Conservative versus tailored surgical treatment in patients with first time lateral patella dislocation: a randomized-controlled trial.

BACKGROUND: Patellar instability has a high incidence and occurs particularly in young and female patients. If the patella dislocates for the first time, treatment is usually conservative. However, this cautious approach carries the risk of recurrence and of secondary pathologies such as osteochondral fractures. Moreover, there is also risk of continuous symptoms apparent, as recurrent patella dislocation is related to patellofemoral osteoarthritis as well. An initial surgical treatment could possibly avoid these consequences of recurrent patella dislocation. METHODS: A prospective, randomized-controlled trial design is applied. Patients with unilateral first-time patella dislocation will be considered for participation. Study participants will be randomized to either conservative treatment or to a tailored patella stabilizing treatment. In the conservative group, patients will use a knee brace and will be prescribed outpatient physical therapy. The surgical treatment will be performed in a tailored manner, addressing the pathologic anatomy that predisposes to patella dislocation. The Banff Patellofemoral Instability-Instrument 2.0, recurrence rate, apprehension test, joint degeneration, and the Patella Instability Severity Score will serve as outcome parameters. The main analysis will focus on the difference in change of the scores between the two groups within a 2-year follow-up. Statistical analysis will use linear mixed models. Power analysis was done for the comparison of the two study arms at 2-year follow-up with regard to the BPII Score. A sample size of N = 64 per study arm (128 overall) provides 80% power (alpha = 0.05, two-tailed) to detect a difference of 0.5 standard deviations in a t-test for independent samples. DISCUSSION: Although several studies have already dealt with this issue, there is still no consensus on the ideal treatment concept for primary patellar dislocation. Moreover, most of these studies show a unified surgical group, which means that all patients were treated with the same surgical procedure. This is regarded as a major limitation as surgical treatment of patella dislocation should depend on the patient's anatomic pathologies leading to patellar instability. To our knowledge, this is the first study investigating whether patients with primary patella dislocation are better treated conservatively or operatively with tailored surgery to stabilize the patella. TRIAL REGISTRATION: The study will be prospectively registered in the publicly accessible database www.ClinicalTrials.gov .

[Combined trochleoplasty and medial patellofemoral ligament reconstruction for patellofemoral instability]. / Kombinierte Trochleaplastik und Rekonstruktion des medialen patellofemoralen Ligaments zur Behandlung der patellofemoralen Instabilität.

OBJECTIVE: Combined anatomical reconstruction of the MPFL and deepening trochleoplasty to improve the stability of the patellofemoral joint in patients with severe trochlear dysplasia. INDICATIONS: Confirmed patellofemoral instability with recurrent dislocations and high-grade trochlear dysplasia. CONTRAINDICATIONS: Open distal femoral physis, degenerative changes of the patellofemoral joint grade ICRS III-IV. SURGICAL TECHNIQUE: Diagnostic arthroscopy, exposure of the femoral trochlea through a lateral parapatellar arthrotomy and preparation of an osteochondral flake were carried out. The aim was to create a recentralized, deepened groove. Fixation of the flake in the newly formed groove was achieved with a Vicryl band and bone anchors. Closure of the capsule followed. Via the same skin incision the quadriceps tendon was exposed. The most superficial layer of the quadriceps tendon with a width of 12 to 15 mm was elevated from the deeper tendon. The graft was dissected superiorly at a length of 8-9 cm. The pedicled slip of the tendon remained distally, leaving the patellar attachment intact. The interval between the capsule and the vastus medialis obliquus was developed to the femoral insertion of the MPFL. The graft was then secured with an interference screw under fluoroscopic control with the knee flexed to 30°. Closure of the aponeurosis of the tendon and the capsule concluded the procedure. POSTOPERATIVE MANAGEMENT: Partial weight-bearing of 20 kg, using crutches, is allowed. Physical therapy with flexion and extension exercises of the knee, and strengthening of the vastus medialis muscle follow. Full weight-bearing is permitted at 6 weeks and earliest return to sport is 3 months postoperatively. RESULTS: Since 2006 a total of 86 patients with patellofemoral instability have undergone trochleoplasty. In 26 patients combined trochleoplasty and anatomical reconstruction of the MPFL with a distal pedicled quadriceps tendon graft was performed. No recurrent dislocation occurred postoperatively, knee scores improved statistically significantly. Ninety-five percent of the patients were satisfied or very satisfied with the result.

[Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws]. / Mittelfristige Ergebnisse nach offener Rotatorenmanschettenrekonstruktion in Double-Row-Technik mit Titanankerschraube.

BACKGROUND: The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented. MATERIAL AND METHODS: 237 patients (m = 142, f = 95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M. G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83 %, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerber's shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated. RESULTS: In SSG a highly significant improvement from 51 to 83 points was found (p < 0.001). In CS 80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5 % 5.1 years postoperative (p < 0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6 %, the relative re-tear rate 17.6 %. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5 % were found. The patient's age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p < 0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p < 0.001) which also resulted in a significantly better outcome in the CS (p < 0.01). The costs for open titanium transfixation technique with 330 € per case are markedly less than for arthroscopic suture bridge technique with 600 to 1000 € per case. CONCLUSION: Open double-row cuff repair with titanium screws is a safe and cost effective technique with a low re-tear rate with comparable clinical results regarding open and arthroscopic procedures.

Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia.

PURPOSE: Trochlear dysplasia is considered to be one of the major factors causing patellofemoral instability (PFI). Dejour's classification is widely used to assess the severity of trochlear dysplasia. Additionally, in current literature, different quantitative parameters are recommended to distinguish between a normal trochlea and a dysplastic trochlea. In order to achieve a more objective evaluation of the trochlea, the aim of this study was to evaluate whether specific measurements of the femoral trochlea can be assigned to the qualitative classification system of Dejour. METHODS: Transverse MRI T2-weighted scans of 80 knees with symptomatic PFI and varying severity of trochlear dysplasia were classified according to Dejour (type A to D). For all MRI scans, quantitative measurements with parameters as described in the literature were applied. The values were then allocated to Dejour's classification. In addition to the four-grade analysis, two-grade analysis was also performed (Dejour type A against type BCD). Dependent on the cut-off values, specificity, sensitivity and Youden index for each parameter was defined. RESULTS: The allocation resulted in the following distribution: type A trochlear dysplasia n = 25, type B n = 23, type C n = 18 and type D n = 14. In descriptive statistics, none of the measurements proposed in the literature could be assigned to the four-grade classification system of Dejour. For the two-grade analysis at the cut-off, sensitivity ranged from 75 to 86 % and specificity from 76 to 84 % for lateral trochlear inclination, trochlear facet asymmetry and depth of trochlear groove. All other measurements showed a poor sensitivity ranging from 49 to 67 % and specificity from 40 to 72 %. Interobserver and intraobserver repeatability for the measured parameters was fair to moderate (ICC values 0.34-0.58) in high-grade dysplasia (type BCD) and substantial to almost perfect (ICC values 0.71-0.88) in low-grade trochlear dysplasia (type A). CONCLUSION: Quantitative measurements of the femoral trochlea have shown to be of limited value for the assessment of trochlear dysplasia. None of the quantitative measurements of the trochlea on transverse images could be assigned to the four-grade descriptive classification of trochlear dysplasia of Dejour. Additionally, measurements could not be reliably performed in high-grade trochlear dysplasia. However, trochlear inclination, trochlear facet asymmetry and depth of trochlear groove may help to distinguish between low-grade and high-grade dysplasia.

Arthroscopic evaluation of trochlear dysplasia as an aid in decision making for the treatment of patellofemoral instability.

PURPOSE: Trochlear dysplasia is an important aetiological factor for the development of patellofemoral instability (PFI). The aim of the study was to identify the arthroscopic morphology of trochlear dysplasia that can be helpful when planning operative treatment for PFI. METHODS: Magnetic resonance imaging (MRI) scans and strict lateral radiographs of 46 patients treated for PFI were assigned according to Dejour and matched with arthroscopic views from the lateral superior arthroscopic portal. On arthroscopy, signs of trochlear dysplasia were identified and classified into two types. Intra- and inter-observer agreements of the arthroscopic evaluation were assessed. RESULTS: Arthroscopically, 2 major types of trochlear dysplasia could be distinguished. Type I shows a flat trochlear groove with an elevated trochlear floor in relation to the anterior femoral cortex. In type II, the proximal trochlea was convex with a lateral trochlear bump. Arthroscopic evaluation was not consistent with the Dejour's radiographic and axial MRI classification. Arthroscopic grading showed excellent intra- and inter-observer agreements (81-92%). CONCLUSION: Arthroscopic evaluation can give additional information about the severity of trochlear dysplasia. This additional information can be used as an aid in decision making for the treatment of PFI. LEVEL OF EVIDENCE: II.

The effects of femoral external derotational osteotomy on frontal plane alignment.

PURPOSE: Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of external derotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment. METHODS: The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle. RESULTS: Proximal derotational osteotomies resulted in an increased mechanical lateral distal femoral angle (mLDFA) of 0.8°-2.6° for 10°, of 1.6°-5.1° for 20° and of 2.3-7.9° for 30° derotational osteotomy, indicating an increased varus angulation. Supracondylar derotational osteotomy resulted in a decreased mLDFA of -0.1° to -1.7° for 10°, of -0.2 to -3.7° for 20° and of -0.7 to -6.9° for 30° derotational osteotomy, indicating an increased valgus angulation. The effect increased with the amount of torsional correction and virtually increased antecurvatum angles. Mid-shaft torsional osteotomies had the smallest effect on frontal plane alignment. CONCLUSION: This three-dimensional computer model study demonstrates the relationship between femoral torsional osteotomies and frontal plane alignment. Proximal external derotational osteotomies tend to result in an increased varus angulation, whilst distal external derotational osteotomies tend to result in an increased valgus angulation. As a clinical consequence, torsional osteotomies have an increased risk of unintentional implications on frontal plane alignment.

Correction of malformative patellar instability in patients with nail-patella syndrome: a case report and review of the literature.

Nail-patella syndrome (NPS) or hereditary onycho-osteodysplasia is a relatively rare autosomal dominant disorder with the classic tetrad of fingernail abnormalities, hypoplastic patellae, radial head dislocation and iliac horns. The anatomic abnormalities in NPS often lead to subluxation or dislocation of the patellaeca causing knee instability and pain. Although most existing literature regarding the knee manifestation of this syndrome has focused on the clinically and radiological changes, only a few articles discussed the surgical treatment. This study reports the clinical, radiological and arthroscopical findings and a 24-month follow-up after operative stabilisation considering the underlying pathomorphology of malformative patellar instability in an 11-year-old girl. The findings of this study confirm the unique pathology of NPS with a synovial band preventing the engagement of the patella into the trochlear groove. NPS is a rare disorder and has to be considered in cases with untypical patella dislocation. The underlying pathology differs completely from patients with patellofemoral instability. The aim of orthopaedic surgery should be correction of the underlying pathology with resection of the synovial band and an additional realignment of the patella by recentering of the quadriceps muscle. Considering the underlying pathology good clinical results can be expected.

Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus.

PURPOSE: Osteochondral autologous transplantation (OAT) from the ipsilateral femoral lateral condyle in osteochondritis dissecans (OD) of the talus has shown good clinical results in the past. To further define, indications and limitations of OAT various factors have been discussed which might influence the clinical outcome. METHODS: In this study, the clinical outcome of OAT of 32 patients (mean follow-up 29 months) was evaluated by means of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, ankle pain on the visual analogue scale (VAS), and Hospital for Special Surgery (HSS) Patella score. We then analysed the statistical correlation between clinical outcome and various variables such as age, pre-existing osteoarthritis, or size of the lesion. RESULTS: Median AOFAS score was 86 (range 68-100), median ankle pain on VAS was 2.0 (range 0-5.5), and median HSS Patella score was 95 (range 35-100). Advanced age (above 40 years of age) was associated with a significantly lower HSS Patella score (80 vs. 97.5, p = 0.035). None of the other variables (obesity, pre-existing osteoarthritis, size of the lesion, necessity of malleolar osteotomy, localization of the lesion, and number of previous surgeries) influenced the clinical outcome adversely. CONCLUSIONS: Osteochondral autologous transplantation in OD of the talus is a safe procedure with good clinical results. As advanced age is associated with higher donor-site morbidity, indication for OAT in older patients should be carefully considered. As none of the other variables affected the clinical outcome of OAT adversely, there is no contraindication for OAT, for example, in osteochondral lesions requiring more than one osteochondral grafts, lateral lesions, patients with BMI >25, pre-existing osteoarthritis, or failed previous surgery. LEVEL OF EVIDENCE: IV.

Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates.

Recurrent lateral patellar dislocation is a common knee injury in the skeletally immature adolescent. In adults, anatomical reconstruction of the medial patellofemoral ligament (MPFL) is recommended, but due to the open physis, operative therapy in children is more challenging. We present a minimal invasive technique for anatomical reconstruction of the MPFL in children respecting the distal femoral physis. This technical note considers the important fact that the femoral insertion is distal to the femoral physis. Since the importance of an anatomical reconstruction respecting the femoral insertion of the ligament has been proven an insertion proximal of the physis has to be strictly avoided.

The relation of the distal femoral physis and the medial patellofemoral ligament.

PURPOSE: The purpose of this study was to analyse true lateral radiographs of children and adolescents to determine the relation of the origin of the MPFL and the distal femoral physis considering the complex anatomy of the physis. The hypothesis was that the femoral insertion of the MPFL is distal to the growth plate. METHODS: Antero-posterior and true lateral radiographs from PACS computer records of 27 patients with a history of patellofemoral instability were assessed. To determine the femoral origin of the MPFL, the method by Schöttle et al. and the method by Redfern et al. were applied independently. On the anteroposterior radiograph, the distance between the medial most part of the physis and the central part of the physis was measured to quantify the concave curvature of the physis. To cross-reference the femoral insertion of the MPFL onto an ap view, the projected MPFL origin-physis distance was subtracted from the distance between the most medial part of the physis and the central part of the physis. RESULTS: The projected median origin of the MPFL as measured on a lateral radiograph was located 3.2 mm (1.2-5.8 mm) proximal to the physis. The median distance between the most medial part of the physis and the physeal line on the anteroposterior radiograph was 9.9 mm (4.1-12.0 mm). Subtracting the two measured values, the median origin of the MPFL as seen on the ap view was 6.4 mm (2.9-8.5 mm) distal to the femoral physis. CONCLUSION: Considering the concave curvature of the distal femoral physis, it can be assumed that the femoral insertion of the MPFL is distal to the femoral physis. As a too proximal insertion of the graft can cause unintentional tightening of the MPFL in knee flexion, these results have to be considered when performing reconstruction of the MPFL in children and adolescents with open growth plates.

[Patellar fracture after patellar stabilization]. / Patellafraktur nach MPFL-Rekonstruktion bei femoropatellarer Instabilität.

We report on a 20-year-old female patient with a fracture of the patella after she fell on"black ice" 2 months after medial patellofemoral ligament (MPFL) reconstruction for patellar instability. For reconstruction of the MPFL, a single hamstring tendon graft was passed through the medial intermuscular septum and was fixed to the superomedial pole of the patella. The fracture was reduced by wire cerclage. Intraoperatively it was shown that the fracture line went through the patellar drill hole. No complications occurred during the further postoperative period. The literature contains only a few case reports describing fractures of the patella after MPFL reconstruction without any specific trauma. In this case, an interruption in blood supply with resulting avascular necrosis was suspected as a causal factor.

[Tarsal coalitions: a rare differential diagnosis of congenital clubfoot]. / Koalitionen des Rückfusses als seltene Differenzialdiagnosen des angeborenen Klumpfusses.

The Ponseti method has proven to be successful in the treatment of idiopathic congenital talipes equinovarus (clubfoot). In particular, if plaster cast treatment as recommended by Ponseti does not show the desired correction of the foot, tarsal coalitions as a rare cause for a secondary clubfoot deformity have to be ruled out. In these cases a surgical release of the coalition in addition to the tenotomy has to be performed to achieve a satisfactory correction.

[Transfixation in slipped capital femoral epiphysis: long-term evidence for femoro-acetabular impingement]. / Transphysäre Fixation bei Epiphyseolysis capitis femoris: Hinweise für femoroazetabuläres Impingement im Langzeitverlauf.

AIM: It was the aim of this study to reveal whether and to what extent femoro-acetabular impingement (FAI) was present 10 to 20 years after transfixation of the gliding epiphysis in patients treated for unilateral slipped capital femoral epiphysis (SCFE). METHOD: Clinical and radiological evaluations were undertaken of 20 patients who were treated with a bilateral transfixation of the epiphysis with screws or Kirschner wires because of mild unilateral SCFE. The Harris hip score, the activity level according to Tegner and Lysholm and the range of motion of both hip joints were noted. An impingement provocation test was performed on both sides. The femoral head-neck junction was qualitatively and quantitatively assessed in anteroposterior radiographs of the pelvis and "cross table" lateral radiographs of both hip joints. Quantitative assessment was achieved by measuring the alpha angle according to Nötzli et al. RESULTS: All except one patient showed excellent results in the Harris hip score. The activity levels of the majority of patients, however, were mediocre. There was no difference for flexion, whereas internal rotation and abduction significantly differed between affected and non-affected hips (p = 0.135, p = 0.002 and p = 0.007, respectively). The impingement provocation test was found positive in eight affected and five non-affected hips (p = 0.004). The alpha angle was significantly different between affected and non-affected hips in the anteroposterior radiographs of the pelvis (86 vs. 61 degrees; p < 0.001), but not so, however, in the "cross table" lateral radiographs (52 vs. 46 degrees; p = 0.145). CONCLUSION: Clinical evaluation of 20 patients at a mean of 14.9 years after transfixation of the epiphysis revealed some evidence for the presence of FAI in affected hip joints. Radiological evaluation suggests that its localisation is more lateral and less anterior.

[Nonsurgical treatment of developmental dysplasia of the hip]. / Konservative Behandlung der Hüftreifungsstörung.

The introduction of hip ultrasound for developmental dysplasia of the hip (DDH) has led to earlier diagnosis and treatment of this condition. The younger the child, the greater the potential of acetabular remodelling. An early-initiated, differentiated therapy according to the Graf classification has led to good treatment results. Nevertheless, there is still a number of residual dysplasia and a risk for late sequelae even after successful ultrasound-guided therapy. Therefore, long-term follow-up of treated hips until skeletal maturity is necessary. Whereas there is no doubt about the good results of the treatment we apply, its economic effectiveness still has to be proven.

[Reliability of digital measurement of acetabular index in hip dysplasia to the time children start walking]. / Reliabilität der digitalen Messung des AC-Winkels bei der Hüftreifungsstörung an Röntgenaufnahmen zum Gehbeginn.

AIM: An assessment of the reproducibility of the acetabular index on the basis of anteroposterior radiographs of the pelvis was performed in order to rule out residual dysplasia of the hip in the second year of life. METHOD: 51 consecutive patients (41 girls, 10 boys) with congenital dysplasia of the hip (35 bilateral, 16 unilateral) were included. Approximately at the time children started walking (mean age: 13.9 months; range: 10 - 22 months), digitised anteroposterior radiographs of the pelvis were recorded. Acetabular indices were measured bilaterally and blinded by two observers (O1 and O2), then classified according to the normal values of the hip joint described by Tönnis et al. (normal = lower single standard deviation [s], light dysplasia = above single standard deviation [s - 2 s] and severe dysplasie = above double standard deviation [2 s]). O2 repeated a second set of observations 6 weeks after the first. 306 values of the acetabular index (O1: 102 values; O2: 204 values) were statistically evaluated. Reliability was expressed by Pearson's correlation coefficient (PCC) and 95 % confidence interval. The rater agreement of the classification into normal values of the hip joint was calculated with the kappa coefficient. RESULTS: The PCC for intraobserver/interobserver reliability was 0.928/0.875. The 95 % confidence interval for intraobserver reliability was +/- 3.1 degrees and for interobserver reliability - 3.1 degrees /+ 5.9 degrees . A comparison of the first series of measurements by O1 with the series of measurements by O2 presented congruence in 66 of 102 hip joints classified according to the normal values of the hip joint as described by Tönnis. In 36 hip joints the classification was deviant, in 15 the classification differed between normal and s, in 21 between s and 2 s. The kappa coefficient of 0.51 showed moderate interobserver agreement. CONCLUSION: The reproducibility of radiological surveillance in congenital hip dysplasia, approximately to the time children start walking, can be considered as adequate. Correct positioning of the patient and exact definition of radiological landmarks are essential. In spite of good statistical values for reliability, decreasing accuracy in classifying into Tönnis' normal values of the hip joint is seen with increasing degree of dysplasia. In marginal cases, before coming to the decision for operative treatment, a second reading, ideally by the same observer and with a chronological shift, is advisable.

Radiological evidence of femoroacetabular impingement in mild slipped capital femoral epiphysis: a mean follow-up of 14.4 years after pinning in situ.

Conventional treatment of mild slipped capital femoral epiphysis consists of fixation in situ with wires or screws. Recent contributions to the literature suggest that even a mild slip may lead to early damage of the acetabular labrum and adjacent cartilage by abutment of a prominent femoral metaphysis. It has been suggested that the appropriate treatment in mild slipped capital femoral epiphysis should not only prevent further slipping of the epiphysis, but also address potential femoroacetabular impingement by restoring the anatomy of the proximal femur. Between October 1984 and December 1995 we treated 16 patients for unilateral mild slipped capital femoral epiphysis by fixation in situ with Kirschner wires. In this study we have reviewed these patients for clinical and radiological evidence of femoroacetabular impingement. There was little clinical indication of impingement but radiological evaluation assessing the femoral head-neck ratio and measuring the Nötzli alpha angle on the anteroposterior and cross-table radiographs showed significant alterations in the proximal femur. None of the affected hips had a normal head-neck ratio and the mean alpha angle was 86 degrees (55 degrees to 99 degrees ) and 55 degrees (40 degrees to 94 degrees ) on the anteroposterior and lateral cross-table radiographs, respectively. While our clinical data favours conventional treatment, our radiological findings are in support of restoring the anatomy of the proximal femur to avoid or delay the development of femoroacetabular impingement following mild slipped capital femoral epiphysis.

[Minimally invasive therapy for osteoid osteoma]. / Minimalinvasive Therapie bei Osteoidosteom.

AIM: We describe a minimally invasive procedure for the treatment of osteoidosteoma and present the outcome of the treatment in our collective. Additionally, a review of the literature for minimally invasive therapy for osteoidosteoma was performed. METHODS: Within approximately three years, ten male patients with the clinical and radiological diagnosis of osteoidosteoma were treated. First, during the procedure for the purpose of orientation, a CT scan of the affected area was performed. Then, under CT-guidance, the nidus of the osteoidosteoma was marked with a k-wire and destroyed with a drill, moulding cutter or the k-wire. The patients' charts and films were reviewed in a retrospective manner, all patients participated in a personal telephone interview. RESULTS: In all cases the intraoperative course was free of complications. After surgery 90 % of the patients were free of pain, in 10 % a significant reduction of the pain was reported. Both in those 10 % and the whole collective there were no clinical symptoms of relapse, the average follow-up in all cases was 19 months. Our results are in accord with data in the literature. CONCLUSION: In our collective the CT-guided, percutaneous removal of osteoidosteoma has been shown to be a safe and effective method. Under DRG conditions it can be performed within a short period of hospitalization or in the out-patient clinic.

[The Pediatric Musculoskeletal Functional Health Questionnaire. A function assessment questionnaire for detection of illnesses of the locomotor system in children and adolescents--initial results of validating a German version]. / Pediatric Musculoskeletal Functional Health Questionnaire. Ein Funktionsfragebogen zur Erfassung von Erkrankungen des Stütz- und Bewegungsapparates bei Kindern und Jugendlichen--Erste Ergebnisse der Validierung einer deutschen Version.

AIM: It was the purpose of this investigation to create a German version of the Pediatric Musculoskeletal Functional Health Questionnaire and to test its reliability, practicability and acceptance in children and adolescents with musculoskeletal disorders. METHODS: In a first step, the Pediatric Musculoskeletal Functional Health Questionnaire was translated into the German language. Then 147 patients with musculoskeletal disorders or respectively, their parents were asked to fill in the questionnaire, in order to test the reliability, the internal consistency, the practicability, and the acceptance of this instrument. RESULTS: The test-retest reliability for the subscales was high, it ranged between r = 0.56 and 0.93. Concerning the internal consistency of items and subscales we found only moderate results. The acceptance of the Questionnaire was high in patients or, respectively, their parents with 92%. Furthermore, the instrument has shown to be practicable and economical. CONCLUSION: With the German version of the Pediatric Musculoskeletal Functional Health Questionnaire a multidimensional instrument is now available that reliably measures health status as well as therapeutic effects in children and adolescents with musculoskeletal disorders.

Allergic reactions to latex in myelodysplasia: a review of the literature.

Current research has identified clinically relevant allergens in natural latex. Children with myelodysplasia are especially considered to be at risk for the development of immunoglobulin E-mediated hypersensitivity, which can lead to life-threatening intraoperative anaphylaxis. A careful medical history is mandatory to identify patients who might be predisposed to anaphylactic reactions. Preventive measures involve primarily the avoidance of latex contact at home and in hospitals for all patients with myelodysplasia. The effectiveness of additional pharmacologic prophylaxis has to be determined further.