Low-intensity pulsed ultrasound as a useful adjuvant during distraction osteogenesis: a prospective, randomized controlled trial.

BACKGROUND: Low-intensity pulsed ultrasound (LIPUS) was proven to have a positive impact on bone healing in animal and clinical studies. METHODS: In this prospective, randomized controlled trial the effect of LIPUS during distraction osteogenesis was investigated. Thirty-six patients who underwent distraction osteogenesis (>2 cm) were enrolled. Sixteen patients in the treatment group received LIPUS, and 20 patients as control group did not. Ultrasound treatment device was transcutaneously applied at the distraction gap for 20 minutes daily (frequency 1.5 MHz, signal burst with 200 µs, signal repetition frequency 1.0 kHz, intensity 30 mW/cm(2)). Evaluation of patients was performed by standard radiographs every 3 weeks to 4 weeks. RESULTS: Average transport distance was 7.0 cm in the ultrasound group and 6.3 cm in the control group. Mean Paley index for the ultrasound group was 1.09 mo/cm and 1.49 mo/cm for the control group. Mean distraction consolidation index for the ultrasound group was 32.8 d/cm and 44.6 d/cm for the control group. The calculated indices indicated no significant statistical difference between the two groups (p < 0.116) but the fixator gestation period could be decreased for 43.6 days in the treatment group. CONCLUSIONS: Therapeutic application of LIPUS during callus distraction constitutes a useful adjuvant treatment during distraction osteogenesis and has a positive effect on healing time with no negative effects.

Distal tibial fracture post syndesmotic screw removal: an adverse complication.

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old woman was admitted with a bimaleollar right ankle fracture. The patient underwent an emergency operation with open reduction and internal fixation. Six weeks after the surgery, the syndesmotic screw was removed without complication. The patient presented 4 weeks after removal of the screw complaining of persistent swelling and tenderness of the right ankle without a history of trauma. Radiographs showed a non-displaced distal tibial fracture around the site at which the syndesmotic screw was inserted. The distal tibial fracture was treated conservatively with a toe-to-knee cast for 6 weeks. In summary, the authors present a rare case of distal tibial fracture. Surgeons should bear this additional complication in mind.

Myths and facts of spondylodiscitis: an analysis of 183 cases.

The authors conducted a retrospective study on 183 cases of spondylodiscitis, treated conservatively (44%) or surgically (56%) between November 1991 and June 2006. The male/female ratio was 99/84, and the mean age 62.6 years. The mean follow-up period was 12 years (range 4-19). Interesting from a clinical viewpoint: temperature, white blood cell count, and CRP were sometimes normal, while pain varied from slight to unbearable. The commonest risk factor was diabetes mellitus, and the most frequent pathogen was Staphylococcus aureus. Methicillin resistant Staphylococcus aureus (MRSA) was found in 6 patients, and 3 or 50% of these died, in sharp contrast with the overall mortality rate of 8.7%. A neurological deficit was seen in 43.7% of the patients; complete recovery occurred in 71% of the patients with a Frankel D stage, but in only 15.4 to 222% of those with a stage A, B or C.

Exogenous nitric oxide donation causes desensitization of arteriolar relaxing activity in vivo: an intravital analysis in mice.

BACKGROUND: The NO/cGMP pathway plays a crucial role in regulation of tissue perfusion. However, a NO-induced desensitization of cGMP-mediated relaxation has been reported in isolated tissue. To examine whether a similar phenomenon can be detected in vivo, we analyzed relaxations of microvessels in response to repeated applications of NO. MATERIALS AND METHODS: The investigations were performed by means of dynamic intravital fluorescence microscopy in the dorsal skinfold chamber of female balb/mice. First, the microvasculature was maximally preconstricted by the application of the vasoconstrictor 5-hydroxytryptamine. Subsequently, relaxation was induced by applying an NO-donator, the S-nitrosoglutathione, to the contracted vessels. Following buffer exchange, constriction and relaxation were repeated. Drugs were given topically into the chamber, directly onto the skin muscle. The response of arterioles to topical administration of vasoactive drugs was determined as the change of the diameter, and quantified using standard software. RESULTS: The relaxation of arterioles was reduced after repetitive application. The short pretreatment with NO-donor entailed a reduced relaxation of arterioles in response to following application. The absolute change in vessel diameter induced by S-nitrosoglutathione was significantly reduced from 21 µm to 16 µm after the first and the second application, respectively. However, the data also revealed a noticeable reduction of the constricting activity of 5-hydroxytryptamine during the second application, indicating a possible desensitization of the 5-hydroxytryptamine response or a humoral and/or neuronal compensatory mechanisms. CONCLUSIONS: The NO-induced cGMP-mediated relaxation of microvessels was quantified, and the phenomenon of desensitization visualized in vivo by means of dynamic fluorescence microscopy.

Osteogenic differentiation of human mesenchymal stromal cells is promoted by a leukocytes containing fibrin matrix.

PURPOSE: Mesenchymal stem cells (multipotent human mesenchymal stromal cells, MSC) are currently the most promising cell type for regenerative medicine. For a clinical approach, it is necessary to develop and establish methods for expansion, differentiation, and delivery. METHODS: A completely autologous plasma clot containing peripheral blood mononuclear cells (PBMC) was tested for the osteopromotive activity towards expanded human mesenchymal stem cells in vitro. The plasma clot was prepared from anticoagulated blood plasma after addition of isolated leukocytes and calcium chloride. Plasma clots after the gelation were added to subconfluently growing MSC or used in a transwell system. Cell proliferation, the activity of alkaline phosphatase, the release of osteoprotegerin, C-terminal procollagen peptide, as well as osteocalcin, the analysis of matrix mineralization as well as bone nodule formation were analyzed up to 3 weeks. RESULTS: In contrast to plasma clots with no exogenously added leukocytes, the presence of PBMC within the plasma clot significantly promoted osteogenic differentiation of MSC correlated to the time period of incubation. Proliferation of MSC was decreased at maximal mineralization time points. In addition, the osteopromotive activity was identified as soluble factor/factors by transwell assay system. There was a decrease in osteoprotegerin when the cells were cultured in the presence of plasma clots compared to control cell cultures without plasma clots. The osteocalcin expression was continuously higher after culture in the presence of plasma clots and significantly higher after 2- and 3-week after culture in the presence of leukocyte-containing plasma clots compared to 1-week cell culture. Differences in the concentration of the C-terminal procollagen peptide were not measured. CONCLUSIONS: The direct inoculation of an autologous mononuclear cell fraction (which contains leukocytes and MSC), e.g., isolated from a bone marrow aspirate or a different source into an autologous plasma gel, may be a further new strategy for bone fracture therapy.

Microvascular response to calcium phosphate bone substitutes: an intravital microscopy analysis.

OBJECTIVES: The purpose was to evaluate inflammatory and microcirculatory reactions after implantation of various calcium phosphate bone substitutes in an in vivo model. METHODS: Calcium phosphate-based bone substitutes were implanted in dorsal skinfold chambers of mice. Intravital fluorescence microscopy was performed to measure inflammatory and microcirculatory reactions based on functional vessel density (FVD), capillary leakage, and relative white blood cell velocity (rWBCV). RESULTS: An increase of FVD was observed in all groups and the capillary leakage grew with a level of significance (p < 0.001). The fraction of rolling and sticking leukocytes (rWBCV) was highest at the beginning of the trial and decreased during the course. CONCLUSIONS: There are differences in microvascular soft tissue reactions between various calcium phosphate bone substitutes, but inflammatory reactions were moderate, and the results revealed no reasons which explain the sporadic failure of the tested substances under clinical conditions.

The beneficial effects of early stabilization of thoracic spine fractures depend on trauma severity.

BACKGROUND: The timing of stabilization for thoracic spine injuries is discussed controversial. Although early repair of long bone fractures is known to reduce complications, few studies investigate this issue in spine trauma. METHODS: We retrospectively investigated 160 patients (January 2000 to March 2003) with spine fractures from Th1 to L1, which were stabilized. Patients were divided into two groups: early stabilization within 72 hours or later. Other subgroups were analyzed for the relationship of neurologic status, injury severity, and incidence of preoperative lung failure. RESULTS: : Severely injured patients (Injury Severity Score >or=38 pts) with early stabilization had a significantly shorter intensive care unit-stay (14 days [1-34 days] vs. 20 days [1-39 days]; p < 0.05) and overall shorter hospital stay (56 days [9-147 days] vs. 108 days [11-198 days]; p < 0.05). Similar patterns were seen for patients with Frankel A deficits (Frankel Score) and preoperative lung failure. The clinical course of less severe-injured patients was not influenced at all. CONCLUSIONS: Our data provide further evidence that early stabilization of spine injuries is safe. In severely injured patients, it does not impair perioperative lung function and results in a reduced overall intensive care unit and hospital stay.

Rare complication after VAC-therapy in the treatment of deep sore ulcers in a paraplegic patient.

The VAC-therapy is a safe, easy, and effective therapy for the management of chronic wounds. Known advantages of the VAC technique are the quicker wound healing by stimulating the blood flow, the formation of granulation tissue, angiogenesis, and cell proliferation. The use of negative pressure treatment can decrease the number of dressing changes and length of hospital stay. However, some related complications after and during VAC therapy have been described. We here describe a rare complication during the treatment of severe os ischium sore with VAC therapy, which has not been reported in the literature yet. We report about a 43-year-old paraplegic patient, referred to our clinic from a regional hospital where he had been admitted 2 months earlier, presenting with a necrotizing fasciitis after VAC therapy during the treatment of fourth grade os ischium sore. After operative debridement and long-term antibiotics with Ciprofloxacin soft tissue closure was performed using a myocutaneous tensor fascia lata flap. Temporary stabilization was achieved by a triangle external fixateur attached to the right femur and the pelvis. After 1 week the tapping point of the muscle flap could be covered with local skin mesh-graft from the right calf as a donor site. The patient was mobilized in a wheelchair and was discharged home 3 months after admission. The VAC technique is a safe, easy, and effective means in chronic wound care management. However, the described rare complication should be kept in mind. The clinical management of VAC therapy requires a distinct indication and close clinical monitoring by experienced medical professionals. The use of VAC therapy in fourth grade sores may have deleterious consequences for the patient.

Custom made Ilizarov ring fixator for fracture care in morbidly obese patients.

BACKGROUND: Fracture care in obese patients is becoming an everyday problem because the prevalence of obesity in European countries has tripled since the last 20 years. PATIENTS AND METHOD: With the use of a custom made Ilizarov ring fixator with a ring diameter of 300 to 340 mm, fracture stabilization in three morbidly obese patients was performed. The patients' body mass index (BMI) ranged from 59 to 89. There were one proximal tibia fracture and two pilon fractures. The tibia fracture was stabilized with a 340-mm frame and the pilon fractures were stabilized by primary ankle arthrodesis with 300-mm frames. Primary ankle arthrodesis was performed because polyneuropathy and Charcot arthropathy were present in one patient and in the other patient because time from injury to referral was too long for reconstruction. RESULTS: All patients were able to fully weight bear. Frame removal after fracture correction and consolidation was performed only in the patient with the tibial fracture (patient BMI 89). The other patients died during the treatment because of decompensated comorbidities. CONCLUSION: The Ilizarov technique is a good fixation modality for stabilizing fractures of the lower limb in morbidly obese patients. Associated medical comorbidities are the limitations of successful fracture care.

Rare anterior shoulder dislocation in a toddler.

Traumatic anterior shoulder dislocation in toddlers and pediatric patients is a very rare injury pattern. The treatment and the recurrence rate are mostly extrapolated from adult and adolescent data. A 2-year-old toddler is presented with a first-time traumatic shoulder dislocation caused by a pull on the abducted arm. The treatment included a gentle closed reduction performing the Milch maneuver and a short-sling immobilization. The 2.5-year-follow-up demonstrated a stable shoulder with free range of motion while still having a Hill-Sachs-lesion. Shoulder dislocation in toddlers maybe addressed less aggressively after closed reduction than in adults due to an unknown recurrence rate.

Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation?

INTRODUCTION: Immobilization in external rotation after a first-time traumatic anterior shoulder dislocation has been shown to improve the position of the labroligamentous lesion relative to the glenoid rim. The purpose of the present study was to evaluate the effect of the external rotation position of the shoulder on different types of labroligamentous lesions in patients with first-time traumatic anterior shoulder dislocation by using MRI. PATIENTS AND METHODS: We performed a standardized MRI in internal and external rotation of the shoulder after initial reduction in 34 patients with a first-time traumatic anterior shoulder dislocation. Labroligamentous lesions were classified as Bankart, Perthes, or nonclassifiable. Four distinct grades were used to classify the amount of plastic deformation of the anterior labroligamentous structures. The position of the labrum was defined relative to the tip of the glenoid rim by measuring the dislocation and separation. RESULTS: In all patients, dislocation and separation of the labrum relative to the rim of the glenoid were significantly improved in shoulders in the external rotation position compared to those in the internal rotation position. We observed 15 Bankart, 15 Perthes, and 4 non-classifiable lesions. No HAGL or GLAD lesions were found. Fourteen patients showed a plastic deformation grade I, 16 showed grade II, 3 showed grade III, and 1 showed grade IV. In regression analysis, the odds ratio was 1.100 for the type of lesion and 1.660 for the grade of plastic deformation. Perthes lesions (with an intact anterior scapular periosteum) and grade I plastic deformations showed the best labral reduction on the external rotation MRI. CONCLUSION: Placing the shoulder in external rotation after a first-time traumatic shoulder dislocation, significantly improves the position of the labroligamentous lesion on the glenoid rim. Perthes lesions that showed a low grade of plastic deformation displayed better reduction in external rotation and then compared to Bankart or other lesions that showed a high grade of plastic deformation. In conclusion, immobilization of the shoulder after a first-time traumatic shoulder dislocation is most effective in patients with Perthes lesions that show low grade plastic deformation.

Treatment of acute and chronic elbow instability with a hinged external fixator after fracture dislocation.

This is a retrospective analysis of the clinical and radiological outcome in 24 patients with acute or chronic posttraumatic elbow instability, who were treated with open reduction, internal fixation and a hinged external fixator. The instability was acute after elbow fracture dislocation in 11 cases; the other 13 had chronic posttraumatic instability of the elbow. Concentric stability and a sufficient range of motion of the elbow joint were achieved in all cases. The addition of a hinged external fixator in noncompliant patients, who underwent open reduction and internal fixation of an acute or chronic posttraumatic unstable elbow, allows early intensive mobilisation and can improve the clinical outcome after these complex elbow injuries.

Systemic IL-17 after severe injuries.

IL-17 is a cytokine produced by a newly identified T-cell subpopulation (THl7/THIL-17). It is a central mediator in inflammatory processes that connects T-cell stimulation with neutrophil mobilization. The role of IL-17 in the immune dysfunction after polytrauma is still not clarified. In a retrospective study, the systemic concentration of IL-17 and IL-6 of 71 polytraumatized patients were analyzed daily by enzyme-linked immunosorbent assay. The patients' collective consist of 55 men and 16 women (43 +/- 16 years; injury severity score, 33 +/- 13). In only 6% of the patients, an increase in systemic IL-17 was detected. In most patients (94%), no systemic IL-17 was detectable or the IL-17 concentrations in plasma were in the range of the healthy donor group. To identify a possible role of systemic IL-17 in the posttraumatic phase, the patients were divided into two groups. Group A (47 men, 15 women) consists of patients with IL-17 concentrations in the range of normal healthy donors. Group B (8 men, 1 woman) consists of patients with elevated (>45 pg ml(-1) on at least 3 consecutive days) systemic IL-17 concentrations. Three patients in group B showed highly increased systemic IL-17 concentrations (median, >200 pg mL(-1)). These patients were male and showed all blunt chest and abdominal trauma with lung contusion and pneumohemothorax. However, there was no conformity in other injury patterns, injury severity score, age, outcome, intensive care period, or clinical complications. After a period of 4 years, we were able to obtain a new blood sample from one patient with high IL-17 level. The systemic IL-17 value of this former patient was now less than the detection limit. However, stimulation of peripheral blood mononuclear cells from thlise patient revealed elevated numbers of cells with the capacity to produce IL-17 as determined by enzyme-linked immuno spot assay and flow cytometry compared with peripheral blood mononuclear cells obtained from current polytrauma patients and healthy donors. In conclusion, IL-17 is not suitable as a pathophysiological or predictive marker after polytrauma. Whether highly increased systemic IL-17 concentrations detected in single patients are due to individually increased numbers of TH17 cells as we have demonstrated with one rerecruited patient has to be further analyzed.

Th1- and Th2-type cytokines in plasma after major trauma.

BACKGROUND: Major trauma induces a dysregulation of immune response supported in parts by lymphocyte dysfunction. Controversial data about a shift within the T-helper cell subsets Th1/Th2 are reported. METHODS: To prove whether Th1/Th2-type cytokine plasma levels reflect the postulated Th2 shift after trauma, we investigated in a retrospective study 195 severely injured patients (47 women, 148 men; mean age 39.7 +/- 15.8 years; Injury Severity Score 32.0 +/- 11.3 points; overall 1,887 samples) during their ICU stay posttrauma. Mortality rate was 19%. Th1-type cytokines interleukin 2 (IL-2), interferon gamma, IL-12 (p70), and IL-18 and Th2-type cytokines IL-4, IL-10, and IL-11 were determined using the enzyme-linked immunosorbant assay technique in patients and in healthy controls. RESULTS: IL-2 and interferon gamma were seldom detectable. All other mediators were significantly increased matched to controls (p < 0.05). All cytokines were elevated most prominent during weeks 1 and 2 posttrauma and declined thereafter. A trend toward lower levels in nonsurvivors was seen for both groups of cytokines. However, significant differences were only seen for Injury Severity Score, age, white blood cells, and C-reactive protein. All mediators correlated positively with each other (p < 0.01), a Th2-type shift was not observed. Two groups of patients were identified: one group with generally high plasma levels of all cytokines investigated and a second group of nonresponders who presented with low or diminished plasma levels in which most nonsurvivors were found. CONCLUSION: We conclude that in plasma no Th1/Th2 shift can be observed after major trauma.

Transsacral colon fistula: late complication after resection, irradiation and free flap transfer of sacral chondrosarcoma.

BACKGROUND: Primary sacral tumors are rare and experience related to accompanying effects of these tumors is therefore limited to observations on a small number of patients. CASE PRESENTATION: In this case report we present a patient with a history of primary sacral chondrosarcoma, an infection of an implanted spinal stabilization device and discuss the challenges that resulted from a colonic fistula associated with large, life threatening abscesses as late complications of radiotherapy. CONCLUSION: In patients with sacral tumors enterocutaneous fistulas after free musculotaneous free flaps transfer are rare and can occur in the setting of surgical damage followed by radiotherapy or advanced disease. They are associated with prolonged morbidity and high mortality. Identification of high-risk patients and management of fistulas at an early stage may delay the need for subsequent therapy and decrease morbidity.

Combined ipsilateral fractures of talus and calcaneus.

INTRODUCTION: The purpose of this study was to evaluate the frequency of combined ipsilateral talar and calcaneal fractures, the fracture pattern in combination and the clinical outcome of the combined operative treatment. MATERIALS AND METHODS: Out of 950 patients with calcaneal fractures and 190 patients with talar fractures treated operatively between 1984 and 2003, 11 patients (1% of calcaneal and 6% of talar fractures) were identified with combined ipsilateral talar and calcaneal fractures. Closed reduction and external fixation was performed in one patient with a crush foot injury, and ORIF in all other patients and fractures. All patients underwent clinical and radiological evaluation after a minimum followup period of one year using the AOFAS-Hindfoot Score. RESULTS: Seven patients had central talar body and 4 patients talar neck fractures. Nine calcaneal fractures were extraarticular sustentaculum, as well as processus anterior fractures, and two were intraarticular fractures. Average followup was 6 (range, 1 to 12.5; median, 4.5) years. There were no perioperative complications related to ORIF. AOFAS-Hindfoot-Score averaged 78.6 (range, 50 to 100). The followup x-rays showed post-traumatic arthritis in the ankle joint in 3 patients and in the subtalar joint in five. AVN with peudarthorsis was present in one patient with an intraarticular calcaneal fracture. Patients with intraarticular calcaneal fractures presented with the worst functional results (AOFAS-Score, 50 and 64), none of these patients required a secondary ankle or subtalar fusion. All other patients had good and excellent functional outcome. CONCLUSION: Combined ipsilateral talar and calcaneal fractures are rare injuries. Extraarticular calcaneal fractures are more common in this injury pattern, while there was no preference for either talar neck or talar body fractures. Operative treatment with anatomic open reduction and internal fixation may result in favorable clinical outcome. Combined surgical approaches to the hindfoot did not result in increased morbidity.

In vivo microvascular response of murine cutaneous muscle to ibuprofen-releasing polyurethane foam.

In view of their pain-relieving effect, the non steroidal anti-inflammatory drugs are more and more used as a pain-reducing component in modern wound dressings. To analyse the effect on new blood vessel growth, implants from Biatain Ibu, a polyurethane foam containing ibuprofen, were inserted into the dorsal skinfold chamber of BALB/c mice. Implants from ibuprofen-free polyurethane foam Biatain served as controls (n = 10 per group). Blood vessel growth and the functional vessel density (FVD) as a parameter for microvascularization of implant's border zone were assessed by intravital fluorescence microscopy (IVFM). IVFM was performed on days 3, 7 and 12 after implantation. Direct comparison showed no significant differences in FVD (mm/mm(2)) for the border zone of the ibuprofen-releasing implants versus controls on day 3 (185.49 +/- 4.75 versus 197.17 +/- 5.21) and day 7 (229.60 +/- 8.53 versus 247.99 +/- 5.39). However, the IVFM showed a significant increased FVD for ibuprofen-releasing implants (301.30 +/- 8.44 versus 279.24 +/- 5.78) on day 12 (P < 0.05). Also, a significant increase of FVD was detected for the ibuprofen-releasing implants throughout the implantation time of 12 days. This study shows that local release of small-dose ibuprofen from a polyurethane dressing does not decrease new blood vessel growth during the implantation time of 12 days. In the end, the microvascularization of implant's border zones in both groups was found comparatively undisturbed.

Mini-open percutaneous transarticular screw fixation for acute and late atlantoaxial instability.

The treatment of atlantoaxial instability by means of posterior transarticular screw fixation combined with a Gallie fusion is an established method when direct anterior odontoid screw fixation is not indicated or has failed. In this retrospective study, the results of a modified percutaneous mini-open transarticular C1-C2 screw fixation are presented. Between February 1998 and March 2006, 47 patients with acute or late (after failed conservative treatment) atlantoaxial instability were treated with the modified technique. Their average age was 74.9 years. There were no intraoperative injuries to neural structures or blood vessels; 96.8% of the screws were placed correctly. A revision operation was necessary in one patient because of infection at the graft donor site. No patient experienced a neurological complication. Three patients died during hospitalisation, 6 others later on; 6 could not be traced, leaving thirty-two patients or 68% available for follow-up. The average clinical follow-up was 42 months (range: 12 to 91). The results with respect to the pain and activity status were good or excellent in more than 90% of cases. The radiographic follow-up averaged 25 months (range: 12 to 75). Bony fusion was documented in all cases. The modified technique of transarticular screw fixation presented here is a safe and functionally satisfactory method of achieving stabilisation of the atlantoaxial complex. Special cannulated instruments are not required. This mini-open transcutaneous technique is an alternative to the conventional open procedure, and reduces operation time as well as blood loss.

Odontoid fractures in the elderly: dorsal C1/C2 fusion is superior to halo-vest immobilization.

BACKGROUND: Odontoid fractures in geriatric patients occur frequently and are associated with a high morbidity and mortality. The decision for operative or nonoperative therapy is still controversial. Recent studies confirmed that external stabilization with halo-vest immobilization is associated with high complication rates and mortality. An operation has a high perioperative risk because of comorbidities, but previous data suggest improved outcome in this group. METHODS: To test this hypothesis, we retrospectively analyzed geriatric patients that underwent operation for isolated unstable type II odontoid fractures (Anderson and D'Alonzo classification) in our institution between March 2003 and March 2005. Twenty-seven patients (17 female, 10 male) with a median age of 85.5 (range, 63-98) years were stabilized by posterior C1/C2 fusion with transarticular screws and an additional modified Gallie fusion with a bone graft. Postoperatively, a rigid cervical collar was applied for 6 to 12 weeks. RESULTS: Six patients died during the observation period (median, 40 days after trauma). Three patients (11%) died perioperatively (cardiac or pulmonary failure, pneumonia), and the other three died as a result of the same after discharge. All 21 surviving patients were reevaluated an average of 3 months after trauma. All but one showed a stable fusion, and all reported no or minor neck pain. No wound infections occurred; one reoperation was necessary for screw misplacement. An initial neurologic deficit improved in two of three cases. Patients were mobilized on day 1 after operation. About two-thirds of patients were discharged directly home. CONCLUSIONS: Posterior stabilization of unstable odontoid fractures with transarticular screws and modified Gallie fusion in old patients can be performed safely, with good clinical results and few complications. However, mortality remains high, but is lower than reported after halo-vest immobilization alone. Dorsal C1/C2 Fusion is superior to halo-vest immobilization in terms of nonunion rate and mortality. Thus, it might be the treatment of choice in this high-risk patient population.

Silver Ion-releasing Dressing (CONTREET) Does Not Disturb Angiogenesis and Microvascularization In Vivo.

This study examined the effects of silver-releasing wound dressing on angiogenesis and microvascularization in vivo. Implants from silver-releasing and silver-free dressings were placed into dorsal skinfold chambers of BALB/c mice. A total of 30 animals (10 implants per group) were observed. Group 1 was treated with Contreet® (Coloplast, Holtedam, Denmark). Group 2 and Group 3 were primed with Biatain™ (Coloplast, Holtedam, Denmark) and SeaSorb Soft® (Coloplast, Holtedam, Denmark). Visualization of angiogenesis and quantification of functional vessel density (FVD) was performed using intravital fluorescence microscopy (IFM). Functional vessel density served as the parameter for vascularization. Functional vessel density was measured on Day 3, 7, and 12 after implantation. Intravital fluorescence microscopy revealed constant development of a sufficient network of perfused microvessels surrounding the silver-based implants. Group 1 showed a stronger morphological alteration of microvessel network at the border zone at Day 3 and even more so at Day 7, compared to the silver-free groups. Reinforced dilatation, elongation, and torsion of capillaries with progressive growth of perfused preliminary stages of new blood vessels were observed for silver-based implants. Border zone FVD of silver-based implants at Day 3 (257.1 ± 33.9 mm/mm2) was significantly increased compared to Group 2 (230.9 ± 31.3) and Group 3 (210.2 ± 35.7). At Day 7, the FVD in Group 1 was still significantly higher as measured in Group 3 (265.9 ± 30.7 versus 219.7 ± 42.6). However, no significant difference between Groups 1 and 2 at Day 7 (265.9 ± 30.7 versus 269.4 ± 31.9) and at Day 12 (258.7 ± 38.1 versus 268.3 ± 39.0) remained. In conclusion, the silver-based implants did not show any anti-angiogenic effects when compared to the silver-free implants.