[Pregnancy-associated osteoporosis. Differential diagnosis of "common" musculoskeletal pain during pregnancy and lactation]. / Schwangerschaftsassoziierte Osteoporose. Differentialdiagnose des "banalen" muskuloskelettalen Schmerzes in Schwangerschaft und Stillzeit.

Musculoskeletal pain during pregnancy and lactation is a common finding. Differential diagnoses range from"normal" findings to disturbances in bone metabolism and pregnancy-associated osteoporosis (PAO). Imaging options are limited due to pregnancy, and laboratory diagnostics are time-consuming. Treatment of PAO with physiotherapy, pain killers and substitution of vitamin D and calcium leads to a rapid recovery from symptoms.

Cloning and characterization of full-length cDNA encoding sucrose phosphate synthase from faba bean.

A 3419-bp cDNA clone encoding sucrose phosphate synthase was isolated from a seed coat-specific cDNA library of Vicia faba L. and conceptually translated into a protein of 1059 amino acid residues. The corresponding 3.4-kb mRNA was found in both source and sink tissues. Southern hybridization data are consistent with a single SPS gene.

Trimalleolar fractures: late results after fixation of the posterior fragment.

From 1969 to August 1981 60 trimalleolar fractures were operated on with fixation of the posterior fragment. A late follow up (average 8 years) including radiographs was possible in 45 patients. In 36 patients, there are no complaints and full function has been obtained. Films of the articulation are normal in 17 cases and show isolated osteophytes in 19. Five patients show some benign arthrosis but only occasional pain and slightly reduced function; four patients show severe arthrosis caused by clearly visible operative technical faults. Depressed areas in the articular surface were present in ten patients. Their prognosis is doubtful. Thus, a correctly reduced and fixed posterolateral fragment helps avoid or reduce postoperative arthrosis in trimalleolar injuries.

[Pseudarthrosis of the capitate]. / Pseudarthrose des Kapitatums.

A 54 years old railway engine-driver fell on his extended right hand in November 1978. In the next few hours he developed increasing pain. He reported similar slight trauma some fourteen months before, but without pain. The tomographic X-ray examination proved the presence of an isolated non-union of the capitate with some shortening. Four days after the second accident an autologous graft was performed following the technique of Matti. The non-union healed after three months in a plaster cast, and the patient returned to full work after four months. Examining him four years and nine months later, the patient complained about persisting pain when stressed. The mobility of the wrist was moderately reduced, and the healed capitate showed unchanged shortening. Isolated non-unions of the capitate can, therefore, be painless for a long time--a situation well-known with scaphoid non-unions. Considering the operative technique, a cancellous graft alone is not able to restore the function of the wrist because of associated collapse of the carpus. To obtain a better late result, the length of the capitate ought to be restored and a cortico-spongious graft inserted.

[Peritendinitis calcarea of the hand, a case report]. / Peritendinitis calcarea an der Hand, ein kasuistischer Beitrag.

The authors present three cases of peritendinitis calcarea in the extensor tendons of the wrist and the flexor tendons of the fingers. The symptoms were gout-like pain attacks and local inflammation. In the X-rays calcification was seen within the tendon sheath. The symptoms and the calcification disappeared spontaneously in a few months. In these rare cases there is no indication for surgery.

[Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year]. / Les fractures associées du radius et du cubitus au niveau du coude chez l'adulte. Analyse de 120 dossiers ayant un recul d'un an et plus.

PURPOSE OF THE STUDY: The purpose of this study was to increase the knowledge about these rare and serious injuries and to produce guidelines for a more successful ORIF. MATERIAL: 120 cases of combined fractures in adults with late results (minimum one year) stored in the AO Documentation-Center between 1979 and 1989 were analyzed. Monotrauma was dominant, additional injuries were rare. No vasculo-nervous lesions were reported. 15 fractures were open. For the ulna 4 fractures types were isolated, fractures of the coronoid process and the radial head (CR) 25 cases. Olecranon and radial head fracture (OR) 22 cases. Combination of anterior (coronoid) and posterior (olecranon) ulnar fracture with radial head fracture (COR) 41 cases. Metaphyseal ulnar and radial head fractures (MR) 32 cases. For the radial head we have distinguished partial (61) and complete (59) fractures, the latter including 14 neck fractures. RESULTS: In the CR type indirect fixation technique was never perfect. Best results were obtained after ORIF of partial radial fractures. After resection, arthrosis (8/11) and valgus (8/11) were very frequent. In the OR type the stability was restored in simple fractures by the tension band technique even when the radial head was resected. In the severe COR type good results were rare. Arthrosis was important and frequent (36/41) especially after radial head resection. In the MR type ORIF of the radial head combined with ulnar plating gave the best results. Ulnar union was delayed or missing in 13 cases especially after radial head resection. Functional results after one year were better than expected on X-rays. This was due to immediate ORIF (92/120) and early mobilization. There were only 3 infections and 2 reflex-dystrophies. DISCUSSION: The Coronoid is the key-fragment of the ulna. It is best reduced in CR-Type under vision by an anterior approach. In COR-lesions its reduction should be the first step of ulnar ORIF. Comminutions in OR, COR and MR-Types showed a high number of delayed or non union. The reason may be a biological weakness (reduced vascularization) in these areas. Therefore we advocate for bridging plates (and cancellous grafts) for the stabilization of such areas, especially for the metaphysis where a strong valgus force appears after radial resection. Radial head as the lateral pillar of the elbow should be restored by ORIF in partial fractures (excellent results) and even in complete fractures (5/10 excellent results) under favourable conditions. Prosthesis is indicated in severe radial comminution or serious ulnar instability.

[Fractures of the lower tibia. Results of 128 osteosynthesis]. / Fractures du pilon tibial. Résultats de 128 ostéosynthèses.

The authors have treated 128 articular fractures of the lower tibial extremity. All were operated on, a cancellous graft being often added to the screw-plate fixation. 87 cases were re-examined after a 4-year average follow-up. It is concluded that surgical treatment is more valuable than conservative treatment. The results were satisfactory in 90 p. 100 of the cases, but it is emphasized that the patients were young and sportsmen, and that the fractures were closed most of the complications were related to a poor post-operative care.

[An unexpected case of lower left-side abdominal pain. Acute reactivation of chronic osteomyelitis]. / Eine unerwartete Ursache von linksseitigen Unterbauchschmerzen. Akute Reaktivierung einer chronischen Osteomyelitis.

Osteomyelitis caused by S. aureus can be reactivated after decades. Our patient presented with an acute episode of lower left-side abdominal pain and subfebrile temperature due to a reactivation of a S. aureus osteomyelitis in the iliac bone which was initially misinterpreted as a sigma diverticulitis. Diagnosis was established by conventional radiographs as well as CT and MR scans. Harvesting the responsible germ by a bone biopsy prior to therapy is mandatory. Therapy consists of a surgical debridement combined with a long-lasting antibiotic therapy. Relapse can be found after long latency.

[Simultaneous functional testing of the metacarpophalangeal joints of the thumb in hyperpronation using a simple device]. / Funktionelle simultane Prüfung der MP-Gelenke des Daumens in Hyperpronation mit Hilfe eines einfachen Geräts.

For the diagnosis of rupture of the ulnar ligaments of MP joint of the thumb functional X-rays are required. The best position for this investigation seems to be - contrary to the routine - overpronation where the metacarpal and the proximal phalanx are both lying nearly straight on the board. If the patient pushes the pulp of his thumb against a barrier he produces stress in abdduction. Both hands can be tightly bandaged together in this uncomfortable position for a certain time. This permits a symmetrical and simultaneous image of both stressed thumbs on only one X-ray film. For this purpose we use a simple wooden board with two small borders which is placed over the film case.

[Simultaneous functional bilateral radiographies of the metacarpophalangeal joint of the thumb in hyper-pronation]. / Radiographies fonctionnelles bilatérales simultanées des métacarpophalangiennes du pouce en hyperpronation.

Diagnosis of tears of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is often made by dynamic radiography. In contrary to the usual technic, the best position is forced pronation of the hand. The metacarpal and the first phalanx are horizontal on the X ray plate. The patient is encouraged to push the tip of his thumb against an object thus obtaining a forced abduction. The two hands can be held in place with a tight bandage. This yields a simultaneous and symmetrical image of the two thumbs on the same film.

[Role of the fibula in distal tibial fracture]. / Die Bedeutung der Fibula bei der Pilon tibial-Fraktur.

Analysing 1077 fractures of the distal segment of the tibia the author found specific morphologies of the accompanying fibula fractures when axial dislocations exist. In valgus position compression and bending forces induce multifragmentary fractures of the diaphysis or impactions of the metaphysis. In varus position bending and traction forces create simple oblique or transverse fractures. The ligaments of the syndesmosis are rarely ruptured when the fibula is fractured. They may remain undamaged when the fibula is intact. Ruptures of the fibulotalar and fibulocalcanear ligaments are not uncommon. The internal fixation of the fibula remains the first step of the AO-tactics for the operative treatment of Pilon-tibial fractures. The initial axial position must be respected. In valgus cases there will be postoperative compression forces (pillar function), in varus cases traction forces (tension band function) acting on the repaired fibula. Indirect reduction techniques ought to be used for complex fibula fractures.

[Surgical treatment of radial head fracture]. / Die operative Behandlung der Radiusköpfchen-Fraktur.

Fractures of the radial head are often combined with ligament ruptures or subluxations creating instability of the elbow joint. Cartilage avulsions of the capitellum trapped between the fragments are a frequent observation. We advocate ORIF for displaced fractures. The posterolateral approach avoiding compression of the radial nerve may be prolonged proximally with an osteotomy of the humeral epicondyle giving full overview of the circumference of the head. It allows the harvesting of cancellous bone used as a graft to fill in articular depressed areas or metaphyseal defects. The stabilisation is achieved with thin screws of 1.5 mm diameter introduced in different planes, their head slightly sunken in the cartilage. Lately miniplates have been used in cases of neck fractures with surprisingly good functional results. The author reports about the results in 42 of 49 operated patients.