[Trendy inline skating sports. Pattern of injuries and groups at risk]. / Trendsportart Inline-Skating. Verletzungsmuster und Risikogruppen.

One hundred and eighty-two patients presented with 200 inline-skating injuries over a 30-month period. Of these, 14% were admitted to hospital, 10% required operative treatment. Fractures (49%), contusions/lacerations (27%) and capsular/ligamentuous injuries (16%) were the most prevalent types of injury. Children had an even higher risk of sustaining fractures (62%). Falling on the extended arm caused 44% of all injuries. Thirteen percent resulted from torque mechanisms of the leg, whereas direct trauma to elbow or knee (5% each) were uncommon injury mechanisms. Injuries of the elbow, forearm, wrist and hand accounted for 55.5% of all cases and 71% of all fractures. Head (13%), knee (9.5%) and ankle (9%) were other regions frequently involved. Protective equipment was often used only for uninjured regions, whereas the injured regions had most often been left unprotected.

[Etiology of cerebral perfusion disorder in patients with severe craniocerebral trauma]. / Ursachen zerebraler Perfusionsstörungen bei Patienten mit schwerem Schädel-Hirn-Trauma.

In 53 patients with severe head injury, a decline of the cerebral perfusion pressure (CPP) was distinguished related to its cause, i.e., by a rise in intracranial pressure (ICP), a decline in the mean arterial pressure (MAP) or both. The mean Glasgow Outcome Scale (GOS) was 1.6 in patients with elevated ICP, 3.8 in those with decreased MAP and 2.7 when impaired CPP was due to both. It is concluded that in cases of decreased CPP, elevated ICP is the main cause of secondary brain injury and poor outcome, independent of the circulatory condition, whereas an isolated decline in the MAP does not show any influence on functional outcome.

[Perioperative antibiotic prophylaxis in hip operations. Penetration into bone, capsule tissue and cartilage exemplified by cefuroxime]. / Perioperative Antibiotikaprophylaxe bei Hüftoperationen. Penetration in Knochen, Kapselgewebe und Knorpel am Beispiel Cefuroxim.

The most serious complication of accident surgery is postoperative osteitis. At the same time, perioperative antibiotic prophylaxis is generally recommended in order to reduce the rate of infection in joint surgery. The criteria for the suitability of a substance as prophylaxis include inter alia the activity spectrum with respect to the expected microorganisms, its retention time in the body and its ability to penetrate the endangered tissue. In the present study, the systemic and local activity levels after a single i.v. dose of 1500 mg cefuroxime was investigated in relation to the time of administration in 30 patients who had to undergo total hip replacement owing to a medial fracture of the neck of the femur. The tissue and serum samples were analyzed by high pressure liquid chromatography (HPLC). The results show that the tissue levels of the intermediary cephalosporin after an i.v. single shot dose are on average still several times higher than the minimum inhibitory concentration (MIC) of the most frequent bacterium. Staphylococcus aureus, as late as 4 hours after application. The optimal time for the administration form selected was immediately prior to the operation and the concentrations measured suggest that several repeat doses of cefuroxime for short-term prophylaxis are not necessary.

[Self-induced injuries--surgical aspects]. / Selbstverletzungen--Chirurgische Aspekte.

So far, psychiatric-psychoanalytic theories have been able to explain the phenomenon "self-injury" only unsatisfactorily. Moreover, the patients do not turn to a psychiatrist in the first place, but to surgeons, dermatologists, gynecologists or general practitioners. This is therefore an interdisciplinary problem. Since general medical knowledge is relatively unhelpful in diagnosing self-inflicted disease and its treatment, these patients often do not receive adequate psychiatric co-management or further care or indeed often get the chance to delegate the act of self-injury to the physician. In view of the sustained tendency for the disorder to chronify, this frequently results in severe, partly irreversible and sometimes iatrogenically co-induced physical impairments. In the final analysis, it also leads to enormous financial burdens for the agencies which bear the costs.

[Rotator cuff rupture. Vascular supply and collagen fiber processes as pathogenetic factors]. / Die Rotatorenmanschettenruptur. Gefässversorgung und Kollagenfaserverläufe als pathogenetische Faktoren.

Light and polarization microscopic appraisal of the pathways of fibers and blood vessels in the region of the rotator cuff shows branches of the suprascapular artery. These initially radiate into the insertion tendon parallel to the muscle fibers. They do not continue there, i.e. the vessel branches have blind endings, or they branch and anastomose with each other. Outliers of the transverse branch of the anterior circumflex artery of the humerus come from lateral (from the direction of the deltoid muscle). They pass from the bony insertion of the supraspinatus tendon into the tendon plate, but only run together with the fibers for a short distance. Consequently, a zone low in vessels or free of vessels can be constantly demonstrated under a magnifying glass in the course of the supraspinatus and to a small extent also of the infraspinatus in the fetus or neonate as well as in the adult in the region of the zone of interweaving of the tendinous muscle outlier with the capsule at length magnification. In the genesis of rotator cuff rupture, the presence of hypovascularity must be considered to be a predisposing factor which is present from birth onwards. It affects the clinical course during the process of aging as the point of least resistance in consequence of arteriosclerosis, collagen degeneration physiological wear and tear friction at the lower surface of the acromion and inflammatory swellings of the subacromial bursa.

[Intracranial pressure monitoring in patients with severe craniocerebral injury]. / Hirndruck-Monitoring bei Patienten mit schwerem Schädel-Hirn-Trauma.

After severe head injury intracranial pressure (ICP) must be measured continuously for management to assess and maintain the cerebral perfusion. Therefore in our hospital epidural transducers are used. To prove the efficiency of this method in a 12-month period the clinical courses of 23 patients with intracranial pressure transducers were analysed retrospectively. Eighteen patients survived, 5 of them without residuals, 13 with residuals and 2 remained in coma. In 14 patients secondary rises of intracranial pressure were observed between days 3 and 6 post injury. The mean ICP value of the survivors revealed 25 mm Hg. whereas the expired showed 60 mm Hg. In 17 patients the measurements were considered as reliable, 6 measurements were not reliable, which included 1 of the 5 patients who died. One transduce was displaced, another one showed a hemorrhage at the drill hole. There was no infection.

Release of daunorubicin from polymethylmethacrylate for the improvement of the local growth control of bone metastasis animal experiments.

Bone metastases are a sign of advanced tumor disease. Surgical therapy is only occasionally curative. Therefore, the therapeutic goals are a limited surgical excision, immediate mobilization, effective stabilization and the avoidance of local recurrence. We investigated the effect of the anthracycline daunorubicin (DNR) in conjunction with polymethylmethacrylate (PMMA) in vitro and in animal experiments for regional control of bone metastases. Previous experiments of local chemotherapy in bone metastases using methotrexate (MTX) were done by Langendorff and Hernigou. In our own experiments we improved the release of daunorubicin from polymethylmethacrylate in vitro and in vivo up to 90% by adding mannitol. In in vivo experiments we investigated the combination of DNR and PMMA in athymic nude mice and Wistar rats. Cells from human breast cancer, bronchial carcinoma, nephroma, and soft tissue sarcoma were subcutaneously implanted bilaterally under the dorsal skin of nude mice. After reaching a diameter of 0.5 cm, the tumors were marginally excised, leaving microscopic tumor residuum behind. The tumor cavities were either filled with PMMA or alternatively with DNR-PMMA. The goal was to avoid tumor recurrence in the DNR-PMMA filled resection cavities. The number of recurrences was significantly lower in the DNR-PMMA treated animals, except in the breast cancer group. Additionally we implanted a rat sarcoma intrafemorally into Wistar rats. After 17 days the tumor was marginally excised and the resection cavity was filled with either DNR-PMMA or PMMA alone. The therapeutic goal was to prevent local recurrence. Histological and pharmacological tests concerning toxicity and drug distribution within the body completed the study. We concluded that the addition of daunorubicin to PMMA supplements surgical resection. We were able to reduce the number of, or delay recurrences in our animal models. Systemic side effects could be minimized despite the achievement of high local drug concentrations.

[Pathologic humeral fracture in secondary osteosarcoma of the humerus: a rare complication of osteodystrophia deformans Paget]. / Pathologische Oberarmfraktur beim sekundären Osteosarkom des Humerus: eine seltene Komplikation der Osteodystrophia deformans Paget.

Pathological fracture in histologically proven post-Paget osteosarcoma of the humerus is a rare complication. Due to individual requests as well as age and comorbidity, a course of primary palliative treatment was chosen in the present case. Survival time after diagnosis was 9 months and the patient died of a tumor-independent disease. Even in combined treatment, consisting of surgery and (neo-)adjuvant radio-/chemotherapy, prognosis of osteosarcomas secondary to Paget's disease remains very disappointing. Therefore, in treatment of this highly lethal tumor the patient's individual requests and personal situation often require more consideration than in many other malignancies.

[Measuring epidural intracranial pressure in patients with severe craniocerebral trauma]. / Epidurale Hirndruckmessung bei Patienten mit schwerem Schädel-Hirn-Trauma.

In 30 patients with severe head injury (SHI), intracranial pressure (ICP) was monitored using epidural transducers. In 22 patients, the measurements were reliable, with average values of 19.4 mmHg in the survivors and 64.6 mmHg in those who died. It is concluded that epidural measurement of ICP provides a helpful method for the management of SHI and to control the indication for CT scans.

[Violence against the elderly from the trauma surgery viewpoint]. / Gewalt gegen alte Menschen aus unfallchirurgischer Sicht.

Violent attacks on people are becoming of ever greater importance in accident surgery emergency treatment. Especially in the international literature, much attention is paid to intentional injuries inflicted on children, handicapped people, helpless and elderly people. The present study will focus on the diagnosis and risk factors as well as the consequences of physical abuse and neglect of the elderly. In particular, we should like to draw attention to possible injury patterns which should not be missed during thorough examination in the emergency admission department. In view of the possibly large number of unreported cases, we deliberately dispensed with statistical analysis of our patients treated as emergencies in order not to make light of the problem nor to overestimate its significance.

[Detection of the tendon of the musculus plantaris longus--diagnostic imaging and anatomic correlate]. / Nachweis der Sehne des Musculus plantaris longus--bildgebende Diagnostik und anatomisches Korrelat.

Using ultrasound as well as magnetic resonance imaging (MRI) and computed tomography (CT), the plantaris tendon can be identified between the top of the calcaneus and the upper third of the lower leg in cross sections. Due to the surrounding fat tissue, the best proof of plantaris tendon existence and diameter can be obtained on sections at the level of syndesmosis and ankle joint. This allows to avoid unnecessary incisions during plastic and reconstructive surgery using this tendon as an autologeous transplant. For the experienced examiner ultrasound seems to be the easiest way to show plantaris tendon existence; in case of doubt, MRI or CT will give further information.

[Electromyography studies of surgically managed knee ligament ruptures. A retrospective analysis of defined injury patterns]. / Elektromyographische Untersuchungen operativ versorgter Kniebandrupturen. Eine retrospektive Analyse definierter Verletzungsmuster.

In 52 patients (5 groups, average age 32.8 years) with operative treatment of knee ligament injuries cutaneous electromyograms (EMG) under dynamic and isometric conditions (100 N, 200 N, 300 N) were performed in an average of 61.2 weeks postoperatively. The subgroups consisted of 13 patients with operative reconstruction of the anterior cruciate ligament (ACL), 12 after reconstruction of the medial collateral ligament (MCL), 21 after combined ACL and MCL reconstruction and 6 patients with autologous or alloplastic ligament replacement, respectively. The control group consisted of seventeen young adults without a history of knee joint injuries. The intensified and filtered analogous signals of 8 investigated thigh muscles were digitalized and analysed with help of a specially developed computer program. In summary, group specific EMG-criteria reveal distinct ligamentomuscular inhibitory reflexes and, vice versa, EMG activities of thigh muscles may indicate tendencies for group specific criterion after operatively treated knee ligament injuries.

[Surgery of bone metastases in advanced age?]. / Skelettmetastasenchirurgie im hohen Lebensalter?

Twenty-seven patients over 70 years of age (1990-1995, n = 100) achieved a stabilisation of skeletal metastasis; preventive (10), or after pathological fracture (17). Medullary pins were preferred to compound osteosynthesis. In all cases the operation was of a palliative nature, but resulted in considerable relief from pain, facilitated nursing or even improved ability to walk. Thus old age is not an indication against palliative stabilisation of skeletal metastasis.

[Diagnosis and therapy of cruciate ligament injuries in childhood. Clinical results]. / Diagnostik und Therapie von Kreuzbandverletzungen im Kindesalter. Klinische Ergebnisse.

In 19 years 21 children were operated upon anterior or posterior ligament ruptures. Follow-up based on policlinical data and 12 out of 21 patients were tested on follow-up (average follow-up time: 5.5 years). We made notes of the clinical data of an examination with the knee-arthrometer KT-1000 as well as of radiologic and sonographic methods. The subsequent scoring revealed mostly good to very good results. Still, in the long run it would be desirable to perform a prospective multicenter study to obtain statistically relevant data to give advice for ideal surgical treatment of ligamentous knee injuries in children.

[Behavior of artificially-induced epiphyseal groove defects. 3: Transplantation of autologous and homologous rib cartilage in Göttingen minipigs. Findings after a 16 week interval]. / Zum Verhalten künstlich erzeugter Epiphysenfugendefekte. Teil 3: Transplantation von autologem und homologem Rippenknorpel beim Göttinger Miniaturschwein. Befunde nach einem Zeitraum von 16 Wochen.

Drillholes of 8 mm diameter were made through the epiphyseal cartilage of the distal femora in 20 6-week-old Göttingen minipigs. The defects were filled with autologous or with homologous cartilage. This was intended to prevent epi-metaphyseal osseous bridge formation. If of appropriate size and location, the latter would lead to subsequent misgrowth. In group A (autologous costal cartilage), at all drillholes the transplanted costal cartilage can prevent ossification of the defect. An epiphyseal boundary lamella was formed over the transplant which precluded penetration of vessels into the defect. In group B (homologous costal cartilage), the transplanted costal cartilage showed a tendency to mineralization in all preparations at the 20 drillholes available. The cartilage was integrated into the primary cancellous bone developing within the defect. An epiphyseal boundary lamella had not formed in the period of the experiment (in contrast to autogenous transplantation). These investigations show that autologous costal cartilage is superior to homologous costal cartilage in the potential clinical application of costal cartilage transplants in the treatment of Brodie abscesses or post-traumatic epiphyseodeses.

[Experiences with plate osteosynthesis in treatment of peri- and sub-prosthetic femoral fractures]. / Erfahrungen mit der Plattenosteosynthese bei der Behandlung peri- und subprothetischer Femurfrakturen.

Plate-osteosynthesis proves to be an established procedure in our department for treatment of fractures of the femur in patients older than 70 years with total hip replacement even when loosened. It offers the advantages of comparably low aggressive standard operation techniques and acceptable success rates. This treatment allows for short preoperative period of the patients with their typical multimorbidity in many traumatological departments. In younger patients with symptomatical loosening, simultaneous exchange of the hip prosthesis should always be considered. Thus, individual therapy concept including the specific fracture type, general condition and age must be followed for each patient.

[Is there an increased risk of infection in trauma surgery emergency admission for medial personnel by unknown HIV-positive patient status?]. / Besteht in der unfallchirurgischen Notaufnahme ein erhöhtes Infektionsrisiko für das medizinische Personal durch unbekannt HIV-positive Patienten?

In the trauma emergency room 212 patients were asked--according to German law--for a blood sample for HIV-testing. Nine (4.2%) victims rejected the test, another 3 (1,4%) did not meet the study criteria since they were previously known to be HIV-positive or suffering from AIDS disease. None of the finally tested 200 patients was HIV-positive. On an anonymous questionnaire that was handed out additionally, 64% of the patients said they would accept HIV-testing without consent prior to operative treatment. 49% would reject HIV-testing without consent in non-operative treatment.

[Examinations with the KT-1000 knee arthrometer in injuries of the posterior cruciate ligament in comparison with stress roentgen images in the Scheuba positioning device]. / Untersuchungen mit dem KT-1000-Kniearthrometer bei Verletzungen des hinteren Kreuzbandes im Vergleich zu Stressröntgenaufnahmen im Scheuba-Halteapparat.

Eighteen patients with surgically treated ruptures of the posterior cruciate ligament were tested on follow-up 2 to 13 years with KT-1000 Kneearthrometer and radiologically according to Scheuba to objectify the clinical results and to compare the 2 methods. It could be shown that both methods are highly specific and do correspond in 89%. In 11% a borderline difference between a "+" posterior drawer and a "++" posterior drawer in the classification by Hughston et al. [5] was detected. Since the Scheuba test does involve radiation, the KT-1000 Knee-arthrometer testing device represents a safe alternative to objectify a posterior drawer.

Cytotoxicity and mutagenicity of Kevlar: an in vitro evaluation.

Toxicity and mutagenicity of Kevlar 49 (PPPT; poly-para-phenylene-terephthalamide) was tested in six strains of Salmonella typhimurium (Ames test; TA97, TA98, TA100, TA102, TA1535, TA1537) with and without an external metabolic activation system (S9), as well as in a mammalian cell mutagenesis assay using V79 Chinese hamster cells. For the Ames test, liquid preincubation, which is considered particularly sensitive, was used. The cells were incubated for 24 h at a temperature of 37 degrees C either directly with Kevlar49 or with ethanol- or chloroform-extracted Kevlar49. The experiments were performed at least twice. The Ames test with six different Salmonella typhimurium strains featuring either base pair substitution or frameshift mutations revealed no cytotoxic or mutagenic activity of Kevlar49. In the mammalian cell mutagenesis assay, using 8-azaguanine (AG) as a selective agent, Kevlar49 was also devoid of cytotoxic or mutagenic activity. Both tests have to be regarded as an initial exploratory screening due to the chosen testing conditions and should be supplemented by tests at different temperatures.