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Ten patients aged 55-85 years with a tibial head fracture AO B3 or C3 were treated primarily by implantation of an endoprosthesis. There were one unilateral, three superficial, and six revision-type prostheses. Follow-up was 6 months to 3 years; two patients were lost to follow-up. There were no intra- or postoperative complications except one deep infection which could be cured by repeated arthroscopic lavage. At last follow-up all eight patients were completely or almost pain free; the extension deficit was less than 10 degrees , and flexion was 100 degrees or more. Primary endoprosthetic replacement of the knee joint is a valuable procedure for the treatment of complex tibial head fractures in elderly patients.

The increasing rate of hip fractures is giving rise to a number of socioeconomic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures. Dislocation and aseptic loosening are the major reasons for revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after total hip arthroplasty, resulting in severely impaired function, pain, and a reduced range of hip motion. In an open study, 37 women who had undergone cementless total hip arthroplasty after accidental hip fractures were treated twice daily with 200 IU salmon calcitonin nasal spray for 12 months. Simultaneously, the patients received one bag of 1000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless total hip arthroplasty were treated with only one bag of 1000 mg calcium plus 880 IU vitamin D daily through the treatment period. The results of this 12-month clinical trial show that 200 IU salmon calcitonin nasal spray per day promotes general independence from foreign assistance, mobility, and fear of further falls in postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray reduces bone turnover serum markers, loss of further bone density, and pain. Additionally, calcitonin promoted the repair of hip fractures and, as a coincidence finding, was associated with a significantly reduced rate of refractures as well as periprosthetic ossifications.

To analyze the characteristics of hemodynamic parameters and cerebral dynamics, the courses of intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP) and PaCO2 were analyzed retrospectively in 29 patients with severe head injury, comparing periods before and after the ventilatory mode was changed from controlled mechanical ventilation to spontaneous breathing with continuous positive airway pressure. Measurements were done before and after changing of the ventilation. Patients were allocated either to group I (n = 22, ICP remained stable: 18 +/- 2 mm Hg in both periods of observation) or group II (n = 7, ICP increased from 25 +/- 3 mm Hg to 33 +/- 4 mm Hg, P < 0.05). While changes of MAP did not reach significant levels in either group, concomitant changes in CCP appeared in group II (67 +/- 2 mm Hg to 60 +/- 2 mm Hg). Based on the observation of relatively high incidence of ICP increases and deterioration of CPP during weaning from ventilator, it is recommended that continuous ICP monitoring should be continued.