Enhancement and human nature: the case of Sandel.

If we assume that "enhancement" names all efforts to boost human mental and physical capacities beyond the normal upper range found in our species, then enhancement covers such a broad range of interventions that it becomes implausible to think that there is any generic ethical case to be made either for or against it. Michael Sandel has recently made such a generic case, which focuses on the importance of respecting the "giftedness" of human nature. Sandel succeeds in diagnosing an important worry we may have about the use of some enhancements by some parents, but his arguments are better understood as opposing "procrustean parenting" rather than enhancement in general.

Humeral nailing revisited.

Unreamed interlocked humeral nailing for stabilisation of acute humeral fractures was introduced a decade ago. Antegrade and retrograde nail insertion are equally popular. The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail (UHN, Synthes) in our Level I Trauma Centre. The mean age of the patients was 63 years. Only eight patients (8.1%) were polytraumatised, nine patients had an open fracture (9.1%), five had a primary radial nerve palsy (5.1%). There were 54 antegrade and 45 retrograde nailings. The procedures were performed by 19 different surgeons, who carefully followed a detailed operation protocol. There were 6 adverse events: 3 secondary radial nerve palsies (3%), 2 fissures at the insertion point (2%) and one false placement of a locking screw (1%). Three patients developed pseudarthrosis (3%). Eight further operation were necessary (8.1%): 3 exploration of the radial nerve, 3 for treatment of pseudarthrosis, one replacement of a locking screw and one wound revision for superficial wound infection. Ninety patients (92 fractures) were evaluated after bone healing. Shoulder function was assessed using the Constant Score, elbow function with the Mayo Elbow Score. 91.3% and 5.4% of patients had an excellent or good shoulder function, 81.5% and 14.1% had an excellent or good elbow function. All patients with a functional deficit of the shoulder joint had antegrade, all patients with a deficit at the elbow joint retrograde nailing. Motor function recovered in all radial nerve palsies. 93.5% of patients had an excellent or good functional end result. Unreamed humeral nailing is a valid therapeutic option for stabilisation of acute humeral shaft fractures. Antegrade and retrograde nailing are associated with specific but different complications. By strictly adhering to the operation technique, the number and severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional outcome is the rule.

[Diagnosis and therapy of osteogenesis imperfecta]. / Diagnostik und Therapie der Osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a congenital connective tissue disorder with an incidence of up to 1:30,000. Patients suffer from deformities and fractures, and many of them never reach ambulation. The therapy consists of conservative, medicamentous and operative procedures that are described in this article.

[Hyperphosphatasia and hypophosphatasia in childhood]. / Hyperphosphatasie und Hypophosphatasie im Kindesalter.

The treatment of phosphate diabetes and hyperphosphatasia requires an interdisciplinary therapy concept between paediatricians and orthopaedic surgeons. The surgical challenge is the correction of the multiplanar bending deformities and the pathological fractures. Different techniques are discussed in the literature without an outstanding recommendation for a special approach. This contribution gives an overview of the published methods and discusses various surgical concepts in view of our own clinical experience.

Distinguishing treatment from research: a functional approach.

The best way to distinguish treatment from research is by their functions. This mode of distinction fits well with the basic ethical work that needs to be carried out. The distinction needs to serve as an ethical flag, highlighting areas in which the goals of doctors and patients are more likely than usual to diverge. The distinction also allows us to illuminate and understand some otherwise puzzling elements of debates on research ethics: it shows the peculiarity of exclusive conceptions of the distinction between research and treatment; it allows us to frame questions about therapeutic obligations in the research context, and it allows us to consider whether there may be research obligations in the therapeutic context.