[Knee joint infections]. / Das infizierte Kniegelenk.

Knee joint infection represents an emergency case at every age. Joint infection occurs frequently after trauma or joint surgery. The infection can be caused by numerous bacteria, viruses, or yeasts; however, Staphylococcus aureus is identified as the cause in 85-95 % of joint infections. Early treatment is important for patient outcome. In addition to synovectomy and therapeutic arthroscopy, antibiotic therapy is essential and should be started after sample recovery.

[Clavicle fractures]. / Klavikulafrakturen.

Clavicle fractures are the most common break injuries in humans second to radius fractures. They often occur alone, mostly after falling directly onto the shoulder and less often onto the stretched out arm. They are also not uncommon in connection with high speed trauma or multiple injuries. Accompanying injuries must also be considered due to the close proximity of important structures such as the subclavian artery and vein and the brachial plexus. Diagnosis is made by inspection and x-ray imaging and in complicated cases computed tomography and/or angiography might also be necessary. Because the clavicle is necessary for precise, powerful and variable use of the arm, an exact morphological repositioning is extremely important. Approximately 90% of all clavicle fractures heal with good results after conservative treatment. However, in particular situations there are absolute (obligatory surgery due to vessel damage) or relative operation indications.

[Preventing malrotation during intramedullary nailing of femoral fractures]. / Bildwandlergestützte Vermeidung einer Torsionsabweichung zur Gegenseite bei der Oberschenkelmarknagelung.

BACKGROUND: The problem of preventing malrotation after closed intramedullary nailing of femoral shaft fractures has not been solved yet. As clinical tests and radiologic criteria for intraoperative use provide little accuracy, the theoretical basis for a C-arm-based measurement of the femoral antetorsion was analysed. METHODS: The directions of femoral neck axis and condylar axis can be identified by the radiologic views "knee joint, lateral view" and "hip joint, axial view". The rotation of the C-arm in relation to a horizontal axis to achieve these views can be measured in degrees. Theoretically, the difference between these rotation angles could be used to calculate the antetorsion. Intact plastic femora (Sawbone) and a femoral shaft fracture model were used to research optical and geometrical phenomena that influence a direct measuring technique. RESULTS: Several geometrical phenomena were observed, making direct measurement with arithmetic corrective factors not recommendable. For practical reasons, a data table was created, correlating the difference between the two C-arm angles with true antetorsion. In an interobserver trial with 18 trauma surgeons, the method proved to achieve high accuracy with a maximum interobserver variation of 5 degrees. CONCLUSIONS: The method is easily reproducible, reliable and can be recommended to every surgeon. Due to the wide range of physiological antetorsion angles in different individuals, fair results can be expected controlling the rotation with standard value tables, and excellent results can be expected using bilateral measurement.