Injuries in competitive boxing. A prospective study.

Boxing remains a subject of controversy and is often classified as dangerous. But the discussion is based mostly on retrospective studies. This survey was conducted as a prospective study. From October 2012 to September 2013, 44 competitive boxers were asked to report their injuries once a month. The questionnaire collected general information (training, competition) and recorded the number of bouts fought, injuries and resulting lost days. A total of 192 injuries were recorded, 133 of which resulted in interruption of training or competition. Each boxer sustained 3 injuries per year on average. The injury rate was 12.8 injuries per 1 000 h of training. Boxers fighting more than 3 bouts per year sustain more injuries (p=0.0075). The injury rate does is not a function of age (age≤19 vs. > 19a, p=0.53). Injuries to the head and the upper limbs occur most frequently. The most common injuries are soft tissue lacerations and contusions. Head injuries with neurological symptoms rarely occur (4.2%). Boxing has a high injury rate that is comparable with other contact sports, but most injuries are minor. Injury frequency is not a function of whether the boxer competes in the junior or adult category. Athletes fighting many bouts per year have a greater risk of injury.

Revised histopathological consensus classification of joint implant related pathology.

This extended classification of joint implant related pathology is a practical histopathologic classification based on defined morphological criteria covering the complete spectrum of pathohistologic changes in periprosthetic tissues. These changes may occur as a consequence of endoprosthetic replacement of large joints and may lead to a reduction in the prosthesis survival rate. We describe the established consensus classification of the periprosthetic membrane, in which aseptic and septic prosthetic loosening can be subdivided into four histological types, as well as histopathological criteria for additional significant pathologies including endoprosthetic-associated arthrofibrosis, particle-induced immunological, inflammatory and toxic mechanisms (adverse reactions), and bone tissue pathologies. These characteristic tissue alterations and their relationships are summarized in the extended classification. Since particle heterogeneity in periprosthetic tissue is high and particle identification is a necessary part of diagnosis, the identification of different types of particles is described in the histopathological particle algorithm. The morphological qualities of prosthetic material particles and the demarcation between abrasion and non-abrasion endogenous particles are also summarized. This feasible classification which is based on low cost standard tissue processing and examination and on well-defined diagnostic criteria is a solid platform for the histological diagnosis of implant associated pathologies providing a stable and reproducible tool for the surgical pathologist. Since this classification is suitable for standardized histopathological diagnostics, it might also provide a useful data set for joint arthroplasty registers, particularly for registers based on so-called routine data.

[Hand ergotherapy for rheumatic diseases and the special importance of hand surgery]. / Ergohandtherapie bei rheumatischen Erkrankungen unter besonderer Bedeutung von Handoperationen.

BACKGROUND: Human hands play an important role in overcoming routine daily life. As a consequence of limitations in the function of the hand due to rheumatic diseases, various manual activities can become an enormous challenge or even become absolutely impossible. MATERIAL AND METHODS: This review article discusses the possibilities of hand ergotherapy and explains the most important assist devices. RESULTS AND CONCLUSION: The main area of occupational and hand therapy interventions in patients with rheumatoid arthritis is the postoperative or conservative treatment of wrist and finger joints. The main areas of concern are to maintain the mobility of the joints, when necessary and possible mobilization of the joints, strengthen the muscles, the prophylaxis or correction of deformities with thermoplastic splints, conservative pain relief and anti-inflammatory treatment, joint protection precautions and teaching of home exercises for prophylaxis of contracture. Further areas of therapy are instruction and provision of adaptive devices for limitations of the upper and/or lower extremities, especially training of activities of daily living (ADL) and patient education.

[Periprosthetic infections in systemic inflammatory rheumatic disease. Review article on diagnostics and therapy]. / Periprothetische Infekte bei rheumatisch-entzündlicher Systemerkrankung. Übersichtsartikel zu Diagnostik und Therapie.

BACKGROUND: Patients with an inflammatory disease have an elevated risk for periprosthetic joint infections due to impairment of the immune system caused by the disease itself in combination with disease-modifying antirheumatic drugs (DMARD). These infections can cause life-threatening sepsis. Unfortunately recommendations on the diagnostics and treatment are mostly based on studies with a level of evidence grade IV or V. OBJECTIVES: This article gives an overview of recent publications evaluating the level of evidence of recommendations on diagnostics and treatment of periprosthetic joint infections in patients with inflammatory diseases. METHODS: A systematic literature search was performed in the Medline database in January and February 2014. The search included all articles on diagnostic and/or treatment of periprosthetic joint infections in patients with inflammatory diseases. Articles in languages other than English or German were excluded, as well as case reports, studies with less than 20 patients and articles only referring to patients with inflammatory diseases without periprosthetic infections. RESULTS: Nearly all recommendations are based on retrospective studies or expert opinions (level of evidence IV or V). Conflicting results are common but there is good evidence on preoperative aspiration of joint fluid (level of evidence I) and a doubled risk of joint infections under treatment with anti-tumor necrosis factor (level of evidence II). An increased mortality has been reported in multiple studies. Two-stage revision seems to have a slightly better outcome than retention of prosthesis or one-stage revision. Generally, therapeutic recommendations for periprosthetic joint infections lack a good level of evidence. Future studies are urgently needed.

[Histopathology and microbiology of joint infections: extension of diagnostic safety in patients with chronic polyarthritis]. / Histopathologie und Mikrobiologie bei Gelenkinfekten : Erweiterung der Diagnostiksicherheit bei Patienten mit chronischer Polyarthritis.

BACKGROUND: It can be difficult to distinguish between synovitis due to rheumatism and synovitis due to a bacterial infection. Microbiological detection of bacteria is not always successful and the clinical significance of low virulent bacteria often remains uncertain. Therefore, the histopathological finding of inflammatory reactions is very important. STUDY DESIGN AND METHODS: From patients with clinically clear signs of infections and rheumatoid arthritis who underwent surgery between April and August 2011, samples were taken during surgery. Histopathological diagnosis was carried out by conventional enzyme and immunohistochemical techniques based on defined criteria of bacterial infection in tissues, synovial tissue and bone. RESULTS: A total of 20 patients were included, 10 males and 10 females with a mean age of 61.7 years. Staphylococcus aureus was the most commonly detected bacteria and in 4 cases bacteria could not be demonstrated. The correlation between the histopathological signs of an infection and microbiological detection of bacteria was 93.3 %. CONCLUSIONS: In patients with rheumatoid arthritis the combination of histopathology and microbiology significantly increased the safety of detecting an infection or contamination.

[Purulent gonarthritis resulting from H1N1 viral pneumonia]. / Eitrige Gonarthritis im Rahmen einer H1N1-Viruspneumonie.

No articles on orthopedic complications of pneumonia due to influenza A H1N1 virus have yet been published. A 44-year-old male patient was hospitalized due to the suspicion of an infected knee. During arthroscopy beta-hemolytic Streptococcus group A and Acinetobacter were found and the histopathological diagnosis of an infectious bacterial synovialitis was made. Despite resistance-oriented antibiotic treatment the patient's general condition worsened. Influenza A H1N1 virus was detected in a nasal sample and was successfully treated with Tamiflu®. If fever and elevated infection markers persist a search for the focus has to be performed including unlikely diseases such as influenza A H1N1 virus.

["Münsteraner foot- and shoe score"--objectivation of patient satisfaction after provision with orthopedic shoes]. / "Münsteraner Fuß- und Schuhfragebogen" - Objektivierung der Patientenzufriedenheit nach orthopädischer Schuhversorgung.

BACKGROUND: Means to improve patient satisfaction and their compliance are essential for the successful outcome of medical interventions, e.g. supply of orthopedic shoes or orthoses in orthopedic patients. A useful validated questionnaire to monitor the subjective opinion of the patients is still lacking. METHODS: In a randomised single blinded study we created a new questionnaire with two parts. Part one deals with ten questions on patient data and illness. Part two consists of 13 questions about pain, disabilities in activities of daily life (ADL), use of painkillers, satisfaction, history of ulceration, correction of shoes and orthoses, handling and compliance using a scale of 1-6. Questions were chosen by asking a group of experts (four experienced physicians of two universities and four shoemaker master-craftsmen). Then an items reduction was performed. The reliability was tested in a pre- and retest in 20 patients of our orthopedic clinic. Then the questionnaire was validated by comparing 40 patients of our orthopedic clinic (intervention group) with 180 subjects without orthopedic treatment (control group) chosen at random. The questionnaire was always done anonymously and without the help of the interviewer. Exclusion criteria for the control group were any kind of orthopedic treatment of the lower limb in the last 2 years, orthopedic shoes or lumbar sciatic pain. Exclusion criteria for both groups were minor or major amputations, inability to walk outdoors without help. RESULTS: We demonstrated highly significant differences for each single question and the total score between orthopedic patients and healthy probands. Additionally, we saw significantly poorer scores for patients suffering from diabetes in the control group, patients with polyneuropathy and those without polyneuropathy, as well as for women vs. men. There was a high rate of diabetics (11 %) in the control group in analogy to the current literature. DISCUSSION: The new questionnaire discriminates highly significantly between healthy and ill probands. Interindividually a screening of people at risk is possible or a comparison of different interventions. Intraindividually it could be used to monitor patient satisfaction after interventions. Objectivation of patient satisfaction is important to improve their compliance and outcome.

[Orthopedic made-to-measure shoes for diabetics. Long-term 5-year outcome]. / Orthopädische Massschuhversorgung bei Diabetikern: 5-Jahres-Outcome.

For patients with diabetes mellitus and diabetic foot syndrome customized orthopedic shoes represent the most effective treatment to avoid foot ulceration and amputation. A total of 53 patients suffering from diabetes and treated with customized orthopedic shoes for more than 5 years were included in the study. Of the patients 91% had peripheral artery occlusion disease, polyneuropathy and diabetic neuropathic osteoarthropathy (DNOAP) and in nearly 25% amputation of one limb had already been carried out. The incidence of ulcers over a time period of 5 years was assessed from the patient records and questioning the patients. Questions on the duration of wearing orthopedic shoes, the durability of the shoes and resulting pain were also included. All patients except for one had problems walking on uneven surfaces. Of the patients 89% claimed to have used their shoes always or nearly always and 25% of the shoes had to be replaced after 1 year. The incidence of ulcers was 38% after 5 years. Treatment with customized orthopedic shoes is an effective method to prevent ulcers and amputation. To be successful it is necessary to control that the shoes are made correctly. Not all shoes last as long as 2 years.

[Reconstructive surgery for Charcot foot. Long-term 5-year outcome]. / Rekonstruktive Chirurgie beim Charcot-Fuss: 5-Jahres-Langzeitoutcome.

INTRODUCTION: Diabetic neuropathic osteoarthropathy (DNOAP) often leads to progressive malpositioning of the foot with subsequent ulcers and a high risk of amputation. There are very few reliable studies on long-term outcome. This study includes the largest follow- up collective ever carried out. METHODS: In a retrospective study 205 surgical procedures (195 patients) for complex malpositioning of the foot and/or chronic ulcers using a fixateur externe (188 cases) or Steinmann pins (17 cases) in patients with NOAP were included. The average follow-up time was 21 months. The goal was walking without pain in customized orthopedic shoes and avoiding amputation. RESULTS: No primary amputations were necessary. Patient activity improved by more than 1 level according to the classification for lower limb amputees following the Hofer activity score. The most common minor complication was persistence or recurrence of ulcers in 48 patients. Only 7 new recurrences of NOAP were observed. In 15 patients secondary amputation was necessary. Approximately 50% of the patients could be mobilized with the help of customized orthopedic shoes 18 months after surgery. CONCLUSION: By using a fixateur externe many amputations could be avoided and patient's activity could be improved. The interdisciplinary teamwork between an orthopedic surgeon, orthopedic shoemaker and orthopedic technician is essential for long term success.

Skeletal benefit after one year of risedronate therapy in patients with rheumatoid arthritis and glucocorticoid-induced osteoporosis: a prospective study.

Glucocorticoid therapy is an important risk factor for osteoporosis in rheumatoid arthritis. Reduction in fracture risk is the most important endpoint for osteoporosis treatments. The aim of this study was to evaluate whether skeletal benefit (increases in osteosonogrammetry parameters, reduction in bone turnover and fracture incidence) are maintained during a follow-up of 1 year with risedronate therapy (5 mg/day). During the study period osteosonogrammetry parameters showed a significant increase and no new osteoporotic fractures were reported, suggesting an antifracture effect of risedronate therapy. Urine crosslinks (as a bone resorption marker) significantly decreased during the follow-up, suggesting a positive balance in the bone remodeling process. The tolerability of risedronate was good and only seven out of 51 patients presented minimal adverse effects. In summary, risedronate significantly decreased new osteoporotic fractures in patients with rheumatoid arthritis and glucocorticoid-induced osteoporosis and is an effective and well-tolerated treatment.