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The objectives of this research were to study the phytochemical composition of Cynodon dactylon and investigate if the oral administration of this plant extract adsorbed on the pellet feed was capable of protecting L. vannamei challenged with white spot syndrome virus (WSSV). The shrimps were distributed into five batches, and experiments were run by triplicate: uninfected shrimps fed with pelleted feed without ethanolic extract of C. dactylon (ECDE, TC), infected shrimps fed with pelleted feed without ECDE (T1), infected shrimps fed with 1% of ECDE (T2), infected shrimps fed with 2% of ECDE (T3), and infected shrimps fed with 4% of ECDE (T4). The phytochemical screening of ECDE showed several compounds such as with important biological activities consistent with the results observed in vivo. Treatment with 2% ECDE showed a protective effect against WSSV and survival of 62% with no clinical signs of infection.

a b s t r a c t Objectives: C-telopeptide crosslaps (CTX) and bone-specific alkaline phosphatase (BAP) do not provide sufficient sensitivity and specificity for diagnosis of osteoporosis. Cathepsin K (CatK), osteoprotegerin (OPG), and receptor activator of nuclear factor B ligand (total (t) and soluble (s) RANKL) play an important role in bone metabolism. Thus serum levels of biochemical markers, each or in combination, may be useful in diagnosis of osteoporosis. Study Design: In total, 121 healthy women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59-81 years, all free of known skeletal disorders were included. They underwent bone density measurement and measurement of biochemical markers. Main Outcome Measures: Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their levels of CatK, OPG, RANKL, CTX and BAP were analyzed. Results: Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. There were no significant correlations of CatK, OPG and RANKL with BMD (T-score) in age-adjusted analysis, but for BAP and CTX. ROC analyses resulted in poor diagnostic validity of all parameters. The best result - also confirmed by discriminant analysis - was yielded by BAP (AUC = 0.646 (0.510; 0.781)). A combination of variables did not significantly improve the diagnostic power. Conclusions: Baseline serum levels of BAP, CTX, CatK, OPG, sRANKL or tRANKL alone or in combination are not suitable to distinguish osteoporotic from non-osteoporotic postmenopausal women with sufficient accuracy.

Background Osteopenia (OP) or osteoporosis (OST) was diagnosed by bone densitometry (DXA) in postmenopausal women free of known skeletal disorders and without acute fracture. DVO guidelines were applied to define therapeutic indication. Methods The study included 94 women aged 59-81 years. Fracture or operation ≤12 months, malignant tumor, ovariectomy, and drugs such as cortisone, strontium, fluorides, bisphosphonates, SERMs, estrogens, and steroids were exclusion criteria. The lowest T-score at the spine, femoral neck, or total hip was decisive. The indication for therapy was determined by evaluating age, BMD, and other risk factors. Results Using the WHO criteria 22.3% (n=21) had normal BMD, 52.1% (n=49) had OP, and 25.6% (n=24) had OST. According to "Dachverband Osteologie" (DVO) guidelines, 28 women (29.8%) of the whole group needed therapy. Of the 28 women receiving therapy, 9 had OP and 19 had OST. Therapy was indicated in 18.4% for OP and 79.2% for OST. Conclusion A preventive measurement of BMD with DXA provides a benefit for postmenopausal women. Combinatory assessment and consideration of other risk factors allows identification of women who might benefit from early treatment.

Objectives Cathepsin K (CatK) is expressed in high levels in osteoplasts and therefore plays an important role in bone resorption. Thus CatK serum levels may be useful in the diagnosis of chronic bone disorders such as osteopenia and osteoporosis. Therefore we aimed at studying CatK levels in women putatively free of known skeletal disorders. Study design In total, 121 voluntary women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59–81 years, all free of known skeletal disorders were included. All women underwent bone density measurement, routine labor parameter and measurement of serum CatK levels. Main outcome measures Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their CatK levels were statistically analyzed. Results Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. All 27 premenopausal women had normal BMD. There were no significant differences in CatK between these groups. ROC analysis resulted in poor diagnostic validity of CatK, where the area under curve was 0.544. There was no correlation neither between CatK and other biomarkers as C-telopeptide crosslaps (CTX) or bone-specific alkaline phosphatase (BAP) nor between CatK and age. Conclusions Serum levels of CatK are not suitable to differentiate women with osteoporosis from healthy subjects.

Background There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture. Methods Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results. Results Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA). Conclusions The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

The scaphocapitate fracture syndrome as a greater arc injury is a special form of the perilunate fracture dislocation. It is a combination of fractures of the scaphoid and capitate bones. This severe injury of the carpus is rare and therefore difficult to diagnose. We report the case of a 22-year-old handball player, who fell on the outstretched hand with the wrist in extension. Open reduction was performed via a dorsal approach and both fractures were treated operatively with Herbert screws. After three months the patient was able to play handball again with a good functional result.

Em 2002 e 2005 realizou-se inquérito transversal em áreas pobres das regiões Norte e Nordeste do Brasil visando avaliar a assistência à gestação e ao parto entre mães de menores de cinco anos. Foram estudadas 1.528 e 1.529 crianças em 2002 e 2005, respectivamente. Neste período, a escolaridade média das mães aumentou em 1,5 anos, a renda familiar em R$ 100,00 e o fornecimento de água tratada passou de 23% para 41%; a realização de seis ou mais consultas de pré-natal aumentou de 42% para 52% e a imunização contra tétano neonatal de 54% para 77%; a avaliação da altura uterina de 54% para 77% enquanto a realização de teste para HIV e sífilis duplicou, passando de cerca de 8% para aproximadamente 16% e de ultra-sonografia de 44% para 64%. No entanto, a realização de exames ginecológicos caiu de 41% para 31% e as orientações sobre amamentação de 66% para 55%. Apesar de melhorias expressivas na maioria dos indicadores estudados, verifica-se que ainda estão abaixo das regiões mais desenvolvidas do país. Esforços devem ser feitos visando reduzir estes diferenciais. In 2002 and 2005, two surveys were conducted in poor areas of North and Northeast Brazil to evaluate prenatal care received by mothers of children under five years old. The study covered 1,528 and 1,529 children in 2002 and 2005, respectively. In this three-year period, maternal schooling and monthly family income increased by 1.5 years and US$ 50.00, respectively, availability of safe drinking water increased from 23% to 41%, the proportion of pregnant woman with six or more prenatal visits increased from 42% to 52%, and immunization against neonatal tetanus increased from 54% to 77%. Coverage of uterine height evaluation increased from 54% to 77%. Testing for HIV and syphilis virtually doubled, from 8% to 16%. Meanwhile, gynecological examinations dropped from 41% to 31% and counseling for breastfeeding decreased from 66% to 55%. Despite improvements, the study's results show that the target indicators in these areas fall short of those in more developed regions of Brazil. Efforts should be made to reduce this gap.

Heterotopic ossification is a complication in patients with surgically treated acetabular fractures. The incidence is related to the surgical approach (extended iliofemoral, posterior or a combined approach). The objective of this study was to evaluate the incidence of heterotopic ossification in patients with acetabular fractures who received a combined prophylaxis with both a single dose of radiation and indomethacin compared to those who received only a prophylaxis with radiation or indomethacin.A total of 24 patients with a combined prophylaxis after surgery were examined retrospectively 24 months after trauma. A systematic literature review was performed and our own results were compared with different methods for prophylaxis of heterotopic ossification from the literature.Only one patient developed a heterotopic ossification. In accordance with the literature, combined prophylaxis showed the least incidence of ossification compared to the other methods. Differences in incidence frequencies were significant between the different prophylaxis methods.A combined prophylaxis for heterotopic ossification in surgically treated acetabular fractures seems to be a better alternative than a prophylaxis with radiation or indomethacin alone.

There is no consensus as to which is the best treatment for intraarticular fractures of the calcaneus. Furthermore, few studies have assessed general health after calcaneus fractures. We therefore measured the state of general health after operation of calcaneal fractures and compared these data with usual foot-scores.We compared the general health of 71 patients with surgically treated calcaneal fractures 2.5 years after injury, with the general health of 71 people from the standard German population (German National Health Survey, 1998) using the SF-36 form. We compared the results of the examination with results of AOFAS Ankle Hindfoot Scale and Maryland Foot Score in the treated patients.In patients with calcaneal fractures, there were significant limitations regarding general health in all 9 elements of the SF-36 form. Correlations between SF-36 and foot-scores were strong regarding function and pain scales, but moderate for all other scales.Patients face significant limitations regarding general health after calcaneal fractures. The usual foot-scores measure only 2 dimensions of outcome: function and pain. To measure all dimensions of outcome, SF-36 is a better alternative.

Ziel der vorliegenden Studie war die Beurteilung von Einschrankungen der gesundheitsbezogenen Lebensqualitat nach operativer Behandlung von Kalkaneusfrakturen und der Vergleich dieser Ergebnisse mit denen gebrauchlicher Fusscores. 55 Patienten mit einseitiger Kalkaneusfraktur und operativer Versorgung durch Plattenosteosynthese wurden 2,9 Jahre nach Unfall mit 55 Probanden der deutschen Normpopulation des Bundes-Gesundheits-Surveys 1998 bezuglich der Lebensqualitat durch Befragung mit dem SF-36 verglichen (Wilcoxon-Test). Die Daten des SF-36 der Patienten wurden mit dem Kalkaneusscore nach Zwipp und der AOFAS Ankle Hindfoot Scale korreliert (Spearman-Korrelationskoeffizient). Die Patienten mit Kalkaneusfrakturen zeigten in 9 von 10 Skalen des SF-36 eine signifikante Beeintrachtigung der gesundheitsbezogenen Lebensqualitat.Die Daten der untersuchten Fusscores korrelierten lediglich mit den Skalen Schmerz und Korperliche Funktion stark, in allen anderen Fallen fanden sich schwache Korrelationen.Kalkaneusfrakturen hinterlassen messbare Beeintrachtigungen der gesundheitsbezogenen Lebensqualitat. Gebrauchliche Fusscores erfassen vorwiegend die Dimensionen “Korperliche Funktion” und “Schmerz”. Fur eine umfassende Outcomebewertung ist die Erganzung durch den SF-36 empfehlenswert. Internationale Vergleiche sowie Vergleiche mit der deutschen Normalbevolkerung sind moglich.

Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. Patients and methods: From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n = 11), femoral neck (n = 6), per- and subtrochanteric region (n=12), femoral shaft (n = 10) and tibia (n = 2). Most of them were malignancies of the kidneys (n = 13), bronchi (n = 7) and breast (n = 6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. Results: No intraoperative complications occurred. 63% of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95% CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n = 1), soft tissue infection (n = 1), dislocation of the nail (n=2), loosening of the distal locking screw (n = 1), proceeding osteolysis with high fracture risk (n = 1). Conclusion: Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.

Fragestellung. Die orthograde Nagelung gilt als Methode der Wahl bei Femurfrakturen. Zugangsbedingt sind Komplikationen nicht selten. Bietet die retrograde Nagelung Vorteile und kann sie das Indikationsspektrum erweitern? Methodik. Im Rahmen einer prospektiven Studie wurden 70 Femurfrakturen bei 62 Patienten mit langem retrograden Nagel stabilisiert. Ergebnisse. 50 Patienten (57 Frakturen) wurden 13,3 Monate postoperativ (3–36) nachuntersucht.Mit Ausnahme einer Infektpseudarthrose heilten alle Frakturen zeitgerecht. Die Kniebeugung war bei Schaftfrakturen (32A–C) im Zeitraum von 12 Monaten in 81% der Falle im Normbereich, bei distalen Frakturen (33A–C) in 44%. Eine Streckhemmung bestand bei keinem Patienten. Zwei Patienten wiesen eine Beinverkurzung von 1 cm auf.Rotationsfehlstellungen uber 5° bestanden nicht. Das funktionelle Ergebnis (Neer) war bei Schaftfrakturen uberwiegend ausgezeichnet (89%), bei supra-/supradiakondylaren Frakturen in 50% der Falle.Bei 18 arthroskopiegestutzten Materialentfernungen zeigte das Femuropatellargelenk keine pathologischen Veranderungen. Schlussfolgerung. Die retrograde Femurnagelung bietet Vorzuge gegenuber dem orthograden Vorgehen und erweitert die Palette der Behandlungsmethoden.

Purpose of the Study: Is the Matti-Russe procedure with postoperative cast immobilisation of 12 weeks in particular still justified, especially under the aspect of new operation procedures with shorter or without cast immobilisation? Material and Method: 241 patients with 283 nonunions of the scaphoid were treated from 1.1.77 up to 31.12.94, 166 of these patients received Matti-Russe procedure. 112 patients could be re-examined after an average follow-up of 32.6 months (6 months until 6.7 years). The analysis was performed according to the evaluation pattern from Meine, Buck-Gramcko and Nigst. Results: A bony union was achieved in 91 of 112 patients (81.2 %), in 11 cases after the second operation, so that altogether 102 of the 112 patients (91.1 %) were treated successfully. The nonunions localised in the middle part showed a favorable healing rate of 93.7% compared to 87.5 % bony unions in the distal and 87.5% in the proximal part. A period of persisting pseudarthrosis longer than 2 years was prognostically more unfavorable. A complete healing could be achieved in 86.9% compared to 93.5% in patients with a period shorter than 2 years. In patients older than 40 years, 90% bony union could be achieved, in contrast to 96.1% in patients younger than 20 years. The best fusion rates were seen in pseudarthrosis in the middle part with a transverse course. We observed a praeoperative existing heavy wrist arthrosis in 4 patients, of whom none obtained bony union. Conclusion: The Matti-Russe operation is still indicated in nonunions in the middle part of scaphoid. Alternative treatment options have no advantages in bony union. The disadvantage of the Matti-Russe graft is the long period of immobilisation.

AIM The purpose of the study was to verify test criteria of the upper-limb DASH questionnaire in patients with Colles' fractures. METHODS 107 of 139 patients with Colles' fractures treated operatively were examined and asked to complete the questionnaire. To establish reliability, the item answers of all questionnaires were analysed by using Cronbach's Alpha correlation coefficient and corrected item total correlation. Construct validity was evaluated by comparing the DASH points with clinical measures according to Gartland/Werley and Castaing (Spearman correlation coefficient). Discriminant validity was assessed by comparing the DASH points of patients with AO-type A/B fractures and AO-type C fractures (Mann-Whitney U-Test). RESULTS 2.7 percent of all questionnaires were unusuable. The time to fill out the questionnaire was on average 12 minutes. Cronbach's alpha values were high in all scales (alpha > 0.8). No items were found unsuitable (corrected item total correlation > 0.5 in 28 of 30 questions). DASH scores were correlated with ROM deficits and clinical measures of wrist function (r = 0.53; r = 0.59; r = 0.52, p < 0.01). The questionnaire could discriminate patients with different fracture types (p < 0.05). CONCLUSIONS DASH is a workable, reliable and valid instrument for patients with Colles' fractures.

Fragestellung. Radiuskopfchentrummerfrakturen stellen ein therapeutisches Problem dar. Sowohl die Resektion als auch die Swanson-Prothese haben aufgrund von Spatfolgen nicht uberzeugen konnen.

Objective Assessment of quality of life after foot injuries. Methods All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05). Results 110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries. Conclusions Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.

The incidence of lesions of the radial nerve associated with humerus shaft fractures varies in the literature between 1.8% and 20%. A revision of the nerve is discussed controversly. At present there are two accepted methods of treatment: - conservative therapy and waiting for spontaneous regression of the lesion of the nerve, - primary revision of the radial nerve. A primary paralysis of the radial nerve is an absolute indication for an operative therapy. We will establish this by the intraoperative findings of 48 patients of our department with surgical revisions of the radial nerve. Material, methods and results: At our former department (Department of traumatology, University of Munster), 174 patients with operatively treated humerus shaft fractures (1974-1990) were evaluated. The rate of primary paralysis of the radial nerve was 27% (n = 47). 39 of these patients were treatet by an surgical revision (31 primary revisions and 8 secondary revisions). Intraoperative we found five complete ruptures and two nerves interposed between fragments. In 17 cases the nerve was extremely contused, in 15 cases the nerve was macroscopically intact. At our department (Department of traumatology, University of Magdeburg) we treated 49 patients operatively between June 1995 and November 1997. The rate of nerval lesions of these patients was 18.4% (9 patients). Intraoperative we found one complete rupture of the nerve, eight extremely contused nerves. Conclusion: In consideration of our results from the departments of traumatology in Magdeburg and Munster we believe, that a humerus shaft fracture with paralysis of the radial nerve is an absolute indication for a surgical revision.

Zusammenfassung Die Ruptur des ulnaren Kollateralbands am Daumengrundgelenk („Skidaumen“) entsteht durch forcierte Radialadduktion, Rotation und Hyperextension bzw. Flektion des Daumens. Die Diagnose wird durch klinische Untersuchung sowie gehaltene Rontgenaufnahmen gestellt. Die operative Behandlung der frischen Verletzung ist dann angezeigt, wenn eine Aufklappbarkeit > 30° in Beugestellung oder > 20° im Seitenvergleich bestehen. Beim Vorliegen einer „Stener-Lasion“ ist die Operation das Therapieverfahren der Wahl. Eine verfeinerte apparative Diagnostik (MRT, Sonografie) versucht, die „Stener-Lasion“ nachzuweisen, um nur die davon betroffenen Patienten der Operation zuzufuhren.

Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.

Objective. The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. Design. In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). Background. Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. Methods. Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. Results. The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. Conclusions. No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Polyglycolic test cylinders (PGA) of different sizes and with a different amount of Ciprofloxacin were synthezised and tested in vitro. The monofil 3,2×5 mm sized cylinders containing 3 mg of Ciprofloxacin showed the best release of the antibiotic up to half a year (measured by HPLC). In vivo setting: in the right femur of 66 rabbits osteomyelitis was induced by injection of 3×10(6) cfu of staph, aureus after the bone marrow had been sclerosed with sodium morrhuate 5%. Two weeks later test cylinders were implanted into the femoral shaft of 30 animals. Thirty-six animals served as controls. Criteria evaluated: weight change, laboratory findings, microbiological, radiological and histopathological parameters. The concentration of Ciprofloxacin was measured in serum, urine and wound secretion by HPLC. All animals developed osteomyelitis. Swabs from the marrow of all treated animals were sterile. The histopathological findings in the control group showed the mild or strong chronic-persistent form of osteomyelitis. In the therapy group even after 2 weeks we mainly found the the chronic-fibrous form. The test-cylinders were well tolerated in the marrow. Levels of the drug were measured in serum, urine and wound secretion.

The implantation of antibiotic-containing cement beads became standard adjuvant local antibiotic therapy of chronic osteomyelitis. The new developed bioabsorbable drug carrier system of polyglycolic acid with the antibiotic Ciprofloxacin was tested in vitro and in vivo. The goal of this study was to determinate the penetration depth of Ciprofloxacin into bone cortex and marrow. Two monofil, PGA cylinders, 3.2 x 5 mm in size, containing 3 mg of Ciprofloxacin each, were implanted into the proximal part of both femora of 18 rabbits (New Zealand white). After sacrifice, the concentration of Ciprofloxacin in micrograms/g cortex and marrow was measured with high-performance liquid chromatography in relation to the distance from the test material at day 2, as well as at 1, 2, 3, 4, and 6 weeks postimplantation. For a distance up to 5 mm, marrow levels of the drug exceeded cortical levels at day 2 (5000 to 240 micrograms/g). At a distance of 5-10 mm, cortex levels were similar to marrow levels after 2 weeks and were higher than marrow levels at week 3. This observation could be made at a distance between 10 and 15 mm only after 2 days. Later, marrow concentrations again exceeded that in cortex. At a distance of more than 15 mm, antibiotic levels were low and approximated. After 6 weeks, at 5 mm distance, a bactericidal drug concentration of about 2 micrograms/g in bone marrow could be measured. Drug penetration into cortical bone in bactericidal concentrations of about 2 micrograms/g was achieved at up to 30 mm in the first few days.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteopenia (OP) or osteoporosis (OST) was diagnosed by bone densitometry (DXA) in postmenopausal women free of known skeletal disorders and without acute fracture. DVO guidelines were applied to define therapeutic indication.The study included 94 women aged 59-81 years. Fracture or operation ≤12 months, malignant tumor, ovariectomy, and drugs such as cortisone, strontium, fluorides, bisphosphonates, SERMs, estrogens, and steroids were exclusion criteria. The lowest T-score at the spine, femoral neck, or total hip was decisive. The indication for therapy was determined by evaluating age, BMD, and other risk factors.Using the WHO criteria 22.3% (n=21) had normal BMD, 52.1% (n=49) had OP, and 25.6% (n=24) had OST. According to "Dachverband Osteologie" (DVO) guidelines, 28 women (29.8%) of the whole group needed therapy. Of the 28 women receiving therapy, 9 had OP and 19 had OST. Therapy was indicated in 18.4% for OP and 79.2% for OST.A preventive measurement of BMD with DXA provides a benefit for postmenopausal women. Combinatory assessment and consideration of other risk factors allows identification of women who might benefit from early treatment.

With regard to the treatment of non-reconstructable radial head fractures, both the resection and the implantation of a prosthesis are considered. Various studies have shown poor results concerning the resection of the radial head with accompanying osteoligamentous injuries. Due to these experiences, different types of prosthesis have been developed. However, the majority of them were not convincing. Judet developed a type of a bipolar prosthesis which had been modeled on the anatomy of the radial head. The aim of our retrospective study consists in examining the results of the Judet prosthesis.Between 1995 and 2007, 50 patients were treated with an arthroplasty. These were, corresponding to the classification by McKee and Jupiter, 19 type III and 31 type IV fractures. Thirty patients were available for a follow-up after 2.5 years on average.According to the Morrey Score, 16 very good, 7 good, 3 fair and 4 bad results could be obtained. Following the criteria of Radin and Riseborough, 17 patients achieved a good, 9 a fair and 4 a bad result. The complications which appeared were: one patient with aseptic loosening, one patient with luxation of a prosthesis, one persistent radial joint instability, three patients with heterotopic ossification and four patients with protrusion relative to the capitulum humeri.

There are well-defined criteria for the treatment of distal radius fractures but the impact of an unrepaired fracture of the styloid process of the ulnar on recovery after operative treatment is uncertain. This study evaluated radiological and functional results after different operative treatment procedures of distal radius fractures in patients with an untreated fracture of the styloid process of the ulna and those without such a fracture.Out of 480 patients with operatively treated distal radius fractures 238 were examined at least 1 year after injury. The fracture of the styloid process of the ulna was not repaired. Three groups (patients without a fracture of the styloid process of the ulna, patients with a tip fracture and those with a basal fracture) were evaluated by multivariate analysis (MANOVA) in order to detect influences of the fracture of the styloid process of the ulna on the radiological and functional results.Neither the existence nor the location of the fracture of the styloid process of the ulna had a significant effect on the radiological and functional results (p(function)=0,849, p(radiology)=0,330, p(scores)=0,426, MANOVA).The repair of a fracture of the styloid process of the ulna is not necessary if reduction and fixation of the distal radius fracture is anatomical and stable.

The scaphocapitate fracture syndrome as a greater arc injury is a special form of the perilunate fracture dislocation. It is a combination of fractures of the scaphoid and capitate bones. This severe injury of the carpus is rare and therefore difficult to diagnose. We report the case of a 22-year-old handball player, who fell on the outstretched hand with the wrist in extension. Open reduction was performed via a dorsal approach and both fractures were treated operatively with Herbert screws. After three months the patient was able to play handball again with a good functional result.

In 2002 and 2005, two surveys were conducted in poor areas of North and Northeast Brazil to evaluate prenatal care received by mothers of children under five years old. The study covered 1,528 and 1,529 children in 2002 and 2005, respectively. In this three-year period, maternal schooling and monthly family income increased by 1.5 years and US$ 50.00, respectively, availability of safe drinking water increased from 23% to 41%, the proportion of pregnant woman with six or more prenatal visits increased from 42% to 52%, and immunization against neonatal tetanus increased from 54% to 77%. Coverage of uterine height evaluation increased from 54% to 77%. Testing for HIV and syphilis virtually doubled, from 8% to 16%. Meanwhile, gynecological examinations dropped from 41% to 31% and counseling for breastfeeding decreased from 66% to 55%. Despite improvements, the study's results show that the target indicators in these areas fall short of those in more developed regions of Brazil. Efforts should be made to reduce this gap.

Revision of cemented hip arthroplasty after periprosthetic fractures of the femur is a demanding procedure. Many different technical devices have been developed for this purpose. This paper presents a new surgical technique of cement removal avoiding excessive exposure of the fracture site.In six patients with periprosthetic fractures of the femur following hip arthroplasty (Johansson Type II and III) cement removal was performed by means of advancing a retrograde nail through the intercondylar notch of the knee.In all cases the cement was removed completely. Intraoperative complications or significant knee problems were not observed.The intracondylar approach provides a simple, rapid and less invasive technique for cement removal in revision hip arthroplasty.

Due to the systemic character of Type 2 diabetes, cellular disturbances paralleled by an altered expression of various growth factors constitute the basis for impaired wound healing. Cell-surface antigens are altered in chronic wounds and may also have an effect on the persistance of diabetic foot lesions.We investigated blood samples of diabetic patients with diabetic foot ulcers (n=21) in comparison with those from healthy control patients subsequent to an injury (n=9). A blood sample (EDTA) was taken from each participant (in the trauma control group on the third day after injury) and examined by flow cytometry [fluorescence-activated cell sorter (FACS)]. Typical cell surface antigens involved in wound healing were studied [cluster of differentiation (CD)2, CD3, CD4, CD25 and human leukocyte antigen (HLA)-diabetic retinopathy (DR)].known to adversely affect wound healing were elevated in diabetic patients (CD2 p0.001; CD3 p=0.016, CD4 p=0.22, CD25 p0.001). HLA-DR expression was also decreased in diabetic foot patients (p=0.023).Cell-surface antigens appear to be altered in diabetic patients when compared to healthy controls. Thus, due to the systemic character of Type 2 diabetes, cellular disturbances may well constitute the basis for impaired wound healing in diabetes.

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the chi2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

The purpose of the study was the assessment of the limitations of health related quality of life after open reduction and internal fixation (ORIF) of calcaneal fractures and the comparison of these results with those of normal foot-scores. The quality of life of 55 patients with calcaneal fractures treated by ORIF was compared 2.9 years after injury with that of 55 people from the standardised German population of the German-Health-Survey 1998 using the Short Form 36 (SF-36) (Wilcoxon test). The results of SF-36 of patients were correlated with results of the calcaneus score according to Zwipp and AOFAS Ankle Hindfoot Scale (Spearman's correlation coefficient). Health related quality of life showed significant limitations in patients with calcaneal fractures in 9 of 10 scales of the SF-36. Correlations between SF-36 and foot-scores were strong in the function and pain scale and moderate in all other scales. The quality of life of shows significant limitations after calcaneal fractures. Usual foot-scores measure only the function and pain dimension of the outcome. To measure all dimensions, application of the SF-36 can be recommended. International comparisons of results and comparison with a standardised German population is possible.

Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept.From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery.No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1).Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.

Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach?In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach.We were able to re-examine 50 patients (57 fractures) 13,3 (3-36) months after the operation. Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient. Two patients had a femoral shortening of up to one centimeter. We observed no rotational malalignment of more than 5 degrees. The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopic follow-up inspection of the knee joint. No knee pathology due to nailing was found in either case.Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.

Communitive fractures of the radial head are a therapeutic challenge when fixation is not possible. Secondary sequelae including ulnar valgus, ascension of the radius, osteoporosis of the humeral condyle and biomechanical impairment of the elbow cannot be avoided with resection or the Swanson prosthesis. The Judet prosthesis, with its floating cup, is a technically attractive solution, but the question is whether it can avoid the secondary effects observed with resection or the Swanson prosthesis.We have used the Judet prosthesis since August 1995 in 16 patients. These patients had Mason type IV (Johnston modification) lesions of the radial head in 14 cases and type III lesions in 2. Associated injuries included: Monteggia fracture in 2, open fracture-dislocation in 1, fracture of the radial neck associated with fracture of the lower radius in 1, and dislocation of the elbow in 2. Preoperatively, 7 of the 16 patients had an osteocartilaginous injury of the humeral condyle. The Judet prosthesis was implanted after resection in 3 patients, after osteosynthesis of the radial head in 3 others, and as the first line treatment in 10. Postoperatively, 13 of the 16 patients were given a unique 7 Gy radiation to prevent ossification as well as nonsteroidal antiinflammatory drugs (indometazin 50 mg b.i.d.) for 3 weeks. None of the patients were immobilized.Mean follow-up for the 16 patients was 19 months (12-45). Deficient extension persisted in 5 patients (mean 5 degrees ). Average flexion was 128 degrees; two patients were limited to 100 degrees. Average pronation was 77 degrees, and average supination 79 degrees. Muscle force was 10% weaker than the healthy side. Sagittal and frontal stability in valgus was preserved in 14 patients. Two patients had a frontal instability with minimal valgus related to a minor insufficiency of the medial collateral ligament. According to the Radin and Riseborough classification, outcome was good in 7, fair in 6 and poor in 3. According to the Morrey classification, outcome was excellent in 2, good in 12, fair in 1 and poor in 1. Radiologically, there were no cases with ulnar valgus, humeral condyle osteoporosis, ascension of the radius, or subluxation of the distal radioulnar joint. The prosthesis loosened in one case without clinical expression.Our results with the Judet prosthesis were much better than those reported in the literature for resection and Swanson prosthesis.

Comminuted fractures of the radial head represent a particular therapeutic problem. Due to characteristic complications the resection as well as the implantation of the Swanson-prothesis could not convince.We applied the radial head prothesis of Judet in 16 cases (14 type IV and 4 type III by Mason).At the moment we survey the follow up of 15 patients after 12 to 45 months (average 18.2), the evaluation was performed using the score of Radin and Riseborough and the score of Morrey. With the score of Radin and Riseborough we found in 7 cases good, in 6 case fair and in 2 case poor results. With the score of Morrey we found 2 excellent, 11 good and 1 fair and poor results. The radiological examination did not show an increase of the carrying angle of the elbow, an osteoporosis, a proximal migration of the radius and a distal radio-ulnar dissociation.Compared with resection or Swanson-prothesis the bipolar prothesis of Judet has definite advantages.

Assessment of quality of life after foot injuries.All patients with foot injuries treated operatively from July 1995 to December 1999 were asked to complete the SF-36 health survey. Values of four subgroups (male with foot injuries without any other injury, multiple injured male with foot injuries, male without any other injury and both calcaneus fractures or other injuries) were compared with the standardized German population (Mann-Whitney-U-Test, alpha = 0.05).110 of 201 patients completed the questionnaire (follow-up 54.7 %). Values of most of the subscales showed significant differences in comparison with the standardized population for three of four groups. Men with calcaneus fractures revealed the highest disabilities especially for the pain subscale. Quality of life in multiple injured patients is dominantly influenced by foot injuries.Foot injuries cause a strong limitation of quality of life. The SF-36 health survey provides a very suitable outcome measurement for foot injuries.

Beantwortung der Frage, ob operativ versorgte Calcaneusfrakturen mit einer Einschrankung der gesundheitsbezogenen Lebensqualitat einhergehen und ob diese durch herkommliche Mesinstrumente erfast wird. Methode: Nachuntersuchung operativ versorgter Calcaneusfrakturen (Zwipp-Score, AOFAS Ankle-Hindfoot Scale) und Befragung zur gesundheitsbezogenen Lebensqualitat (SF-36). Bildung von matched pairs. Gruppe 1: Patienten mit operierter, einseitiger, intraartikularer Calcaneusfraktur ohne Begleitverletzungen. Gruppe 2: Falle aus der bevolkerungsreprasentativen Normpopulation des SF-36. Matching-Kriterien: Alter, Geschlecht, Erwerbstatigkeit, Berufsgruppe, Nebenerkrankungen. Vergleich der Werte aller Subskalen sowie der korperlichen und psychischen Summenskala des SF-36 beider Gruppen (Wilcoxon-Test, p < 0,05). Korrelationsanalyse zwischen den Werten dieser Skalen der Gruppe 1 mit denen der herkommlichen Instrumente (Spearman-Korrelationskoeffizient). Ergebnisse: 40 Falle wurden jeder Gruppe zugeordnet. Vollige Strukturgleichheit wurde fur die ersten 4 Matching-Kriterien erreicht, fur die Nebenerkrankungen wurde partielle Strukturgleichheit erzielt. Die Werte samtlicher Skalen des SF-36 lagen in Gruppe 1 deutlich unter denen der Kontrollgruppe. Die Unterschiede waren signifikant (p < 0,01) in 9 der 10 Skalen. Nicht signifikant (p = 0,063) war der Unterschied in der psychischen Summenskala. Samtliche Skalen korrelierten schwach positiv mit den Werten des Zwipp-Scores und der Ankle-Hindfoot Scale. Die starksten Korrelationen wurden jeweils mit den Skalen korperliche Funktionsfahigkeit (Zwipp r = 0,486; AOFAS r = 0,516), korperliche Schmerzen (r = 0,453 bzw. r = 0,451) und der Korperliche Summenskala (r = 0,477 bzw. r = 0,519) erreicht. Schlusfolgerungen: Calcaneusfrakturen gehen mit einer deutlichen Beeintrachtigung der gesundheitsbezogenen Lebensqualitat einher. Diese wird durch die gebrauchlichen Mesinstrumente nur partiell erfast. Der SF-36 kann fur die Ergebnisbewertung von Calcaneusfrakturen empfohlen werden.

We analyzed reasons, numbers and results of arterial lesions accompanying fractures (n = 21) and luxations (n = 6) in a 6-year-period (1993-1998) retrospectively. Traffic accidents were in nearly 50% responsible for the injuries. 8 patients had suffered multiple injuries. In 17 patients the lower, and in 10 patients the upper extremities were affected. The vascular wall was completely disrupted or severed in 74%. In 7 cases (26%), patients had suffered blunt or indirect arterial trauma with intima- and media-lacerations due to subcapital fracture of the humerus (n = 2), fractured femoral bone (n = 1), luxation of the knee joint (n = 3) or the elbow (n = 1). The mean preoperative time period was 6 hours and 20 minutes (2 to 16 hours) in patients with complete ischaemia. Vascular reconstruction was performed by interposition of an autologous vein graft or an autologous venous bypass (n = 20), by direct reconstruction and primary suturing (n = 2), by use of a venous patch plasty (n = 2) and, in a single case, by autologous bypass procedure. In one case, a crural artery was ligated, in another case with a Mangled Extremity Severity Score (MESS) of 7 points a primary amputation of the lower leg was necessary. In 5 patients (19%) secondary amputations were performed. No patient died. The final outcome is mostly influenced by the preoperative period of ischaemia.

Despite considerable knowledge about the effects of shock waves on eukaryotic soft tissues, no data are available concerning their effect on prokaryotic micro-organisms. In vitro studies on the bactericidal effect of extracorporeal shock waves on staphylococci were performed with energy levels that are standard for the disintegration of calculi. Suspensions containing 10(4)-10(5) cfu of Staphylococcus aureus/ml were sealed in plastic tubes and exposed to shock waves, resulting in a mean decrease of 3.1 log(10). Whereas impulse rates ofor =350 resulted in a decrease of cfu/ml equalling the detection limit, lower numbers of impulses did not result in an appreciable bactericidal effect. The bactericidal effect of extracorporeal shock waves might provide the basis for the development of novel therapeutic strategies for bacterial infections.

In the late 1970s it was generally accepted that the patient with multiple injuries was too ill to undergo surgical stabilization of a long bone fracture in the period prior to admission to the Intensive Care Unit. Priority in the resuscitation phase was given almost exclusively to ensuring that respiratory and cardiovascular function was restored and maintained, by intubation and fluid replacement. An exception to this rule was the emergency treatment of uncontrollable massive bleeding from large vessels in the extremities, which if ignored, would render useless any concomitant treatment for shock.

Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.

In this paper we present the unusual case of a fistula after implantation of a total hip prosthesis. In a 75-year old woman with a fracture of the thigh bone, we observed a paraproctic fistula 42 months after implantation of a total hip prosthesis. To our knowledge there have been no such cases reported with this complication. Thus, we wound like to demonstrate the progress of the illness, the first symptoms, and the kind and success of the treatment.

Between 1976 and 1993 we have operated 253 patients with 350 fractures of the radius-and/or ulna. 180 fractures were stabilized with a plate (ASIF) or external fixation. In 100 patients with 170 fractures Hackethal's bundle nailing was performed, including 23 times nailing of one bone and external fixation or plating of the other bone. Our indications for Hackethal's bundle nailing of forearm fractures are closed and 1 degree open A and B-fractures of the 2. to 5. sixth of the radius and/or the ulna. 83 of 100 patients, stabilized with bundle nailing, were followed up clinically and radiologically after a mean of 6.8 years. For evaluating follow-up results, the score by Oestern and Tscherne was employed. Very good and good results were found in 74.7%, satisfying and poor results in 25.2% of the cases. Injuries of the same extremity, e.g. fractures of the humerus, arterial- or nerve lesions interfered with the results. We found a low complication rate after bundle nailing: 1 osteomyelitis (0.59%), 3 non-unions (1.76%), 1 refracture (0.59%), 5 synostoses (4.12%, incl. 2 patients (1.18%) with a combination of bundle nailing and plate osteosynthesis or external fixation). In the mentioned indications the stabilization of forearm fractures by Hackethal's bundle nailing is a low-risk method with fast bone healing and short operation time.