[Association between allergy to benzoyl peroxide, vitiligo and implantation of a cemented total knee joint prosthesis: Is there a connection?]. / Assoziation zwischen Benzoylperoxidallergie, Vitiligo und Implantation einer zementierten Knieprothese: Ein Zusammenhang?

Allergies against bone cement or bone cement components have been well-described. We report on a 63-year-old patient who presented with progressive vitiligo all over the body after implantation of a cemented total knee replacement. A dermatological examination was performed and an allergy to benzoyl peroxide was found. A low-grade infection was diagnosed 5 months after implantation of the total knee replacement and the prosthesis was replaced with a cement spacer. After treating the infection of the knee replacement non-cemented arthrodesis of the knee was performed. In cases of new, unknown skin efflorescence, urticaria and periprosthetic loosening of cemented joint replacement, the differential diagnosis should include not only infections but also possible allergies against bone-cement and components such as benzoyl peroxide or metal components.

[Arthrodesis of the infected ankle joint: results with the Ilizarov external fixator]. / Die Arthrodese des Sprunggelenks in Infektsituationen: Ergebnisse mit dem Ilizarov-Ringfixateur.

BACKGROUND: The treatment of severe bacterial infections of the ankle joint is difficult and complex. In the case of a chronic infection with destruction of the ankle joint, a tibiotalar arthrodesis with external fixation is the treatment of choice. In this study the results of ankle arthrodesis due to bacterial infection using the Ilizarov external fixator are presented. PATIENTS AND METHODS: Between 2001 and 2004 37 patients (10 female, 27 male, mean age 58 years) were treated with a tibiotalar arthrodesis using the Ilizarov fixator. All patients had a confirmed infection in the course of their disease. Active infection was present in 20 patients at the time of the operation. Most secondary ankle arthritides (81 %) were caused post-traumatically after various internal fixation procedures. Previous ankle arthrodeses were tried in 14 cases (12 cases with internal fixation, two cases with external monolateral fixation). Patients were treated with a four-ring Ilizarov frame (in two cases with a five-ring frame) and stainless steel wires. All patients could be included at a mean follow-up of 46 (12-49) months. A modified AOFAS score was used for the functional outcome. RESULTS: The operation took 141 minutes at an average ranging from 90 to 252 minutes. The inpatient treatment lasted between 10 and 63 days (mean 26 days). The time spent in the fixator was 116.7 (69-245) days. All patients were mobilised under full weight bearing with the external fixator. Surgical revision was necessary in 13 patients: four patients needed wound revisions due to ongoing infection, six patients needed wire exchange due to deep infection in three cases and wire breakage in three cases, one patient needed additional wires because of an initially instable frame configuration and two patients needed secondary skin grafting. Bony consolidation was achieved in 32 patients (86.5 %). With a re-arthrodesis performed in four patients using the Ilizarov fixator, the overall fusion rate was 94.6 %. Infection was persistent in two cases with one solid ankle fusion and one ankle pseudarthrosis. At the time of follow-up 35 patients were able to walk under full weight loading with orthopaedic shoe modifications, four patients needed support of a cane and three patients wore an ankle-foot orthesis. The two patients with persistent pseudarthrosis were mobilised in a lower-leg orthesis after declining another surgical revision. The positioning of the hindfoot showed in seven cases an equinus of 10°, in one case a varus of 10° and in two cases a valgus positioning of 10°. A plantigrade foot positioning or with minimal degrees of deviation could be achieved in all other cases. The modified AOFAS score at the time of the follow-up examination ranged from 19 to 86 with an average score of 67.9 points. All patients except three were satisfied or rather satisfied with the treatment procedure and its results. CONCLUSION: The Ilizarov external fixator is a safe method for ankle fusion in cases of infection. The advances are a possible application at acute infection and immediate mobilisation at full weight bearing. However, it remains a time-consuming and stressful procedure for the patient.

[Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma]. / Stumpfe Verletzungen im Kampfsport bei Kindern--ein diagnostisches Problem? Verzögerte Diagnose eines infizierten Hämatoms.

INTRODUCTION: Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. METHODS: A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. RESULTS: Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. DISCUSSION: The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

[Operative treatment of pediatric open fractures of the lower limb using the Taylor spatial frame fixator]. / Versorgung der kindlichen offenen Unterschenkelfraktur mit dem Taylor-spatial-frame-Fixateur.

The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications. Acute angular shortening of the fracture enabling primary soft tissue closure is still an uncommon operative technique because of difficulties in correcting the secondary deformity. The case of a pediatric open fracture of the lower limb (Gustilo type IIIa) is described, which was treated with acute angular shortening followed by gradual correction using the Taylor spatial frame (TSF).

[Deformity correction of post-traumatic tibial non-unions using the taylor spatial frame]. / Die Korrektur von posttraumatischen Fehlstellungspseudarthrosen der Tibia mit dem Taylor Spatial Frame.

BACKGROUND: Correction of severe tibial deformity due to a non-union of the tibia is best achieved by a slow gradual correction which allows the compromised tissue to adapt. The Taylor spatial frame (TSF) is a hexapod-based ring fixator that allows a simultaneous gradual correction of a multiplanar deformity through a virtual hinge. The aim of this study was to demonstrate the application of the TSF and the clinical outcomes of ten patients with a non-union of the tibia. PATIENTS AND METHOD: Ten patients with either a hypertrophic or atrophic non-union of the tibia were treated between 2003 and 2006 with the TSF. The mean age of these patients was 43 years (range: 12-73). There were 5 hypertrophic and 5 atrophic non-unions. Five of the ten fractures were initially open. The mean preoperative magnitude of the angulation deformity was 21.9 degrees (range: 5-44). In nine patients, the correction was performed in a closed manner; one patient had hardware removed prior to the frame application. RESULTS: In all ten patients, the deformities were corrected. The average duration of time that the frame was worn was 158.5 days (range: 89-300). The mean time for gradual correction was 23.1 days (range: 5-43) with an average correction speed of 1.3 mm/day (range: 0.5-2). No additional bone stimulation was performed. In terms of complications, one patient had a residual valgus deformity of 5 degrees , one a pin tract infection, and one a stress fracture next to a pin hole. CONCLUSION: In patients with either a hypertrophic or oligotrophic non-union of the tibia and severe deformity, the TSF is a powerful tool to correct the deformity in a closed manner which preserves the remaining viability of the non-union.

[The Taylor Spatial Frame. Correction of posttraumatic deformities of the tibia and hindfoot]. / Der Taylor Spatial Frame : Korrektur von posttraumatischen Deformitäten an Unterschenkel und Rückfuss.

INTRODUCTION: Posttraumatic deformities in the lower limb are mainly multidirectional, with angulation, translation, and rotatory deformities. Acute corrections with internal fixation are often not possible due to the soft tissue damage and the extent of the deformity. The Taylor Spatial Frame (TSF) allows correction in a virtual hinge with 6 axes, thus enabling the correction of multidirectional deformities simultaneously. METHODS: From February 2003 until December 2006, we applied 31 TSFs to 20 patients with a posttraumatic deformity of the tibia and hindfoot. The mean patient age was 41 years (range 12-73). 9 patients had a nonunion of the tibia with deformity, 6 had a malunion of the lower tibia and ankle, 3 had an angular deformity after ankle fusion, and 2 had malaligned Ilizarov bone segment transports. The mean follow-up time was 25.3 months (range 10-82). RESULTS: In all 20 patients, full correction of the deformity was achieved. The mean time for correction was 29 days (range 5-82). On average, the frame was worn (time to healing) 164.2 days (80-300) and the mean distraction rate was 1.1 mm/day (0.5-2.0). The Web-based planning was done two times per case for full deformity correction. Complications were 3 pin-site infections, 2 insufficient callus formations and 1 pinhole stress fracture. CONCLUSIONS: The main advantage of the TSF compared with other external frames is the ability to perform simultaneous correction of angular, axial, translational, and rotatory deformities. This enables a reduced correction time and increased patient comfort.

[Bridging knee arthrodesis using a modular titanium rod after infected tibial head fracture]. / Uberbrückende Arthrodese des Kniegelenks mittels modularem Titanstab nach infizierter Tibiakopffraktur.

High-energy fractures of the tibial head can lead to severe soft tissue damage which determines the time of definitive osteosynthesis. Due to infections during treatment, both soft tissue defects and bony infections may occur. We report on a 60-year-old motorcyclist who suffered a tibial head fracture Schatzker type VI. After open reduction and internal fixation he was sent to us with a severe soft tissue defect and infection of the proximal tibia and knee joint. Infection eradication and avoidance of amputation were achieved by resection of the infected proximal tibia and bridging arthrodesis with a cementless titanium rod (Brehm, Weisendorf, Germany).

[Polytrauma with severe lung contusion. Early use of extracorporeal membrane oxygenation]. / Polytrauma mit schwerem Lungenparenchymschaden. Frühzeitiger Einsatz der extrakorporalen Membranoxygenierung.

Extracorporeal membrane oxygenation (ECMO) is a technique for sustaining body oxygenation in case of respiratory failure. Since ECMO technology has undergone improvements resulting in better hemo-compatibility and reduced side effects, venovenous ECMO is a mostly accepted treatment of adult respiratory distress syndrome (ARDS). One should discuss the early initiation of ECMO therapy for post-traumatic respiratory failure. We report about a 23-year-old male and a 15-year-old female patient, who suffered polytrauma and received early treatment with ECMO because of severe lung contusion.

[Bilateral atraumatic epiphysiolysis of the head of the tibia]. / Beidseitige atraumatische Tibiakopfepiphysiolyse.

We report above a 14-year old boy, who suffered from a bilateral epiphyseal fracture type Salter/Harris II of the proximal tibia within four weeks without having an adequate trauma. Accompanying injuries were not found. On the left side we performed a osteosynthesis by K-wires due to an dorsal flexion of the epiphyseal fragment, the other side was treated conservatively with an plaster tutor. On both sides we achieved a correct axis and length in a uncomplicated healing with free joint movement. On the base of the result of our treatment we show a literature review of this rare form of epiphysiolysis.