[Femoral shaft fracture and secondary diagnosis of ipsilateral femoral neck fracture. Typical constellation or a complication of the distal femoral nail (DFN)?]. / Femurschaftfraktur und sekundär diagnostizierte ipsilaterale Schenkelhalsfraktur. Typische Konstellation oder eine Komplikation des distalen Femurnagels (DFN)?

We present a case of two patients with a distal femur shaft fracture due to a high velocity trauma. Both were treated with a distal femur nail (DFN). After mobilisation a fracture of the neck of the femur was diagnosed which was not seen in the x-rays on admission. In this paper we discuss whether this is a typical constellation of ipsilateral fractures of the neck of the femur in femur shaft fractures or a complication of implantation of a DFN. Immediately after operative treatment of a femur shaft fracture specifically after high velocity trauma or in polytraumatized patients an x-ray of the hip in two plains should be made in the same narcosis. A possible fracture of the neck of the femur could be treated at same time. Post-operatively a further diagnostic should be done in case of suspicion, e.g. pain during mobilisation.

[The Heibronnen roll-off shoe. An improved forefoot strain reducing orthosis using biomechanical principles]. / Der Heilbronner Abrollschuh. Eine neuartige Vorfussentlastungsorthese nach biomechanischen Grundlagen.

To reduce the strain on the middle and forefoot in postoperative and posttraumatic care, we developed a new shoe. It is applied as part of treatment following skeletal or soft tissue surgery in this region and in treatment of the diabetic foot (types I and II). Pedographically, we found the vertex of the roll-off process located at the base of the fifth metatarsal bone, meaning that the foot starts to roll-off at this point while walking. The movement was recorded by a pedobarograph bearing full weight and with the use of one crutch in comparison to the roll-off process in a regular shoe. Results show a reduction of the plantar strain on the forefoot of 70% and of 62% on the Chopart joint while bearing full weight. The use of (forearm-) crutches reduces strain further. The new design of the sole enables the (podiatric) patient to stand and walk in a well-balanced fashion. Since immobilisation of the calf is avoided and muscular function is increased, the risk of thromboembolic complications can be minimized. Four different sizes of the "Strain Minimizing Shoe", including seven modular insoles are available, providing a wide range of individually adapted shoe applications for the patient's foot.

Localized amyloid in the menisci of the knee joint.

This is, to the best of our knowledge, the first report on amyloid deposits in menisci. Fragments of menisci gained by arthroscopy from 316 patients between 20 and 80 years of age were examined. Amyloid was found in 70% of the cases from male, as well as female patients. The amyloid amount found was always very small, but the deposits seemed to increase with age. Patients more than 50 years of age all had menisceal amyloid. Two types of deposits were observed: a)stroma-deposits in the deep central portions of the menisci (tiny dots of intensely stained amyloid and/or ill defined patches of low staining intensity) and b) surface associated deposits: band-like amyloid imbibition of the collagenous stroma immediately beneath the surface of the menisci but not deeper than 0.2 mm. In all cases, amyloid was resistant when pretreated by KMn04 and immunohistologically antisera against amyloid types AA, AB and AF were negative. 3/25 cases showed a reaction with an amyloid-lambda-antibody. We assume, that amyloid in menisci is a further type of localized senile amyloidosis.

[The severely injured patient in the emergency center--new diagnostic, therapeutic and organizational concepts]. / Der Schwerverletzte an der Unfallstelle--Neue Diagnostik-, Therapie- und Organisationskonzepte.

Recent advances in clinical intensive care medicine and legal aspects of quality assurance require new concepts and methods in preclinical emergency medicine. Different new methods of emergency medicine are presented and evaluated as to their economy, practicability, and medical efficacy, points which have to be considered in order to make general recommendations.

[Dislocation fractures of the Chopart and Lisfranc joint]. / Luxationsfrakturen im Chopart- und Lisfranc-Gelenk.

Dislocation fractures of Chopart's and Lisfranc's (mediotarsal) articulation result from the effects of impact and, because there are many possible complications, require a high level of experience on the part of the treating traumatologist. To avoid residual joint incongruities and intra-articular osteochondral fragments with subsequent early arthrosis and the corresponding complaints, the indications for open reduction and functionally stable osteosynthesis should be broad. The osteosynthesis can be achieved by transfixation with adjustable screws and 3.5 or 2.7 mm screws suitable for small fragments. This permits postoperative treatment to be carried out with a walking cast rather than a full plaster cast. In emergency patients with multiple injuries, dislocation fractures in the tarsal region require immediate and definitive treatment in order to avoid grave consequences and pain severe enough to influence the quality of life.

[Acute ligamentous injuries of the Chopart and Lisfranc joint line]. / Akute ligamentäre Verletzungen der Chopart- und Lisfranc-Gelenklinie.

The foot is a complex structure with numerous articular surfaces. As there are many potential complications (severe edema, compartment syndrome of the intrinsic foot musculature, bone and soft tissue necrosis, joint abnormalities, limitation of movement, deformities, etc.), traumatic surgeons must have a detailed knowledge of the relevant functional anatomy and treatment procedures. If there are multiple injuries, in the context of management, early definitive treatment for the injury is to be stressed. One requirement is an exact clinical and radiological diagnosis. As a rule, closed reduction is therapeutically successful. In a stable injury, immobilization can be achieved with a cast; in open wounds and malalignment of joint surfaces, an operative procedure is indicated. Particular attention must be paid to injuries of the tarsal bones in children to avoid delayed failure of growth, as the results of radiological investigations are often difficult to interpret. The diagnosis, techniques of management, and principles of follow-up are presented.

[Femoral neck fractures during the growth period. Treatment principles, results, prognosis]. / Die Schenkelhalsfraktur im Wachstumsalter. Behandlungsprinzipien, Ergebnisse, Prognose.

Therapy and prognosis of femoral neck fractures in children is illustrated by means of 14 patients, treated by us. In adequate treatment, prognosis of fractures type II (medially) and III (laterally) is good. Medical care has to relieve the hip joint emergently, either by operative opening of the joint during osteosynthesis or at least by punction. Because of the tendency to dislocation, it is necessary to make an internal fixation even of little or not dislocated fractures of the neck. Screws are best suited for osteosynthesis. They must not cross the upper femoral epiphysis. To prevent further damage to the epiphyseal plate, the traumatic separation of the upper femoral epiphysis (fracture type I) is stabilized by K-wires. The postoperative treatment in a spica cast is necessary only in unreliable children.

[Injuries of the proximal humeral epiphysis. Indications for surgical therapy and results]. / Verletzungen der proximalen Humerusepiphyse. Indikationen zur operativen Therapie und Ergebnisse.

Lesions of the proximal humeral epiphyseal plate occur most frequently as epiphysiolysis with metaphyseal fragment between the age of 12 and 16 years. The conservative treatment with Desault plaster cast is recommended for stable fractures. In unstable fractures the percutaneous K-wire osteosynthesis after reduction is the adequate procedure. Hypertrophic scars were found after open reduction in half of all patients treated. Only when closed reduction was impossible, the fracture should be exposed and stabilised with K-wires and/or lag screws. All 21 patients who were followed-up have been free of complains with a full range of motion in shoulder and elbow joints.

[Use of the mammography tube for better roentgen diagnosis in hand surgery]. / Einsatz der Mammographieröhre zur besseren Röntgendiagnostik in der Handchirurgie.

Mammography using X-ray with low penetration allows a sharp picture with very good contrast of the trabecular medulla and the diaphyseal cortex in the hand skeleton. Because of the higher X-ray dosage the technique should be used only in the following indications: 1. Fractures and fissures in the joints. 2. Evaluation of osseous consolidation in doubtful cases. 3. Distinction between recent and old changes.