[Secondary forearm deformity due to premature closure of the distal ulnar physis]. / Posttraumatische Deformität am distalen Unterarm nach vorzeitigem Verschluss der ulnaren Wachstumsfuge.

We report on a 16-year-old boy with deformity of the forearm with painful functional limitation after a fracture of the distal radius associated with an unapparent lesion of the distal physis of the ulna suffered 4 years earlier. The lesion caused premature growth arrest in the ulna and a bowing of the distal radius with a carpal slip. It was treated with a corrective osteotomy in the radius together with a lengthening of the ulna, with excellent functional results.

[Risk profiling of postoperative complications in 17,644 total knee replacements]. / Identifizierung von Risikofaktoren postoperativer Komplikationen in der primären Knieendoprothetik.

AIM: Postoperative complications following primary total knee replacement performed between 2000 and 2002 were assessed to determine perioperative patient- and procedure-related risks associated with the procedure. METHODS: For this analysis, the data collected during postoperative hospitalization for 17,644 total knee arthroplasties were assessed. The analysis included two steps. First, using logistic regression, we identified and quantified significant risk factors for the occurrence of general postoperative complications. Second, univariate analysis was utilized to qualitatively and quantitatively analyze the influence of these significant risk factors on the occurrence of major complications (hematoma, cardiovascular complication, deep venous thrombosis, pulmonary embolism, joint infection, and pneumonia). RESULTS: General postoperative complications were reported in 11.3%. Major postoperative complications occurred in 7.2% with hematoma in 2.9%, cardiovascular complications in 1.8%, deep venous thrombosis in 1.2%, pulmonary embolism in 0.2%, joint infection in 0.8%, and pneumonia in 0.3%. Patient-related risk factors such as age, surgery time, gender, high ASA classification as well as procedure-related risk factors such as allogeneic blood transfusions and lateral release significantly increased the rate of postoperative complications. Males were more prone to hematoma, joint infection, and pneumonia in the immediate postoperative course than females, who were more in danger of developing deep venous thrombosis. Allogeneic blood transfusions increased the risk for postoperative hematoma, infection, and cardiovascular complication. Regional anesthesia was shown to decrease the risk for the occurrence of postoperative deep venous thrombosis and pulmonary embolism. CONCLUSIONS: Postoperative complications in total knee replacement are increased in males and elder patients. Increased time of surgery and allogeneic blood transfusions also represent important risk factors for postoperative complications following primary total knee replacement.

[Metal removal after osteosyntheses. Indications and risks]. / Die Metallentfernung nach Osteosynthesen. Indikationen und Risiken.

This paper presents guidelines for indications, risks, and technical aspects of removal of metal works. The indications comprise the general condition of patient, age, location of the implant, risks and disadvantages of the procedure. Problems concerning removal of metal are for example: lesions to nerves and re-fracture. Problems concerning maintaining the implant are for example: a compromise concerning necessary diagnostic procedures and late infections. In order to aid the decision making process two distinct groups of indications were applied. First, the definite indications, as for example disturbing implants as well as implants in the growing individual. Second, debatable indications, as for example removing screws from the femoral head, or implant-tissue-interactions. The issue of obtaining the consent of a patient to an operation, often not an operation for novice, may not be neglected. Lesions to nerves are amongst the most common complications. The technical guidelines refer to the specific locations and to the problem of broken intramedullary nails.

[Surgical treatment of femoral neck pseudarthrosis associated with delayed union of ipsilateral femoral shaft fracture]. / Operative Behandlung einer Schenkelhalspseudarthrose bei verzögerter Heilung einer ipsilateralen Femurschaftfraktur.

A femoral neck fracture combined with an ipsilateral shaft fracture is often primarily not diagnosed. The later treatment is technically more difficult, because in the choice of operative technique for the shaft fracture the neck fracture it was not considered. In this case report the treatment of the shaft fracture with a reamed nail, and the secondary stabilisation of the femoral neck fracture with screws resulted in a pseudarthrosis of the femoral neck with an unfavourable inclination of the fracture plane. Both fractures healed without complications after changing the nail against a bridging plate and an intertrochanteric osteotomy with correction in two planes.

[Patellar metastasis of colon carcinoma. A rarity in differential diagnosis of acute knee pain. Case report]. / Patellametastase eines Kolonkarzinoms. Eine Rarität in der Differenzialdiagnose des akuten Knieschmerzes--Fallbericht.

Although bone tumors are often located in the knee area, primary tumors of the patella are rare, and patellar metastases extremely rare. Only a few cases were reported in the literature originating from different primary tumors, mostly lung and breast [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 18, 19, 20, 22]. There is only one other case description of a colon carcinoma [21]. We present a rare case of primary sigma carcinoma and patellar metastasis. Because of the increasing rate of colon carcinomas, neoplastic disease must be considered in the differential diagnosis in any patient with otherwise unexplained knee pain.

[Value of sonography of the anterior cruciate ligament in post-traumatic hemarthrosis]. / Die Aussagekraft der Sonographie des vorderen Kreuzbandes beim posttraumatischen Hämarthros.

Periosteal avulsions of the femoral insertion of the anterior cruciate ligament (ACL) should be treated by reinsertion within 2 weeks of the injury. Due to painful muscular hypertension, the clinical examination of ligament stability incorrectly revealed negative results in 12-62% posttraumatically. The only sufficiently sensitive indication of ACL rupture is posttraumatic hemarthrosis. Therefore, early arthroscopy of any posttraumatic hemarthrotic knee joint is required to exclude or confirm ACL rupture. Up to 30% of such procedures are carried out with no clinical consequences. We therefore set out to test the value of sonography of the ACL in hemarthrosis of the injured knee joint. A total of 117 posttraumatic hemarthrotic knee joints were subjected to ultrasound examination prior to arthroscopic evaluation. With a 5 MHz linear scanner, the femoral insertion of the ACL at the femoral condyle is represented in the same projection of injured and noninjured knee joints. In noninjured knee joints the hypoechoic insertion of the ACL lies directly on the S-shaped line of the lateral femoral condyle. The space between the condyles is hyperechoic. In case of a femoral ACL avulsion the insertion of the ACL and the hyperechoic structures between the condyles are forced aside by a hypoechoic area. Of 51 arthroscopically demonstrated complete ruptures of the ACL, 49 were detected by sonography. In 16 cases sonography suggested ACL rupture, but this could not be confirmed by arthroscopy, though 8 of these cases showed evidence of ACL strain without any lost of stability of the knee joint. For sonography we found a sensitivity of 96.1% and a fairly good specificity of 75.2%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arthroscopy following pediatric injuries of the knee joint--a helpful or superfluous diagnostic procedure?]. / Die Arthroskopie nach kindlichen Kniegelenkverletzungen--ein hilfreiches oder überflüssiges diagnostisches Verfahren?

Between 1983 and 1987, 1082 arthroscopies were carried out on the knee joint. This included 48 cases of children between the age of seven and fifteen with knee injuries. In 21 cases the clinical diagnosis was confirmed. In 5 cases the clinically indications for an operation could not be confirmed. In 9 cases of arthroscopy, it was demonstrated that an operation was necessary, although this was not clinically diagnosed. Finally in 15 cases, specific conservative therapy could be planned on the basis of the medical evidence. From 35 cases of haemarthrosis, 27 proved to have injuries requiring therapy, 12 of which were not obvious during clinical examination. The results underline advantages of arthroscopy for childhood knee joint injuries, in allowing a definite diagnosis and varying therapeutic measures.

Autogenous fibula grafting of a radial defect complicating acute hematogenous osteomyelitis in a child.

The emphasis of this case report is on the management of a radial defect after diaphysectomy complicating acute hematogenous osteomyelitis in a 15-month-old girl. An autogenous fibular graft was used to replace the defect of the radius. It was wedged between the proximal and distal radial fragment and fixed in position by two miniplates. After 6 weeks the fibula had incorporated. The graft fractured, unfortunately, through a drill-hole created for neovascularization, requiring further interventions until complete cure occurred. A re-examination 2 years after grafting revealed a good functional result. Radiographically, the radius was completely remodeled. We consider the autogenous fibular graft to be especially suitable for replacing the radius for the following reasons: it is firm enough for bridging, it has a corresponding caliber, and it can be obtained with adequate length. Within a few weeks the fibular defect refills with new bone formation, provided that the periosteum has been tightly sutured. No interference with ankle growth was observed.

Morphologic aspects of bone healing after third-degree open fractures. An experimental study.

The morphologic aspects of undisturbed and disturbed bone healing following third-degree open fractures is demonstrated by means of experimental investigations using animals. As an experimental model we used a canine thigh fractured by a shot. The data was obtained as part of bioballistic investigations of the effect of highvelocity bullets in living tubular bones. The shot fracture was immobilized by external fixation. Progressive radiological controls, as well as microangiographic, microradiographic and histological findings are used to show bone healing. Bone healing following shot fractures follows the basic pattern of secondary bone healing, which is manifested in an X-ray by the formation of periosteal callus. The periosteal callus tissue has its own vascular system and receives blood from the extraosseous vessels of the adjacent soft tissue surrounding it. It not only fulfills the function of the biological stabilizer of the fragments, but also contributes decisively to their revascularization through transcortical anastomosis. The morphologic appearance and the causes for the disruption of bone healing are demonstrated using individual examples. Predominant are insufficient stability and above all circulatory disturbances. In the case of fractures with considerable soft-tissue damage, not only is the intramedullary vascular system destroyed, but the blood supply to the periosteal vessels is also disrupted. The resulting delay to or absence of callus formation leads on the one hand to insufficient biological stabilization, and on the other hand to an impairment of fragment revascularization. The morphologic appearance is dominated by the fragment necroses and related complications, such as pseudarthrosis induced by bone necrosis and infected pseudarthrosis.

[Corrective measures following imperfectly healed fractures]. / Korrektureingriffe nach fehlverheilten Frakturen.

An overview of forms and localization of falsely healed fractures and possibilities for their correction is presented. In contrast to statically loaded lower limbs, posttraumatic arthrosis due to false position of the upper limbs is less common. In these cases indication for corrective osteotomy is aimed above all at improving the limb function. Central restorative measures are corrective osteotomy following falsely healed supracondylar humerus fractures in childhood and open wedge osteotomy of distal radius fractures. Even minimal axial deviations in the lower limbs will lead to false loading of joint surfaces and to early arthrosis, thus corrective osteotomy is indicated at a much earlier stage.