Ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction in a 13-year-old male.

We present the case of an adolescent male developing an ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction (ACLR). The patient was shifted to our institution with postoperative septic arthritis associated with a systemic septic condition. Before, repeated arthroscopic surgery had been conducted without any improvement. MRI showed a concomitant osteomyelitis. The infection (Gächter IV, Staphylococcus aureus) was controlled by an open surgical approach and graft removal. An increasing joint stiffness was documented. X-rays showed an ankylosis at 30° of flexion and early closure of growth plates. Functional knee scores showed significantly worse results. Early diagnosis and a stage-adapted treatment in septic arthritis following ACLR are mandatory. In advanced stages or concomitant osteomyelitis an open approach and graft removal may be appropriate. The antibiotic treatment should be adapted consistently.

[Hip arthroscopy after luxatio obturatoria. With contralateral unstable pelvic ring fracture]. / Hüftgelenkarthroskopie nach Luxatio obturatoria. Bei kontralateraler instabiler Beckenringfraktur.

Traumatic dislocation of the hip is a severe injury. Even in cases of an early uncomplicated repositioning there is a high risk of associated intra-articular injuries, such as lesions of the labrum, ruptures of the ligament of the head of the femur and loose bodies. The degree of damage caused by dislocation of the hip becomes apparent with a highly increased risk of developing postinjury osteoarthritis after dislocation of the hip. Some of the major intra-articular damage resulting from hip dislocation, e.g. loose bodies, can be detected by computed tomography and magnetic resonance imaging and can be effectively addressed by hip arthroscopy, thus aiming at reducing the acute symptoms and the risk of postinjury osteoarthritis. The force effect which causes dislocation of the hip can generate severe associated extra-articular injures as in the case described with an unstable fracture of the pelvis. This supplementary injury had to be considered while planning the operative therapy and rehabilitation. A patient presented after a traffic accident with a luxatio obturatoria on the right side and a complex fracture of the left pelvis including the posterior ring and the anterior wall of the acetabulum. After reposition of the right hip and operative therapy of the left side, a loose body was identified in the right hip joint during the computed tomography control of the osteosynthesis. Before patient mobilization extraction of the intra-articular loose body was performed arthroscopically. This was done in consideration of the reduced possibility of distraction due to the osteosynthesis on the contralateral side. Attention was particularly paid to the risk of intra-abdominal fluid extravasation (IAFE). This syndrome is described as a severe complication during hip arthoscopy especially in cases of defects of the hip capsule as assumed after hip dislocation and magnetic resonance imaging.

[Arthroscopy-guided fracture management. Ankle joint and calcaneus]. / Arthroskopisch gestütztes Frakturmanagement. Oberes Sprunggelenk und Kalkaneus.

Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.

Laser-induced interstitial thermotherapy of liver metastases in an interventional 0.5 Tesla MRI system: technique and first clinical experiences.

Laser-induced interstitial thermotherapy (LITT) surveyed by magnetic resonance imaging (MRI) has been shown to be effective in various applications. The laser treatment of colorectal liver metastases usually requires a separate device (e.g., ultrasound or CT) to position the laser applicator. In this study, we used an interventional 0.5 T MRI system, allowing both the navigation to the target tissue and on-line thermometry. Laser irradiation was performed using a near-infrared laser source combined with a cooled laser light guide. We treated 20 patients exhibiting a total of 58 colorectal liver metastases. Clinically relevant complications did not occur. No residual tumor was observed after laser irradiation in all metastases with a diameter below 2 cm. Metastases with a mean diameter between 2 and 3 cm demonstrated total necrosis in 71%, while in larger tumors this proportion decreased to 46% (diameter, 3-4 cm) and 30% (diameter, >4 cm), respectively. We conclude that LITT, guided by the employed interventional MRI system, is feasible and safe. The results suggest a more aggressive treatment, especially for larger metastases. J. Magn. Reson. Imaging 2001;13:729-737.

[Principles of surgical management of stromal tumor]. / Prinzipien des chirurgischen Vorgehens beim Stromatumor.

Gastrointestinal stromal tumors (GIST) have been regarded as rare tumor manifestations of the mesenchymal tissue fraction of the intestinal building principle; however, this tumor is now established as an independent tumor entity owing to independent immunohistochemical and ultrastructural characteristics. In spite of increasing awareness of their biological behavior and their molecular-biological basis, evaluating the grade of many of these tumors remains open, not only on a preoperative but also on a postoperative basis. Thus, how radical the surgical procedure must be is not standardized, as it is in carcinoma surgery. The literature available today is not sufficient to make a valid analytical assumption possible because of small numbers of cases and the heterogeneity of clinical and pathological variables. Therefore, recommendations concerning oncological-surgical radicality have at this time an empirical character. Owing to the rarity of the tumor, this will probably not change in the near future. Adjuvant therapeutical treatment of relevant effectiveness does not exist. Therefore, the radicalness of the operation is organ-specific, tumor-specific and based on tumor-biological criteria.