On-cartridge preparation and evaluation of 68Ga-, 89Zr- and 64Cu-precursors for cell radiolabelling.

INTRODUCTION: Indium-111 when formulated as indium-111 oxine remains the gold standard for long term cell tracking, whereas radiometals for improved PET applications still have to be established. We here describe the on-cartridge formation of gallium-68, zirconium-89 and copper-64 complexes in small volumes suitable for cell labelling, including labelling of red blood cells (RBC) and white blood cells (WBC) and their biological evaluation in vivo. METHODS: Small volumes (1-2 mL) of tracers (oxine, tropolone) were directly prepared on an anion exchange cartridge (Sep-Pak QMA). Cells were radiolabelled and the labelling efficiency and efflux were evaluated. The in vivo biodistribution of copper-64-labelled WBC using [64Cu][Cu(oxinate)2] and [64Cu][Cu(tropolonate)2] was monitored in an infection and inflammation animal model using BALB/c mice. RESULTS: On-cartridge concentration of gallium-68, zirconium-89 and copper-64 enabled formation of oxine and tropolone tracers in small volumes with good yields (≥50%) and quality (extraction ≥90%). Prepared tracers radiolabelled the RBC comparable to indium-111 tracers and in vivo biodistribution of copper-64 labelled WBC showed clear accumulation of cells at the site of infection and inflammation. CONCLUSIONS: This on-cartridge preparation method enables simple formation of various PET tracers for cell radiolabelling. Zirconium-89 and copper-64 tracers radiolabelled cells with sufficient stability. Due to their longer half-life this approach could be promising for routine applications where longer evaluation periods for cell tracking are needed. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE: This novel approach for on-cartridge concentration and preparation of oxine and tropolone precursors with different positron emitters, in small volume and suitable pH, offers a versatile tool towards cell labelling for preclinical and clinical PET applications.

[Bone marrow edema and joint injuries]. / Knochenmarködem bei Gelenkverletzungen.

BACKGROUND: The development of bone marrow edema in body regions adjacent to joints can have many causes and a differentiation is not possible using magnetic resonance imaging (MRI). DEFINITION: Bone marrow edema is not necessarily an indication for microfractures. The definition of bone marrow edema is a purely radiological description. There is no uniform classification of bone marrow edema. The clinical significance, therapy and course are heterogeneous; therefore, there are no uniform recommendations for therapy. DIAGNOSTICS: A bone marrow edema visible in MRI does not always lead to certain inferences regarding the pathogenesis. In order to be able to detect fractures it is necessary to carry out a biopsy and a histological examination. CONCLUSION: The interpretation of MRI results and the derivation of a therapy in every case need a balanced assessment of the MRI results, medical history, clinical investigations and clinical symptoms.

Pain and quality of life 1 year after admission to the emergency department: factors associated with pain.

OBJECTIVES: This study describes the prevalence of pain in trauma patients 1 year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain. METHODS: Patients were contacted 12 months after admission in order to complete the following questionnaires: Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Trauma Outcome Profile (TOP), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and additional questions concerning satisfaction, work and financial status. Relevant pain at follow-up was defined as <80 points on the pain subscale of the TOP. RESULTS: Two hundred and twenty patients were included. The Injury Severity Score (ISS) ranged from 1 to 41. Fifty-three percent (53 %) of patients suffered a severe trauma (ISS > 15). One year after injury, 55 % of patients had relevant pain according to the TOP. Patients with pain were older (41.4 vs. 34.4 years, p = 0.003) and had slightly more severe injuries (ISS 17.1 vs. 14.9, p = 0.115). There were significant differences between pain and no-pain patients on all domains of QoL (p < 0.001) and on the BDI, STAI and IES-R (p < 0.001). Pain patients more often experienced a stressful event and job-related and financial difficulties. Multivariate logistic regression analysis revealed post-traumatic stress disorder (PTSD) as the strongest predictor for pain [odds ratio (OR): 4.38, p = 0.015], followed by a stressful life event (OR: 4.08, p = 0.001). DISCUSSION: Pain is strongly associated with psychosocial complaints 1 year after trauma. For the treatment of pain following a traumatic event, social reintegration and emotional regulation by means of occupational rehabilitation and psychotherapy should receive more attention.

Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN).

BACKGROUND: Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion. PATIENTS AND METHODS: Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results. RESULTS: In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred. CONCLUSION: Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

The sheep as a knee osteoarthritis model: early cartilage changes after meniscus injury and repair.

The purpose of this study was to analyse cartilage changes after traumatic meniscal lesions and to provide a detailed description of the model used with a view to reducing the number of animals used in future studies. The sheep's knee was chosen, as ovine biomechanics are similar to that of humans. In two groups of 10 animals each, a radial tear in the medial meniscus was either sutured with polydioxanone (PDS) or left untreated (sham-operated). Half of the animals in each group were sacrificed after six months, the other half after one year. The time periods to achieve weight bearing, meniscus healing, joint effusion (magnetic resonance imaging scan) and knee cartilage in the medial, lateral and patellofemoral compartments were evaluated in comparison to the opposite knee (control). Osteoarthritis (OA) was assessed by a modified Outerbridge classification and confirmed by scanning electron microscopy. Only one sutured meniscus remained completely adapted. In all other meniscus lesions, the rupture healed with a scar. In the PDS and sham-operated groups, OA was significantly higher in the medial knee compartment than in the lateral compartment and in controls (P < 0.001). In the operated groups, joint effusion was higher in the right hindlimb knee than in the normal left hindlimb knee (control) after six and 12 months (P < 0.001). Non-treated, displaced and even adapted sutured radial ovine meniscus tears produced intense OA within less than six months. Therefore, this animal model is suitable for assessment of new therapeutic regimens in meniscal surgery.

[Correction of lower limb deformity by using an expandable nail system. Adaption of osteosynthesis to dystrophe soft-tissue situation]. / Korrektur einer valgischen Unterschenkelfehlstellung bei postradiogener Hautveränderung. Anpassung der Osteosyntheseart an die gegebenen Weichteilverhältnisse.

Operative procedures on the lower limb demand crucial handling of the surrounding soft tissues. Otherwise skin necrosis may develop and in cases of overlapping to the bone there is a risk of osteitis. Therefore the operative treatment requires an approach which reduces operative trauma to a minimum. However, in some cases even a minimal incision is too traumatic. The case we present, describes the use of an expandable nail-system to correct a valgus deformity in a lower limb, years after radiation therapy for synovial sarcoma. The distinctiveness in this case is the dystrophic skin after irradiation and the surgical options for correction.

[Elastic titanium nails in minimally invasive osteosynthesis for mid-clavicular fractures]. / Elastischer Titannagel zur minimal-invasiven Osteosynthese der Klavikulaschaftfraktur.

BACKGROUND: In up to 31% of cases, conservative treatment of mid-clavicular fractures leads to unsatisfactory results. The aim of this study was to define the value of minimally invasive elastic stable intramedullary nailing (ESIN) of mid-clavicular fractures with titanium elastic nails. MATERIAL AND METHODS: Within 5 years, ESIN was performed in 45 patients. We studied the functional results and complications. RESULTS: Retrospectively we analysed the results of all patients at a mean follow-up of 24.7+/-2.4 months. Iatrogenic perforation of the lateral cortex occurred twice and medial migration in eight patients. Superficial skin infection developed in one. Nail breakage after fracture healing was observed twice. Twelve patients sustained clavicular shortening of > or =5 mm in relation to the intact contralateral side. After 6 months the mean constant score was 94.3+/-2 points, and the mean DASH score was 5.4+/-2.2 points. CONCLUSION: Intramedullary stabilisation of mid-clavicular fractures with titanium elastic nails is a minimally invasive technique with good functional results. Patients must be informed about the possibility of open reduction in about half of the cases as well as shoulder asymmetry, migration of the nail, and iatrogenic nerve and vessel injury.

[Helical computed tomography in penetrating injury to the torso. Diagnostic value in emergent use]. / Spiralcomputertomographie bei penetrierendem Rumpftrauma. Diagnostischer Wert in der Notfallsituation.

BACKGROUND: Nontherapeutic laparotomy and thoracotomy rates in penetrating torso trauma remain high. The aim of this study was to define the value of helical computed tomography (CT) in this emergency situation. MATERIAL AND METHODS: Retrospectively, we studied 11 hemodynamically stable patients with penetrating injury to the torso admitted to our trauma center over a 3-year period who underwent intravenous contrasted helical CT immediately after admission. A positive CT scan was defined as showing any evidence of intrathoracal or intra-abdominal injury necessitating immediate operation. Patients with positive CT underwent laparotomy and/or thoracotomy. Patients with negative CT were observed. RESULTS: Eleven consecutive patients were studied: nine male, two female; mean age 39 years (range 19-62). Nine stab wounds and two shotgun wounds were seen. Seven patients had positive helical CT findings, and four patients were negative. All patients with positive CT findings were operated on; those with negative scans recovered uneventfully. This imaging method accurately predicted whether thoracotomy or laparotomy was needed in 10/11 cases. CONCLUSION: In penetrating torso trauma, helical CT can clarify the need for thoracotomy or laparotomy vs nonoperative treatment.

[Bipolar dislocation injury of the forearm]. / Die bipolare Unterarmverrenkungsverletzung.

Bipolar dislocation injury of the forearm is rarely documented. It is a combined forearm injury with trauma on the elbow side and on the side of the wrist joint. We describe two different cases of this complex dislocation. The first patient suffered from a Monteggia-like dislocation fracture with transscaphoid dislocation of the wrist. The second person had an acute longitudinal radioulnar membrane dissociation after elbow dislocation with an additional scapholunate tendon rupture. The difficult management of these injuries is illustrated by these cases.

Retropatellar chondromalacia associated with medial osteoarthritis after meniscus injury. One year of observations in sheep.

BACKGROUND/AIMS: In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. METHODS: A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls). RESULTS: Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05). CONCLUSION: Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

[Primary care of fractures of the extremities]. / Erstversorgung von Extremitätenfrakturen durch den Hausarzt. Reponieren, ruhig stellen und den Schmerz behandeln.

The initial care of a fractured bone provided by the general physician includes reduction followed by immobilization and the treatment of pain. Open fractures must be covered by a sterile dressing, prior to the transportation of the patient to a hospital. Depending upon the severity of the injury, further treatment is provided by an orthopedic surgeon or in an appropriate hospital.

[Fractures of the extremities--surgical or conservative treatment?]. / Gipsen oder schrauben?

When a fracture of an extremity has been established, the question immediately arises: should it be treated conservatively or surgically? For each of these options the three "R's" of fracture treatment apply "reduction, retention, rehabilitation". In humans, the most common fracture is that of the distal radius, which is usually amenable to conservative treatment. A fracture of the ankle is treated conservatively only when it is stable with no syndesmotic injury, and the fragments are in good alignment. Should surgical treatment be necessary, stabilization is accomplished with a plate and screws. The advantages and disadvantages of each of the options must be weighed up on an individual basis.

[After care of fractures of the extremities]. / Nachsorge von Extremitätenfrakturen beim Hausarzt. Wie Sie die Patienten wieder in Gang bringen.

Today, early mobilization is recommended, irrespective of whether a patient with a fracture of the extremities has been treated conservatively or surgically. In this way, morbidity and mortality risks can be considerably reduced, in particular in the elderly patient. As a result of the continuing trend towards an ever shorter hospital stay, the general physician is faced with the task of providing aftercare to such patients at an early stage in the healing process of the fracture. This includes wound care, prevention of thromboembolism, the timely initiation of physiotherapeutic measures, and the requesting of x-ray follow-up.

Cementless hemiarthroplasty in femoral neck fractures: evaluation of clinical results and measurement of migration by EBRA-FCA.

Aim of the present study was to evaluate migration rates of cementless primary hemiarthroplasty in acute femoral neck fractures. In a longitudinal, prospective study 46 patients were treated by cementless hemiarthroplasty. Clinical follow up was correlated with the EBRA-FCA method. In 30% of all patients stem migration amounted to more than 2 mm; further, these patients were seen to have a high level of activity. A high degree of migration in more than 30% of all patients requires critical scepticism toward further use of the investigated cementless stem as hemiarthroplasty. According to literature, migration of more than 2 mm suggests a high probability of early aseptic loosening. In patients with a low degree of activity good results could be observed; nevertheless, in patients with a high level of activity the combination of the investigated cementless stem with a solid fracture head cannot be recommended.

[Implantation of an inverse prosthesis after management of an infected subcapital humerus fracture initially treated with osteosynthesis]. / Implantation einer inversen Schulterprothese nach Sanierung einer primär osteosynthetisch versorgten, infizierten, subkapitalen Humerusfraktur.

After repeated failure of osteosynthesis of a subcapital humerus fracture, the humeral joint got infected. Radical surgery, use of a temporary Palacos-Refobacin spacer, and secondary implantation of an inverse prosthesis achieved painlessness and satisfying functional results.

[Spondylodiscitis after perioperative peridural catheter]. / Spondylodiszitis nach perioperativem Periduralkatheter.

Peridural anaesthesia is used to avoid operative, postoperative and chronic pain, especially in surgery, gynecology and urology. Complications have rarely been described but can entail serious local and systemic sequelae. Three cases with spondylitis and spondylodiscitis after peridural anaesthesia are presented. The failure to recognize the peridural catheter as the cause of vertebral pain led to therapeutic delay in two cases. The result of antimicrobial therapy and in two cases radical surgical treatment was complete recovery. The occurrence of spondylodiscitis after the use of peridural catheters is often a late manifestation of disseminated pathogens. The insidious progression of infection and non-specificity of clinical symptoms may lead to diagnostic delay. Awareness of the possibility of even delayed complications after the use of peridural anaesthesia is important.

[Benign desmoplastic fibroblastoma of the lower leg. A rare case]. / Benignes desmoplastisches Fibroblastom am Unterschenkel. Ein seltener Fall.

Desmoplastic fibroblastoma ("collagenous fibroma") is a benign fibrous soft tissue tumor. We report a rare case of a "collagenous fibroma" located in the proximal lower leg in 56-year-old man. The clinical, radiological, and pathological-morphological findings are documented. The operative treatment was performed according to general principles of surgical management of benign soft tissue tumors.

[Capacity to participate in sports after injuries of the acromioclavicular joint]. / Sportfähigkeit nach Verletzungen des Schultereckgelenks.

In 79 patients athletic activities were evaluated retrospectively 32 months after grade II and grade III sprains of the acromioclavicular joint. Group I consisted of 29 patients with grade II sprains according to Tossy and group II consisted of 50 patients with grade III sprains according to Tossy. In group Ia 14 patients underwent surgery, and in group Ib 15 patients were treated nonsurgically. In group IIa 41 patients were treated surgically, and in group IIb 9 patients were treated conservatively. Forty-seven patients were injured during participation in sports. Among these 16 were injured during participation in their specific sport. In group I patients had to curtail sports activities more frequently after surgery than after conservative treatment (p < 0.05). In group II the reduction of sports activities was not different for the two treatment groups. Of a total of 79 patients, 23 had to reduce their sports activities. Among these, 7 patients had to give up sports. All patients had performed overhead athletic activities. Climbers and patients performing strength training had to reduce their activities or give up sports. Additionally, sprains of the acromi-oclavicular joint adversely affected athletic activities in overhead ball sports, bicycling, and skiing irrespective of treatment.

[Total endoprosthesis of the upper ankle joint after post-traumatic arthrosis]. / Totalendoprothese des oberen Sprunggelenks nach posttraumatischer Arthrose.

In 1997 six patients with posttraumatic ankle arthritis aged 54 (45-71) years were treated with a LINK S.T.A.R. ankle prothesis. The average follow up was 29 (21-36) months. Results were evaluated according to the ankle score of H. Kofoed [7]. Two patients had an excellent outcome and 1 patient had a fair result. In three patients secondary arthrodesis had to be performed, due to loosening of the implant. Based on our experiences we cannot recommend this implant for patients with posttraumatic arthritis at this time.