[Diagnostic ability of power measurement of different grip forms for distal median nerve lesion]. / Stellenwert der Kraftmessung verschiedener Greifformen zur Diagnostik der peripheren Medianusläsion.

BACKGROUND: Peripheral lesions of the median nerve cause characteristic changes of the grip function of the hand. For evaluating grip force changes, measurement by dynamometers (JAMAR dynamometer and pinch dynamometer) is of high relevance. In this study the ability of grip force measurements of different grip forms was evaluated to discriminate between a simulated median nerve lesion and healthy subjects. MATERIAL AND METHODS: In 21 healthy subjects, the grip force of power grip was measured by the JAMAR dynamometer at the second stage including measurement of force at the fingertips and the thenar by a sensor glove. With a pinch dynamometer the power of palmar abduction, precision grip, pincer grip and pinch grip was determined. Measurements were performed with and without median nerve block at the wrist. RESULTS: In power grip of the JAMAR dynamometer at the second stage a significant reduction of the grip force of 13.4% was found (p < 0.03). The power distribution between the fingers D2-D5 did not change with median nerve block. The most relevant reduction of grip force in median nerve block compared with the healthy control was measured in palmar abduction (72.1%, p < 0.0002), followed by precision grip 31.0% (p < 0.0001), pincer grip 23.6% (p < 0.0004) and pinch grip 18.8% (p < 0.0002). CONCLUSIONS: For the discrimination between healthy subjects and subjects with a median nerve block there was a limited relevance of the measurement of the power grip and force distribution at the fingers by the JAMAR dynamometer. However, the best distinction was observed by dynamometric measurement of other grips than power grip, such as palmar abduction, precision grip, pincer grip and pinch grip. The results could be relevant for the clinical diagnostics and rehabilitation of median nerve lesion, complementing the widespread measurement of the power grip by other grip forms.

[Total Hip and Knee Arthroplasty - Utilization of Postoperative Rehabilitation]. / Implantation einer Hüft- oder Knietotalendoprothese und die Inanspruchnahme einer Anschlussrehabilitation.

BACKGROUND: After total hip and knee arthroplasty, patients have different options of subsequent treatment: an early postoperative rehabilitation, with or without a period at home, or only outpatient services. The aim of this study was to identify factors predicting the utilization of an early postoperative rehabilitation. METHODS: This cross-sectoral analysis is based on claims data of AOK Baden-Württemberg (Statutory Health Insurance), Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Baden-Württemberg (German Pension Insurance). Predictors for participation in an early postoperative rehabilitation and for an interim period were determined using logistic regression analysis. RESULTS: 82.6% of 9 232 patients were going to an early postoperative rehabilitation after total hip arthroplasty. After total knee arthroplasty, 83.9% of 7 656 patients were utilizing postoperative rehabilitation. Moreover, there was less utilization of postoperative rehabilitation in young, male and foreign patients. The analysis shows that the utilization of post-acute rehabilitation was significantly predicted by sociodemographic variables (age, sex, nationality) as well as comorbidity, outpatient treatment and medication. CONCLUSION: The results provide an indication of higher severity of patients in group "postoperative rehabilitation without a period at home". Nevertheless there are some indications for under-utilization of certain patient groups.

Change in the temporal coordination of the finger joints with ulnar nerve block during different power grips analyzed with a sensor glove.

Ulnar nerve injuries can cause deficient hand movement patterns. Their assessment is important for diagnosis and rehabilitation in hand surgery cases. The purpose of this study was to quantify the changes in temporal coordination of the finger joints during different power grips with an ulnar nerve block by means of a sensor glove. In 21 healthy subjects, the onset and end of the active flexion of the 14 finger joints when gripping objects of different diameters was recorded by a sensor glove. The measurement was repeated after an ulnar nerve block was applied in a standardized setting. The change in the temporal coordination of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints with and without the nerve block was calculated within the same subject. In healthy subjects, the MCP joints started their movement prior to the PIP joints in the middle and ring finger, whereas this occurred in the reverse order at the index and little finger. The DIP joint onset was significantly delayed (P<0.01). With the ulnar nerve block, this coordination shifted towards simultaneous onset of all joints, independent of the grip diameter. The thumb and index finger were affected the least. With an ulnar nerve block, the PIP joints completed their movement prior to the MCP joints when gripping small objects (G1 and G2), whereas the order was reversed with larger objects (G3 and G4). The alterations with ulnar nerve block affected mainly the little finger when gripping small objects. With larger diameter objects, all fingers had a significant delay at the end of the PIP joint movement relative to the MCP and DIP joints, and the PIP and DIP joint sequence was reversed (P<0.01). Based on the significant changes in temporal coordination of finger flexion during different power grips, there are biomechanical effects of loss of function of the intrinsic muscles caused by an ulnar nerve block on the fine motor skills of the hand. This can be important for the diagnosis and rehabilitation of ulnar nerve lesions of the hand.

[Outcome Quality in Medical Rehabilitation: Relationship Between "Patient-Reported Outcomes" (PROs) and Social Security Contributions]. / Ergebnisqualität medizinischer Rehabilitation: Zum Zusammenhang zwischen "Patient Reported Outcomes" (PROs) und geleisteten Sozialversicherungsbeiträgen.

Aim of the Study The outcome quality of medical rehabilitation is evaluated often by "Patient Reported Outcomes" (PROs). It is examined to what extent these PROs are corresponding with "hard" or "objective" outcomes such as payments of contributions to social insurance. Methods The "rehabilitation QM outcome study" includes self-reports of patients as well as data from the Rehabilitation Statistics Database (RSD) of the German pension insurance Baden-Wurttemberg. The sample for the question posed includes N=2 947 insured who were treated in 2011 in 21 clinics of the "health quality network" and who were either employed or unemployed at the time of the rehabilitation application (e. g. the workforce or labour force group, response rate: 55%). The sample turned out widely representative for the population of the insured persons. Results PROs and payment of contributions to pension insurance clearly correspond. In the year after the rehabilitation improved vs. not improved rehabilitees differed clearly with regard to their payments of contributions. Conclusions The results support the validity of PROs. For a comprehensive depiction of the outcome quality of rehabilitation PROs and payments of contributions should be considered supplementary.

[Associations of the Employment Status during the First 2 Years Following Medical Rehabilitation and Long Term Occupational Trajectories: Implications for Outcome Measurement]. / Zusammenhänge zwischen dem Erwerbsstatus in den ersten 2 Jahren nach Rehabilitation und langfristigen Erwerbsverläufen: Implikationen für die Outcome-Messung.

Study Objectives: The aim was to investigate the predictive value of the employment status measured in the 6th, 12th, 18th and 24th month after medical rehabilitation for long-term employment trajectories during 4 years. Methods: A retrospective study was conducted based on a 20%-sample of all patients receiving inpatient rehabilitation funded by the German pension fund. Patients aged <62 years who were treated due to musculoskeletal, cardiovascular or psychosomatic disorders during the years 2002-2005 were included and followed for 4 consecutive years. The predictive value of the employment status in 4 predefined months after discharge (6th, 12th, 18th and 24th month), for the total number of months in employment in 4 years following rehabilitative treatment was analyzed using multiple linear regression. Per time point, separate regression analyses were conducted, including the employment status (employed vs. unemployed) at the respective point in time as explanatory variable, besides a standard set of additional prognostic variables. Results: A total of 252 591 patients were eligible for study inclusion. The level of explained variance of the regression models increased with the point in time used to measure the employment status, included as explanatory variable. Overall the R²-measure increased by 30% from the regression model that included the employment status in the 6th month (R²=0.60) to the model that included the work status in the 24th month (R²=0.78). Conclusion: The degree of accuracy in the prognosis of long-term employment biographies increases with the point in time used to measure employment in the first 2 years following rehabilitation. These findings should be taken into consideration for the predefinition of time points used to measure the employment status in future studies.

[Current Developments of the Interdisciplinary Subject Rehabilitation, Physical Medicine, Naturopathic Treatment in the German Medical Faculties: Results of the DGRW Faculty Survey in 2015]. / Aktuelle Entwicklungen der rehabilitationsbezogenen Lehre in den humanmedizinischen Studiengängen in Deutschland: Ergebnisse der DGRW-Fakultätenbefragung 2015.

To ascertain the current development of the rehabilitation-related medical teaching in the interdisciplinary subject Rehabilitation, Physical Medicine, Naturopathic Treatment (Q12) regarding its execution, content, exams and evaluation of teaching at the Medical Faculties the German Society of Rehabilitation Science conducted another faculty survey in 2015. Representatives of all degree courses of human medicine in German Universities (n=41) received a pseudonymised standardised questionnaire in summer 2015. The response rate was 76% (n=31). Half of the faculties (48%) stated that they had a teaching and research unit for at least 1 of the 3 subjects of the interdisciplinary Q12. The Q12-teaching of faculties including these units partially differed from the other faculties. Model medical education programmes provide on average 2 semesters more for Q12-teaching in comparison to the traditional programmes. More than 3 quarters of the traditional programmes and all other courses include other medical professionals besides physicians as lecturers. Multiple choice questions still constitute the most common examination type (94%). Nearly all Medical Faculties evaluate the rehabilitation-related teaching but only half of all them have implemented a financial gratification based on the evaluation results. Even 10 years after the implementation of Q12, major variations were demonstrated regarding the execution, content and methods of medical education in rehabilitation. In the future the influence of the National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education on the Q12-development and the Q12-teaching in medical university education in Germany with foreign qualification will be of particular interest.

[Effects of a Combined Orthopedic and Psychosomatic Rehabilitation Concept]. / Effekte einer Verbund-Rehabilitation Orthopädie-Psychosomatik.

Objective: Effects of a combined orthopedic and psychosomatic rehabilitation (VOP) concept are evaluated in contrast to psychosomatic and orthopedic rehabilitation. Therefore both mental and physical health of rehabilitants are compared. Methods: A prospective case-control study was performed in order to gather psychic strain and bodily constitution. Covariance analysis was conducted to expose significant differences between groups. Results: An equal clinically relevant reduction of psychological distress could be achieved with psychosomatic rehabilitation (N=322) and VOP (N=511). Moreover, bodily constitution could be increased by the same amount through VOP and orthopedic rehabilitation (N=135). In conclusion the therapy concept is successful in patients with both somatic and psychic problems.

[Recommendations for the Stepwise Occupational Reintegration: Can the Characteristic of the Patients Explain the Differences Between the Rehabilitation Centers?]. / Nachsorgeempfehlungen zur stufenweisen Wiedereingliederung: Inwieweit erklären Rehabilitandenmerkmale die bestehenden Unterschiede zwischen den Einrichtungen?

BACKGROUND: The first step to initiate a stepwise occupational reintegration (SOR) is the recommendation of the rehabilitation centers. Therefore rehabilitation centers have a significant impact on the use of SOR. There is evidence that the recommendation rate between the rehabilitation centers differs clearly. The present survey therefore analyses in detail the differences of the recommendation rate and examines which patient-related factors could explain the differences. METHODS: This study is based on analysis of routine data provided by the German pension insurance in Baden-Württemberg (Rehabilitationsstatistikdatenbasis 2013; RSD). In the analyses rehabilitation measures were included if they were conducted by employed patients (18-64 years) with a muscular-skeletal system disease or a disorder of the connective tissue. Logistic regression models were performed to explain the differences in the recommendation rate of the rehabilitation centers. RESULTS: The data of 134 853 rehabilitation measures out of 32 rehabilitation centers were available. The recommendation rate differed between the rehabilitation centers from 1.36-18.53%. The logistic regression analysis showed that the period of working incapacity 12 month before the rehabilitation and the working capacity on the current job were the most important predictors for the recommendation of a SOR by the rehabilitation centers. Also the rehabilitation centers themselves have an important influence. DISCUSSION: The results of this survey indicate that the characteristic of the patients is an important factor for the recommendation of SOR. Additionally the rehabilitation centers themselves have an influence on the recommendation of SOR. The results point to the fact that the rehabilitation centers use different criteria by making a recommendation.

[The User Survey on the Revision of the Classification of Therapeutic Procedures]. / Die Anwenderbefragung zur Aktualisierung der Klassifikation therapeutischer Leistungen (KTL).

INTRODUCTION: An extensive user survey was conducted in the context of updating the Classification of Therapeutic Procedures (KTL 2015). This paper reflects the results of the user survey and raises critical discussion points. METHODS: The user survey was sent to all rehabilitation centers contracted by the German pension insurance as well as professional associations. The user survey was available both as a paper questionnaire and as an online version. The feedback of the user survey provided an important basis for the revision of the KTL. RESULT: The survey yielded 1,868 suggestions from 360 users. Most of them related to chapters E ("occupational therapy, work therapy, other functional therapy") and C ("information, motivation, training"). The change from German diplomas to the international Bachelor's and Master's degrees, and the inclusion of diagnostic and work-related procedures were the main focus of the user feedback. CONCLUSION: For the revision of the KTL, the user survey provided valuable information. Only by the inclusion of practitioners can the KTL meet the requirements of realistic and comprehensive acquisition of data on therapeutic procedures also in future.

[Development of a Set of Rehabilitation Related Multiple-choice-questions in Medical Education]. / Entwicklung eines Prüfungsfragenpools für die rehabilitationsbezogene Lehre im Studiengang Humanmedizin.

In the rehabilitation related teaching as in other subjects of the medical training multiple choice (MC) examinations are the most frequent type of examinations. Compared to other subjects only a few MC questions are available for the interdisciplinary subject Rehabilitation. Therefore an internet-based online platform "Pool of rehabilitation related MC questions" was developed to assist teachers regarding the provision, design and organization of high-quality rehabilitation related MC questions. A total of 502 existing MC questions were collected from 12 German Medical Faculties. After removal of 59 questions not suitable for formal and content reasons a total of 443 questions were presented to 6 reviewers for triple reviews (a total of 1 329 expert reviews received). Of the 502 questions 335 (67%) were included in the final pool including short cases with 46 case studies. The questions refer to the following learning objectives: principles of rehabilitation (40%), rehabilitative interventions (20%), diagnosis and assessment (18%), initiation and control of the rehabilitation process (12%) and methods/quality of rehabilitative interventions (10%). The use of the online platform modules resp. the questions are for free for lecturers. This includes the compilation and output of complete examinations, the statistical evaluation, and other audit-related materials. This examination pool counteracts the current lack of quality-assured rehabilitation-related MC questions and contributes to set common standards for the Medical Faculties to rehabilitation related examinations.

[Return to Work after Fractures of the Pelvis and the Acetabulum]. / Berufliche Wiedereingliederung nach Becken- und Azetabulumfrakturen.

BACKGROUND AND INTRODUCTION: Pelvic and acetabular fractures are severe injuries with serious consequences that mainly happen to young people. Therefore it is highly interesting to find out to what extent affected patients succeed in returning to work, which is an important factor concerning quality of live. Thus, the objective of this study was to estimate the "return to work" in a two-year follow-up after rehabilitative treatment of patients with pelvic and acetabular fractures and to identify influencing factors. METHODS: A retrospective cohort study was conducted using population-based administrative data of the Baden-Württemberg statutory pension fund. All patients (age 18 to 63 years) who had participated in a rehabilitation programme between 2004 and 2009 due to a pelvic or acetabular fracture were included. Return to work was modelled using multivariate logistic regression analysis. Rehabilitants were classified as "returned" if they have paid at least one monthly contribution due to employment during 13 to 24 months after rehabilitation. Age, gender, diagnostic group, type of rehabilitation programme, fractures of the spine, nerve injuries of the lumbosacral area and/or the lower limb and employment status before the fractures were considered as prognostic covariates. RESULTS: Two-thirds of the 249 researched patients returned to work. This corresponds to a reduction of employment amounting to 16.6 % for patients with a pelvic fracture and 20.8 % for patients with an acetabular fracture. Main predictor for a return to work was the employment status before the fracture. Younger patients had a better chance to return to work than older ones. Patients with fractures of the spine or nerve injuries of the lumbosacral area and/or the lower limb had a 73 % or, respectively, 78 % higher risk of not returning to work. CONCLUSION: Fractures of the pelvis and the acetabulum currently lead in one of five patients to loss of employment. Thereby the trauma threatens the social security of the young patients. Follow-up care should be intensified to increase recovery rates and reduce the burden of long-term work disability.

[Return to work after total hip arthroplasty]. / Rückkehr in das Erwerbsleben nach Hüfttotalendoprothese.

BACKGROUND: Return to work is an important prerequisite to achieve subjective success of an operation. The analysis of the routine data from the German Federal Pension Fund allows a comprehensive evaluation and investigation of factors which influence reintegration into employment. METHODS: A random 2 % sample of rehabilitants was drawn from the scientific use file "Abgeschlossene Rehabilitation im Versicherungsverlauf 2002-2009" (completed rehabilitation in the course of health insurance 2002-2009) of the German Federal Pension Fund. Patients were included if they were 18-60 years old and had participated in rehabilitation due to the diagnosis arthritis of the hip. To obtain information on employment status the national insurance contributions and labor force groups in the year before and 2 years after rehabilitation were used. Using regression analysis the influence of sociodemographic factors was analyzed. RESULTS: Of the 736 patients included in the survey 625 (84.9 %) were employed again 2 years after rehabilitation. Out of these 519 (83.0 %) returned to their previous profession and 228 (36.5 %) paid less insurance contributions. Increasing age and a manual job were identified as risk factors for re-entry into employment. CONCLUSION: In Germany a high percentage of 84.9 % of patients return to work after joint replacement due to coxarthrosis. Nevertheless, the results indicate that the social situation becomes worse for approximately one sixth of the patients.

[Clinical evaluation of PFNA® and relationship between the tip-apex distance and mechanical failure]. / Klinische Evaluation des PFNA® und Zusammenhang zwischen Tip-Apex-Distanz und mechanischem Versagen.

The incidence of trochanteric fractures is increasing in Europe, and the economic impact and mortality is high. The aim of the study was to evaluate the PFNA® (proximal femoral nail antirotation) with respect to its clinical use and mechanical complications.All patients with a trochanteric fracture who had been treated with a PFNA® between 12/2004 and 12/2007 were identified and analysed regarding complications and radiological findings. The study included 195 patients; 61.2% of the patients were classified as Singh I und II. The mean duration of surgery was 57 min. In ten cases (5.1%) the blade migrated, four cases (2.1%) showed blade cut out and in one case the nail broke (0.5%). The mean TAD was 26.7 mm, in cases of cut out 41.3 mm and in blade migrations 38.6 mm. No failure could be documented when the TAD was less then 30 mm. There is a strong relationship between increasing TAD and mechanical failure (P<0.001); 84.6% of the patients have been followed up, and 30.2% died in the follow-up period.The PFNA® is an easy-to-use implant for the treatment of stable and instable proximal femur fractures. Mechanical failure depends on the TAD.

[Treatment of peritrochanteric fractures: biomechanical considerations]. / Versorgung pertrochantärer Femurfrakturen: Biomechanische Überlegungen.

Biomechanical considerations are relevant in the treatment of peritrochanteric fractures. Concomitant diseases and osteoporosis place high demands on the primary stability of the operative treatment. In the situation of unstable fractures (AO/ASIF 31-A2 and A3), even normal activities of life can easily exceed the critical limits of stability, which can result in implant failure. Both intramedullary and extramedullary implants are used successfully in the treatment of even unstable fractures. Different variations in the implant design and anchorage of the load carrier of the femoral neck are available and may have different biomechanical characteristics. Biomechanical tests show that new developments of implants can increase stability. Nevertheless, accurate reduction and operative technique is essential to ensure uneventful fracture healing. Although some supportive measures are very promising, such as augmentation, further research is required to increase stability in the unstable and osteoporotic fracture situation.

Side plate fixation vs. intramedullary nailing in an unstable medial femoral neck fracture model: A comparative biomechanical study.

BACKGROUND: The objective of this study was to investigate primary stability of the proximal femoral nailing antirotation for the indication of unstable medial femoral neck fractures. The device was compared to the dynamic hip screw blade, which is a "gold standard" in the treatment of proximal femoral fractures. METHODS: Six pairs of human cadaver femurs were tested in a cyclic loading model with loads up to 200 N, 400 N, 600 N, 800 N, and 1000 N, respectively. Iliotibial tract was simulated by a chain that applied forces on the greater trochanter during loading. In vitro combined axial and bending loads were applied. Angular displacements during loading were recorded in all directions, and loads to failure were recorded. FINDINGS: For the cyclic loading test no statistically significant differences between the two groups could be detected. Specimens fixed with the dynamic hip screw blade showed higher displacements in the varus direction at 400 N and 600 N, in the external rotation at 200 N, 400 N and 600 N, and in the anterior direction at 400 N. Load to failure revealed no statistical difference between the two implants. INTERPRETATION: The proximal femoral nailing antirotation achieves primary stability comparable to the dynamic hip screw blade. The proximal femoral nailing antirotation combines the biomechanical favorable concept of intramedullary fixation with a minimally invasive surgical technique, which theoretically may be advantageous in clinical use. Further biomechanical studies are required to clarify to what extent the results of the present study can be transferred to the clinical situation.

Biomechanical comparison of two side plate fixation techniques in an unstable intertrochanteric osteotomy model: Sliding Hip Screw and Percutaneous Compression Plate.

BACKGROUND: Our objective was to determine the biomechanical primary stability of two different side plate fixation devices in an unstable intertrochanteric cadaver model: the Sliding Hip Screw with an additional derotation screw was compared with the Percutaneous Compression Plate. METHODS: Eight pairs of human cadaver femurs were tested for comparison of the primary stability of the two implants in two modes: (a) cyclic loading up to 200 N, 400 N, 600 N, 800 N, and 1000 N, respectively. In vitro combined axial and bending loads were applied. Angular displacements of the proximal head fragment during loading were recorded in rotational, varus-valgus, and anterior-posterior directions. (b) The load to failure was determined. FINDINGS: Specimens fixed with the Percutaneous Compression Plate showed higher displacements in the varus during loading up to 200 N (P=0.033), and 400 N (P=0.001), compared to the Sliding Hip Screw. A similar tendency was observed for higher loads. The Percutaneous Compression Plate allowed more external rotation of the proximal fragment only at loads up to 800 N (P=0.019). No statistical difference could be found for the slight migrations in the posterior direction. Load to failure also revealed no statistical difference between the two implants. INTERPRETATION: The Percutaneous Compression Plate as a double-axis fixation device with a sliding capability allows higher displacements in the varus direction and also in external rotation at 800 N loading compared to the Sliding Hip Screw as a single-axis fixation device combined with an additional derotation screw. While both implants are successful used in clinical practice, this should be considered in treatment of unstable intertrochanteric fractures with inferior comminution in osteoporotic patients.

The effects of non-steroidal anti-inflammatory drug application on incisional wound healing in rats.

OBJECTIVE: There is evidence that non-steroidal anti-inflammatory drugs (NSAIDs) delay both epithelialisation and angiogenesis in the early phases of wound healing because of an antiproliferative effect. We investigated the influence of diclofenac, a non-selective NSAID, on incisional wound healing. METHOD: Ten male Wistar rats were given 5 mg diclofenac per kg bodyweight per day; 10 rats were given placebo pellets. After 10 days, unimpaired healing occurred independently of drug treatment both macroscopically and microscopically. Histomorphometry revealed a significant reduction (p = 0.006) in fibroblasts after diclofenac application (median 3 166 cells per mm2) compared with the placebo group (median 3940 cells per mm2). Epidermal thickness was not statistically different between the two groups. RESULTS: Diclofenac diminished the amount of fibroblasts in connective tissue, reflecting the known antiproliferative effect of NSAIDs on fibroblasts. Clinical healing was not affected. CONCLUSION: We recommend short-term diclofenac application for post-surgical and post-traumatic patients with wounds who would benefit from its antiphlogistic and analgesic effect. However, if wound healing is disturbed, the negative effect of diclofenac on fibroblasts should be considered. This is particularly relevant for patients with chronic wounds or conditions such as diabetes which can delay wound healing.

The non-steroidal anti-inflammatory drug diclofenac reduces appearance of osteoblasts in bone defect healing in rats.

INTRODUCTION: Non-steroidal anti-inflammatory drug (NSAID) is well known to significantly delay fracture healing. Results from in vitro studies implicate an impairment of osteoblast proliferation due to NSAIDs during the initial stages of healing. We studied whether diclofenac, a non-selective NSAID, also impairs appearance of osteoblasts in vivo during the early phase of healing (at 10 days). MATERIALS AND METHODS: Two defects (Ø 1.1 mm) were drilled within distal femurs of 20 male Wistar rats. Ten rats received diclofenac continuously; the other obtained a placebo until sacrificing at 10 days. Osteoblast proliferation was assessed by cell counting using light microscopy, and bone mineral density (BMD) was measured using pQCT. RESULTS: Osteoblast counts from the centre of bone defect were significantly reduced in the diclofenac group (median 73.5 +/- 8.4 cells/grid) compared to animals fed with placebo (median 171.5 +/- 13.9 cells/grid). BMD within the defect showed a significant reduction after diclofenac administration (median 111.5 +/- 9.3 mg/cm(3)) compared to the placebo group (median 177 +/- 45.4 mg/cm(3)). CONCLUSION: The reduced appearance of osteoblasts in vivo implicates an inhibiting effect of diclofenac on osteoblasts at a very early level of bone healing. The inhibition of proliferation and migration of osteoblasts, or differentiation from progenitor cells, is implicated in the delay of fracture healing after NSAID application.

[Predictive value of the HISS-scoring system for estimation of trauma severity and the time off work after hand injuries]. / Einschätzung der Verletzungsschwere sowie der Dauer der Arbeitsunfähigkeit bei Handverletzungen mit dem HISS-Bewertungsschema.

BACKGROUND: The estimation of the time off work depending on the injury pattern and severity is of major interest in the treatment of hand injuries. The predictive value of the HISS score (Hand Injury Severity Scoring System) was evaluated. MATERIAL AND METHODS: According to this score, 184 work-related injuries (1999 to 2002) were analyzed prospectively, excluding injuries of both hands. The median age was 37.9 years (18 to 65 years), 11 % of the patients were female. RESULTS: A significant correlation was established between the HISS score and the time off work (p < 0.0001, r = 0.51). The score also correlated with the degree of work incapacity (p < 0.0001). CONCLUSION: Our data confirm the predictive value of the HISS score for the early estimation of the time off work resulting from hand injuries. However, the estimation is limited to injuries distal to the wrist.

Difference in metallic wear distribution released from commercially pure titanium compared with stainless steel plates.

INTRODUCTION: Stainless steel and commercially pure titanium are widely used materials in orthopedic implants. However, it is still being controversially discussed whether there are significant differences in tissue reaction and metallic release, which should result in a recommendation for preferred use in clinical practice. MATERIALS AND METHODS: A comparative study was performed using 14 stainless steel and 8 commercially pure titanium plates retrieved after a 12-month implantation period. To avoid contamination of the tissue with the elements under investigation, surgical instruments made of zirconium dioxide were used. The tissue samples were analyzed histologically and by inductively coupled plasma atomic emission spectrometry (ICP-AES) for accumulation of the metals Fe, Cr, Mo, Ni, and Ti in the local tissues. Implant corrosion was determined by the use of scanning electron microscopy (SEM). RESULTS: With grades 2 or higher in 9 implants, steel plates revealed a higher extent of corrosion in the SEM compared with titanium, where only one implant showed corrosion grade 2. Metal uptake of all measured ions (Fe, Cr, Mo, Ni) was significantly increased after stainless steel implantation, whereas titanium revealed only high concentrations for Ti. For the two implant materials, a different distribution of the accumulated metals was found by histological examination. Whereas specimens after steel implantation revealed a diffuse siderosis of connective tissue cells, those after titanium exhibited occasionally a focal siderosis due to implantation-associated bleeding. Neither titanium- nor stainless steel-loaded tissues revealed any signs of foreign-body reaction. CONCLUSION: We conclude from the increased release of toxic, allergic, and potentially carcinogenic ions adjacent to stainless steel that commercially pure Ti should be treated as the preferred material for osteosyntheses if a removal of the implant is not intended. However, neither material provoked a foreign-body reaction in the local tissues, thus cpTi cannot be recommend as the 'golden standard' for osteosynthesis material in general.