[Hematogenous osteomyelitis due to clavicular fracture : A rare complication after conservative treatment]. / Hämatogene Osteomyelitis bei Klavikulafraktur : Eine seltene Komplikation nach konservativer Behandlung.

We present a case of a nondislocated clavicular fracture that was conservatively treated for 4 weeks with a sling. The patient was a smoker and suffered from type 2 diabetes mellitus. After 2 months a suppurative infection occurred due to an escalation based on a clavicular osteomyelitis. Through antibiotic treatment and an aggressive surgical approach the infection was cured but ended up with a painful malunion of the clavicle. The bone reconstruction was achieved with a long locking plate with an additional vascularized medial femoral condyle free flap. After 18 months the patient was subjectively very satisfied with the outcome, had no pain and excellent functional results in the Constant Murley and DASH (Disabilities of Arm, Shoulder and Hand) scores. The X­ray assessment showed full bone union.

[Locking, multidimensional plate osteosynthesis of midshaft clavicle fracture]. / Winkelstabile, mehrdimensionale Plattenosteosynthese der Klavikulaschaftfraktur.

BACKGROUND: The goal of this consecutive, retrospective clinical follow-up study was to analyse the quality of treatment with a multidimensional, anatomical locking plate osteosynthesis after comminuted clavicle shaft fracture (Robinson 2B). PATIENTS AND METHODS: Of 38 operated patients, 35 were examined after locking plate osteosynthesis, with a median follow-up of 32 months (11-65). Four patients had suffered a 2B1 Robinson fracture and 31 patients a 2B2 Robinson fracture. The clinical and functional results were determined based on the standard clinical examination of the shoulder, the Constant and DASH scores, an analogue visual scale and a patient survey. RESULTS: The clinical examination yielded a mean DASH score of 1.25, a mean Constant score of 98 and a mean VAS score on the visual analogue scale of 0.4 (with a range of 0-6). Neither nonunion nor implant failure was observed. We did, however, have one case of infection of the soft tissue. CONCLUSION: The treatment of comminuted shaft fractures of the clavicle by means of a multidimensional locking plate is a safe treatment option that includes early functional postoperative care with free range of motion.

[Nickel allergy and painful unicondylar knee arthroplasty]. / Nickelallergie und schmerzhafte monokondyläre Kniegelenksschlittenprothese.

A 56-year-old woman with unicondylar knee arthroplasty (Oxford III, Biomet) complained of persistent, burning pain in her knee. The arthroplasty failure was caused by a nickel allergy. The diagnosis was confirmed by positive patch testing, lymphocyte transformation test and histological analysis of the neosynovia around the implant. The unicondylar knee arthroplasty was explanted and replaced by a titanium-coated knee prosthesis (INNEX CR, Zimmer).

Value of the urinary stone promoters/inhibitors ratios in the estimation of the risk of urolithiasis.

An imbalance between urinary-promoting and -inhibiting factors has been suggested as more important in urinary stone formation than a disturbance of any single substance. To investigate the value of promoter/inhibitor ratios for estimation of the risk of urolithiasis, urinary citrate/calcium, magnesium/calcium oxalate, and oxalate/citrate x glycosaminoglycans ratios were determined in 30 children with urolithiasis, 36 children with isolated hematuria, and 15 healthy control children. The cutoff points between normal children and children with urolithiasis, accuracy, specificity, and sensitivity for each ratio were determined and compared with those of the 24-h urine calcium and oxalate excretion and urine saturation calculated with the computer program EQUIL 2. The neural network application (aiNET Artificial Neural Network, version 1.25) was used for the determination of the cutoff points for the classification of normal children and the urolithiasis group. The best test for differentiating stone formers from non-stone formers proved the aiNET determined cutoff values of oxalate/citrate x glycosaminoglycans ratio. The method showed 97.78% accuracy, 100% sensitivity, and 93.33% specificity. Two cutoff points between normal and urolithiasis groups were found showing that the children with urolithiasis had ratio values either above 34.00 or less than 10.16. Increased oxalate excretion was linked to the first cutoff value (34.00), and decreased glycosaminoglycans excretion was typical of the second cutoff value (10.16).

[Relation between successful treatment of urinary tract inflammation and the disappearance of changes in the bladder mucosa in children and adolescents with cystoscopically proven cystitis cystica]. / Odnos uspjesnosti lijecenja upale mokracnog sustava i nestanka promjena sluznice mjehura u djece i mladih s cistoskopskim nalazom cisticngo cistitisa.

Bladder epithelium nodular changes called cystitis cystica are commonly found in children and adolescents suffering from long-term lower urinary tract infection. Recurrent urinary infection was found in pediatric patients with urinary tract abnormalities as well as in others without it with nearly the same frequency. The authors studied 63 pediatric patients with recurrent urinary tract infection and cystitis cystica of which 59 (94%) were females. The age of the examined patients varied from 1 to 16 years, mean 7.35 years. Thirty five of them (55.5%) had diverse anomalies of the urinary tract. Vesicoureteric reflux was demonstrated on the cystogram in 41.1% patients. Escherichia coli was found to be the major pathogenic organism in the urine. Thirty eight (60.3%) children and adolescents were treated medically for months (two years mostly) by reason of prolonged recurrent urinary tract infection before nodular changes of the bladder mucosa at cystoscopy were detected. Even thirteen (39.7%) of all studied patients were treated medically more than five years. In the present study only 47 (74.6%) of the observed patients have had an adequate follow-up and might be considered. In these cases repeated cystoscopy was performed and the successively sterile urine cultures were obtained. Twenty-one (44.3%) patients were medically treated up to one year before the urinary tract infection was eradicated and nodular mucosal changes disappeared. In 6 (12.8%) patients more than five years were needed to achieve this result.