[Intraosseous foreign body or osteoma : Challenging differential diagnosis after open radius fracture]. / Intraossärer Fremdkörper oder Osteom : Anspruchsvolle Differenzialdiagnose nach offener Radiusfraktur.

Presentation of a 16-year-old male patient due to a cycling accident while mountain biking 14 days after primary treatment after open epiphyseal injury. Metaphyseal intraosseous stones within the anatomically reduced distal radius fracture were misinterpreted as an incidental osteoma.

[Three-point buttressing with internal fixator for minimally invasive stabilization of the anterior pelvic ring : Operative technique and first clinical results]. / Die Dreipunktabstützung mittels Fixateur interne zur minimalinvasiven Stabilisierung des vorderen Beckenrings : Operative Technik und erste klinische Ergebnisse.

BACKGROUND: The changing age distribution in society inevitably leads to a percentage increase in osteoporotic and fatigue fractures as well as the absolute number of insufficiency fractures of the pelvic ring. Due to pain these fractures lead to a loss of mobility and autonomy. To prevent these consequences surgical treatment is increasingly being performed. OBJECTIVE: This article presents a new configuration of an internal fixator on the anterior pelvic ring, the principle of which correlates to a three-point buttressing. METHODS: In addition to a description of the configuration of the internal fixator on the anterior pelvic ring and the surgical technique, the article presents the results after the first 23 applications. RESULTS: The first results after application of the new internal fixator on the pelvic ring show a low risk, sufficient and minimally invasive stabilization with an encouraging clinical and radiological outcome. CONCLUSION: Missing long-term results, also taking into account a higher number of patients, as well as the biomechanical examination of the presented fixator configuration still have to be evaluated.

[Validation of a 4-Item-Questionnaire on Familial and Hereditary Colorectal Cancer Risk in General Practice]. / Validierung eines 4-Item-Fragebogens zum familiären und hereditären Darmkrebsrisiko in der Hausarztpraxis.

BACKGROUND: A 4-item-questionnaire has been developed by the "Netzwerk gegen Darmkrebs e. V." (Network against colorectal cancer) to identify familial or hereditary susceptibility to colorectal cancer. The aim of this inquiry was to validate the questionnaire in 40 to 54 year old persons in a general practice setting. METHODS: Four general practices from the "Forschungsnetzwerk Allgemeinmedizin Frankfurt" database generated a sample of 100 index patients whose first-degree relatives were known to the general practitioner. The general practitioners prepared pedigrees in accordance with the four items of the questionnaire. Subsequently, the index patients were surveyed by a healthcare assistant on the basis of the questionnaire. The level of agreement between the patients' and general practitioners' responses was measured using Cohen's kappa coefficient. RESULTS: An almost perfect level of agreement was found for question 1 on whether a first-degree relative had been diagnosed with colorectal cancer (kappa coefficient 0,82; CI: 0,58-1,10). Question 2 on the existence of a first-degree relative under the age of 50 diagnosed with colorectal cancer was not answered positively by general practitioners for any patient, whereas one patient answered the question positively. Interpreting the level of agreement using the kappa coefficient was meaningless in this case. General practitioners did not have information to answer question 3 on the occurrence of a colorectal polyp in a first-degree relative under the age of 50. Likewise, it was impossible to find the necessary information on second-degree relatives in practice files (question 4). Overall, 18,8% of all patients (15/80) answered "yes" to one or more questions on the existence of a hereditary colorectal cancer risk. CONCLUSION: Question 1 allows the identification of a familial colorectal cancer risk among 40 to 54 year old persons in a general practice setting. Questions 2 to 4 of the questionnaire could not be validated using the chosen methodology. However, the valid answer of 40 to 54 year old persons to question 1 allows familial risk to be identified. More detailed family history-taking regarding hereditary risk should be conducted in this group.

Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation.

BACKGROUND: To evaluate return-to-activity (RtA) after anatomical reconstruction of acute high-grade acromioclavicular joint (ACJ) separation. METHODS: A total of 42 patients with anatomical reconstruction of acute high-grade ACJ-separation (Rockwood Type V) were surveyed to determine RtA at a mean 31 months follow-up (f-u). Sports disciplines, intensity, level of competition, participation in overhead and/or contact sports, as well as activity scales (DASH-Sport-Module, Tegner Activity Scale) were evaluated. Functional outcome evaluation included Constant score and QuickDASH. RESULTS: All patients (42/42) participated in sporting activities at f-u. Neither participation in overhead/contact sports, nor level of activity declined significantly (n.s.). 62 % (n = 26) of patients reported subjective sports specific ACJ integrity to be at least the same as prior to the trauma. Sporting intensity (hours/week: 7.3 h to 5.4 h, p = .004) and level of competition (p = .02) were reduced. If activity changed, in 50 % other reasons but clinical symptoms/impairment were named for modified behavior. QuickDASH (mean 6, range 0-54, SD 11) and DASH-Sport-Module (mean 6, range 0-56, SD 13) revealed only minor disabilities at f-u. Over time Constant score improved significant to an excellent score (mean 94, range 86-100, SD 4; p < .001). Functional outcome was not correlated with RtA (n.s.). CONCLUSION: All patients participated in sporting activities after anatomical reconstruction of high-grade (Rockwood Type V) ACJ-separation. With a high functional outcome there was no significant change in activity level (Tegner) and participation in overhead and/or contact sports observed. There was no correlation between functional outcome and RtA. Limiting, there were alterations in time spent for sporting activities and level of competition observed. But in 50 % those were not related to ACJ symptoms/impairment. Unrelated to successful re-established integrity and function of the ACJ it should be considered that patients decided not return-to-activity but are very content with the procedure.

[Latissimus dorsi transfer for the treatment of irreparable rotator tears: indication, surgical technique, and modifications]. / Latissimus-dorsi-Transfer bei nichtrekonstruierbarem Rotatorenmanschettendefekt : Indikation, Operationstechnik und Technikmodifikationen.

OBJECTIVE: Improvement of glenohumeral dynamic centering and active external rotation by a transfer of the latissimus dorsi tendon to the greater tuberosity or the lateral proximal humerus. INDICATIONS: Irreparable posterosuperior rotator cuff tears. CONTRAINDICATIONS: Cuff tear arthropathy, subscapularis tendon tear, deltoid insufficiency, palsy of the axillary nerve. SURGICAL TECHNIQUE: Diagnostic arthroscopy in lateral decubitus position. Placement of suture through the biceps tendon and supragleonidal tenotomy. Posterior approach. Preparation and mobilization of a pedicled latissimus dorsi flap. Second anterior incision with delta split. Debridement of the torn rotator cuff. Insertion of suture anchors in the greater tuberosity. Passing of the muscle flap inferior to the posterior deltoid and fixation with suture anchors to the greater tuberosity (where applicable suturing with remaining rotator cuff tissue). POSTOPERATIVE MANAGEMENT: Immobilization in a thorax abduction cast for 6 weeks. Passive exercises out of the cast (IR/ER 0-0-free and ABD/ADD free-45-0°). Active assistive exercises from week 4 postoperatively. Stepwise increase of passive range of motion from week 7. Unlimited active range of motion from week 10. RESULTS: After an average follow-up of 57.6 (SD 27.5) months 17 patients were examined clinically. The average age at time of surgery was 55.6 (SD 7.7) years. At follow-up the patients showed an average Constant score of 64.4 points (SD 17.4). The active external rotation in 0° abduction was 16° (SD 17). The 4 patients (23%) with a sonographically-detected retear of the latissimus flap presented worse clinical results.

The 5-year survival following the marginal resection of a primary leiomyosarcoma of the distal femur and a stump fracture.

In this case, we present a 5-year follow-up of a 3-fault-affected primary leiomyosarcoma of the distal femur (spontaneous fracture treated by osteosynthesis; marginal resection; stump fracture after adequate trauma) with an extended local recurrence but without metastasis.

Loosening pattern in a cementless custom-made hip stem: X-ray analysis, finite-elements and photoelasticity measurements.

Thirty-three X-press cementless stems (Depuy) manufactured according to standardized X-rays were inserted from 1992 to 1994. The patients' mean age was 49 (range 15-79) years with a mean follow-up of 32 (+/-6) months. A characteristic radiographic pattern of aseptic loosening with erosion of the medial cortex by the tip of the stem occurred in 28 patients and a valgus shift of the implant in 14 cases. A radiolucent line with increased sclerosis below the tip (zone Gruen 4) was observed in 17 cases. Four stems were revised due to histologically confirmed aseptic loosening. Biomechanical investigation of one of the revised stems with the typical pattern of valgus angulation and medial cortex erosion included photoelasticity and finite-element analysis. The intertrochanteric fit and fill obviously resulted in an unfavorable distribution of contact areas, including peaks of high stress on the medial tip of the stem. These experimental findings are even evident for a postulated rotational stability. The clinical and radiographic results of the cementless X-press stems do not seem to support the fixation concept of intertrochanteric fit and fill of femoral components.

Necrotizing skin lesions induced by low-molecular-weight heparin after total knee arthroplasty.

We report the unusual complication of focal necrotizing skin lesions accompanied by moderate thrombocytopenia in a female patient undergoing thromboprophylaxis with low-molecular-weight heparin after total knee arthroplasty. Heparin-induced thrombocytopenia was suspected and confirmed using the heparin-induced platelet activation assay. The skin lesions improved gradually after the discontinuation of heparin application. In addition to the description of this exceptionally rare adverse effect of low-molecular-weight heparin, a brief discussion of previously reported cases is provided.

[Determination of skeletal age using the Oxford Score in children with epiphyseolysis of the femur head]. / Bestimmungen des Skelettalters mit dem Oxford-Score bei Kindern mit Epiphyseolysis capitis femoris.

Pelvis radiographs of 47 children with slipped capital femoral epiphyses (SCFE) and 24 without a hip disorder were reviewed in a retrospective study by four readers to determine the skeletal age by the Oxford method. 72% of the children suffering from SCFE had a body weight above the standard level but a normal body height at the time of diagnosis. The mean chronologic age was 3 years higher than the skeletal age determined by the Oxford-score. The linear regression analyses showed that children with SCFE have had a skeletal maturation delay in comparison with the normal group at the beginning of the age period in question. This deficiency became greater as chronologic age increased. All children with the SCFE disease showed a nearly uniform skeletal age clearly below the bone age standard irrespective of their chronologic age. These results, in connection with obesity in most cases, support the idea of hormonal disorders with delayed skeletal maturation development in the aetiology of SCFE disease.

Labor migration in Southern Africa and agricultural development: some lessons from Lesotho.

The authors examine policy issues with regard to attempts by Lesotho to develop agriculture as a viable alternative to out-migration for employment and income. They argue that "an appropriate agricultural development strategy for Lesotho would emphasize relatively labor- and land-intensive agricultural enterprises, such as horticultural operations and closely managed livestock activities. The suggestion is that only agriculture of this kind will generate sufficient returns on a limited land base to dissuade men from going to the mines. Our paper develops a more complete theoretical and empirical foundation for examining this as well as other agricultural strategies."

Labor migration in Southern Africa and agricultural development: some lessons from Lesotho.

PIP: Using Lesotho as a case study, this paper presents an analytical framework regarding certain policy issues relevant to agriculture becoming a viable alternative to migration for employment and income. 60% of adult Basotho (people of Lesotho) males between the ages of 20 and 44 are employed in the mines in South Africa. About 70% of rural households in Lesotho have at least 1 member who is a migrant. In recent years, over 40% of Lesotho's gross national product has come from mine wages. Migrant remittances contributed about 65% of rural household incomes in the late 1970s. Future opportunities for migrant employment will either remain at current levels or decline as mining becomes less labor intensive and South Africa gives priority to employing local blacks. In Lesotho, only about 2% of the land is arable. Also, the impact of so much migration to South Africa has a direct effect on labor available to Lesotho agriculture. To estimate indirectly the costs of migration, 34 Basotho migrants employed in the South African mines were interviewed in the Nyakosoba area in 1983. Results show that the cost of migration was valued at 40% of their annual average income in 1983. There is sparse ownership of and access to land and oxen; there is also a scarcity of agricultural equipment. The authors calculate that 1) returns from growing traditional field crops using traditional technology are abysmally low, 2) net return from growing the same crops with improved technology are greatly improved, and 3) the commercial planting and cultivation of fruit trees would yield net returns that far exceed the amounts most surveyed migrants indicated would be sufficient to stop them from migrating. Constraints to improved technology adoption include 1) investment in fixed capital and variable inputs, 2) higher levels of management and knowledge of how to use the technology, 3) the necessity to quit mine work and pursue agriculture full time. Production risk needs to be reduced. Orchard development represents an ideal transition enterprise from mining to agriculture. The necessary levels of real income can be generated from rotational field crops with improved practices on at least 2-3 hectares of land. Irrigated fruit or vegetable production is an alternative for those without sufficient land for traditional field crops.^ieng