Randomized controlled single center study comparing a polyhexanide containing bio-cellulose dressing with silver sulfadiazine cream in partial-thickness dermal burns.

OBJECTIVE: A prospective, randomized, controlled single center study was designed to evaluate clinical efficacy of a polyhexanide containing bio-cellulose dressing (group B) compared to a silver-sulfadiazine cream (group A) in sixty partial-thickness burn patients. PATIENTS AND METHODS: Local ethics committee approval was obtained and patients consented. Parameters were: pain reduction (VAS), healing time and wound bed condition, comparing day 0 (start) versus day 14 (end), as well as, ease of dressing use and treatment costs. RESULTS: All completed the study (n=30/n=30) and were included in the ITT analysis, with a total of 72 burns (group A: n=38, group B: n=34). We noted no differences in healing time. Pain reduction was significantly faster and better in group B (p<0.01). There were fewer dressing changes in group B, compared to group A. Ease of use for the bio-cellulose dressing was rated better compared to group A. In group B, € 95.20 was saved for a 10 day treatment period, compared to group A. CONCLUSION: Group B demonstrated a better and faster pain reduction in the treated partial-thickness burns, compared to group A. The results indicate the polyhexanide containing bio-cellulose dressing to be a safe and cost effective treatment for partial-thickness burns.

[The significance of the acetabular labrum for hip joint stability--an experimental study]. / Die Bedeutung des Labrum acetabulare für die Hüftstabilität--eine experimentelle Studie.

AIM: Aim of our study was to create artificial labra for joint models of different diameters (28, 32 and 36 mm) and to measure their stability potential at rest (SPR). The experiment was performed under the same conditions as a previous one with capsulated joint models. Our target was to prove the hip stabilising effect of the atmospheric pressure (AP) as well as the parameters for joint stability and to test the function of the artificial labra. METHOD: Uncapsulated joint models having 28 (A), 32 (B) and 36 (C) mm diameters were sealed with moulded preformed silicone labra. An increasing traction force was applied under water on the fixed joint. Using specially designed software, the exerted force and the dislocation distance were simultaneously and continuously recorded on a computer. The SPR of the examined joint models was calculated as the difference between the maximal exerted force and the weight of the ball-neck component. RESULTS: Statistical analyses showed that SPR had mean values of 58.12 +/- 2.23 N for the 28 mm joint model (n = 118; A), 75.66 +/- 2.75 N for the 32 mm model (n = 88; B) and 99.91 +/- 1.30 N for the 36 mm model (n = 82; C). CONCLUSION: The traction force required for dislocation agreed closely to the expected precalculated SPR values of 58.6 N (A), 76.4 N (B) and 96.7 N (C), which proves the joint stabilising effect of AP in the presence of the essential prerequisites (spherical ball articulating in a hemispherical socket, hermetically closed joint capsule and/or labrum, which contains a small amount of fluid and excludes air). The measured SPR was directly proportional to the square of the joint diameter. Indirectly, it was concluded that the dislocation work at rest is directly proportional to the joint diameter cubed. Consequently, the risk of dislocation after total hip arthroplasty (THA) can be reduced by applying bigger, size-adapted hip balls, whose diameter grows according to the outer diameter of the cup. The increasing range of motion is a favourable side-effect. With careful reconstruction of the capsule and insertion of an intracapsular drain, the risk of dislocation in the early postoperative period could be furtherly reduced. Theoretically, artificial labra could be a useful alternative to augment joint stability in THA with a high dislocation tendency instead of constrained liners.

[Webers experiments regarding the stabilising effect of atmospheric pressure on the hip joint - a historical and experimental retrospect]. / Die Weber'schen Versuche zur hüftstabilisierenden Wirkung des atmosphärischen Druckes - ein historischer und experimenteller Rückblick.

BACKGROUND: The stabilising effect of atmospheric pressure on the hip joint was first described by the brothers Eduard and Wilhelm Weber in 1836. Later in 1837, they conducted an experiment in which they examined a weight-bearing cadaveric hip joint in an evacuable container and could repeatedly demonstrate dislocation of the femur head due to the significant reduction of surrounding pressure and its repositioning by normalisation of the pressure. In our study we aimed to honour the contribution of the Weber brothers, to reflect on the historical argument about the hip stabilising effect of atmospheric pressure they initiated, to repeat the famous experiment they did in 1837 using advanced sensors and radiological equipment and to demonstrate the consequences of the effect on total hip arthroplasty. METHOD: A weight-bearing human cadaveric hip joint was placed in a radiolucent evacuable container, in which the pressure was reduced with a vacuum pump and normalised by opening a valve. Pressure and dislocation distance were measured continuously by sensors. The state of the hip joint was documented both by X-ray as well as by permanent fluoroscopy with video recording. RESULTS: Conforming to the experiments published in 1837 we demonstrated dislocation of the hip joint as a result of a significant reduction of pressure. Normalisation of the pressure caused joint reduction. The ability of the cadaveric hip to bear weight depended to a great extent on its quality. Reduction of the pressure harmed the cadaveric hip and reduced the number of possible experiments. CONCLUSION: The stabilising effect of atmospheric pressure on the hip joint is a fact, which was proved in 1836/37 by the Weber brothers, who conducted convincing experiments with human cadaveric hip joints. Nevertheless, the investigation into this relationship continues until today. We repeated and reproduced their experiment published in 1837 which irrefutably proved the stabilising effect of atmospheric pressure on the hip joint. The surgical application is of the utmost importance in the field of hip arthroplasty. Careful handling and reconstruction of the capsula, the use of size-adapted large hip balls as well as the intra-articular drainage provide the basis for maintaining the optimal mechanical environment and avoiding postoperative dislocation. Due to the variation in quality and anatomic characteristics of cadaveric hip specimens, we decided to use standardised model joints for further experiments.

[Operative treatment of an expansive enchondroma of the distal phalanx of the thumb]. / Operative Therapie beim expansiven Enchondrom der Daumenendphalanx.

Enchondroma is the second most common benign bone tumour and the most common tumour affecting the bones of the hand. In the hand, they are most frequently found in the proximal phalanges. The case presented here is that of an expansive enchondroma in the distal phalanx of the thumb, which is rare. By operative treatment (curettage, reduction plastic and cancellous bone allografting) we were able to correct the deformity of the distal phalanx and the thumbnail almost completely, as well as improving the stability and achieving a good cosmetic result.