[A several-week history of inflammatory changes in the right foot and right hand of a 57-year-old male patient]. / Seit mehreren Wochen bestehende entzündliche Veränderungen an rechtem Fuß und rechter Hand bei einem 57-jährigen Patienten.

Metastatic fat necrosis due to inflammatory or neoplastic pancreatic diseases is rare. This phenomenon is attributed to systemic effects of pancreatic enzymes. Depending on the sites of fat necrosis, a number of different diseases may be mimicked, leading to incorrect diagnosis and therapies. Many case reports describe the phenomenon of skin, joint and bone manifestations of fat necrosis under the acronym PPP (pancreatic, panniculits, polyarthritis) syndrome. The management of "autodigestion" primarily consists of treating the underlying pancreatic disease.

[Osteoarthritis of the upper ankle joint]. / Arthrose des oberen Sprunggelenks.

The majority of cases of upper ankle joint (UAJ) osteoarthritis are due to secondary causes. Clinically, osteoarthritis is usually characterized by an increasing limitation in dorsal extension of the UAJ with often relatively mild symptoms. In the course of time the full scale of the typical symptoms and the progressive restriction of the global function of the joint develop. Conservative therapy is often able to provide long-term improvement of the symptoms for the majority of patients by means of intermittent analgesics and orthoses as well as shoe modifications. Operative treatment strategies for initial stages are based on joint-sparing methods. The most frequently used therapy for progressive destruction of the UAJ is still arthrodesis. Total ankle replacement is becoming an increasingly more competitive procedure. Total ankle replacement provides a valuable extension of therapeutic possibilities for UAJ osteoarthritis.

[Autologous fibula transplantation for reconstruction of bone defects]. / Die autologe Fibulatransplantation zur Rekonstruktion knöcherner Defekte.

The reconstruction of large bone defects following tumor resection, trauma or infection is difficult and subject to individual preferences of each surgeon. Free autologous fibula grafts are a reliable biological treatment method, whereas both a vascularised and a non-vascularised transplantation is possible. The use of either treatment option - vascularised or non-vascularised - is accompanied by individual advantages and/or disadvantages that should be taken into consideration during the preoperative planning process. Vascularised fibula transplants should be used especially for the reconstruction of large segmental defects and in patients, in whom adjuvant chemo- and/or radiation therapy is to be administered. Non-vascularised fibula grafts - which offer the advantage of a certain regeneration potential at the donor site as well as a shorter operation time - might be beneficial for bridging hemicortical defects and segmental defects with good soft tissue coverage.

[Lateral instability of the upper ankle joint]. / Laterale Instabilität des oberen Sprunggelenks.

Because of their frequency, ankle sprains are of major clinical and economic importance. The simple sprain with uneventful healing has to be distinguished from the potentially complicated sprain which is at risk of transition to chronic ankle instability. Conservative treatment is indicated for the acute, simple ankle sprain without accompanying injuries and also in cases of chronic instability. If conservative treatment fails, good results can be achieved by anatomic ligament reconstruction of the lateral ankle ligaments. Arthroscopic techniques offer the advantage of joint inspection and addressing intra-articular pathologies in combination with ligament repair. Accompanying pathologies must be adequately addressed during ligament repair to avoid persistent ankle discomfort. If syndesmotic insufficiency and tibiofibular instability are suspected, the objective should be early diagnosis with MRI and surgical repair.

[Injuries of the ankle ligaments]. / Bandverletzungen des oberen Sprunggelenks.

Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If the clinical presentation is suspicious, additional injuries to the deltoid ligament complex and the syndesmosis should be considered. The indications for additional diagnostics should be generously applied. Injuries to the deltoid ligament usually occur as part of a complex ankle injury and should also be addressed in the surgical treatment of accompanying injuries. Chronic instability in this area necessitates complex bony and soft tissue procedures. Syndesmotic injuries with insufficiency of the capsule-ligament apparatus are frequent in ankle fractures and are stabilized during fracture treatment. Isolated syndesmotic instability should also be surgically treated as chronic injuries are usually associated with poor clinical results and early osteoarthritis.

Feasibility and safety of minimally invasive calcaneal osteotomy (MICO) through a medial approach: a case-control study.

INTRODUCTION: Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no description of a medial approach for MICO has been published. MATERIAL AND METHODS: Between August 2022 and March 2023, 32 consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6 months. RESULTS: All osteotomies consolidated within 6 months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5 MMICO and 6 LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction. CONCLUSION: In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C­arm.

[Minimally invasive forefoot surgery: concept and techniques]. / Minimal-invasive Vorfußchirurgie: Konzept und Techniken.

Minimally invasive surgery (MIS) has advanced to an established approach in the correction of all deformities of the forefoot. For the first ray the minimally invasive chevron and Akin osteotomy (MICA) shows very good clinical results and provides a broad spectrum of indications in comparison to the classical chevron osteotomy. The minimally invasive treatment of hallux rigidus also seems to achieve comparable results to the open techniques, although the surgical indications must be thoroughly evaluated. Lesser toe deformities are often easier to treat with minimally invasive osteotomy, capsule release and tendon lengthening than with complex open procedures and usually do not require any internal fixation material. Compared to the classical Weil osteotomy, distal metatarsal osteotomy shows a reduced rate of cock-up deformities and does not require internal fixation. In relation to open procedures, minimally invasive approaches should be accepted as a valuable addition and alternative to the classical open techniques due to the reduced rate of wound healing disorders and postoperative pain.

[Tumors of the foot: diagnostics and therapy]. / Fußtumoren: Diagnostik und Therapie.

Despite the compact anatomy with thin soft tissue coverage, diagnosis of both benign and malignant tumors of the foot is often delayed. Diagnostic errors are more common than in other body regions, as neoplasias are rarely considered. Barring a few exceptions the foot is not a typical predilection site for malignant musculoskeletal tumors, although, basically any tumor entity of the musculoskeletal system can affect the foot. Delays in specific diagnostic and therapeutic procedures of these lesions can entail serious consequences for patients as tumor size is a major prognostic factor for recurrence-free survival. In cases of an indistinct persistent swelling or bone lesion a tumorous process should always be considered to ensure early diagnosis and therapy of foot tumors.

[Injuries of the foot and ankle in winter sports]. / Fuß- und Sprunggelenkverletzungen im Wintersport.

Winter sports injuries of the foot and ankle are a relevant entity due to the high enthusiasm for alpine skiing and snowboarding. The condition of the footwear and rigidity of the binding have a significant influence on the pathobiomechanics of fracture development and have been shown to influence the frequency of knee and ankle injuries. Foot injuries are rare due to the sport-specific footwear with good padding and frequent hard shell casings.

[Heterotopic ossifications in total hip arthroplasty: prophylaxis and therapy]. / Heterotope Ossifikationen im Rahmen der Hüftendoprothetik: Prophylaxe und Therapie.

Heterotopic ossification (HO) is a frequent and occasionally severe complication after total hip arthroplasty. Clinical symptoms of this benign abnormal bone formation are loss of mobility and local pain. The etiology and pathomechanisms are not yet completely understood. Overexpression of bone morphogenetic proteins and dysregulation of prostaglandin metabolism seem to be relevant. Medication with non-steroidal anti-inflammatory drugs (NSAIDs) and perioperative single dose radiotherapy are used for prophylaxis, whereby radiotherapy should only be performed in patients with a history of HO or additionally after resection of HO. From currently available data selective cyclooxygenase-2 inhibitors seem to have a preventive efficacy equal to the classical NSAIDs diclofenac and indometacin. This work discusses current knowledge about the pathophysiology, risk factors and the clinical approach for prevention and treatment of HO.

[Primary malignant bone tumors]. / Primär maligne Knochentumoren.

Among human neoplasms, primary malignant bone tumors are fairly rare. They present an incidence rate of roughly 10 cases per 1 million inhabitants per year. During childhood (<15 years), the percentage of malignant bone tumors amounts to 6% of all infantile malignancies. Only leukemia and lymphoma show a higher incidence in adolescence. Of all primary malignant bone tumors, 60% affect patients younger than 45 years and the peak incidence of all bone tumors occurs between 15 and 19 years. The most common primary malignant bone tumors are osteosarcoma (35%), chondrosarcoma (25%), and Ewing's sarcoma (16%). Less frequently (≤ 5%) occurring tumors are chordoma, malignant fibrous histiocytoma of bone, and fibrosarcoma of bone. Vascular primary malignant tumors of bone and adamantinoma are very rare. Staging of the lesion is essential for systemic therapeutic decision-making and includes complete imaging and histo-pathological confirmation of the suspected entity. In most cases, this is established by open- or image-guided biopsy. Based on this information, an interdisciplinary tumor board will determine the individual therapeutic approach. Endoprosthetic or biological reconstruction following wide tumor resection is the most common surgical therapy for primary malignant bone tumors. There is vital importance in a thorough postoperative follow-up and continous after-care by a competent tumor center which is permanentely in charge of therapy.

[Mega cups and partial pelvic replacement]. / Megapfannen und Beckenteilersatz.

Extensive bone loss, as encountered in both revision arthroplasty of the hip and after resection of malignant tumors of the pelvis, is a major challenge for the surgeon as well as for the revision implant. The aims are, despite extensive acetabular defects, to achieve a primary and load-stable fixation of the revision prosthesis in the pelvic bone as well as restoring the physiological joint biomechanics. At present, a large number of different alloarthroplastic revision implants and complex techniques are available for reconstruction of acetabular deficiencies. According to D'Antonio's classification of acetabular defects, particularly high-grade defects with loss of the posterior column or a pelvic discontinuity require special attention regarding implant selection and surgical planning. The object of this paper is to highlight the most important tools and techniques of endoprosthetic reconstruction for grade III and IV defects (D'Antonio) of the acetabulum by means of a classification-oriented therapeutic concept and to discuss the pros and cons of the particular implant.

[Pathological Fractures of the Humerus: Experience with 76 Cases in a Musculoskeletal Oncology Centre]. / Pathologische Frakturen des Humerus: Erfahrungen an 76 Fällen eines muskuloskeletalen Tumorzentrums.

BACKGROUND: Pathological fractures can be caused by numerous local and systemic processes. The humerus is one of the commonest sites of pathological, tumour-associated fractures. PATIENTS AND METHODS: In a retrospective study, 76 cases of pathological fractures of the humerus were analysed; 57 (75 %) were caused by a malignant disease, 19 fractures were associated with benign musculoskeletal disorders (25 %). The grade of the tumour, treatment strategy, intra- and postoperative complications, and survival rates in malignant tumours were documented. RESULTS: Two thirds of fractures were localised in the proximal third of the humerus. In 59 % of patients, malignant lesions were metastases (mainly renal cell, breast, lung and prostate cancer), followed by haemato-oncological diseases and primary sarcomas. Most benign tumours were simple bone cysts and enchondromas. A total of 70 patients were treated surgically and only 6 conservatively. Most malignant tumours were treated with compound osteosynthesis and tumour prostheses. Complications in both groups were rare. CONCLUSION: The demographic transition - with an increasing number of malignancies on the one hand and improved life expectancy under modern, adjuvant therapies on the other - will become a challenge in the treatment of pathological fractures of the humerus for a variety of disciplines.