p 0.001). All patients were able to mobilize on the day of surgery. In addition, there was a significant improvement in independent activities within the first 6 days postoperatively: sitting on a chair (p 0.001), walking (p 0.001) and personal hygiene (p 0.001). There was no significant difference between the measured preoperative and postoperative (day 6 after surgery) thigh circumferences above the knee joint. Compared to preoperatively, there was a significant (p 0.001) improvement of the HHS 4 weeks after surgery. In 100% of the cases, the operation was reported to be successful and all of the treated patients would choose a fast-track setup again.Application of a fast-track scheme is effective regarding function and mobilization of patients. Low pain values and rapid improvement of walking distance confirms the success of the fast-track concept in the immediate postoperative course. Future prospective studies have to confirm the results comparing a conventional and a fast-track pathway.EINFüHRUNG: Die Hüftgelenktotalendoprothetik zählt zu den schmerzhaften chirurgischen Eingriffen, und perioperative Management- und Rehabilitationsvorgehensweisen sind für den Erfolg von großer Bedeutung. Ziel dieser Studie war die Evaluierung von Funktion, Mobilisierung und Schmerzwerten während des stationären Aufenthalts (6 Tage postoperativ) und 4 Wochen nach Fast-Track-Hüftgelenkendoprothetik.In diese retrospektive Studie wurden 102 Patienten nach minimal-invasiver zementfreier Hüftendoprothesenimplantation unter Spinalanästhesie in einem Fast-Track-Setup eingeschlossen. Der Umfang der Mobilisierbarkeit bei Vollbelastung mit Krücken (Gehstrecke [m] und Pflegebedürftigkeit) sowie Schmerzwerte wurden unter Verwendung einer numerischen Bewertungsskala (NRS) gemessen. Die Funktion wurde bewertet, indem die Beweglichkeit (ROM), die Fähigkeit zum Sitzen auf einem Stuhl und zum Gehen sowie die Durchführung persönlicher Hygienemaßnahmen analysiert wurden. Darüber hinaus wurden die Oberschenkelumfänge gemessen, um das Ausmaß der postoperativen Schwellung zu objektivieren. Der weit verbreitete Harris Hip Score (HHS) wurde verwendet, um die Ergebnisse vor sowie 4 Wochen nach der Operation zu vergleichen.Die Auswertung der Schmerzwerte im postoperativen Verlauf zeigte eine konstante Abnahme in der ersten postoperativen Woche (Tage 1–6 postoperativ). Die Schmerzwerte vor der Operation waren signifikant höher als nach der Operation (Tag 6), während der Mobilisierung (p 0,001), sowie in Ruhe (p 0,001) und in der Nacht (p 0,001). Alle Patienten konnten am Tag der Operation mobilisiert werden. Zusätzlich gab es innerhalb der ersten 6 Tage nach der Operation eine signifikante Verbesserung bei Sitzen auf einem Stuhl (p 0,001), Gehen (p 0,001) und Durchführung persönlicher Hygienemaßnahmen (p 0,001). Es bestand kein signifikanter Unterschied zwischen dem präoperativ und postoperativ gemessenen Oberschenkelumfang oberhalb des Kniegelenks (Tag 6 nach der Operation). Im Vergleich mit dem präoperativen Score zeigte sich 4 Wochen nach der Operation eine signifikante (p 0,001) Verbesserung des HHS. Alle Patienten gaben an, dass die Operation erfolgreich gewesen sei und dass sie sich wieder für die Fast-Track-Vorgehensweise entscheiden würden.Ein Fast-Track-Schema ist hinsichtlich Funktion und Mobilisierung von Patienten erfolgreich umzusetzen. Niedrige Schmerzwerte und eine schnelle Verbesserung der Gehstrecke bestätigen den Erfolg des Fast-Track-Konzepts im unmittelbaren postoperativen Verlauf. Künftige prospektive Studien müssen die Ergebnisse bestätigen, nach Möglichkeit im Vergleich eines konventionellen und eines Fast-Track-Vorgehens.

Unicompartmental knee arthroplasty and total knee arthroplasty are well established treatment options for end-stage osteoarthritis, UKA still remains infrequently used if you take all knee arthroplasties into account. An important factor following knee arthroplasty is pain control in the perioperative experience, as high postoperative pain level is associated with persistent postsurgical pain. There is little literature which describes pain values and the need for pain medication following UKA and/or TKA. So far, no significant difference in pain has been found between UKA and TKA. The aim of the study was to evaluate differences in the postoperative course in unicompartmental knee arthroplasty vs. total knee arthroplasty regarding the need for pain medication and patient-reported outcomes including pain scores and side effects. We hypothesized that unicompartmental knee arthroplasty is superior to total knee arthroplasty in terms of postoperative pain values and the need of pain medication. In this project, we evaluated 2117 patients who had unicompartmental knee arthroplasty and 3798 who had total knee arthroplasty performed, from 2015 to 2018. A total of 4144 patients could be compared after performing the matched pair analysis. A professional team was used for data collection and short patient interviews to achieve high data quality on the first postoperative day. Parameters were compared after performing a 1:1 matched pair analysis, multicenter-wide in 14 orthopedic departments. Pain scores were significantly lower for the UKA group than those of the TKA group (p p = 0.004 for non-opioids). The opiate consumption was similarly lower for the UKA group, but not statistically significant (p = 0.15). In the ward, the UKA group needed less opioids (p

Intrinsically disordered protein regions (IDRs) pervasively engage in essential molecular functions, yet they are often poorly conserved as assessed by sequence alignment. To understand the seeming paradox of how sequence variability is compatible with function, we examined the functional determinants for a poorly conserved but essential IDR. We show that IDR function depends on two distinct but related properties: sequence- and chemical specificity. While sequence-specificity works via linear binding motifs, chemical-specificity reflects the sequence-encoded chemistry of multivalent interactions through amino acids across an IDR. Unexpectedly, an apparently essential binding motif can be removed if compensatory changes to the sequence chemistry are made, highlighting the orthogonality and interoperability of both properties. Our results provide a general framework to understand the functional constraints on IDR sequence evolution.One-Sentence SummaryInteractions driven by intrinsically disordered regions can be understood using a two-dimensional landscape that defines binding via motif-dependent and motif-independent contributions.

Background: Total hip arthroplasty combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate functional outcome and quality of life 4 weeks and 12 months after cementless total hip arthroplasty in combination with an enhanced recovery concept. Methods: A total of 109 patients underwent primary cementless Total Hip Arthroplasty (THA) in an enhanced recovery concept and were retrospectively analyzed. After 4 weeks and 12 months, clinical examination was analyzed regarding function, pain and satisfaction, results were evaluated using Harris Hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D-5L, EQ-VAS and subjective patient-related outcome measures (PROMs). Preoperatively, HADS (Hospital Anxiety and Depression Scale) was collected. A correlation analysis of age, American Society of Anesthesiologists (ASA), HADS and comorbidities (diabetes mellitus, art. hypertension, cardiovascular disease) with WOMAC, Harris Hip score (HHS) and EQ-5D was performed. Results: Patients showed a significant improvement in Harris Hip score 4 weeks and 12 months postoperatively (p &lt, 0.001). WOMAC total score, subscale pain, subscale stiffness and subscale function improved significantly from preoperative to 12 months postoperative (p &lt, 0.001). EQ-5D showed a significant improvement preoperative to postoperative (p &lt, 0.001). The influence of anxiety or depression (HADS-A or HADS-D) on functional outcome could not be determined. There was a high patient satisfaction postoperatively, and almost 100% of patients would choose enhanced recovery surgery again. Conclusion: Cementless THA with the concept of enhanced recovery improves early clinical function and quality of life. PROMs showed a continuous improvement over a follow-up of 12 months after surgery. PROMs can help patients and surgeons to modify expectations and improve patient satisfaction.

Background and purpose ��� Improving health care and demographic change have resulted in a steady increase in geriatric patients undergoing total hip (THA) and knee (TKA) arthroplasty. Postoperative delirium (POD) is a frequent and severe complication after major surgery. Therefore, we analyzed the impact of POD on outcome after THA and TKA. Patients and methods ��� In a consecutive series of 10,140 patients who had undergone elective THA or TKA between 2011 and 2020, rates of reoperation within 90 days, readmission within 90 days, complications, and responder rate as defined by the OMERACT-OARSI criteria were compared between patients with and without POD. Multivariable logistic regression models were used to assess the relationship between POD and other postoperative complications. Results ��� Patients with POD showed higher rates of reoperation (12% vs. 5%), readmission (15% vs. 5%), surgical complications (7% vs. 2%), non-surgical complications (8% vs. 4%), Clavien���Dindo IV�� complications (10% vs. 2%) and transfusion (14% vs. 2%). POD led to lower responder rate (76% vs. 87%) 1 year after total joint replacement. All previous comparisons statistically significant. Multivariable logistic regression analyses revealed POD as an independent risk factor for reoperation (OR = 2; CI 1���3), readmission (OR = 2; CI 2���4) and Clavien���Dindo IV�� complications (OR = 3; CI 2���5). Interpretation ��� POD is a serious problem in elective joint replacement. Affected patients suffer more complications and show poor patient-reported outcome 1 year postoperatively. Systematic prevention strategies and standardized therapy protocols are mandatory to avoid burden to patients and healthcare providers.

Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

We present the case of a patient who took 150 mg per kg bodyweight of iron in a suicidal attempt. We illustrate the diagnostic and therapeutic procedures required to successfully cope with this poisoning, which is, by surprise, potentially lethal.

Background: Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention. Objectives: Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given. Material and methods: Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation. Discussion: The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.

Due to the frequent presence of comorbidities in patients suffering from rheumatism with increased perioperative risk factors, conservative treatment is often needed. Besides pharmacological treatment, physiotherapy and occupational therapy, a variety of orthoses are available depending on the individual indications. They can be used to stabilize or support joints, limit the range of motion, prevent unphysiological movements or provide relief for affected limbs. In order to choose the right kind of orthosis, the physician should know the underlying cause of disease. Furthermore, for patients with rheumatism many devices are available for daily living that use ergonomic handles or improved leverage effects to compensate for the often severe limitations and to improve the quality of life.

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

Animal models have been instrumental in reproducing key aspects of human tauopathy. In pursuing these efforts, the mouse continues to have a prominent role. In this chapter, we focus on models that overexpress wild-type or mutant forms of tau, the latter being based on mutations found in familial cases of frontotemporal dementia. We review some of these models in more detail and discuss what they have revealed about the underlying pathomechanisms, as well as highlighting new developments that exploit gene editing tools such as TALEN and CRISPR. Interestingly, when investigating the role of tau in impairing cellular functions, common themes emerge. Because tau is a scaffolding protein that aggregates in the somatodendritic domain under pathological conditions, it traps proteins such as parkin and JIP1, preventing them from executing their normal function in mitophagy and axonal transport, respectively. Another aspect is the emerging role of tau in the translational machinery and the finding that the somatodendritic accumulation of tau in Alzheimer's disease may in part be due to the induction of the de novo synthesis of tau by amyloid-β via the Fyn/ERK/S6 pathway. We further discuss treatment strategies such as tau-based vaccinations and therapeutic ultrasound and conclude by discussing whether there is a future for animal models of tauopathies.

Repair of covalent DNA–protein crosslinks (DPCs) by the metalloprotease SPRTN prevents genome instability, premature aging and carcinogenesis. SPRTN is specifically activated by DNA structures containing single- and double-stranded features, but degrades the protein components of DPCs promiscuously and independent of amino acid sequence. This lack of specificity is useful to target diverse protein adducts, however, it requires tight control in return, in order to prohibit uncontrolled proteolysis of chromatin proteins. Here, we discover the components and principles of a ubiquitin switch, which negatively regulates SPRTN. We demonstrate that monoubiquitylation is induced in an E3 ligase-independent manner and, in contrast to previous assumptions, does not control chromatin access of the enzyme. Data obtained in cells and in vitro reveal that monoubiquitylation induces inactivation of the enzyme by triggering autocatalytic cleavage in trans while also priming SPRTN for proteasomal degradation in cis. Finally, we show that the deubiquitylating enzyme USP7 antagonizes this negative control of SPRTN in the presence of DPCs.

Hintergrund Der Anstieg der älteren Bevölkerungsgruppe und der damit einhergehende Zuwachs des intensivmedizinischen Bedarfs betont die Notwendigkeit einer effizienten Bettenkapazitätsanalyse. Insbesondere Herz-Kreislauf-Erkrankungen stellen ein häufig auftretendes Erkrankungsbild bei über 65-Jährigen dar. Ziel dieser Arbeit war somit die Analyse des retrospektiven und zukünftigen Intensivbedarfs von älteren Patienten über 65 Jahre mit 6 ausgewählten (kardiovaskulären) Codes der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (ICD-10) am Beispiel einer Einrichtung der Maximalversorgung in einer ländlichen Region. Methodik Für die retrospektive Analyse wurden Daten für den Zeitraum 2015–2017 deskriptiv und bivariat ausgewertet. Die Analyse des Intensivbettenbedarfs erfolgte anhand der Warteschlangentheorie. Ergebnisse In dem betrachteten Zeitraum lagen die monatlichen Auslastungsraten kontinuierlich über der idealen Auslastungsrate von 80 % und zum Teil sogar über 100 %. Insbesondere die Nachfrage von Patienten mit I50.14 war im gesamten Krankenhaus sehr hoch. Die Bettenbedarfsanalyse zeigt einen Anstieg von 9 benötigten Betten im Jahr 2017 auf 11 Betten bis zum Jahr 2030 für die 6 Diagnosegruppen. Ohne Einschluss der Diagnosegruppe I50.14 wird sowohl retrospektiv als auch zukünftig etwa die Hälfte der Betten, die bei Einschluss aller 6 Diagnosen benötigt wurden, nachgefragt., BACKGROUND: The increasing number of elderly individuals in the population and the simultaneous increase of the intensive care demand emphasizes the relevance of an efficient bed capacity analysis. Particularly, cardiovascular diseases represent afrequently occurring disease in the population group over 65years of age. The objective of the following paper is the analysis of the retrospective and prospective intensive care demand by patients over 65years with 6selected (cardiovascular) codes of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).; METHODS: For the retrospective analysis, data from 2015-2017 were analyzed applying descriptive and bivariate methods. The analysis of the intensive care bed demand was based on the queuing theory.; RESULTS: The monthly capacity utilization rates were constantly higher than the target capacity utilization rate of amaximum of 80% and in some cases even higher than 100%. In particular, the demand of patients with I50.14 was very high throughout the entire hospital. The bed demand analysis shows an increase from 9needed beds in 2017 to 11beds by 2030 for the 6diagnosis groups. Regarding the 5diagnosis groups without I50.14, only approximately half of the required beds were needed, retrospectively and in future.; CONCLUSION: The effect of demographic change on the intensive care demand already exists, and acontinuing, prospective increase of the demand is expected. The results underline the need of effective and demand-oriented intensive care capacity planning. However, prior to expanding bed capacities, the analysis of admission criteria of intensive care unit patients is necessary to reserve capacities primarily for patients with real intensive care needs.

Eine hohere Lebenserwartung und gesteigerte Aktivitat der Bevolkerung fuhren zu einer Zunahme von degenerativ gepragten Krankheitsbildern wie der Achillessehnenruptur. Die Anamnese und die korperliche Untersuchung sind Mittel der Wahl zur Diagnosestellung der Achillessehnenruptur. Sonographie und Rontgendiagnostik stellen erweiterte, sinnvolle Diagnostika dar. Fur die Indikationsstellung der Therapie mussen multifaktoriell die Vor- und Nachteile der konservativen gegen die operative Therapie individuell abgewogen werden. Fur beide Verfahren gibt es klare Kontraindikationen. In den operativen Verfahren stehen die offene Nahttechnik, minimalinvasive Verfahren als auch rekonstruktive Verfahren zur Verfugung. Genauso wichtig wie die Wahl des richtigen Operationsverfahrens ist eine adaquate Nachbehandlung des Patienten. Unter richtiger Indikationsstellung und Betreuung konnen sowohl mit der konservativen als auch der operativen Therapie auserst zufriedenstellende Ergebnisse fur den Patienten erreicht werden.

Animal models have been instrumental in reproducing key aspects of human tauopathy. In pursuing these efforts, the mouse continues to have a prominent role. In this chapter, we focus on models that overexpress wild-type or mutant forms of tau, the latter being based on mutations found in familial cases of frontotemporal dementia. We review some of these models in more detail and discuss what they have revealed about the underlying pathomechanisms, as well as highlighting new developments that exploit gene editing tools such as TALEN and CRISPR. Interestingly, when investigating the role of tau in impairing cellular functions, common themes emerge. Because tau is a scaffolding protein that aggregates in the somatodendritic domain under pathological conditions, it traps proteins such as parkin and JIP1, preventing them from executing their normal function in mitophagy and axonal transport, respectively. Another aspect is the emerging role of tau in the translational machinery and the finding that the somatodendritic accumulation of tau in Alzheimer’s disease may in part be due to the induction of the de novo synthesis of tau by amyloid-β via the Fyn/ERK/S6 pathway. We further discuss treatment strategies such as tau-based vaccinations and therapeutic ultrasound and conclude by discussing whether there is a future for animal models of tauopathies.

We present the case of a patient who took 150 mg per kg bodyweight of iron in a suicidal attempt. We illustrate the diagnostic and therapeutic procedures required to successfully cope with this poisoning, which is, by surprise, potentially lethal.

The need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient's hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.

Unter dem Begriff Ruckfusdeformitat lassen sich viele Krankheitsbilder subsumieren, die mit Achsfehlstellungen einhergehen. Komplexe Beispiele sind die Ruckfusdestruktionen, die durch rheumatologische oder diabetische Grunderkrankungen bedingt sind. Dieser Artikel soll den Leser befahigen, die wichtigsten und haufigsten (adulten) Ruckfusdeformitaten zu diagnostizieren und uber stadiengerechte konservative und operative Therapiemoglichkeiten zu entscheiden.

Background The number of cases of orthopedic surgery is still increasing and postoperative pain management is of great importance for the patients. Therefore, in this study factors influencing the pain and the developement of pain in general in the first 7 days after total knee arthroplasty were examined. Material and methods A total of 28 patients were included in this prospectively designed trial and underwent total knee arthroplasty with psoas compartment and sciatic nerve regional anesthesia and additionally propofol sedation. Postoperative pain scores were documented using a numerical rating scale (NRS) and anthropometric data and perioperative parameters were correlated with the postoperative pain score. Results Evaluation of the pain values per interval showed that the maximum and the mean postoperative pain levels decreased up to day 4 after surgery and then increased. No significant effects of the analyzed parameters age, body mass index (BMI), duration of surgery and catheter indwelling time could be found. Female patients had significantly more pain than males in this collective. Conclusion The results show that there were no factors which have a significant influence on the degree of postoperative pain. Female patients suffered from more pain than males. There was an increase in pain after postoperative day 4 which might be the effect of more extensive mobilization and reduced effects of regional anesthesia. It is important that pain is treated in the early postoperative period.

The evolution of texture in copper has been studied in situ as a function of the applied mechanical stress. A uniaxial tensile stage was integrated onto a Eulerian cradle in a laboratory X-ray diffraction system, providing a platform for pole figure measurements on samples under an externally applied mechanical load. Thin strips of rolled copper were investigated at various stages of elongation. The pole figures were of good quality such that the orientation distribution function could be well determined. Changes in the orientation distribution function as a function of strain along the β-fiber could be clearly observed; the initial main component S is replaced by the Copper component at higher stages of elongation.

Therapeutic strategies for cartilage repair of the talus are varied. With the use of biologic scaffolds and biologic agents new cell-based therapies have become the focus of attention.Ankle cartilage repair techniques are presented and assessed by current data. In addition, technical notes for each technique are given.Currently, the following established ankle cartilage repair procedures exist: microfracturing, AMIC (autologous matrix-induced chondrogenesis), OCT (osteochondral transplantation, mosaicplasty), allograft transplantation.The success of each repair technique is dependent on the proper indication, addressing of co-morbidities like axis deviation or ligament instabilities, the experience of the surgeon and the appropriate rehabilitation. Mid- and long-term results are often good or excellent. Best results are seen in isolated cartilage defects without co-morbidities in patients younger than 40 years of age and non-smokers with normal BMI and early intervention. New cell-based therapies utilize scaffolds and biologic agents. They offer promising perspectives, although current data is inconsistent.

Due to the frequent presence of comorbidities in patients suffering from rheumatism with increased perioperative risk factors, conservative treatment is often needed. Besides pharmacological treatment, physiotherapy and occupational therapy, a variety of orthoses are available depending on the individual indications. They can be used to stabilize or support joints, limit the range of motion, prevent unphysiological movements or provide relief for affected limbs. In order to choose the right kind of orthosis, the physician should know the underlying cause of disease. Furthermore, for patients with rheumatism many devices are available for daily living that use ergonomic handles or improved leverage effects to compensate for the often severe limitations and to improve the quality of life.

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

Arthroscopy of the wrist has developed in the shadow of arthroscopy of the large joints. Nowadays, wrist arthroscopy has a relevant importance in the diagnostics and therapy in hand surgery and is indispensable for serious surgery of the wrist. Special equipment and extensive knowledge of the surgeon are necessary for carrying out the procedure.

Patienten mit rheumatologischen Erkrankungen leiden langfristig haufig unter sekundaren Sprunggelenks- und Fusdeformitaten. Diese gehen oft mit erheblichen Beschwerden bis hin zur Immobilitat einher. Operativ korrigierende und versteifende Verfahren konnen eine sinnvolle Therapieoption darstellen. Die vorliegende Arbeit beschreibt die Epidemiologie, die Klinik, Diagnostik und mogliche Therapieoptionen mit postoperativen Ergebnissen bei Sprunggelenks- und Ruckfusarthrosen. Retrospektiv wurden die Ergebnisse von 56 Patienten nach 26 Arthrodesen des oberen Sprunggelenks sowie nach 30 Ruckfusarthrodesen (unteres Sprunggelenk oder Talonavikulargelenk) ausgewertet. Nach durchschnittlich 52 Monaten Nachbeobachtungszeit zeigten sich weit uberwiegend gute bis sehr gute klinische Ergebnisse mit deutlicher Schmerzreduktion und Wiederherstellung der Fusfunktion. Sprunggelenks- und Ruckfusarthrodesen stellen bei entsprechender Indikation eine gute Therapieoption dar und konnen betroffene Patienten vor einer zunehmenden Immobilisierung bewahren.

Die chronische Polyarthritis nimmt bei der Atiologie der Arthrose des oberen Sprunggelenks den zweiten Rang hinter der posttraumatischen Genese ein. Der Patient wird durch die schmerzhafte Sprunggelenksarthrose in seiner Mobilitat sehr stark eingeschrankt. Neben anderen konservativen und operativen Verfahren steht bei geeigneten Fallen die endoprothetische Versorgung des Sprunggelenks als Therapiemoglichkeit mit sehr guten Ergebnissen zur Verfugung. Neben der Beschreibung der Epidemiologie, des klinischen Beschwerdebilds, der notwendigen Diagnostik, der Therapiealternativen und des Komplikationsmanagements berichtet diese Arbeit uber das mittelfristige Outcome nach endoprothetischer Versorgung des oberen Sprunggelenks. Retrospektiv wurden die Ergebnisse von 44 Patienten nach endoprothetischer Versorgung des Sprunggelenks ausgewertet. Bei einem Follow-up von 53 (20–98) Monaten zeigten sich gute bis sehr gute Ergebnisse nach Totalendoprothese des oberen Sprunggelenks. Bei sorgfaltiger Beachtung der Eignungskriterien stellt die endoprothetische Versorgung des oberen Sprunggelenks eine gute Option fur die Therapie der fortgeschrittenen OSG-Arthrose dar.

Beim Knochenmarkodem (KMO) handelt es sich um eine pathologische Vermehrung der interstitiellen Flussigkeit im Knochen mit unspezifischem Erscheinungsbild im Magnetresonanztomogramm (MRT). Unterschieden werden das traumatische, das atraumatische, oft ischamische, das reaktive und das mechanische KMO. Das schmerzhafte KMOS wird uneinheitlich als eigene Entitat oder als reversibles Vorstadium der Osteonekrose (ON) betrachtet. Die Gefahr seines Ubergangs in eine ON mit Gelenkdestruktion ist immer gegeben. Am haufigsten sind das Huft-, Knie- und obere Sprunggelenk betroffen. Diagnostische Methode der Wahl ist das MRT. Je nach Atiologie ist eine konservative oder operative Therapie zu diskutieren. Das KMOS wird primar konservativ behandelt. Die Infusion von Prostazyklin oder Bisphosphonaten stellt eine gute Option fur viele KMO dar. Etabliertes Verfahren ist die sog. „core decompression“. Beim ischamischen KMO sowie im Fruhstadium einer ON konnte eine Kombination beider Verfahren von Vorteil sein.

The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.