[Fracture of the neck of the talus in a child]. / Talushalsfraktur beim Kind.

Fractures of the talus in children are rare. Repeated clinical examination and imaging techniques such as magnetic resonance imaging are often needed to establish a diagnosis. In case of the late recognition of talus fractures, catastrophic results may occur for the hind-foot. This case report presents a 5 year old boy with a non-displaced talus neck fracture with good outcome after minimally invasive osteosynthesis.

[Soft tissue protective, stable osteosynthesis of fractures after elbow ankylosis. Two case reports]. / Weichteilschonende stabile Versorgung nach Fraktur bei Ellbogenankylose. Zwei Fallberichte.

The two cases presented are fractures of ankylosed elbow joints with severe soft tissue damage. Closed reduction and percutaneous osteosynthesis were performed using the IP-XS-nail system to prevent further soft tissue damage. By implanting two parallel XS-nails between the humerus and ulna and humerus and radius, we achieved a situation allowing early functional treatment of the weight bearing joints. There were no complications.

[Pathological fracture in fibrous histiocytoma of the proximal radial metaphysisJoint-preserving stabilization with the IP-XXS nail]. / Pathologische Fraktur bei fibrösem Histiozytom der proximalen RadiusmetaphyseGelenkerhaltende Stabilisierung mit dem IP-XXS-Nagel.

In this paper the authors report on a rare site for a benign bone lesion. They describe the clinical, radiological diagnostic, and therapeutic procedures for a benign fibrous histiocytoma (BFH) of the proximal radial metaphysis. Good results of operative treatment after excochleation, transplantation of an autologous bone chip, and stabilization with the IP-XXS nail are presented.

New concepts in the treatment of ankle joint fractures. The IP-XS (XSL) and IP-XXS (XXSL) nail in the treatment of ankle joint fractures.

INTRODUCTION: The most important factor in the treatment of ankle joint fractures is stable anatomical reconstruction of the syndesmosis and joint surface. In the course of this, attention must be paid to soft-tissue damage with the risk of deep infections. Early functional therapy and exercise tolerance must be called for. The choice of surgical access route, in particular in the case of critical arterial circulation, and the possible irritation of the soft tissue by the osteosynthesis material prompted us to seek alternative osteosynthesis techniques. MATERIAL AND METHODS: Following a preclinical study and very good initial results with the XS nail in the treatment of patella and olecranon fractures, this was now also used for ankle joint fractures at the medial malleolus and lateral malleolus. In the period from 5/2000 to 1/2002, 194 ankle joint fractures were treated using the XS nail. These were predominantly Weber B, C and bimalleolar fractures. In the case of ankle joint fractures, osteosynthesis was carried out following precise open fracture repositioning. In the case of isolated fibula fractures, early loading was allowed within 1 week; in the case of bimalleolar fractures, there was immediate partial loading with 20 kg for 4 weeks, after which they were subjected to full loading. Where there was an additional Volkmann fracture, we allowed only immediate partial loading with 10 kg for 6 weeks. All 194 patients were observed prospectively, and 162 (83.5%) could be followed up after 15 months. The results were classified according to the scale described by Olerud. RESULTS: It has been possible to follow up 162 patients, with an average age of 49.7 years. There were 62 (38.3%) Weber B and 45 (27.8%) Weber C fractures. In 55 (34.0%) cases, bimalleolar fractures were present. According to the Olerud score, 95 (58.6%) of the patients had an excellent outcome, 54 (33.3%) a good one, 9 (5.5%) a fair one and 4 (2.5%) an unsatisfactory outcome. In 3 cases a threaded wire dislocation occurred, without complications. Two mesh graft transplants were necessary; otherwise, there were no soft-tissue problems requiring review. One pseudarthrosis was seen. CONCLUSION: The XS nail which is introduced here fulfils the requirements made of an implant as regards maximum protection of soft tissue, secure fracture fixation and early exercise tolerance, including ankle fractures. No implant dislocation, no deep infection and no re-osteosynthesis were observed. Its advantages over conventional techniques lie precisely in the treatment of complex fractures and for patients with poor bone, vascular and soft-tissue situations.

[New concept in therapy of distal tibial metaphyseal fractures and pilon fractures with minor dislocations and severe soft tissue damage]. / Neues Konzept in der Therapie der distalen Tibiametaphysenfrakturen und wenig dislozierten Pilonfrakturen mit schweren Weichteilschäden.

The treatment of pilon fractures and distal metaphysial tibia fractures demands very high standards on the osteosynthesis material regarding the soft tissue and the essential joint reconstruction. The selection of the surgical entrance, particularly in case of a critical arterial or venous circulation and the possible irritation of the soft tissue caused by the osteosynthesis material led us to search for alternative osteosynthesis methods. After the elaboration of a pre-clinical study and good first results in the treatment of patella, olecranon and ankle joint fractures by means of the XS-nail the latter is now also employed for pilon fractures. Within a time period of 8 month 5 fibula fractures coming with pilon fractures had been treated with the XS-nail. This case report will demonstrate both the technique of treatment and the flexibility of the new implant.

[Problems in osteosynthesis of patella fractures with the AO tension belt and consequences for new implants. The XS nail]. / Probleme der Zuggurtungsosteosynthese von Patellafrakturen und deren Konsequenzen für weitere Implantatentwicklungen.

The eccentric ventral AO tension belt system represents the standard therapy of fractures of the patella. This often leads to unsatisfying results. Relating to Klute and Meenen [10] and the results of our own retrospective study, expressed as a percentage, 5-34% (own results 12.4%) have extremely poor treatment outcome, 23-60% (39%) end in deficiencies of bending, and there are 51-79.5% (65.7%) with subjective complaints after patella osteosynthesis. The disadvantages due to the eccentric tension belt position and the impossibility of applying the tension belt directly to the bone surface are abolished with the development of the XS nail. Due to its central position, constant compression of the entire fracture surface is provided. This is valid for all tension-stressed fractures such as those of the patella and olecranon. In synthetic patellae [5] standardized stress testing with changing tension up to 500 Newton was carried out. The XS nail was compared with the AO tension belt osteosynthesis after osteotomy and osteosynthesis in synthetic patellae. The XS nail was superior to the tension belt for all tests and therefore can be applied to all types of fractures where tension stress exists. We repaired the first 15 patella fractures with the XS nail. In 13 of 15 cases, full load of the injured leg was possible (for stairs a plaster splint was used). The experimental patella tests and first clinical results with the XS nail osteosynthesis after patella fracture confirm the new type of osteosynthesis, and functional treatment with loading seems possible.

[Calcaneus pseudarthrosis: a clinical rarity]. / Die Kalkaneuspseudarthrose. Eine klinische Rarität.

The calcaneus pseudoathrosis is rarely seen in clinical workday and we couldn't find any case be reported. In two cases the authors present the diagnosis and therapy of a non-union after a calcaneus fracture. The authors point especially at anatomical characteristics and biomechanical reasons and their meaning for aetiology of pseudoathrosis after a calcaneus fracture.

[Locked dorsal shoulder dislocation and contralateral ventral shoulder dislocation fracture. A rare combination]. / Dorsal verhakte Schulterluxation und kontralaterale ventrale Schulterluxationsfraktur. Eine seltene Kombination.

The posterior luxation of the shoulder joint is a rarely reported and often not recognized lesion in the clinical workday. The authors present the first case of a posterior luxation of the shoulder joint in combination with an contralateral anterior shoulder joint fracture dislocation. In that case the authors stress the importance of an exact clinical and radiology diagnostic and the right way to reduce a posterior luxation of the shoulder joint. Finally they draw the readers attention to operative steps to prevent a reluxation of the shoulder joint.

Short-term hemodynamic changes in episcleral arteriovenous anastomoses correlate with venous pressure and IOP changes in the albino rabbit.

In the present study we have determined the effects of acute diameter changes in the recently discovered episcleral arteriovenous anastomoses (AVA) on episcleral venous pressure and intraocular pressure (IOP) in the rabbit eye. The pressure was measured in episcleral arterioles, AVA and veins (vascular pressure) with a pressure chamber mounted on the tip of a microendoscope. After constriction of the AVA following topical administration (100 micrograms) of epinephrine we observed a decrease in the episcleral vascular pressure as well as in the IOP. Acute widening of the AVA after topical administration of 5mg nitroprusside led to a significant increase in the pressure of arterioles, AVA, veins and IOP which lasted several min. After 0.5mg topical nitroprusside the blood flow in the AVA increased. No significant effects were seen in the intravascular pressures; the IOP had a tendency to decrease. Experimental lowering of the IOP to 10mmHg caused an increase of vascular diameters and of blood flow in the AVA. It is assumed that-at least in drastic hemodynamic disorders-the degree of the AVA-perfusion might influence aqueous humor outflow and IOP due to changes of the episcleral venous pressure.

Pharmacokinetics of rioprostil in rats.

The pharmacokinetics of rioprostil in rats has been investigated following a single intravenous or oral dose of rioprostil between 0.004 and 10 mg/kg. Rioprostil is eliminated from plasma following an intravenous dose rapidly (t1/2 = 0.22 h) and nearly exclusively by biotransformation. The high total clearance (CL = 5.4 l.h-1.kg-1) indicates an additional extrahepatic metabolism. A systemic bioavailability of 2%, in spite of a rapid and nearly complete absorption (fa = 90%), indicates an extended first-pass effect. Twenty-four hours after the administration of [3H]rioprostil the residual radioactivity in the animal amounted to less than 1% of the dose administered.

Activation and inhibition of phosphorylase kinase by monospecific antibodies against preparatively isolated alpha, beta and gamma subunits.

Homogeneous alpha and beta subunits were isolated for the first time in preparative amounts in the presence of sodium dodecyl sulfate. Analysis by analytical polyacrylamide electrophoresis, sedimentation velocity, and immunoprecipitation with monospecific antibodies indicated homogeneity. The apparent molecular masses of the purified subunits as determined electrophoretically in the presence of dodecyl sulfate are: alpha = 140.2 +/- 2.1 kDa and beta = 123 +/- 1.8 kDa. Amino acid analyses show that per 100 mol amino acid the alpha-subunit has a higher serine content (Ser alpha/Ser beta = 1.32, Ser alpha/Ser gamma = 1.42) and a lower aspartic acid/asparagine (Asx) content (AsX alpha/Asx beta = 0.76, Asx alpha/Asx gamma = 0.90) than the beta and gamma subunits. Monospecific antibodies against the purified alpha, beta and gamma subunits were produced in sheep [J. Immunol. Methods (1984) 70, 193-209] and their action on the catalytic activity of non-activated phosphorylase kinase assayed. It can be shown that certain antibody fractions of anti-alpha, anti-beta and anti-gamma inhibit the Ca2+-dependent and Ca2+-independent activity at pH 6.8 as well as at pH 8.2. Other antibody fractions against the beta and gamma subunits however activate the Ca2+-dependent activity at pH 6.8 threefold to fourfold, although they inhibit the activity at pH 8.2. These antibodies lead to a ca. five fold increase in the pH 6.8/8.2 activity ratio. Activating anti-beta can even overcome the inhibitory action of anti-alpha at pH 6.8. A kinetic analysis shows that inhibition is the result of a mixed type mechanism whereas activation is due to a fivefold to tenfold increase in V for phosphorylase b. The results illustrate the importance of possibly large, concerted conformational changes of phosphorylase kinase. It appears that activation or inhibition can be triggered by the antibody binding to conformational determinants of a single subunit type leading to a structural alteration of the holoenzyme.

Generation, characterization and ELISA of monospecific antibodies against the subunits of a Ca2+-dependent protein kinase and a Ca2+-transport ATPase from rabbit skeletal muscle.

Monospecific precipitating sheep antibodies were generated for the first time against the purified, homogeneous alpha-, beta- and gamma-subunits of the Ca2+-dependent protein kinase, phosphorylase kinase, from rabbit muscle. As reference, antibodies against the holoenzyme and the CA2+-transport ATPase of sarcoplasmic reticulum were induced. In all cases antibody titers could be quantitated (standard error 5-10%) by enzyme-linked immunosorbent assay. Differentiation of antibody binding was achieved by quantitative precipitation and complement fixation assays. In general maximal antibody titers were reached 56 days after primary immunization and high titers (approximately 5000) were maintained for several weeks. Anti-alpha, anti-beta and anti-gamma avidly precipitate the denatured subunits employed as immunogens as well as the native enzyme. No cross-reactivity between antibodies against a specific subunit and any of the other heterologous subunits was demonstrable in double immunodiffusion assays providing no evidence for immunologically identical sites on the alpha-, beta- and gamma-subunits. Since anti-alpha, anti-beta and anti-gamma strongly inhibit enzyme activity, it is likely that they do so primarily by sterically interfering with the binding of the large substrate phosphorylase b (Mr 2.0 X 10(5)) to phosphorylase kinase (Mr 1.3 X 10(6)). It cannot be excluded, however, that anti-beta and anti-gamma bind to the active sites on these 2 subunits.