Treatment of Tibial Non-Unions - State of the Art and Future Implications.

healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

[Diagnostics and therapy of luxation after total hip arthroplasty]. / Diagnostik und Therapie der Luxation nach Hüfttotalprothesenimplantation.

BACKGROUND: Luxation following endoprosthetic hip replacement represents a frequent and severe complication and is the reason for a relevant number of hip arthroplasty revision interventions. The probability of occurrence of luxation of a total hip arthroplasty is associated with the indications, patient and operation-specific risk factors. Approximately 50 % of luxations after total hip arthroplasty occur within 3 months of the operation (early luxation). DIAGNOSTICS: The diagnostics of luxation of total hip arthroplasty are carried out by clinical and radiological methods. The causative assignment is made by assessment of joint stability, the bony situation (e.g. loosening, periprosthetic fracture and defects) and the soft tissue (e.g. pelvitrochanterian musculature). In cases of clinical and paraclinical signs of infection and of late luxations, a joint puncture is indicated. THERAPY: Therapy decisions are made depending on the cause (e.g. implant malpositioning, pelvitrochanterian insufficiency, impingement, incongruence between head and inlay and combinations of causes). Therapy of acute total hip prosthesis luxation begins with imaging controlled repositioning carried out with the patient under adequate analgesia and sedation. Conservative therapy is carried out by immobilization with a hip joint orthesis or pelvis-leg cast for 6 weeks. Operative therapy strategies for recurrent luxation are restoration of the correct implant position and sufficient soft tissue tension. Larger hip heads, bipolar heads and tripolar cups are more commonly used due to the geometrically lower probability of dislocation (higher jumping distance). Luxation of total hip prostheses due to infection is treated according to the principles of periprosthetic infection therapy. The rate of recurrence of luxation of 30 % is high so that in cases of unsuccessful therapy treatment should best be carried out in a center for revision arthroplasty. CONCLUSIONS: The search for the exact cause of total hip prosthesis luxation is extremely important. A classification is only possible when the exact cause is known and together with patient and implant-specific details the therapeutic approach can be ascertained. In revision operations the intraoperative functional diagnostics must be exactly documented. The reasons for delayed luxations could be prosthesis infections, abrasion and loosening.

[Diagnostic standards for extradural tumors and metastases of the spinal column]. / Diagnostische Standards bei extraduralen Tumoren und Metastasen der Wirbelsäule.

Because of the heterogeneous clinical and paraclinical symptoms accompanied by the urgent necessity to rapidly find a diagnosis, the differential diagnostic delineation of spinal tumors from back pain related to other reasons is a special challenge in the orthopedic practice. Employing an algorithm based on anamnesis, clinical, radiological and paraclinical examinations, a guideline-related biopsy as well as histological processing of the biopsy material, tumor lesions can usually be classified regarding entity, dignity and extent. Following this a treatment strategy can be defined. Because of the necessity of an interdisciplinary approach the diagnostic algorithm should be planned during a tumor conference and performed in specialized centers.

Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat.

We compared iron intake and iron nutritional status of two groups of healthy term infants who received meat-containing baby foods fortified with ferrous sulphate (2 mg Fe/100 g). One group received an Fe-fortified formula (1.6 mg Fe/100 kcal) and the other a nonfortified formula. Fe intake of the group fed the nonfortified formula was significantly lower (p less than 0.0001). These infants received Fe mainly from fortification Fe with beikost (75-86%) and less than 10% met the recommended intake of 1 mg.kg-1.d-1; whereas 80-85% of the infants fed the Fe-fortified formula did. Hb, Hct, FEP, and ferritin were similar in both groups with the exception of lower ferritin values at age 365 d (p less than 0.05) in the group fed the nonfortified formula. No infant had hemoglobin less than 100 g/L. We conclude that regular consumption of commercially prepared Fe-fortified beikost with meat prevents most healthy term infants from Fe deficiency even if Fe intake is substantially below the recommended intake.

Vitamin K in breast milk: no influence of maternal dietary intake.

There is limited information available on the vitamin K intake of lactating mothers, concentration of vitamin K1 in breast milk, and the effect of long-term vitamin K1 supplementation of lactating mothers on the vitamin K1 concentration in breast milk. In a randomized study, we followed 20 mothers who received a daily oral vitamin K1 supplement (average 88 micrograms, supplemented group) and 16 mothers receiving no supplement (control group) from 4 throughout 91 days postpartum. Maternal vitamin K intakes (weighed dietary intake) at 4-6, 25-29 and 87-91 days postpartum ranged between 73 and 1735 micrograms/day. Differences between the groups were statistically not significant. Average intake exceeded the recommended dietary intake for lactating women of 55 micrograms/day by 670%. In the supplemented group, mean breast-milk vitamin K1 concentrations (HPLC) at 5, 26 and 88 days postpartum were 1.73 (SD 0.74), 1.36 (SD 0.81) and 1.67 (SD 2.01) ng/ml, respectively. Corresponding values in the control group were 1.44 (SD 0.57), 1.68 (SD 0.70) and 1.78 (SD 1.05) ng/ml. The latter were not statistically different from values in the supplemented group. Mean daily vitamin K1 intakes of infants breast-fed by supplemented mothers were 0.69 (SD 0.42), 0.93 (SD 0.51) and 1.25 (1.53) micrograms, respectively on days 5, 26 and 88. Corresponding values in the control group were 0.69 (SD 0.30), 1.07 (SD 0.58) and 1.31 (SD 0.95) micrograms and were statistically not different from values in the supplemented group. Average vitamin K1 intakes corresponded to 7-13% of the recommended dietary intake of 10 micrograms/d for infants.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lead intake with food of young infants in the years 1980/81 (author's transl)]. / Die bleibelastung des jungen Säuglings mit der nahrung in den Jahren 1980/81.

Several studies related minimal cerebral dysfunction in children to environmental lead exposure. We calculated the lead intake of young infants based on measurements of the lead content in their food. There was no significant difference between the lead content of 13 samples of pooled breast milk (50.2 +/- 22.5 micrograms/l), 11 samples of adapted and followup formulas (67.4 +/- 9.9 micrograms/l) and 9 samples of cow milk (59.5 +/- 22.5 micrograms/l). In fruits, commercially prepared strained fruits and juices lead concentrations were between 18.7 and 123.6 micrograms/kg. Based on the mean concentration of all products we calculated the average lead content in an infant's fruit or juice dinner to be 67 micrograms/kg. In plain and creamed vegetables lead concentrations were between 98.2 and 204.0 micrograms/kg, with the highest lead content in potatoes, spinach and carrots. The average lead content in an infant's plain or creamed vegetable dinner was 117 micrograms/kg. The lead intake over the first 6 months of life was calculated from the above-mentioned data and the average amount of food consumed per day. It was found to be below the maximum daily permissible intake from all sources. However, especially after introduction of mixed feeding (vegetables!) at the age of 4 months, the daily lead intake was close to the tolerance limit. There was no evidence of lead contamination during production of commercially-prepared baby food. Environmental contamination seems to be the main reason for the high lead content in infant food, especially in vegetables.

[Zinc-protein binding in different types of milk and the effect of pepsin (author's transl)]. / Zinkbindung an Eiweiss in verschiedenen Milcharten und Einfluss von Pepsin.

Human milk, cow milk and an infant formula containing skimmed milk and demineralized whey with and without added ZnSO4 were separated by gel chromatography. The bulk of zinc from all four types of milk eluted with a high-molecular protein fraction. In human milk zinc in an additional peak which corresponded to a protein fraction with an approximate molecular weight of 10(4) Daltons. The zinc-binding ligands described in the literature are of comparable size. After incubation with pepsin at pH 2, all zinc was eluted from human milk with the low-molecular protein fraction (1-1.5 x 10(4) Daltons). Incubation of the infant formula also resulted in the appearance of a new zinc peak at 1-1.5 x 10(4) Daltons. These data show that zinc-protein binding is markedly affected by peptic digestion. It appears possible that low-molecular zinc-binding ligands are present in milk types other than human milk and that they are released from aggregated by peptic digestion.

[Carrot soup analysis (author's transl)]. / Analyse der Karottensuppe.

The sodium and potassium concentration, the osmolality and the carbohydrate content were determined in carrot soups prepared in 4 different children's hospitals and used as oral therapy for infantile diarrhoea. The results were compared with the sugar/electrolyte solutions increasingly recommended for oral rehydration. If adequately prepared (Moro),the carrot soup can replace enteral loss of sodium and potassium and contains sufficient glucose and sucrose as free sugars to ensure optimum sodium and water absorption in the jejunum. The addition of high osmolar glucose in a commercially available carrot food (Hipp) used in the preparation of the soup in two hospitals increases its osmolality, which might provide an extra strain on the affected intestine of these ill infants.

[Shortening of interval between first and second TBE vaccination in asthmatic children (author's transl)]. / Verkürzung des Intervalls bei FSME-Impfung bei asthmakranken Kindern.

37 children suffering from asthma had to be vaccinated against tick-borne encephalitis (TBE) with an interval of only 10 days between the first two vaccinations. Sufficient antibodies were detected in samples taken 14 days after the second injection. No differences were found between the results in this group of asthmatic children and in children who were vaccinated with the usual interval of 1 to 3 months elapsing between the first two injections. The asthmatic children tolerated the vaccination very well, moreover the indicence of side reactions was not different from that of the control group.

[Lead intake from drinking water in the city of Vienna]. / Die Bleizufuhr mit dem Trinkwasser in der Stadt Wien.

Daily lead intake from drinking water was estimated on the basis of lead concentrations in running and boiled drinking water samples of 42 Viennese households and reported drinking water consumption of adults living in those households. Lead concentration (means, SD, median) in running water samples (15.3 (37.9) micrograms Pb/l, median 6.3) was significantly higher (p less than 0.005) than in boiled water samples (6.4 (11.1) micrograms Pb/l, median 4.1). The highest lead concentrations in running water samples were found in houses built before 1945. Reported drinking water consumption was 1306 (576) ml/day (median 1242); more than 70% of drinking water was consumed at home. Calculated lead intake from drinking water in Vienna was 11.8 (22) micrograms Pb/day (median 5.2). Lead intake from drinking water was highest (19.5 (31.3) micrograms Pb/day, median 7.3) in houses built before 1945. Lead intake with food was calculated using published data on lead concentrations in food items and on food intake and data from the present study. Calculated average lead intake with food (206 micrograms Pb daily) was far below the estimated safe lead intake proposed by WHO 1972. We conclude that lead intake from drinking water in Vienna is low in most households. However, lead intake may be close to toxic levels if persons living in houses built before 1945 are consuming extremely large amounts of drinking water.

[Preventive use of vitamin D and fluoride in Austria]. / Vitamin-D- und Fluorprophylaxe in Osterreich.

The implementation of the recommended daily vitamin D and fluoride supplements for infants in Austria has been investigated during a nationwide infant nutrition survey (n = 1069). 93.9% of the infants received daily vitamin D supplements, whereas only 38% received fluroide. Rejection of fluoride supplemtation was most common among mothers aged between 30 and 45 years and mothers with university education. In Carinthia, Vorarlberg and Styria only 2 out of 10 infants received fluoride supplements. It seems necessary to reconsider the recommendations for fluoride supplementation in Austria.

[Vaccination status and sociodemographic variables in Viennese public school students]. / Impfstatus und soziodemographische Variablen bei Wiener Volksschülern.

A representative sample of 585 children, attending 2nd grade elementary school in Vienna, was examined. Vaccination certificates were collected, the parents' attitudes towards recommended vaccinations and data on sociodemographic variables were obtained by questionnaire. Compared to 95.9% of the less educated only 90.4% of the higher educated parents are interested that their children receive all vaccinations recommended (p < 0.01). When the dominant country equals "Austria", parents are more reluctant (p < 0.05) to have their children vaccinated (80.4%), compared to others (former Yugoslavia 92%, Turkey 90.9%, other countries 93.1%). A complete immunization against Diphtheria, Tetanus and Poliomyelitis (DT/OPV) was observed in 65.3% of the children. DT/OPV and additionally Mumps and Measles (MM) in 54% and DT/OPV + MM and Pertussis in 43.8% respectively. The immunization coverage is significantly higher (p < 0.01) in children with the dominant country = Austria (DT/OPV 70.7%, DT/OPV + MM 61.8%, DT/OPV + MM + Pertus sis 51.1%) compared to children from former Yugoslavia (DT/OPV 56.3%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%), Turkey (DT/OPV 54.5%, DT/OPV + MM 40.9%, DT/OPV + MM + Pertussis 33.3%), and "other countries" (DT/OPV 41.4%, DT/OPV + MM 34.5%, DT/OPV + MM + Pertussis 24.1%).

Reduction of rotavirus infection in children receiving bifidobacteria-supplemented formula.

This study was conducted at Pakkred Babies Home, Bangkok, Thailand; with the hypothesis that children receiving probiotic-supplemented milk-based formula may be protected from developing diarrheal diseases. Salivary rotavirus-specific IgA antibody was used as an indicator of rotavirus infection. One hundred and seventy-five children, aged 6-36 months, were enrolled in the study. They were divided into 3 groups according to the type of formula given. There were 81 episodes of diarrhea during an 8-month study period, most of which were caused by bacterial enteropathogens. Ninety-seven pairs of salivary samples were adequate for the analysis of rotavirus antibody. Among 23 children receiving milk-based follow-up formula and serving as control group, 30.4 per cent of them had > or = 4-fold increase in the antibody titre, indicating subclinical rotavirus infection. The majority of children in the other 2 study groups, receiving the same formula supplemented with either Bifidobacterium Bb12 alone or together with Streptococcus thermophilus, had no significant change in the antibody titres between the two time points. The results of this study support our hypothesis that children receiving bifidobacteria-supplemented milk-based formula may be protected against symptomatic rotavirus infection.

[Dislocation after total hip arthroplasty]. / Luxationen nach Hüftendoprothetik.

Dislocations after total hip arthroplasties are one of the most common complications of the procedure. According to registers, recurrent hip dislocations account for up to 30 % of the indications for a revision operation. The incidence of a dislocation is influenced by indication-associated, patient-dependent and operation-specific risk factors. 50 % of the dislocations occur within the first 3 months which confirms the high relevance of operation-specific influencing factors. The diagnosis is almost always made with the help of computed tomography, as this is the only method to determine the three-dimensional relationship of the components. A dynamic fluoroscopic examination can verify an increased translation (reduced soft-tissue tension) and thus enables a functional examination to determine the mechanism of the dislocation. By means of a classification of dislocations into five types under consideration of the implant position, the sufficiency of the pelvitrochantar musculature, the presence of an impingement, the congruence of head and acetabular liner as well as combinations of these factors it is possible to plan an adequate therapy. From the therapeutic point of view the correct positioning of the stem and head is of decisive importance. In addition therapeutic success can be realized by using larger head diameters through to tripolar sockets, reconstruction of soft tissues and, last but not least, an adequate postoperative immobilization. Even so, this treatment is associated with a high rate of complications and in the literature failure rates of up to one third, i.e., the reoccurrence of a dislocation, are reported.

[The Nutrition Commission of the Austrian Society of Pediatrics and Adolescent Medicine. Prevention of caries]. / Ernährungskommission der österreichischen Gesellschaft für Kinder- und Jugendheilkunde. Kariesprävention.

Effective preventive programs must be instituted early in the life of a child. The pediatrician plays an important role in preventive oral health care, because most children do not visit a dentist before 3 years of age. Fluoride therapy decreases the caries vulnerability of the tooth, oral hygiene measures are important to remove bacterial plaque, and dietary modifications reduce the number of carbohydrate exposures per day. Community water fluoridation is proposed in Austrian cities, because it continues to be the most cost-effective caries prevention measure available. As long as the population does not have access to optimally fluoridated water, dietary fluoride supplementation offers an effective alternative. The recommended dosage of fluoride supplements for children depends on the amount of fluoride present in their drinking water and on the child's age. Liquid fluoride supplements and chewable tablets are proposed for children between 0.5 and 3 years and children between 3 and 13 years, respectively. Home use topical fluorides and professionally applied topical fluorides are useful beyond 3 years of age. Teaching of oral hygiene measures should be continued in kindergarten and school. The 3-6 year-old children require parental assistance to achieve effective plaque removal. Semiannual dental visits should begin at the age of three and continue throughout childhood and adolescence. As far as the diet is concerned, the frequency of exposure to sugar appears to be the most important factor in the development of dental caries. It now appears that most sugars are nearly equally cariogenic in a pure form.

Body composition of adolescent males. Part I. Total body water in normal adolescent males. Part II. Body composition of the male reference adolescent.

This study was undertaken to obtain total body water (TBW) data suitable for derivation of body composition of the typical adolescent male. TBW by the deuterium dilution method, stage of sexual development and anthropometric parameters (weight, height and triceps and subscapular skinfold thickness) were determined in 108 males between 10 and 14 years of age, whose weight and height fell between the 10th and the 90th percentile of the NCHS reference data. TBW/weight did not change significantly between 10 and 14 years, although a slight increase after age 11 years and from genital stage 2 to stage 5 was present. This indicates that body fat content decreases after 11 years and after genital stage 2, especially if the fact is taken into account that water content of fat-free body mass decreases during this age period. The ability of single anthropometric parameters to predict TBW/weight was low (subscapular skinfold thickness, r = -0.62; triceps skinfold thickness, r = -0.54; weight/height cube ratio, r = -0.48). Even with the use of various combinations of anthropometric parameters in multiple stepwise prediction equations it was not possible to explain more than 50% of the variation of TBW/weight and the high standard error of the estimate indicated large errors in prediction. Thus, body composition of normal adolescent males cannot be predicted with an acceptable degree of accuracy by anthropometric parameters. On the other hand, the deuterium dilution method using salivary water represents a noninvasive method for the determination of TBW which is quite simple and suitable for field studies.

[Causes of phosphate deficiency syndromes and calcification disorders in premature infants fed human milk]. / Ursache von Phosphatmangelsyndrom und Mineralisationsstörung bei frauenmilchernährten Frühgeborenen.

Premature infants fed human milk frequently show biochemical signs of phosphate depletion syndrome and bone undermineralisation. In order to explain those findings we calculated calcium- and phosphorus intake, -retention and -distribution in the body of premature infants and compared it to calcium- and phosphorus-gain and -distribution in the body of the fetus. The premature infants retained markedly less calcium and phosphorus than the fetus. Compared with the fetus premature infants utilized a higher percentage of retained phosphorus for formation of new body cell mass. Therefore, only a small amount of phosphorus was available for bone mineralisation. The calcium: phosphorus ratio in human milk is about 2:1 (mg:mg). Calcium is almost exclusively utilized for skeletal mineralisation and is deposited in bone in a 2,16:1 (mg:mg) ratio with phosphorus. Because of insufficient phosphorus supply for skeletal mineralisation, only part of the calcium provided with human milk could be utilized by the premature infants. In order to avoid disturbances of calcium-, phosphorus- and bone metabolism premature infants fed human milk need calcium and phosphorus supplementation.