[Orthopedic surgery in Dhulikhel, Nepal]. / Unfallchirurgie in Dhulikhel/Nepal.

Nepal is one of the 20 poorest countries in the world. Thus, medical care in Nepal is dependent on significant medical and financial commitment from within and outside the country. Dhulikhel Hospital - Kathmandu University Hospital (DH-KUH) was founded in 1996 by Prof. Dr. Ram and colleagues. Collaboration and support of many people and institutions are, in contrast to the experience in other hospitals of the third world, characterized by an extraordinary sustainability. The reason for this is the spirit lived according to the motto "best service for the poor". The structures in DH-KUH are influenced by a very close cooperation with a number of international (university) hospitals. Most of the DH-KUH departments have an amazingly high technical standard. Assuming this development and progress can be continued, a splendid future for DH-KUH can be predicted.

[Primary nerve transplantation: does it make sense in defect injury of peripheral nerves?]. / Macht die primäre Nerventransplantation bei Defektverletzungen peripherer Nerven Sinn?

Regeneration of damaged nerves limits the outcome of complex injuries of the upper extremities. We report the follow-up results in 7 of 10 patients over 5 years who underwent a transplantation of n. suralis in 6 cases and n. cutaneus antebrachii ulnaris in 4 cases. The average DASH-score of 30 points, no neurinoma and a protective sensibility in 5 cases are comparable with the literature.

Detection of infection in postoperative orthopedic patients with technetium-99m-labeled monoclonal antibodies against granulocytes.

A prospective study of 106 orthopedic patients was performed for the detection of infection in the early postoperative stage using 99mTc-labeled murine Mabs directed against epitopes on granulocytes. Accuracy was 81% in the hips (n = 26), 81% in the thigh (n = 21), 84% in the knee (n = 19), and 100% in the tibia (n = 27). The technique did not work well in the spine where false-negative results were observed in the three patients studied. One patient suffered transient swelling of the eyelids following injection. Optimal imaging results were obtained 2-6 hr postinjection.

[Inveterate pediatric dislocation of the radial head with an intact annular ligament. A case report]. / Veraltete kindliche Radiusköpfchenluxation bei intaktem Ringband. Ein Fallbericht.

A girl of 3 years of age sustained an isolated traumatic dislocation of the radial head. The injury was diagnosed 2 1/2 years later and required open reduction, repair of the annular ligament and temporary transcapitellary Kirschner wire fixation. The operative procedure--the annular ligament still intact--is reported.

[Extra-ligamentous valgisation additive tibial head osteotomy. Indications-technic-complications-errors. Critical analysis]. / Die Extraligamentäre Valgisierende Additive (EVA) Tibiakopfosteotomie. Indikation-Technik-Komplikationen-Fehler. Kritische Analyse.

In patients with posttraumatic or idiopathic gonarthritis, varus deformity and stable medial collateral ligaments the valgus high tibia correction osteotomy in the open wedge method is performed extraligamentary. An autologous wedge from the iliac crest is used, a bridging plate osteosynthesis brings stability for early movement. 58 patients with 64 osteotomies operated between 1981 and 1986 underwent a follow-up examination. There was an infection rate on the tibial head of 15%. The reason for that was not in the procedure itself but in its application and performance. Respecting the site of osteotomy (less than or equal to 6.5 cm below tibial joint line), the size of the wedge at its basis (less than or equal to 10 mm), a strong indication in cases of repeated interventions and the correct technical performance of the procedure we see in the high tibia valgus osteotomy (open wedge method) a proper way of treatment in unilateral varus gonarthritis or varus deformities compared to other existing methods.

[Diagnosis of infection in surgery of the locomotor system with Tc-99m-HMPAO leukocyte scintigraphy]. / Infektionsdiagnostik in der Chirurgie des Bewegungsapparates mit der Tc-99m-HMPAO-Leukocytenszintigrafie.

70 patients with confirmed (23 patients) or suspected (47 patients) bacterial infection in the skeleton following diseases, injuries or operations in orthopedic surgery were investigated using Tc-99m-HMPAO leucocyte scintigraphy in order to evaluate the accuracy of this procedure. Infections could be detected correctly in 37 of 70 patients (right positives) while 28 patients had negative scans corresponding to the clinical course (right negatives). One false negative finding was observed. Five patients with clinically suspected infection had a focal uptake in the WBC-scan and were not operated subsequently. They range as false positive results, although they belong to a special group (Infection: Yes-Operation: No [IYON]-group). In the assessment of the Tc-99m-HMPAO-WBC-scan there was a senstivity of 97.1%, specificity of 82.9% and an overall accuracy of 90%. The method is suitable for detection of early and late infection as well as chronic or hematogenous osteomyelitis in the locomotor system. This means an important contribution in diagnosis of infection determining further operative or conservative treatment.