Prevention of periarticular heterotopic ossification after endoprosthetic hip joint replacement by means of diclofenac.

This prospective study involves 644 patients who received ossification prophylaxis by means of the drug diclofenac after implantation (87.5%) or revision (12.5%) of a total hip endoprosthesis between August 1992 and June 1994. One hundred patients (15.5%) stopped the treatment because of side-effects of the drug, and medication was stopped when gastrointestinal troubles occurred. The follow-up examination after 6 months revealed ossification of HO degree 1 according to Brooker in 13.8% of cases, of degree 2 in 4.8%, and of degree 3 in 1.4% of cases. Severe HO of degree 4 was not observed at all, and 80% of the patients exhibited no ossification what ever. Thus, in comparison to our own studies and to the literature, diclofenac must be regarded as an extremely effective drug for the prevention of ossification.

[Injuries due to inline skating]. / Verletzungen beim Inline-Skating.

In order to elucidate the patterns of injuries associated with in-line skating all patients with a inlineskate injury have been sampled prospectively during summer 1996. 58 patients were included in the study, aged 8 to 54 years (mean 22.2 years). The total number of injuries was 63, that is 1.1 injury in every injured skater. The upper extremity was the region most commonly injured (63.5%), with the distal radius fracture being the most common single fracture (25.4%). The most severe injuries, however, could be found in the lower extremity, including two femoral neck fractures and one pertrochanteric fracture in three patients aged more than 35 years. 22.4% of patients required hospitalization up to 54 days, and 36.2% of injuries had to be treated operatively. The most common single procedure was closed reduction and percutaneous wire fixation of displaced radius fractures. It is concluded that in-line skating imposes a risk of severe injuries especially on first-time skaters aged 35 years and up. The typical skating injury is the fracture of the wrist, a fact pointing out the necessity of the use of appropriate safety gear.

[Preserving the length of amputation stumps by microvascular flap transfer of the lower extremity]. / Längenerhalt von Amputationsstümpfen durch mikrovaskulären Lappentransfer an der unteren Extremität.

With different case reports we want to show the role of microvascular tissue transfer in preservation of lower extremity amputation length. To salvage amputation stumps after traumatic amputation, as well as in case of chronic soft tissue problems after amputation, the radialis forearm flap is preferred for smaller defects, for example after transmetatarsal amputation, whereas with the latissimus dorsi muscle flap bigger areas can be reconstructed. But also the tensor fascia latae flap and the scapular flap can be used for soft tissue reconstruction. With microvascular soft tissue transfer amputation stump length can be preserved in order to have a better functional outcome, especially for prosthetic rehabilitation.

[Long-term results of arthrodesis of the upper ankle joint]. / Langzeitergebnisse nach Arthrodese des oberen Sprunggelenkes.

From 1985 to 1987 a total of 95 ankle arthrodesis were performed. The retrospective study showed in most cases a bony healing within 14 weeks with a complication rate of 20%, due to reduced conditions of the soft tissue. The follow up examination of 52 patients showed a good to very good result in 48 cases. Nearly 70% of the patients did not use orthopaedic made-to-measure shoes at the time of follow up. Only 4% were dissatisfied with this procedure. Therefore the arthrodesis of the ankle should be preferred in comparison to the arthroplastik.

[Tuberculous destruction of the talus--a rare form of extrapulmonary skeletal TBC--a case report]. / Die tuberkulöse Destruktion des Talus--Eine seltene Form der extrapulmonalen Skelett-TBC--Eine Fallbeschreibung.

A 29 year old vietnamesian patient comes to an examination because of pain in the ankle one week after the arrival in Germany. The clinical examination is inconspicuous, x-ray pictures show a necrosis of the talus. A puncture is sterile. A partial astragalektomie is done. Histology demonstrates a tuberculosis.