[Mental practice has influence on limitation of motion and muscle atrophy following immobilisation of the radiocarpal joint - a prospective randomised experimental study]. / Mentales Training beeinflusst Bewegungseinschränkung des ruhiggestellten Handgelenks - eine prospektive Experimentalstudie.

PURPOSE: Distal radial fracture is the most common bony injury in man. Still there are unsatisfying treatment results, such as limited joint movement, muscle atrophy and pain, resulting from immobilisation while the fracture is healing. During this period, also joint movement seems to be "forgotten". This study experimentally examined if the method of mental practice, meaning the systematic repetition of a consciously imagined movement or action without simultaneous practical execution, can positively influence these findings. MATERIALS AND METHODS: 21 right-handed males had application of a circular forearm plaster for immobilisation of their left radiocarpal joint, simulating a distal radial fracture for three weeks. Following randomisation, half of the study participants learned mental practice for "virtual movement" of their radiocarpal joint and had to perform it, the others were not treated at all. At beginning and end of the experiment, joint movement was measured, and an MRI examination of the forearm muscles was performed. The brain (cortex) areas, responsible for radiocarpal joint movement, were examined concerning their activity with functional MRI at the beginning and also at the end of the three weeks. The experiment was also performed on three "real" patients suffering from a distal radial fracture demanding plaster immobilisation, all of them were mentally treated. RESULTS: Mental practice significantly ameliorated dorsal extension and ulnar abduction after plaster removal in comparison to those not having been mentally trained. Muscle atrophy of forearm muscles, measured via MRI, was significantly less in those having mental training. The cortex areas responsible for radiocarpal joint movements (supplementary motor area, precentral gyrus, putamen, nucleus caudatus, prefrontal cortex, thalamus and cerebellum) showed significant signal changes at the end of the three weeks in those having been mentally trained. There were significant correlations between MRI and functional MRI findings. The findings in the three "real" patients were similiar. CONCLUSIONS: The results of this experimental study show that mental practice can have a positive influence on the outcome of distal radial fractures demanding immobilisation. A study with a larger number of "real patients" should follow.

[Endovascular treatment of traumatic ruptures of the thoracic aorta]. / Endovaskuläre Versorgung der traumatischen thorakalen Aortenruptur.

Traumatic rupture of the descending aorta is an acute life-threatening event. The most common cause is deceleration trauma resulting in a sudden stretching of the aortic isthmus as for example in car and motorcycle accidents and falls from a great height. Exemplified by a case report of a multiply injured 57-year-old male the diagnostic pathways, therapy and postoperative complications are presented.

Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

The aim of this study was to investigate whether the final displacement of conservatively treated distal radius fractures can be predicted after primary reduction. We analysed the radiographic documents of 311 patients with a conservatively treated distal radius fracture at the time of injury, after reduction and after bony consolidation. We measured the dorsal angulation (DA), the radial angle (RA) and the radial shortening (RS) at each time point. The parameters were analysed separately for metaphyseally "stable" (A2, C1) and "unstable" (A3, C2, C3) fractures, according to the AO classification system. Spearman's rank correlations and regression functions were determined for the analysis. The highest correlations were found for the DA between the time points 'reduction' and 'complete healing' (r = 0.75) and for the RA between the time points 'reduction' and 'complete healing' (r = 0.80). The DA and the RA after complete healing can be predicted from the regression functions.

[Lower limb salvage using Pirogoff ankle arthrodesis : minimally invasive and effective fixation with the Ilizarov external ring fixator]. / Extremitätenerhalt durch tibiokalkaneare Arthrodese nach Pirogoff : Minimal-invasive und effektive Osteosynthese mit dem Ilizarov-Ringfixateur.

BACKGROUND: Irreversible destruction of the forefoot and midfoot generally leads to amputation. So-called limited surgical procedures such as transmetatarsal or Chopart/Syme amputations often result in poor clinical outcomes. Prostheses for these stumps are difficult to fit, a fact that reduces mobility for these patients, so reamputations are not rare. The very old method of tibiocalcaneal arthrodesis introduced by Pirogoff in 1854 can be an interesting surgical alternative in these cases, and the use of an Ilizarov external ring fixator may solve the stabilisation problem. MATERIAL AND METHODS: From 1 January 1990 to 1 January 2007, six patients underwent surgery for tibiocalcaneal Pirogoff arthrodesis with an external Ilizarov ring fixator. RESULTS: All patients could be evaluated postoperatively, with a medium follow-up time of 45.8 months. Outcome was measured with a modified ankle disarticulation score. In four cases, the outcome was good or excellent. Two cases (33%) with initially successful arthrodeses required transtibial reamputations because of secondary infection. All other cases healed very well. There was no delayed union or nonunion of the arthrodeses in our series. CONCLUSIONS: Tibiocalcaneal Pirogoff arthrodesis can be a surgical alternative in forefoot and midfoot destructions to achieve a well-covered, comfortable stump with a minimum of leg-length shortening that is easy to fit with a prosthesis and even allows some limited barefoot mobility. Bony fixation and healing of the arthrodesis are the challenges, but these difficulties can be avoided by using an external ring fixator system. Despite a failure rate of up to one-third, this method can be an effective solution due to the good functional outcome.

[Osteitis. Infections of the locomotive system]. / Osteitis. Infektionen des Bewegungsapparates

Infections of the locomotive system appear in many different forms such as acute inflammation of joints or bone following injury or surgical or chronic processes, often lasting for years. They demand an exact treatment plan not only to remove necrotic tissue but also for reconstruction of defects. A special problem is infection following alloplastic reconstruction of joints or spine. Multiple surgical procedures are required to hinder reinfection, restore function, and assure acceptable patient quality of life.

[Complaints in the follow-up of conservatively treated distal radius fractures--predictors in the initial radiograph]. / Beschwerden im Verlauf nach konservativ behandelten distalen Radiusfrakturen--Prädiktoren aus der initialen Röntgenaufnahme.

PURPOSE: Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment. MATERIALS AND METHODS: A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed. RESULTS: Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = +/- 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD +/- 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %. CONCLUSION: In the analysis of the initial radiographs after distal radius fracture, age and radial shortening primarily correlate with functional results after four years after conservative treatment. Using the values age > or = 75 and radial shortening > or = 4 mm, it is possible to predict an unfavorable functional outcome with a positive predictive value of 73 %. This could aid in the indication of operative treatment.

[Does mental training improve learning to walk with an above-knee prosthesis?]. / Verbessert mentales Training das Erlernen der Gehbewegung mit Oberschenkelprothese?

BACKGROUND: Mental training is a method for optimizing movement patterns, which has become well established through its application in high performance sport and is also adopted in therapeutic contexts. The question arises as to whether the process of learning to walk following the fitting of a femoral prosthesis can be enhanced by means of mental training. METHODS: In the framework of a prospective randomized study, healthy subjects (36 students) were required to learn to walk with a femoral prosthesis: the control group (n=18) exclusively with the aid of practical training and the experimental group (n=18) with practical and mental training. Dependent variables were specified as the gait parameters of a computer-supported and an observational gait analysis. RESULTS: In comparison to the control group, the experimental group made significantly faster learning progress in all parameters of the computer-supported and observational gait analysis. CONCLUSIONS: Mental training seems to be an effective gait training method following the fitting of a femoral prosthesis. Transferring this method to rehabilitation, particularly in young patients, would most certainly appear feasible.

Hip arthroplasty with proximal transmission of force: first clinical results with a new partially cemented femoral stem.

BACKGROUND: Proximal stem fixation by partial cementing is a new concept in hip arthroplasty. We conducted a prospective clinical and radiological analysis to evaluate the preliminary outcome of this new technique with the Option 3000 stem (Mathys Orthopaedics, Bettlach, Switzerland). METHODS AND FOCUS: One hundred and thirty-three hip replacements in 123 patients have been performed between 1996 and 2003: All of them were followed up regularly both clinically and radiological and 53 were analysed with the EBRA-FCA method. Eighty-six patients with 95 hips could be seen in August 2004. At this point of time, the mean follow-up time was 61 months (5.08 years) with a maximum of 100 months (8.33 years) RESULTS: The clinical data reported an average Harris Hip Score of 85.5. Nine stems had to be exchanged over the period of study. The EBRA-FCA analysis reported a mean subsidence less than 1.5 mm after 2 years, then an average stable subsidence of 2.4 mm. So the results are similar to the early results obtained with other fixation concepts and the long-term results appear promising.

[Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65]. / Frakturen der oberen Extremität beim geriatrischen Patienten - Harmlose Monoverletzung oder Ende der Selbstständigkeit? Eine prospektive Studie zum Outcome nach distaler Radius- und proximaler Humerusfraktur bei über 65-jährigen.

In a prospective study 104 patients >or=65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in "fear of falling" throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.

[Osteitis. Infections of the locomotive system]. / Osteitis. Infektionen des Bewegungsapparates.

Infections of the locomotive system appear in many different forms such as acute inflammation of joints or bone following injury or surgical or chronic processes, often lasting for years. They demand an exact treatment plan not only to remove necrotic tissue but also for reconstruction of defects. A special problem is infection following alloplastic reconstruction of joints or spine. Multiple surgical procedures are required to hinder reinfection, restore function, and assure acceptable patient quality of life.

[Fatal outcome after multiple trauma. The thoracic injury as the decisive factor]. / Letaler Verlauf nach Mehrfachverletzung. Das Thoraxtrauma als entscheidender Faktor.

In patients suffering from multiple injury, chest trauma is often the main cause of fatality. A case report is given and the literature reviewed.A 49 years old motorcyclist hit a car frontally in a road accident. After primary stabilization and first clinical care, he was transferred to our trauma centre because of severe chest injury, suspected pericardial effusion and lesion of the thoracic aorta. Initial diagnostics (plain radiographs, CT scan of thorax, abdominal ultrasound, echocardiography) showed left-sided serial rib fractures, a fracture of the left scapula, a hematopneumothorax left-sided, bilateral lung contusion, a small pneumothorax of the right side, a minimal pericardial effusion and a small splenic hematoma. The patient was treated in the intensive care unit, and the situation was initially stable. After 12 h, respiration deteriorated and a bronchoscopy showed filling of the airways with mucous fluid. The CT scan showed a worsening of the pulmonary damage and increasing pericardial fluid compression. A pericardiotomy was carried out, but the situation remained unstable. The patient was treated with invasive ventilation (PEEP>10, FiO2>0,5). Sudden severe bleeding out of left lower lobe was managed by thoracotomy and lobectomy. The patient remained unstable and died 95 h after the accident. This case shows that the severity of chest trauma does not necessarily correlate with the initial clinical and radiological findings. Even with all diagnostic and therapeutic procedures, a fatal outcome could not be prevented. This demonstrates the role of chest injury as a major and unforeseeable cause of death in multiple trauma patients.

[Special considerations in therapy of injuries of the cervical spine in ankylosing spondylitis (Bechterew disease)]. / Besonderheiten der Therapie von Verletzungen der Halswirbelsäule bei Spondylitis ankylosans (M. Bechterew).

Cervical spine changed by Bechterew's disease is severely endangered with any increased load. Even decent trauma is enough to produce a fracture with affection of spinal cord. Because of little knowledge in these special items, late diagnosis of overlooked injury is not rare, especially in two-level injuries. Neurolesions following secondary fracture dislocations may occur ("fatal pause"). From january 1990 to february 2000 12 patients underwent surgery (dorsoventral stabilisation, ventral stabilisation, laminectomy). Diagnostic procedures, levels of injury, pre- and postoperative neurostatus (following Frankel's score), operative technique, typical complications and follow-up (Ø 17.8 months) were analyzed and compared with the literature. 11 patients showed preoperative neurodeficits. They were better in five cases and disappeared at all in another five cases after surgery (83% positive neurological outcome). There was no increase of neurology failure. Two patients died (ARDS and cerebral ischemia with destruction of vertebral arteries). One patient had to be reoperated because of implant dislocation. MRI is obvious in diagnostic for these lesions. There is also an absolute need for total (both clinical and radiological) examination of the whole spinal column, because there is often injury of more than one level (three times in our study). Therapy should be operative (dorsoventral stabilisation, in certain cases only anterior procedure or laminectomy). Late diagnosis and therapy with secondary worsening after fracture dislocation is not rare because of "overlooked injury". There were four patients, that would not have suffered cervical spine fracture (minimal injury force) without Bechterew's changes. There is often pulmonary failure through limitation of thoracic movement and cerebral ischemia following rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) in our collective is less than literature's medium rates (35-57%).