[Optimized resource mobilization and quality of treatment of severely injured patients through a structured trauma room alarm system]. / Optimierte Ressourcenmobilisation und Versorgungsqualität Schwerstverletzter durch eine strukturierte Schockraumalarmierung.

BACKGROUND: The treatment of severely injured patients in the trauma resuscitation unit (TRU) requires an interdisciplinary and highly professional trauma team approach. The complete team needs to be waiting for the patient in the TRU on arrival. Treating severely injured patients in the TRU, the trauma team connects the initial preclinical emergency stabilization with the subsequent sophisticated treatment. Thus, the trauma team depends on concise information from the emergency personnel at the scene to provide its leader with further information as well as an accurate alarm including all departments necessary to stabilize the patient in the TRU. METHOD: Aiming at an accurate and most efficient trauma team alarm, this study was designed to provide and analyze an alarm system which mobilizes the trauma team in a stepwise fashion depending on the pattern of injuries and the threat to life. The trauma team alarm system was analyzed in a prospective data acquisition at a level I trauma center over a period of 12 months. Evaluation followed the acquisition phase and provided comparison to the status prior to the establishment of the alarm system. All items underwent statistical testing using t­tests (p < 0.05). RESULTS: The data of 775 TRU patients showed a significant reduction of false information on the patients status prior to arrival. It also showed an increase in punctual arrival in the TRU of the emergency teams. False alarms were significantly reduced (from 11.9% to 2.7%, p > 0.01). The duration from arrival of the patient in the TRU to the initial multislice computed tomography (CT) scan was reduced by 6 min while the total period of treatment in the TRU was reduced by 17 min. After the alarm system to gradually mobilize the trauma team was put into action, team members left the TRU if unneeded prior to finishing the initial treatment in only 4% of the cases. The patient fatality rate was 8.8% (injury severity score, ISS = 23 points) after establishment of the alarm system compared to 12.9% (ISS = 25 points) before. CONCLUSION: The implementation of an accurate and patient status-based alarm system to mobilize the trauma team can improve the quality of treatment while the duration of treatment of the severely injured patients in the TRU can be decreased. It also provides a most efficient mobilization of personnel resources while sustaining patient safety.

Comparison of parathyroid hormone and strontium ranelate in combination with whole-body vibration in a rat model of osteoporosis.

We investigated the combinatorial effects of whole-body vertical vibration (WBVV) with the primarily osteoanabolic parathyroid hormone (PTH) and the mainly antiresorptive strontium ranelate (SR) in a rat model of osteoporosis. Ovariectomies were performed on 76 three-month-old Sprague-Dawley rats (OVX, n = 76; NON-OVX, n = 12). After 8 weeks, the ovariectomized rats were divided into 6 groups. One group (OVX + PTH) received daily injections of PTH (40 µg/kg body weight/day) for 6 weeks. Another group (OVX + SR) was fed SR-supplemented chow (600 mg/kg body weight/day). Three groups (OVX + VIB, OVX + PTH + VIB, and OVX + SR + VIB) were treated with WBVV twice a day at 70 Hz for 15 min. Two groups (OVX + PTH + VIB, OVX + SR + VIB) were treated additionally with PTH and SR, respectively. The rats were killed at 14 weeks post-ovariectomy. The lumbar vertebrae and femora were removed for biomechanical and morphological assessment. PTH produced statistically significant improvements in biomechanical and structural properties, including bone mineral density (BMD) and trabecular bone quality. In contrast, SR treatment exerted mild effects, with significant effects in cortical thickness only. SR produced no significant improvement in biomechanical properties. WBVV as a single or an adjunctive therapy produced no significant improvements. In conclusion, vibration therapy administered as a single or dual treatment had no significant impact on bones affected by osteoporosis. PTH considerably improved bone quality in osteoporosis cases and is superior to treatment with SR.

[A new total knee arthroplasty with physiologically shaped surfaces. Part 2: First clinical results]. / Eine neuartige Kniegelenksendoprothese mit physiologischer Gelenkform. Teil 2: Erste klinische Ergebnisse.

The human medial tibial plateau is concave, whereas the lateral tibial plateau is convex. In a normal knee, the convex femoral condyles roll and glide on the tibia during the standing phase of walking. The designs of most commercially available knee prostheses do not take this morphological feature into consideration. The novel design of the AEQUOS G1 knee replacement prosthesis is based on the natural anatomy of the knee joint, with a convex lateral tibia plateau and a sagittal offset of the medial and lateral compartments. Following extensive development and testing, initial clinical results of the AEQUOS G1 prosthesis in a mulitcenter study are presented. From Mai 2005 to March 2007, 158 patients in 4 clinics underwent total knee arthroplasty with the AEQUOS G1 and agreed to participate in the study. Patients were evaluated preoperatively and at 3, 6 and 12 months of follow-up using a standardized protocol that included the American Knee Society Score (AKSS), the Oxford Knee Score (OKS) and the Visual Analog Scale (VAS) for pain. After 3 months, 151 patients appeared for follow up appointments, after 6 months, 134, and after 12 months, 127. The mean range of motion preoperatively was 97.0 degrees (+/-19.9 degrees ) and 107.5 degrees (+/-15.9 degrees ) 12 months after surgery. The AKSS, as well as the modified OKS, significantly improved (p<0.0001) from preoperative scores of 98.8 (+/-35.8) and 37.3 (+/-6.9) points, respectively, to 165.8 (+/-34.1) and 21.9 (+/-7.8) points, preoperatively, and 12 months postoperatively. The VAS score significantly decreased (p<0.001) from 7.4 (+/-1.8) points preoperatively to 1.9 (+/-2.2) points 12 months postoperatively.One implant was revised because of arthrofibrosis and another due to patellar luxation. Two patients required revision because their implants revealed malalignement with ligamentous instability. No infections, aseptic loosening or other implant-specific complications were observed at this early follow-up. Good clinical results were observed at early follow-up with the AEQUOS G1 knee arthroplasty. However, longer follow-up is necessary for a general evaluation of the implant.

[A novel knee endoprosthesis with a physiological joint shape. Part 1: Biomechanical basics and tribological studies]. / Eine neuartige Knieendoprothese mit physiologischer Gelenkform. Teil 1: Biomechanische Grundlagen und tribologische Untersuchungen.

The natural tibiofemoral joint (TFJ) functions according to a roll-glide mechanism. In the stance phase (0-20 degrees flexion), the femur rolls backwards over the tibia plateau, while further flexion causes increased gliding. This kinematics is based on the principle of a quadruple joint. The four morphological axes of rotation are the midpoints of the curvatures of the medial and lateral femoral condyles and the medial and lateral tibia plateau. In addition, the medial and lateral compartments are shifted a few millimetres in a sagittal direction, the medial tibia plateau being concave and the lateral plateau convex. In most knee arthroplasties, these factors are not taken into account; instead they are equipped with symmetrical medial and lateral joint surfaces. Thereby, the midpoints of the curvatures of the sagittal contours of the lateral and medial joint surfaces, on the femoral as well as on the tibial sides, create a common axis of rotation which does not allow a physiological roll-glide mechanism. The goal of this study was therefore to report on the biomechanical basis of the natural knee and to describe the development of a novel knee endoprosthesis based on a mathematical model. The design of the structurally new knee joint endoprosthesis has, on the lateral side, a convex shape of the tibial joint surface in a sagittal cross section. Furthermore, from a mathematical point of view, this knee endoprosthesis possesses essential kinematic and static properties similar to those of a physiological TFJ. Within the framework of the authorization tests, the endoprosthesis was examined according to ISO/WC 14243 in a knee simulator. The abrasion rates were, thereby, lower than or at least as good as those for conventional endoprostheses. The presented data demonstrate a novel concept in knee arthroplasty, which still has to be clinically confirmed by long term results.

[Acute colonic pseudo-obstruction (Ogilvie's syndrome), a life-threatening complication after total hip replacement]. / Akute Pseudoobstruktion des Kolons, "Ogilvie-Syndrom", eine lebensbedrohliche Komplikation nach Implantation von Hüfttotalendoprothesen.

INTRODUCTION: In the literature, an acute colonic pseudo-obstruction (Ogilvie's syndrome) is frequently observed as a complication after hip arthroplasty. It results in a massive colon dilatation without mechanical obstructions and can lead to a life-threatening colon perforation with a high mortality. CASE REPORT: We report on a 81-year-old male patient who suffered from an acetabular fracture after falling down with a concomitant coxarthrosis at the same hip side. A total hip arthroplasty was performed using a Müller cap. Postoperatively, he developed an acute colonic pseudo-obstruction that was treated conservatively with multiple colonoscopic decompressions. The importance of prompt recognition, careful monitoring and appropriate management to reduce morbidity and mortality are supported by this case. CONCLUSION: Early diagnosis and colonoscopic decompressions play a key role in the therapy for Ogilvie's syndrome. In case of a failure of conservative treatment or peritonism, an early laparotomy and coecostomy are necessary.

virtX - evaluation of a computer-based training system for mobile C-arm systems in trauma and orthopedic surgery.

OBJECTIVES: Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. METHODS: Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) - IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (alpha = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. RESULTS: CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 +/- 55 vs. 101 +/- 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 +/- 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 +/- 9 years, professional experience 8.3 +/- 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. CONCLUSIONS: Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.

[Results of a prospective multicenter trial for treatment of acromioclavicular dislocation]. / Ergebnisse einer prospektiven Multicenterstudie zur Behandlung der Schultereckgelenksprengung.

OBJECTIVE AND METHODS: The treatment of the acromioclavicular joint dislocation is a topic of constant debate. Objective of the study was to analyze if operative treatment of Rockwood types 3 and 5 acromioclavicular joint dislocations is superior to nonoperative treatment. Treatment outcomes of 100 patients (91 male, 9 female, median age 33.7 +/- 8.6) from 4 different hospitals/departments of trauma surgery were analyzed. Clinicofunctional, radiological, as well as subjective parameters were taken into consideration. RESULTS: Clinicofunctional outcome of the operative treatment of acromioclavicular joint dislocation was very good in 91.2 % of patients. 87.7 % of the operated patients had a subjectively stable joint. The patients operated on for the acromioclavicular joint dislocation were capable of exercising after 13 weeks post surgery. versus 25.3 weeks in nonoperatively treated patients. The operated patients had a Rowe score and Constant score as high as 90.7 and 91.8 respectively, reflecting an excellent treatment outcome. CONCLUSION: Operative anatomic reconstruction of the injured acromioclavicular joint leads to very good clinicofunctional outcomes. The operative technique plays only a minor role in achieving these outcomes. The rate of complications is low for all operative techniques listed here. Demanding patients and multimedia education of patients are the reasons for a majority of operated patients in this study (97 %).

[Influence of cyclops syndrome after anterior cruciate ligament reconstruction on the functional outcome]. / Einfluss des Zyklops-Syndroms nach vorderer Kreuzbandplastik auf das klinische Ergebnis.

BACKGROUND: A review of recent reports concerning the functional outcome after treatment for Cyclops syndrome can produce contradictory results. Therefore, the purpose of this study was to evaluate the functional outcome of our patients treated for Cyclops syndrome after anterior cruciate ligament reconstruction. METHODS: Between 1998 and 2006 ten patients were followed for the occurrence of a Cyclops syndrome. The Lysholm score, Marshall score and Tegner activity score was used for clinical evaluation at final follow up; in addition, a subjective assessment of knee function and knee pain on a visual analogue scale was registered. Knee stability was measured using the KT-1000 arthrometer. Results were compared with a control group of 24 uneventful ACL reconstructions. RESULTS: Revision arthroscopy for symptomatic extension block was performed after a mean of 6.8 months. After a mean follow-up of 23 months after second surgery all patients' regained full range of motion. The mean Lysholm score and Marshall score was 85 and 41 after Cyclops syndrome and 92 and 46 for the control group. After Cyclops syndrome patients experienced a significantly increased ACL transplant laxity but no significant difference was found concerning patient's subjective rating of knee function and knee pain. CONCLUSION: Although patients subjective rating of knee function and knee pain was nearly identical in both groups objective knee scores disclosed impaired knee function in our patients treated for Cyclops syndrome.

[Free scapular or parascapular flaps for soft tissue damage accompanying talus or calcaneus fractures]. / Freier Paraskapular-/Skapularlappen bei frakturbegleitendem Weichteildefekt an Talus oder Kalkaneus.

BASIS: Fractures of the talus or calcaneus with accompanying soft tissue damage require precisely planned treatment to prevent infection of the wound over time, especially in severely injured patients. MATERIAL AND METHODS: Seven patients with fractures of the talus or calcaneus and accompanying 2nd and 3rd degree open or 3rd degree closed soft tissue injuries were followed up retrospectively. These patients were operated on between January 1999 and January 2006 with free fasciocutaneous scapular or parascapular flaps. The average age was 34 (range 16-54). Follow-up was at 6-36 months. RESULTS: Osteosynthesis was primarily in six cases, post-primarily in one, and in four cases exterior fixation was used additively. Temporary vacuum therapy was performed for a mean of 28 days (6-42). Parascapular, scapular, and Latissimus dorsi flap coverage was performed six, one, and one times, respectively. Six flaps healed without complication. One necrosis of a parascapular flap occurred and made a Latissimus dorsi flap necessary. In one case of donor-site wound dehiscense, a local rotation flap became necessary. There was no joint infection or osteomyelitis. Bony consolidation was achieved within all fractures. CONCLUSION: Traumatic soft tissue damage must be taken into account when primary or secondary internal fixation is performed and should influence the choice of implant. Free fasciocutaneous parascapular or scapular flaps are a powerful tool for preventing infection if local flaps are not sufficient to achieve stable soft tissue coverage.

[Promoting Young Talents in Trauma Surgery through Students-On-Call]. / Nachwuchsförderung in der Unfallchirurgie durch studentischen Rufdienst.

BACKGROUND: Due to restrictions on admission to medical school, changing claims to an optimized work-life balance and occupational perspectives, surgical professions in particular are struggling with strategies to motivate young academics. Surgical disziplines aim towards a profound transfer of knowledge and pique student's interest by ensuring a sustainable education at university. OBJECTIVES: The goal of this study was to evaluate a Students-On-Call System (SOCS) and to identify a financial benefit. MATERIALS AND METHODS: In this study the SOCS was compared pre-/postevaluation using questionnaires and the supporting X­rays within a curricular teaching module of orthopedic trauma surgery, with students in the fourth semester of specialism and those in the practical semester at medical school. RESULTS: The students of SOCS showed significantly better results prior to the course and afterwards than the two other groups. By establishing SOCS medical students get involved into the treatment of emergency patients in the trauma resuscitation unit (TRU) and operating room (OR). Students get the chance to enhance their comprehension of diagnostics, therapy and decision making in surgical context. This highly valuable traineeship combines a minimized teaching effort with an effective motivation of young academcis for the surgical profession. A SOCS has reduced the workload of medical colleagues. Establishing SOCS spare the residents being on call and results in reduced costs of 23,659.86 Euro per year. CONCLUSION: The results presented show that the SOCS leads to an excellent cost-benefit balance, which has been established in multiple surgical departments at the medical school of the University of Göttingen. Apart from practice-oriented surgical teaching, the SOCS is a way of promoting successful young talent saving resources in the medical on-call services.

[Diagnosis and classification of calcaneal fractures in computed tomography]. / Diagnostik und Klassifikation von Kalkaneusfrakturen in der Computertomographie.

PURPOSE: To compare image quality of single-slice spiral CT (SSCT) and multislice spiral CT (MSCT) in the diagnosis and classification of calcaneal fractures and to present a rapid and precise algorithm for the classification system of Stuermer. MATERIALS AND METHODS: In 102 patients with 124 calcaneal fractures, spiral CT was performed, in 82 cases as SSCT with a slice thickness (SD) of 3 mm, a table speed (TS) of 3 - 4 mm/rot and an increment of 1.5 mm. In 42 cases, patients were scanned using MSCT (SD of 1.25 mm, increment 0.8 mm). For these examinations, 2 different scan protocols were used, with a TS of 3.75 mm/rot in one group (n = 21) and a TS of 7.5 mm/rot in the other group (n = 21). The image quality of axial sections and reconstructed images was assessed on a scale from 1 to 5 (1 = very good; 5 = insufficient). The fractures were evaluated using a classification system according to Stuermer, which assigns three main groups (A/B/C) and three subtypes (1/2/3). RESULTS: MSCT had substantial advantages over SSCT with respect to scan time and image quality, especially for multiplanar reformatting (median 1.5 versus 4.0). TS showed no significant influence on the image quality. The standardized evaluation of the images enabled a classification of fractures within 5 minutes. All fractures could be assigned to the different types and subtypes. This classification system takes into account the severity of the fracture and the therapeutic approach. The most common type (90 of 124 fractures) were "joint depression" fractures (type C), which were treated by surgery in 92 %. Type A fractures were treated conservatively in 72 %. CONCLUSION: Spiral CT, especially MSCT, allows rapid diagnosis and precise classification of calcaneal fractures, achieved with high quality multiplanar reformatting. The presented classification in different fracture types and subtypes allows an adequate planning of therapy.

Biocompatibility and ingrowth of Trevira prostheses following replacement of the cruciate ligaments.

Five of 97 cruciate ligament prostheses (5.15 per cent) implanted for an average of 3 years (8-53 months) in 70 patients with acute chronic cruciate ligament instability were removed due to failure after a mean of 9 (3-15) months. Investigation of the explanted polyethylene terephthalate (PET)-grafts by scanning electron and light microscopy showed not bony but fibrous tissue ingrowth in all parts of the prostheses. The extent of local host response in the interface region differed with the intensity of mechanical strain at the three parts of the prostheses (intra-articular, bone tunnel, cortical). Inflammatory cells and foreign body giant cells were abundant close to the rupture sites at the intra-articular entries of the bone tunnels and scarce at the intra-articular part of the prostheses and at the cortical anchoring. Evaluation of the reasons for early prostheses failure indicates that (1) non-ideal placement of bone tunnels and (2) inadequate strain were responsible for reoccurring instability and rupture after prosthetic cruciate ligament replacement.

[Heparin-induced thrombocytopenia and thrombosis. Thrombosis as an early cardinal symptom of heparin allergy]. / Heparininduzierte Thrombozytopenie (HIT) und Thrombose. Die Thrombose als frühes Leitsymptom der Heparinallergie.

Apart from bleeding complications, heparin-induced thrombocytopenia (HIT) type II is the most severe side effect of heparin therapy. It is widely agreed that its most important clinical symptom is thrombocytopenia, with or without thromboembolism.Assuming, unlike other authors, that thrombosis is the leading clinical symptom of HIT type II, we investigated the frequency of an immunological reaction indicative of HIT type II in patients suffering from thrombosis. From January 1999 to December 2000, 77% ( n=6713) of our in-patients received heparin for more than 5 days as thrombosis prophylaxis. When thrombosis was suspected on the grounds of clinical appearances, the patient concerned underwent phlebography, and two different serological tests for anti-heparin antibodies were also carried out. In such cases, patients were immediately switched to hirudin instead of heparin. In 29 out of 101 patients, the clinical suspicion of thrombosis was confirmed. Three patients developed pulmonary embolism. In 4 patients both serological tests revealed the presence of anti-heparin antibodies. Three of the remaining 72 patients with negative phlebography results were found to have antibodies on serological testing. In none of the 7 patients with a confirmed diagnosis of HIT type II was the classical sign of thrombocytopenia was present. Even with thorough clinical and phlebographic examinations, the incidence of HIT type II is only 0.13% in our institution. One of the 7 patients with thrombosis was not thrombocytopenic but did show the typical immunological reaction. Since the incidence of HIT type II is low and thrombocytopenia is not a reliable indicator for HIT II, the need for frequent thrombocyte counts (twice weekly) should be reconsidered.However,patients developing thrombosis while receiving heparin need to be treated for clinically suspected HIT type II until the final diagnosis is made.

[Atypical heparin-induced thrombocytopenia (HIT)--"heparin allergy" with thrombocytosis]. / Atypische heparininduzierte Thrombocytopenie (HIT)--"Heparinallergie" mit Thrombocytose.

We report a truck driver with severe soft tissue contusion of both legs who developed atypical heparin-induced thrombocytopenia (HIT) after a thrombosis prophylaxis with unfractionated heparin; despite a thrombosis the patient showed a systemic allergic reaction to heparin in combination with elevation of thrombocytes and positive heparin-dependent antibodies. Six days after the initial trauma deep vein thrombosis of the left lower leg was diagnosed and fasciotomy was performed, preventing an imminent compartment syndrome. Another 5 days later the patient developed exanthema of the trunk and upper extremities and urticaria on his face, as well as severe headache. His platelet count increased from 134,000/microliter to 258,000/microliter. After exclusion of other causes for these symptoms, a reaction to heparin-dependent antibodies (heparin-platelet-factor 4 complex) was demonstrated 2 days later. Thrombosis prophylaxis was changed to hirudin (Refludan) and elevation of thrombocytes to 445,000/microliter was noted. Shortly after rinsing of an intravenous line with less than 50 IE unfractionated heparin at day 36 after trauma the patient developed an anaphylactic shock, which could be managed with cortisone. We suggest that in HIT the thrombocytopenia may represent only one form of an allergic reaction to heparin. The cause of the thromboembolic event is an antigen-antibody reaction to heparin taking place on the surface of the thrombocyte. This is similar in all forms of systemic reaction to heparin application, even though the symptoms may vary. As thrombocytopenia may not be the main symptom of a heparin-induced antibody reaction--in our hospital only 5 of 10 patients with HIT--the disease should rather be named "heparin allergy". We suggest a new classification of different pattern of heparin allergy types I-IV. The new types I and II are similar to HIT types I and II. Type III is the reaction of antibodies without decrease of thrombocytes, and type IV the reaction of antibodies associated with systemic allergic symptoms.

[Refixation of osteochondral fragments using absorbable implants. First results of a retrospective study]. / Refixation osteochondraler Fragmente mit resorbierbaren Implantaten. Erste Ergebnisse einer retrospektiven Studie.

An osteochondral lesion in a weight bearing joint causes therapeutic problems. Surgical therapy focuses on the restoration of the articular surface, unlimited motion of the joint and prevention of cartilaginous degeneration. A causal therapy to prevent posttraumatic osteoarthritis is the fixation of osteochondral fragments. Various absorbable implants for the purpose of refixation are available, but only a few have proved to be biocompatible. This retrospective study presents the preliminary results after refixation of osteochondral fragments of the ankle and knee joints. We used self-reinforced absorbable pins, nails and screws made of polylactide acid. The results for 15 patients with 17 fractures of 16 joints were evaluated. All patients were scored by the Tegner-activity-level, the McDermott-score and the DGKKT-score, and 13 of them were monitored by postoperative magnetic resonance imaging (MRI). The follow-up extended for an average of 14.3 months (range: 4-43 months). The clinical results for all patients were good (McDermott-score: Ø 89 points, DGKKT-score: Ø 78.8 points, Tegner: pre-op vs post-op=Ø 4.6 vs Ø 5.1) and the surgical therapy proved to be successful. The MRI showed the complete incorporation and vitality of the fragment as well as a congruence of the joint surface. The clinical course and the MRI gave little reference to an inflammatory reaction due to the implants that complicated the course of two patients. These results indicate that absorbable implants made of polylactide acid are biocompatible and effective in the fixation of osteochondral fragments.

[HCV, HBV and HIV infections: risk for surgeon and staff. Results and consequences of routine screening in emergency patients]. / HCV-, HBV- und HIV-Infektionen -- Gefahren für Arzt und Pflegepersonal. Konsequenzen aus dem Routinescreening von unfallchirurgischen Notfallpatienten.

BACKGROUND: Trauma and emergency surgeons (S) are in contact with high-risk patients (P) infected with HBV, HCV, and HIV without knowing which P is and which is not infected. The aim of this paper was to analyze routine screening (SCR) in trauma care. METHOD: Microparticle enzyme immunoassays (MEIA) (Abbott Axym system) were analyzed from routine blood samples: HBsAg (V2), HCV version 3.0, HIV 1/2gO. All positive or uncertain samples were confirmed with ELISA/PCR. RESULTS: From January 2002 to October 2002 a total of 1074 emergency P were examined. The results were available within 50 min after admittance to the emergency room. In 53 of 1074 (4.9%) the MEIA was positive or in threshold margins (LV): HBV 15 P plus 3 LV (9 secured by ELISA/PCR), prevalence (PV) 0.84%. HCV 34 P plus 1 LV (31 secured with ELISA/PCR), PV 2.9%. HIV 2 P, PV 1.86 per thousand, 1 in co-infection with HCV, 1 with HBV. Of 42 infections, 21 were unknown before screening, and in 5 P the S suspected an infection. After screening, nine surgical procedures were changed to safer procedures. CONCLUSION: MEIA is a good tool for quick SCR of HCV, HBV, and HIV in emergency surgery (ES). When the infection is known the S is more aware to perform only safe procedures during surgery (no touch technique) or to use more protective devices (e.g., fluid shield, double gloves). Our results indicate that surgeons and nurses in ES are exposed four to six times more often to infection with HCV, HBV, and HIV than represented by officially published data. We recommend routine SCR of HBV, HCV, and HIV for all P in ES. Prevention procedures are discussed.

[Results of palmar T-plate osteosynthesis in unstable fractures of the distal radius]. / Ergebnisse der palmaren Plattenosteosynthese bei instabilen distalen Radiusfrakturen.

For unstable fractures of the distal radius, the dorsal plate requires exposure of the fragments, frequently spongioplasty, and usually removal of the implant later on. However, with the palmar approach for the reconstruction of the articular surface and restoration can easily be achieved with the T-plate. In the Traumatology Department of the University at Göttingen, we have gained experience in the treatment with the palmar T-plate in more than 400 patients. In a prospective study, we investigated the functional and radiological results after palmar T-plate osteosynthesis in Colles fractures. From September 1994 to December 1998 we treated 200 patients with the palmar T-plate (AO, 3.5 mm, titanium). 166 patients (83%), mean age 59 years, could be followed up >18 months. AO classification: A2:10, A3:45, B1:18, B2:10, C1:24, C2:40, C3:19. We compared group 1 (younger than 60 years, n=88) vs group 2 (older than 60 years, n=78). The patients' evaluation of the usability of the hand was normal in 56% and in 26,5% slightly reduced. 12,5% felt handicapped and 5% felt severely handicapped. 5% of the patients changed the domain hand, 15,4% at least partly. Function according to Lidström: 23% excellent, 58% good, 15% fair and 4% poor results. Radiological results according to Lidström were excellent and good in 88,3% and fair in 11,7%. Gartland and Werley score was excellent in 66%, good in 24%, fair in 6% and poor in 4%. There was no significant difference between group 1 and group 2 in the age-depending results. The secondary dislocation, the average dorsal tilt was 3 degrees, the mean shortening of the radius was 1,5 mm. We saw steps in the joint surface from 0,5-1 mm in 10%. An algodystrophy occurred in 5%. 12% of the patients complained of limited sensitive irritations of the medianus nerve most likely originating in the formerly used approach close to the medianus nerve. After changing this approach, we saw no irritation of the Nervus medianus among 50 patients so far. Evaluation of the functional and radiological investigations: The palmar T-plate has produced reliable and good results in the treatment of unstable distal fractures of the radius without angle-stable screws up to now. This type of osteosynthesis is stable for exercise and ensures early mobilization with good functional results even in elderly patients.

[Treatment of Galeazzi's fracture - is the surgical revision of the distal radioulnar joint necessary?]. / Die Therapie der Galeazzifraktur - Ist die Revision des distalen Radioulnargelenkes zwingend notwendig?

PURPOSE: Fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ) are termed as Galeazzi-fractures. In Galeazzi's fracture, the aim of treatment is restoring the congruency of the joint and the stability of the DRUJ, thus preventing a loss of pronation or supination. PATIENTS AND METHOD: In this study, we included 24 patients (m = 22, f = 2) with 25 Galeazzi fractures treated between 1980 and 1998. Surgical treatment and the duration of therapy were analyzed retrospectively. The clinical and radiological results of 15 patients were followed up. Two children were treated conservatively with immobilization in an above-the-elbow plaster. 19 patients were treated surgically by rigid internal fixation with a plate approximately one week after the accident. Four patients were treated initially in a different way. In 13 cases, the distal radioulnar joint was immobilized by pinning with Kirschner wires. In ten patients, the DRUJ showed no instability. Patients with DRUJ pinning received an above the elbow plaster for six weeks, the other patients received a forearm cast for the time of wound healing. RESULTS: Two patients developed a pseudarthrosis following Kirschner-wire or rush-pin osteosynthesis. The consolidation of remaining fractures was regular. In two patients, the DRUJ was not completely stable after temporary fixation. The remaining patients revealed a stable DRUJ. Eight patients showed a limited pro- or supination after temporary Kirschner wire fixation of the DRUJ. The other patients did not reveal a decrease in range of motion. CONCLUSION: A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.

[Kickboards - Cause of injury, patterns of injury and prevention]. / Trendsportart Rollerfahren - Unfallursache, Verletzungsmuster und Prävention.

69 patients with kickboard injuries were treated over a 5-month period. 6 patients were admitted to hospital. Fractures (48%), contusions/ lacerations (45%) and capsular/ ligamentuous injuries (27%) were the most prevalent types of injury. Injuries of the elbow, forearm, wrist and hand accounted for 54% of all cases. Ankle (23%), head (6%) and knee were other regions frequently involved. It is concluded that kickboard-driving imposes a severe risk of injuries. The typical kickboard injuries was the fracture of the wrist and the ankle sprain. Protective equipment for the injured regions is very important to prevant injury.