[Retrospective Analysis of Diabetics with Regard to Treatment Duration and Costs]. / Retrospektive Analyse von Diabetikern im Hinblick auf Behandlungsdauer und Behandlungskosten in einem überregionalen Traumazentrum.

Background: The increasing incidence of diabetes mellitus is also reflected in the patient population of a trauma and orthopaedic centre. Diabetics also exhibit more comorbidities than non-diabetics. In addition to surgical problems in these patients, hospitalisation is often accompanied by complications, which can prolong treatment and increase costs. The aim of this retrospective study is to analyse hospitalisation of diabetics compared to non-diabetics, as well as differences in treatment costs, depending on associated age and comorbidities. Patients/Material and Methods: 17,185 patients were treated at a transregional trauma and orthopaedic centre and were included in this retrospective analysis between 2012 and 2015. Comorbidities and hospitalisation of diabetics and non-diabetics were recorded. All costs charged by DRG were evaluated to calculate the cost per day and per patient, on the basis of the specific case rate. In this calculation, patient-related case rates were divided by the average residence time and the means of the calculated daily rates were calculated. Inclusion criteria were treatment within the various departments and a minimum hospitalisation of one day. Statistical analysis was performed with the SPSS program (version 22.0, SPSS Inc., Chicago, USA). Results: In comparison to non-diabetics (ND), diabetics (D) exhibited significantly more comorbidities, including: obesity, arterial hypertension, coronary heart disease, myocardial infarction (in the history), peripheral arterial disease, chronic kidney disease and hyperlipidaemia. Pneumonia in hospital was considerably commoner in diabetics (2.45 % [D] vs. 1.02 % [ND], p < 0.001). Time in hospital was significantly longer in diabetics (endoprosthetics 13.52 days [D] vs. 12.54 days [ND], p < 0.001; septic surgery 18.62 days [D] vs. 16.31 days [ND], p = 0.007; traumatology 9.82 days [D] vs. 7.07 days [ND], p < 0.001). For patients aged under 60 years, time in hospital was significantly longer for diabetics than for non-diabetics (9.98 days [D] vs. 6.43 days [ND] p < 0.001). Because of the longer time in hospital, treatment costs were higher by € 1,932,929.42 during the investigated time period. Conclusion: Because of their comorbidities, diabetics need to be categorised at an early stage as high-risk patients in traumatological and orthopaedic departments. Hospitalisation and the associated increased treatment costs, as well as postoperative complications, could be minimised in patients with diabetes by implementing an interdisciplinary treatment concept.

[Periprosthetic Acetabulum Fractures]. / Periprothetische Azetabulumfrakturen.

In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.

Loss of spatial organization and destruction of the pericellular matrix in early osteoarthritis in vivo and in a novel in vitro methodology.

OBJECTIVES: Current repair procedures for articular cartilage (AC) cannot restore the tissue's original form and function because neither changes in its architectural blueprint throughout life nor the respective biological understanding is fully available. We asked whether two unique elements of human cartilage architecture, the chondrocyte-surrounding pericellular matrix (PCM) and the superficial chondrocyte spatial organization (SCSO) beneath the articular surface (AS) are congenital, stable or dynamic throughout life. We hypothesized that inducing chondrocyte proliferation in vitro impairs organization and PCM and induces an advanced osteoarthritis (OA)-like structural phenotype of human cartilage. METHODS: We recorded propidium-iodine-stained fetal and adult cartilage explants, arranged stages of organization into a sequence, and created a lifetime-summarizing SCSO model. To replicate the OA-associated dynamics revealed by our model, and to test our hypothesis, we transduced specifically early OA-explants with hFGF-2 for inducing proliferation. The PCM was examined using immuno- and auto-fluorescence, multiphoton second-harmonic-generation (SHG), and scanning electron microscopy (SEM). RESULTS: Spatial organization evolved from fetal homogeneity, peaked with adult string-like arrangements, but was completely lost in OA. Loss of organization included PCM perforation (local micro-fibrillar collagen intensity decrease) and destruction [regional collagen type VI (CollVI) signal weakness or absence]. Importantly, both loss of organization and PCM destruction were successfully recapitulated in FGF-2-transduced explants. CONCLUSION: Induced proliferation of spatially characterized early OA-chondrocytes within standardized explants recapitulated the full range of loss of SCSO and PCM destruction, introducing a novel in vitro methodology. This methodology induces a structural phenotype of human cartilage that is similar to advanced OA and potentially of significance and utility.

[Refracture of long bones after implant removal. An avoidable complication?]. / Refrakturen nach Entfernung von Osteosynthesematerialien. Eine vermeidbare Komplikation?

Refractures of long bones after implant removal are a rare but serious complication, which in most cases make a reoperation necessary. We analysed our own cases and reviewed the scarce literature on this subject. As a result we found that it is possible to reduce this complication by performing thorough preoperative preparation, observing an adequate interim time between initial osteosynthesis and hardware removal, cautiously exposing the weakened bone to force for a certain time period after implant removal and taking the character of the fracture healing into consideration. It is not possible to entirely eradicate this complication because a lot of patients demand the implant removal even though it is known that demineralisation and residual screw holes both induce a reduction of energy-absorbing capacity and therefore predispose the patient to refracture. In some cases the surgeon should recommend that the implants remain in situ.

[Hardware removal after pelvic ring injury]. / Implantatentfernung nach Beckenringfraktur.

BACKGROUND: Pelvic ring fractures are considered as rare injuries. Minimally invasive sacroiliac screw fixation has been used increasingly in recent years as an operative strategy for the treatment of these injuries, if the dorsal pelvic ring needed to be addressed. Treatment options for the anterior pelvic ring comprise plates, screws or external fixation. METHOD: Based on the limited number of publications on this subject and our own experience with 80 patients who suffered pelvic ring B- or C-type injuries during a period of 8 years we are able to show that the indication for hardware removal in the pelvic ring should be strictly defined. RESULTS: In some cases like external fixation, implant-associated infection, malpositioning, allergic implant reaction, critical soft tissue covering, palpable hardware and consolidated juvenile fractures implant removal is certainly indicated. In patients without symptoms and in patients with trauma-associated symptoms which are not definitely associated with the hardware, the removal should be only indicated after thorough consideration of the risks versus the benefits and additionally by taking the initial injury pattern into account. If despite all these objections the hardware removal has been indicated it should always be considered that hardware removal may be challenging with several possible severe complications.

[Hardware removal after spinal instrumentation]. / Metallentfernung an der Wirbelsäule.

Because of the increasing number of patients with surgically treated injuries of the spine we more often have to answer the question of indication for hardware removal. In the cervical spine and after anterior instrumentations of the thoracic and lumbar spine hardware removal is only indicated as part of the management of postoperative complications. After dorsal instrumentation for fractures of the thoracic and lumbar spine, implant-associated discomfort is possible. In addition, in non-fusion procedures there is the risk of implant failure. In these cases the hardware should be removed. If the consolidation of the fracture is in doubt, a preoperative CT scan is useful.

[Evaluation of image quality of two different three-dimensional cone-beam-scanners used for orthopedic surgery in the bony structures of the pelvis in comparison with standard CT scans]. / Vergleich der Bildqualität zweier unterschiedlicher mobiler 3-dimensionaler Röntgen-C-Bögen mit einem konventionellen CT bei der Darstellung relevanter Strukturen am knöchernen Becken.

AIM: This study evaluated the image quality of two different cone beam CT scanners used in the operation theatre in pelvic trauma surgery in relation to their radiation dosage. Furthermore, the assumption that a higher dosage would result in better image quality was analysed by using the different acquisition scanner modes. MATERIAL AND METHODS: We scanned the acetabulum (n=4) and iliosacral joints (n=4) of two human cadavers with a conventional CT and with two mobile cone beam CT scanners (Siemens Arcadis Orbic 3D and Ziehm Vision Vario 3D). With the two cone beam CT scanners (3D-BV), we used 6 different acquisition modes with different radiation dosages. The axial views of all scans were exported and blinded. Subsequently, the images were evaluated by 7 medical doctors with regard to identifiability of cortical structures (acetabular joint, fovea capitis femoris, cortical bone of the femur head, iliosacral joint, and sacral foramina), and the quality of the cancellous structure of the femur head. The evaluation was performed on axial views by using a defined five-point score. The interrater quality was statistically analysed according to Cohen with the kappa coefficient. In addition, the Wilcoxon test was used to identify significances between the 21 paired results of the evaluators. For determination of the signal-to-noise ratio, a Catphan 600 reference block with two different test elements (Teflon, PMP) was used. RESULTS: Overall, the image quality of the conventional CT scans received the best score. Comparing the two 3D cone beams, the image quality of the Siemens Arcadis Orbic 3D in high-dosage mode received the best score (median: 2.40), the Ziehm Vision Vario 3D in low-dose mode without large patient key received the lowest score (median: 3.16). The differences in the 21 paired results of the two different acquisition modes were significant in 17 cases (p < 0.05) but the size of difference when comparing the different acquisition modes was almost always small. The interobserver agreement in one acquisition mode was low (kappa 0.008-0.134). The overall evaluation results of the same acquisition mode diverged by up to 2 score points. We noted a higher signal-to-noise ratio in the high dosage mode than in the low dosage mode. DISCUSSION: When using intraoperative 3D imaging with the cone beam CT technique for pelvic injury, image acquisition in low-dose mode is adequate in terms of signal-to-noise ratio and image quality. The image quality does not correlate linearly with a higher radiation dosage. Therefore, the pelvic trauma surgeon using this technique is encouraged to gather his own experience with low dose modes thereby reducing patient radiation exposure.

Acetabular bone reconstruction in revision arthroplasty: a comparison of freeze-dried, irradiated and chemically-treated allograft vitalised with autologous marrow versus frozen non-irradiated allograft.

Deficiencies of acetabular bone stock at revision hip replacement were reconstructed with two different types of allograft using impaction bone grafting and a Burch-Schneider reinforcement ring. We compared a standard frozen non-irradiated bone bank allograft (group A) with a freeze-dried irradiated bone allograft, vitalised with autologous marrow (group B). We studied 78 patients (79 hips), of whom 87% (69 hips) had type III acetabular defects according to the American Academy of Orthopaedic Surgeons classification at a mean of 31.4 months (14 to 51) after surgery. At the latest follow-up, the mean Harris hip score was 69.9 points (13.5 to 97.1) in group A and 71.0 points (11.5 to 96.5) in group B. Each hip showed evidence of trabeculation and incorporation of the allograft with no acetabular loosening. These results suggest that the use of an acetabular reinforcement ring and a living composite of sterile allograft and autologous marrow appears to be a method of reconstructing acetabular deficiencies which gives comparable results to current forms of treatment.

[Vitalised allogenic cancellous bone in the treatment of segmental defects of the tibia after distraction osteogenesis: two case reports]. / Vitalisiertes Allograft zur Behandlung von Regeneratversagen der proximalen Tibia nach Kallusdistraktion: Zwei Fallberichte.

Two case reports are presented in which segmental defects of the tibia after distraction osteogenesis have been filled with vitalised allogenic cancellous bone. Bone healing was achieved within three months. The effectiveness of this method for treating segmental defects of limbs should be investigated by means of prospective randomised trials.

[Gait analysis in limb-preserving tumour surgery--kinematic gait patterns after resection of malignant bone tumours near the knee joint]. / Ganganalyse bei extremitätenerhaltender Tumorchirurgie--Vergleich der Bewegungsmuster nach Resektion primär maligner Tumoren im Bereich des Kniegelenkes.

AIM: Limb-preserving surgery is the most common therapeutic approach in cases of malignant bone tumours near the knee joint. Although good functional results have been reported for tumours located in the distal femur, tumours in the proximal tibia have been investigated less frequently. The objective of the current study was to compare the kinematic gait patterns in patients with tumours in the femur vs. the tibia. METHOD: 11 patients with an arthroplasty after a primary malignant bone tumour were included (5 femur, 6 tibia). Their speed-specific kinematic gait patterns were quantified. 10 healthy volunteers and 6 patients with normal knee arthroplasty served as a reference group. RESULTS: The tibia patients walked significantly more slowly than the femur patients. They showed a similar overall gait pattern predominantly characterised by a hyperextended knee during stance. CONCLUSION: The differences in walking speed between the two groups of tumour patients did not transfer to different gait patterns. Limb-preserving surgery is thus a valuable therapeutic option also for patients with primary tumours in the tibia.

EBRA migration patterns of the Plasmacup with ceramic or polyethylene inserts: a randomised study.

AIM: In this prospective randomised study, the influence of different bearing materials on migration and wear was measured and their effect on the function of the artificial joint and the patient outcome was investigated. Mid-term results were recorded so that recommendations can be made on the use of certain bearings, which minimise wear and thus the danger of subsequent aseptic loosening. METHOD: Sixty-six patients met the inclusion criteria and were willing to take part in the study. These patients were randomised to 2 groups. All of them had total hip arthroplasty with implantation of a cementless Bicontact stem and Plasmacup using a cementless press-fit technique. Thirty-five of these patients were given a ceramic-ceramic bearing and 31 patients a ceramic-polyethylene bearing (gamma sterilised/nitrogen environment). At the most recent follow-up, they underwent detailed clinical and radiological examination and evaluation by means of the Harris Hip Score, Hannover function questionnaire and single-film X-ray analysis (EBRA). RESULTS: The overall follow-up rate was 65.2 % (43 of 66) and the mean follow-up period was 8.1 (7.1 - 9.2) years. The median Harris Hip Score at the time of follow-up was 90.1 (58.7 - 99.9) points. The average Hannover function score was 87.14 % (63.9 - 100). In 4 of 66 cases (6.1 %) there was a tendency for the Plasmacup to subsidence in the first postoperative months that was slight but detectable by EBRA; however, this stopped subsequently. This primary subsidence was independent of the chosen bearing material. No significant difference in the clinical and radiological parameters was found between the two groups. CONCLUSION: The very good results with regard to the rate of loosening confirm the press-fit cup fixation concept. The study shows a similar medium-term result for the ceramic-ceramic and ceramic-polyethylene bearing so that use of both bearings can continue to be recommended. Only long-term studies with sufficiently large numbers of patients will be able to show whether significant differences can be detected between the two slide bearings with regard to wear and migration behaviour and so that a recommendation can be given to the surgeon.

Treatment of large femoral bone defects--15-year experiences with the cementless Bicontact revision stem with distal interlocking.

AIM: With the steady growth in the number of hip arthroplasty revision operations, the concept and long-term results of the Bicontact revision stem with distal interlocking for the treatment of extensive femoral bone defects were investigated in this prospective study. METHOD: The first 156 stem revision operations performed between January 1992 and December 2002 were evaluated. The indication for operation was aseptic loosening in 133, stem fracture in 14, recurrent dislocation in 2 and reimplantation following Girdlestone removal of a septic prosthesis in 7. The cup component was revised at the same time in 74 cases. RESULTS: Higher-grade femoral bone defects were found intraoperatively in 66 %. The average age of the patients was 71.4 (34 - 88) years at operation and 76.9 (44 - 94) years at the last follow-up. The average period until follow-up, re-revision or loss to follow-up was 5.54 (0.1 - 14.9) years. The clinical and radiological follow-up rate (with reference to the total number of patients) was 35 % (55 von 156), and 51 % (55 of 107) with reference to patients still living. The median Harris Hip Score was 63.7 points. In the observation period, 12 stems were exchanged for a cemented standard stem, 5 stems were removed because of infection and 2 stems were revised because of periprosthetic fracture. The calculated survival rate for the stems after 14.9 years was 85.9 %. CONCLUSION: The 15-year results confirm the biomechanical concept of the Bicontact revision stem with optional distal interlocking for the treatment of extensive bone defects in stem revision surgery.

Prospective long-term follow-up of the cementless bicontact hip stem with plasmapore coating.

AIM: A prospective long-term study of the first 250 cementless Bicontact stems implanted in the BG Trauma Centre, Tuebingen, Germany. METHOD: All of the patients in this series (treatment period June 1987 to April 1990) who were still contactable were invited for clinical and radiological follow-up. The radiographs were analysed for signs of loosening in the form of Gruen lysis zones, stress shielding, subsidence behaviour, heterotopic ossification and spot welds. RESULTS: The average follow-up period was 17.8 (16.7 - 19.5) years. The overall rate of follow-up was 65 % (162 of 250) and 91 % of patients who were still alive (162 of 179). The average patient age was 56.2 years at the time of operation and 74.0 years at follow-up. The average HHS was 81.6 points. In the course of the first 10 years (up to 03/1998), a total of 8 stem revisions had to be performed. In the period from 03/1998 to 01/2007, 2 cases of loosening requiring revision occurred in the patients still alive at the time of follow-up. The survival rate calculated was thus 95.6 %. CONCLUSION: These outstanding results provide enduring support for the philosophy of the cementless and bone-preserving fixation principles underlying the Bicontact hip stem with proximal intertrochanteric transmission of forces and high primary rotational stability.

[Prophylaxis and therapy for hip dislocations in patients with infantile cerebral palsy (ICP): motor functional, radiological and clinical results after subcutaneous adductor tenotomy]. / Prophylaxe und Therapie der Hüftgelenksluxation bei infantiler Zerebralparese (ICP): statomotorische, radiologische und klinische Ergebnisse nach subkutaner Adduktorentenotomie.

AIM: The current study assessed the clinical and radiological outcome and motor function improvement after subcutaneous adductor tenotomy in children with cerebral palsy (ICP). It was also analysed if groups with different preoperative hip functions and radiological hip migrations differed in their final clinical, radiological and motor function outcome. METHOD: A prospective study of 91 children with infantile cerebral palsy (ICP, mean age 4.9 years, range: 1.1 - 15.8) with 141 hip dislocations or subluxations analysed preoperatively the hip abduction and radiologically the migration percentage (MP). Depending on the preoperative status, all patients were grouped into 3 abduction and 3 MP groups. Additionally, the motor function was classified according to the Rancho los Amigos scale. A subcutaneous adductor tenotomy was performed mono- or bilaterally and all patients were treated for 4 - 6 weeks with a hip abduction splint. Patients were assessed annually for 4 years; clinical and radiological results and the motor function were analysed according to their preoperative status. RESULTS: The mean hip abduction was preoperatively 30.3 +/- 1.2 degrees and was significantly improved to 50.3 +/- 1.3 degrees 1 year and to 43.3 +/- 2.2 degrees 4 years post surgery. The preoperative mean MP was preoperatively 42.3 +/- 1.3 % and was significantly improved to 34.6 % 1 year and to 31.9 % 4 years post surgery. After 4 years, 41 % had undergone a motor function improvement and 52 % no change in motor function. After 4 years, patients with a hip abduction

[Open augmented repair according to Silfverskjöld for Achilles tendon rupture: an alternative for athletes?]. / Die Umkipp-Plastik nach Silfverskjöld bei Achillessehnenruptur: Eine Alternative für Sportler?

AIM: The most recent meta-analysis of randomized trials recommended open repair for competitive athletes suffering from Achilles tendon rupture due to low re-rupture rates and recommended for all other patients percutaneous repair. The report did not include patients with open augmented repair. The aim of this study was to analyse our results with open augmented repair after Silfverskjöld and to discuss whether this method is an alternative form of treatment, especially for athletes. METHODS: This retrospective study included all patients who received open augmented repair in the Silfverskjöld technique between the years 1996 and 2002. A total of 104 patients were clinically evaluated, involving ultrasound as well, and were scored according to the Thermann scale. The average age was 43 years. The operation took place on average within 5.7 days. Twenty athletes were identified and were compared with non-athletes using the Thermann scale and the two randomsample t-tests. The follow-up period averaged 3.7 years. RESULTS: Overall, the results were rated as good, with an average of 88.1 points. The re-rupture rate was 1.9% (2 out of 104) with a deep infection incidence of 2.8% (3 out of 104). Athletes averaged 88.7 and non-athletes 88.0 points. No significant difference was recorded (t=0.98). Nineteen out of 20 (95%) athletes and 48 out of 84 (57%) non-athletes were able to return to their original level of sport activity. CONCLUSIONS: Open augmented repair after Silfverskjöld is found to be a real alternative to simple open reconstruction of Achilles tendon ruptures. Clinical outcome in both athletes and nonathletes was recorded as good to very good. Especially athletes were able to regain their original activity level with an overall low re-rupture and infection rate.

[Treatment of osteochondritis dissecans of the knee: one-step procedure with bone grafting and matrix-supported autologous chondrocyte transplantation]. / Einzeitige Rekonstruktion osteochondraler Defekte am Kniegelenk bei Osteochondrosis dissecans.

AIM: The aim of this study was to establish and assess a one-step reconstruction procedure of deep osteochondral defects of the knee joint with bone grafting and matrix-supported autologous chondrocyte transplantation in osteochondritis dissecans. METHOD: Between 2004 and 200622 patients with osteochondral defects in the weight-bearing zone of the femoral condyles(ICRS OCD III and IV) were reconstructed simultaneously with bone grafting and matrix-supported autologous chondrocyte transplantation (NOVOCART 3D). All patients were analysed prospectively. RESULTS: 17 Males and 5 females(age 28.3, range: 17-49 years) were surgically treated with the above-mentioned novel method. Before reconstruction osteochondral defects had an average defect area of 4.8 (2.4-9.0) cm2 and a depth of between 4 and 15 mm. For reconstruction an average of 2.6 (1-6) monocortical cancellous bone cylinders (diameter 8mm) was used to fill the osseous defect and to reconstruct the subchondral bone plate with adequate positioning of the monocortical layer of the graft. Then a Matrix-ACT was used to cover the reconstructed subchondral bone plate. The average follow-up was 16 (6-36) months. The average Tegner activity score was 4 (3-7) of 10. The Lysholm-Gillquistscore and the Cincinnati Sports Medicine and Orthopedic Center score were significantly improved postoperatively. The IKDC-2000 questionnaire was also significantly increased by 50%. CONCLUSION: The simultaneous reconstruction of deep osteochondral detects of the knee joint with bone grafting and matrix-supported autologous chondrocyte transplantation in osteochondritis dissecans is a biological, one-step alternative to previously reported methods with encouraging first results.

[A novel therapeutic approach to bone replacement: vitalisation of industrial processed allogenic bone graft with autologous bone marrow]. / Das "vitalisierte" Allograft als Alternative im Knochenersatz.

AIM: Osseous defects of the human skeleton are a common problem in reconstructive orthopaedic and trauma surgery. In spite of a long-standing history of research on different organic and inorganic bone replacement materials, a clinically applicable alternative to autogenous bone transplants has not been found. METHODS: The current paper describes a novel bone replacement material, which is vitalised through injection of autologous bone marrow. Industrially processed bone allografts were used for bone replacement; the cancellous bone graft was gained from femoral heads from living human donors and processed by a French tissue bank (Banque de Tissus France, TBF). Sterile packed allogenic bone grafts can be stored at room temperature, are easy to handle and can be adapted to almost every bone defect due to their stability and versatility. RESULTS: From July 2003 to February 2006 125 patients,70 men and 55 women, underwent bone grafting with composite transplants composed of autogenous marrow cells and industrial processed bone allografts. The average age at surgery was 62 (14-84) years; the follow-up period was 11 months. The indication to use the allograft included the whole spectrum of bony defects conventionally treated with autologous cancellous bone grafts such as primary and revision surgery in THA (n = 64) and the treatment of pseudarthrosis particularly of the lower limb (n = 30). CONCLUSION: In comparison to current bone replacement materials applied in clinical use, this approach promises to replicate the biomechanical and biological properties of autogenous cancellous bone. This is an important advantage over conventional approaches to ensure successful healing and regeneration of bone defects. Hence application of vitalised bone allograft represents an important alternative to conventional autogenous cancellous bone which avoids certain complications associated with harvesting and transplantation of autogenous bone. This applies in particular in situations in which harvesting of autogenous cancellous bone is not or no longer possible.

[Open augmented repair according to Silfverskjöld for Achilles tendon rupture: an alternative for athletes?]. / Die Umkipp-Plastik nach Silfverskjöld bei Achillessehnenruptur: Eine Alternative für Sportler?

AIM: The most recent meta-analysis of randomized trials recommended open repair for competitive athletes suffering from Achilles tendon rupture due to low re-rupture rates and recommended for all other patients percutaneous repair. The report did not include patients with open augmented repair. The aim of this study was to analyse our results with open augmented repair after Silfverskjöld and to discuss whether this method is an alternative form of treatment,especially for athletes. METHOD: This retrospective study included all patients who received open augmented repair in the Silfverskjöld technique between the years 1996 and 2002. A total of 104 patients were clinically evaluated, involving ultrasound as well,and were scored according to the Thermann scale. The average age was 43 years. The operation took place on average within 5.7 days. Twenty athletes were identified and were compared with all non-athletes using the Thermann scale and the two random sample t-tests. The follow-up period averaged 3.7 years. RESULTS: Overall, the results were rated as good,with an average of 88.1 points. The re-rupture rate was 1.9% (2 out of 104) with a deep infection incidence of 2.8% (3 out of 104). Athletes averaged 88.7 and non-athletes 88.0 points. No significant difference was recorded (t = 0.98). Nineteen out of 20 (95%) athletes and 48 out of 84(57%) non-athletes were able to return to their original level of sport activity. CONCLUSIONS: Open augmented repair after Silfverskjöld is found to be a real alternative to simple open reconstruction of Achilles tendon ruptures. Clinical outcome in both athletes and non athletes was recorded as good to very good. Especially athletes were able to regain their original activity level with an overall low re-rupture and infection rate.

[Experience in operations for scoliosis in patients with cerebral palsy]. / Erfahrungen mit operativer Skoliosekorrektur bei Patienten mit infantiler Zerebralparese.

AIM: Experiences in operation of scoliosis in cerebral palsy are very different. Therefore a therapeutic regiment does not exist. In this study we want to report our experiences. METHODS: This retrospective-clinical study (1986-2003) includes 46 patients with cerebral palsy who had been operated for scoliosis. The data focus in particular on the therapeutic strategies and its success and complications. Publications from 1946 to 2003 were reviewed and served for comparison. RESULTS: 28 female and 18 men during one period by median 3.4 years were after-observed. The post office-operationally reached correction of the curvature of all operation procedures was appropriate for median between 51 and 68 % depending upon localization of the curvature. In the last re-examination median a correction loss of 3-25 % existed. A fusion to S1 corrected a thoraco-lumbale or lumbale scoliosis significantly better than a fusion to L5. The posterior and the combined posterior-anterior operation procedure showed comparable correction results. The total complication rate was with 35 %. CONCLUSIONS: Due to good correction successes and smaller complication rate we favor a posterior-anterior operation procedure. A fusion to S1 is indicated with thoraco-lumbale and lumbale fusion. Altogether complication rate was reduced in patients with scoliosis and cerebral palsy after operation at the spinal column in the last years.

[Shoulder dislocation in the newborn. Report of 12 cases and review of the literature]. / Die Schulterluxation beim Neugeborenen. Bericht über 12 Fälle und Literaturübersicht.

Shoulder dislocation in the newborn is a rare entity. Therefore, a therapeutic regimen does not exist. This retrospective clinical study (1967-2003) includes 9 newborns with 12 dislocations of the shoulder. The data focus in particular on the therapeutic strategy and its success. The position of the joint and its functionality were monitored with a questionnaire. Publications from 1904 to 2003 were reviewed and served for comparison. Results of calculations showed that 0.018-0.07% of newborns suffer from shoulder dislocations. The diagnosis was made on average at the age of 22 days. Our data include four cases each of congenital and paralytic and two cases each of spastic and traumatic shoulder dislocations. All of them were initially treated conservatively, but because of inadequate results one patient finally had to be operated. In the follow-up of 19.4 years, none of them developed a redislocation and all shoulder functions were suitable for daily life. We propose that patients primarily be treated conservatively; however, if therapy fails, surgery has to be performed.