Failure of metal-backed uncemented patellar components. Report on 3 cases.

We report 3 cases of metal-backed patellar component failure of the Microloc total condylar knee, which was implanted in 51 cases. The main reason for failure was the design of the patellar and femoral components in combination with flexion of more than 100 degrees.

[Partial femur replacement: implanted without cement]. / Femurteilersatz: zementfrei implantiert.

The following indications are well accepted for subtotal femur replacement: 1. Malignoma of the hip region. 2. Pertrochanteric fractures. 3. Loosening of hip prosthesis in case of large bony defects. The common devices are implanted by use of bone cement,--we report on three cases, treated by cementless subtotal femoral replacements with bony ingrowth surface. The surface design imitates the structure of spongious bone. The mean observation time of our three patients is more than two years, no complaints are to be observed. By intensive permeation of bone in the surface structure we achieve a more advantageous biomechanical situation.

[Use of collagen films for bridging defects in sliding tissue during achillotenotomy and Achilles tendon ruptures]. / Die Verwendung von Kollagenfolien zur Uberbrückung von Defekten des Gleitgewebes bei Achillotenotomien und Achillessehnenrupturen.

After Achillean tendon rupture defects of the gliding tissue can often be observed. To prevent fixation of the tendon by scar tissue formations we recommend the use of collagen films in the defective area to isolate the tendon surface.

[Conservative therapy of activated gonarthrosis. Double-blind study of proglumetacine and piroxicam]. / Konservative Therapie der aktivierten Gonarthrose. Doppelblindstudie mit Proglumetacin und Piroxicam.

In a randomized double-blind clinical investigation, the efficacy and safety of proglumetacin 450 mg/day (150 mg in the morning, 300 mg in the evening) were compared to those of piroxicam 20 mg/day (placebo in the morning, 20 mg in the evening), in 50 patients with activated gonarthrosis. After decoding it was found that 25 patients had been treated with proglumetacin and 25 with piroxicam. Joint troubles, knee circumference, function tests were recorded at time 0 and after 3, 7, 14 and 21 days; on the same days an overall doctor's rating of efficacy was also given. The rating of efficacy was "good" in 70% of patients in the proglumetacin group compared to 60% for piroxicam. The efficacy of the two medicaments was not significantly different. The patients treated with proglumetacin did not report any adverse reactions. Conversely, 5 patients of the piroxicam group dropped out: 1 for epigastric pain, 1 for vomiting and epigastric pain, 1 for an increase of severity of knee pain, 1 for an allergic reaction, 1 for an exanthema. The difference in drop-out rate is statistically significant. A further patient complained of gastrointestinal upsets, but continued on the treatment. Hematology and laboratory parameters were not affected by the treatments. It is concluded that in activated gonarthrosis proglumetacin has an efficacy comparable to that of piroxicam, but is significantly safer for the patients.

[Spinal scintigraphy following Harrington's spondylodesis]. / Wirbelsäulen-Szintigraphie nach Harrington-Spondylodese.

About one year after Harrington-Spondylodesis in 29 patients scintigraphy was performed in order to find non-unions. Scintigraphy is more successful in this question and can be recommended in routine-diagnostics.

Contribution to stress X-ray visualization of the fibular ligaments.

To determine the extension of a lesion of the fibular ligament with customary techniques is a highly subjective matter, since it underlies personal evaluation criteria. These criteria determine the indication for surgery. Socalled fixation devices are now made available, to avoid a wide margin of errors and to provide a means of attaining standardized and reproducable findings, which facilitate clinical diagnosis. We examined the Scheuba-fixation device in terms of its diagnostic value. In routine application in the clinic the device has proven to be useful, helping to decide on the proper treatment, especially in borderline cases.

[The scintigraphic diagnosis of pseudo-arthroses following Harrington's spondylodesis (author's transl)]. / Szintigraphische Diagnostik von Pseudarthrosen nach Harrington-Spondylodese.

The development of pseudo-arthroses is the most common complication following operative treatment of severe scoliosis. Early recognition of this event is important to prevent recurrence of the curvature. The diagnosis is not possible by radiological examination of the rigid spine. Routine reexploration implies a second operation, which is unnecessary in the majority of patients with stable fusion. In an attempt to develop a non-invasive method for the diagnosis of pseudo-arthroses, bone scintigrams were carried out in 29 patients with idiopathic scoliosis twelve months after a Harrington's spondylodesis. In 24 patients (82.8%) a definite conclusion could be drawn, either of stable fusion (65.5%) or pseudo-arthrosis formation (17.3%). No pseudo-arthroses were missed by scintigraphy. These results indicate that bone scintigraphy plays an important role in the post-operative care after Harrington's spondylodesis.

[Contorsionists and athlete at competitive sports events - acquired hypermobility (author's transl)]. / Kontorsionisten und Wettkampfgymnasten - erworbene Hypermobilität.

The problems of hypermobility are getting more and more important. Whereas at high-performance competitive events extraordinary results are achieved in some disciplines by means of early and extremely intensive training aiming at improved flexibility, professional acrobats are not so much the center of attraction as they used to be. This article reports on the basis of examination of 16 competitive sportswomen on a national level, on extreme forms of mobility and on the clinical and radiological findings in "indiarubber" contorsionists and "Klischnigg" acrobats. It was possible to observe and follow up the progression of the extremely rare case of a spondylolysis the lumbar vertebrae L 31 and L 32 as well as concomitant olisthesis L 3/4 and L 5/S 1, over a period of 25 years.

[Experimental study on regeneration of bone in standardized defects of rabbits tibia after application of collagen grafts in comparison to transplantation of cancellous bone (author's transl)]. / Tierexperimentelle Untersuchung der Knochenregeneration am standardisierten Tibiadefekt des Kaninchens nach Implantation von Kollagenvlies im Vergleich zur autologen und homologen Spongiosaplastik.

This study demonstrates, that regeneration of bone in cortical layer defect is about as intensive after application of collagen grafts as after transplantation of autologous of homologous cancellous bone.

[Hemorrhagic enteropathy]. / Hämorrhagische Enteropathie

Intestinal infarction in the absence of organic vascular occlusion received increasing attention in recent years. The clinical picture is discussed based on results in 9 cases, an attempt to suggest a possible pathophysiological mechanism is made. Prophylactic digitalisation especially in the elderly patient in the absence of severe heart failure and in cases with already low mesenteric perfusion may lead to a further vasoconstriction and to hemorrhagic enteropathy. Therapeutic possibilities are discussed.

[Conservative treatment of extensor tendon injuries]. / Konservative Behandlung von Strecksehnenabrissen

Report on 35 cases of mallet finger treated conservatively: a circular plaster cast was modeled in hyperextension of the distal interphalangeal joint. The immobilisation of the whole finger form the tip to the proximal phalanx was maintained for six weeks. The reported results were good or excellent with the exception of two cases.

[The local effect of a silver chelate on standardized scald wounds of the rat]. / Die lokale Wirkung eines Silberchelates auf die standardisierte Verbrühungswunde der Ratte

In rat experiments a new silver chelate salt preparation is tested on scald wounds after standardized infection by Pseudomonas aeruginosa. 30% of the animals survive scalding and infection after treatment with the new cream. This percentage does not reach the gentamycin treated reference group (60%). After combining gentamycin and silver chelate salt in local therapy 75% of the animals survive. Combination of silver chelate salt and gentamycin seems to be a very successful local therapy of scald wounds.

[Verner-Morrison syndrome]. / Das Verner-Morrison-Syndrom

Based on one case the Verner-Morrison-syndrome is demonstrated and discussed in detail. Clinically profuse watery diarrhea and severe hypokalemia are predominant. The pathogenesis is not quite clear. Curative therapy consists in radical surgical removal of the endocrinologically active tumores or diffuse hyperplasia.