[Preformed plate-fixation system for type AO 13C3 distal humerus fractures: clinical experiences and treatment results taking access into account]. / Das präformierte LCP-Plattenfixateursystem bei distalen Humerusfrakturen AO-Typ 13C3 : Klinische Erfahrungen und Behandlungsergebnisse unter Berücksichtigung des Zugangsweges.

In distal intraarticular humerus fractures primary stable osteosynthesis is essential for early mobilization of the elbow joint. Double-plate osteosynthesis techniques using different configurations are the gold standard. In the literature plate position is sometimes discussed controversially. In cases of distal humerus fractures (type AO 13C3) with metaphyseal comminution, as well as in elderly patients with poor bone quality, utilizing locking plates with angular stability was found to have increased structural properties with regard to primary fixation stability. The dorsal approach with osteotomy of the olecranon seems to be very effective in open reduction and internal fixation of this type of fracture. One new development is the anatomically preformed plate-fixation systems such as the LCP-System for distal humerus (Synthes). This study presents our first experience with this system in 11 cases of open reduction and internal fixation of type AO 13C3 distal humerus fractures. The system-specific features and intraoperative options were analyzed.

[Proximal femoral fractures in the elderly. Data from health insurance providers on more than 23 million insured persons--part 2]. / Proximale Femurfrakturen im Alter. Krankenkassendaten von über 23 Mio. Versicherten--Teil 2.

BACKGROUND: The section of geriatric trauma ("AG-Alterstraumatologie") of the"Deutsche Gesellschaft für Unfallchirurgie" (DGU) and the"Lohmann & Birkner Health Care Consulting GmbH" in co-operation with the health insurance funds (VdAK and AEV) supplied the relevant data of approximately 23 million insured persons from the years 2002 to 2004. All data from patients over the age of 60 staying in hospital because of proximal femur fractures and without further injuries as the main diagnosis were extracted from the available amount of data and then analysed. RESULTS: In comparison to the effective number of beds there was a significant increase in the treatment of proximal femur fractures in hospitals with 101-300 beds. There was no difference in the operative treatment of proximal femur fractures in comparison to the number of beds of the hospital. The average hospital expense for osteosynthesis was 6000 euro per each case and there was no difference in comparison to the different osteosynthetic procedures. The average hospital expense for hip replacement (7036-7201 euro) was about 1000 euro higher than osteosynthetic procedures. There was no difference in the average hospital expense in comparison to the age of the patients. CONCLUSION: There was a significant age-dependent increase of acute hospital mortality with a maximum of 8.6% in the group of the patients older than 85 years. As a result of the demographic change fracture rates in the elderly population will rise significantly.

[Proximal femoral fractures in the elderly. Analysis of data from health insurance providers on more than 23 million insured persons--part 1]. / Proximale Femurfrakturen im Alter. Auswertung von Krankenkassendaten von über 23 Mio. Versicherten--Teil 1.

BACKGROUND: The section of geriatric trauma ("AG-Alterstraumatologie") of the "Deutsche Gesellschaft für Unfallchirurgie" (DGU) and the "Lohmann & Birkner Health Care Consulting GmbH" in co-operation with the health insurance funds (VdAK and AEV) supplied the relevant data of approximately 23 million insured persons from the years 2002 to 2004. METHODS: All data from patients over the age of 60 staying in hospital because of proximal femur fractures and without further injuries as the main diagnosis were extracted from the available amount of data and then analysed. There were 68,929 (9.5%) cases diagnosed with proximal femur fractures of 724,606 patients treated in hospital. RESULTS: There was a significant age-dependent increase in incidents of proximal femur fractures with a maximum of 3,000 injuries around the age of 82 years. The surgical treatment of proximal femur fractures was carried out with a joint-preserving stabilising method (osteosynthesis-screws-"DHS"-nailing systems) in 49.5%, with endoprosthesis in 48.6 % as well as other methods in 1.9% of the cases. In comparison to hip replacement care, a shorter hospital stay could be proved with osteosynthetic methods.

[Is use of the fixateur externe no longer indicated for the treatment of unstable radial fracture in the elderly?]. / Ist die Behandlung der instabilen distalen Radiusfraktur beim älteren Menschen mittels Fixateur externe nicht mehr indiziert?

BACKGROUND: In recent years there has been an increasingly marked shift in the operative treatment of unstable fractures of the distal radius. The introduction of locking compression plates has made it possible to extend the indications for palmar stabilisation according to the principles of internal fixation to extension fractures even in osteoporotic bone, and since then the new design has been used more and more widely. First clinical results show very good and good clinical and radiological outcomes in over 80% of cases after locking compression plate osteosynthesis. All this raises the question of whether external fixation is no longer indicated for distal radius fractures in the elderly, or is now no more than a second-line treatment. PATIENTS AND METHODS: Within a 5-year period, 67 patients over 65 years of age were identified among 220 who had had unstable fractures of the distal radius in our hospital with external fixation. The average follow-up period (clinical and radiological examinations) was 37 months. We devoted particular attention to the analysis of complications and problems during the treatment. RESULTS: Complete bone healing was observed in all patients treated with external fixation. In most cases, complications were minor pin-track infections (10%). The radiological follow-up examination revealed radial shortening by an average of 2 mm and an average radial shift of 0.2 mm. The joint angle was 2.5 degrees with lateral irradiation and 18 degrees with dorso-palmar irradiation. According to the Gartland and Werley score, the functional, radiological and subjective outcome was excellent or good in 87% of these patients. CONCLUSIONS: Overall, internal fixation with angular fixed plates has definite benefits. The medium- and long-term follow-up and functional outcome still show no benefits over external fixation, however. External fixation is a genuine option, even if as second-line treatment.

[Extraosseous calcifications in dermatomyositis. A rare differential diagnosis of a benign heterotropic ossification]. / Extraossäre Kalzifikationen bei Dermatomyositis. Eine seltene Differenzialdiagnose bei benignen heterotopen Ossifikationen.

Juvenile dermatomyositis is rare but still the most common idiopathic inflammatory myopathy of the childhood. Operative treatment may be indicated, whenever joint motion and patients mobility is limited through the manifestation of calcinosis cutis. Although Vitamin K dependent coagulation pathways have been described, the entire pathophysiological mechanism of its occurrence is currently not clarified. Standard therapy includes the systemic application of steroids and cytotoxins, other options involve aluminum-hydroxid or diltiazem. Only in serious functional obstructions operative resection may be indicated. The case of a 39-year-old female with a 24 year history of dermatomyositis involving most areas of the upper and lower extremities like a coat of mail is presented. Surgical resection of the calcification revealed a good functional recovery of the joint but because of a high recurrency rate the operation is only indicated in special cases.

[A new irrigation-suction boring system facilities low-pressure intramedullary boring of isolated swine femurs]. / Ein neues Spül-Saug-Bohrssystem ermöglicht die druckarme Markraumbohrung an isolierten Schweinefemora.

AIM: Intramedullary nailing is the treatment of choice for the stabilization of fractures of long tubular bones. An important disadvantage of this method is the increase in intramedullary pressure and the resulting release of fat into the venous blood system during reaming of the medullary canal. We have developed a new type of rinsing-suction-reamer (SSB) in order to minimize these disadvantages. Trials were initiated to investigate whether it is possible to ream the medullary canal with the SSB without pressure increase in comparison with the standard AO-reamer (AOB). METHODS: Reamed intramedullary nailing was performed in 20 isolated pig femora. The intramedullary pressure was recorded continuously. RESULTS: While stepwise reaming was performed, the pressure only rose above the physiological level in AOB. During insertion of the guide wire and the nail, comparable values were measured for AOB and SSB. CONCLUSION: Our experiments show that reaming of the medullary canal is possible without a pressure increase using the SSB in comparison with AOB.

[Gangrene of the fingers caused by accidental intra-arterial injection of diazepam]. / Fingergangrän nach akzidenteller intraarterieller Injektion von Diazepam.

HISTORY: A 51-year-old woman was accidentally given an intra-arterial injection of 10 mg diazepam to control an acute claustrophobic anxiety attack. She complained of severe knocking pain in the entire left arm during the injection. On the second day the hand and lower arm were red an swollen and she complained of increasingly feeling cold and having paraesthesias. On the fifth day the radial half of the palm as well as the first to third digits showed livid discoloration. In the further course necrotic areas developed in the palmar aspect of the distal phalanx of the thumb and of the index finger proximal to the middle phalanx. INVESTIGATION: Angiography on the tenth day after the injection revealed very poor perfusion of the radial artery as far as the wrist, occlusion of the superficial palmar arterial arch and occlusions of the digital arteries of the five fingers. TREATMENT AND COURSE: Infusion of 25,000 IU heparin over 24 h brought no improvement. On the 24th day after the diazepam injection the palmar aspect of the distal phalanx of the thumb and the index finger became necrotic, requiring amputation of the latter and, after removal of necrotic tissue, flap-plasty using subcutaneous soft tissue of the extensor surface of the index finger to cover the defect on the thumb. The patient was without symptoms on discharge and the wounds were healing well. CONCLUSION: Every doctor should be aware of the dangers of accidental intra-arterial injection. The slightest suspicion and symptoms require immediate and adequate treatment to save the limb.

Aprotinin diminishes inflammatory processes.

Many of the recent reports concerning cytokine levels in cardiopulmonary bypass have documented changes in the levels of these trauma indicators. In the present report, we also document their levels but in the presence of Aprotinin. Aprotinin is a protease inhibitor used not only to diminish bleeding, but also to diminish elements of the diffuse inflammatory response associated with this type of surgery. We report in plasma obtained from 20 patients that initially interleukin-8 (IL-8) levels (53.4 +/- 7 pg/ml) plasma to 185.5 +/- 30 pg/ml) increased 20 min from the start of surgery. This is followed by IL-6 (5.3 +/- 1.1 to 200 +/- 50 pg/ml) peaking 15 h post surgery. These levels return to normal by day 3 postop. IL-1 beta and tumour necrosis factor (TNF) levels remained at baseline for the observation period. Associated with these changes in cytokine levels is the activity state of immunocytes (granulocytes and monocytes) noted by conformational changes obtained from computer-assisted microscopy. The cells exhibited an ameboid conformation and became mobile (67%), peaking at 120 min after surgery began and returned to a more rounded conformation with only 6% exhibiting the ameboid conformation by day three. In in-vitro experiments, where immunocytes not exposed to cardiopulmonary bypass were exposed to plasma obtained from patients having undergone this surgery, their activity level rose to 65%. In the same experiment, when Aprotinin was added to the cell-plasma mixture, the level of activation dramatically dropped to 25%. Thus, aprotinin was found at high doses to lower cytokine and cellular activation associated with the acute inflammatory responses of cardiopulmonary bypass, suggesting that this may be initiated by hyperstimulated immunocytes.