Local delivery of growth factors using coated suture material.

The optimization of healing processes in a wide range of tissues represents a central point for surgical research. One approach is to stimulate healing processes with growth factors. These substances have a short half-life and therefore it seems useful to administer these substances locally rather than systemically. One possible method of local delivery is to incorporate growth factors into a bioabsorbable poly (D, L-lactide) suspension (PDLLA) and coat suture material. The aim of the present study was to establish a procedure for the local delivery of growth factors using coated suture material. Sutures coated with growth factors were tested in an animal model. Anastomoses of the colon were created in a rat model using monofilament sutures. These were either untreated or coated with PDLLA coating alone or coated with PDLLA incorporating insulin-like growth factor-I (IGF-I). The anastomoses were subjected to biomechanical, histological, and immunohistochemical examination. After 3 days the treated groups showed a significantly greater capacity to withstand biomechanical stress than the control groups. This finding was supported by the results of the histomorphometric. The results of the study indicate that it is possible to deliver bioactive growth factors locally using PDLLA coated suture material. Healing processes can thus be stimulated locally without subjecting the whole organism to potentially damaging high systemic doses.

Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland.

Although currently there are many different recommendations and strategies in the therapy of odontoid fractures in the elderly, there are still no generally accepted guidelines for a structured and standardised treatment. Moreover, the current opinion of spine surgeons regarding the optimal treatment of odontoid fractures Type II of the elderly is unknown. In order to have an objective insight into the diverging strategies for the management of Anderson Type II odontoid fractures and form a basis for future comparisons, this study investigated the current concepts and preferences of orthopaedic, neuro- and trauma surgeons. Spine surgeons from 34 medical schools and 8 hospitals in Germany, 4 university hospitals in Austria and 5 in Switzerland were invited to participate in an online survey using a 12-item 1-sided questionnaire. A total of 44 interviewees from 34 medical institutions participated in the survey, consisting of trauma (50%), orthopaedic (20.5%) and neurosurgeons (27.3%). Out of these, 70.5% treated 1-20 fractures per year; 63.6% favoured the anterior screw fixation as therapy for Type II odontoid fractures, the open posterior Magerl transarticular C1/C2 fusion, the posterior Harms C1/C2 fusion, and conservative immobilisation by cervical orthosis was preferred by 9.1% in each case. 59.1% preferred the anterior odontoid screw fixation as an appropriate treatment of Anderson Type II odontoid fractures in the elderly. 79.5% chose cervical orthosis for postsurgical treatment. Following operative treatment, nonunion rates were reported to be <10% and <20% by 40.9% and 70% of the surgeons, respectively. 56.8% reported changing from primary conservative to secondary operative treatment in <10% of cases. The most favoured technique in revision surgery of nonunions was the open posterior Magerl transarticular fusion technique, chosen by 38.6% of respondents. 18.2% preferred the posterior Harms C1/C2 fusion technique, 11.4% the percutaneous posterior Magerl technique and the anterior odontoid screw fixation in each case. This study discovered major variations in the treatment of Anderson Type II odontoid fractures in the elderly in terms of indication for conservative and operative treatment between several treatment centres in 3 European countries. Difficulty and complexity in formulating general guidelines based on multicenter studies is conceivable.

[Treatment of fingertips]. / Infektion der Fingerbeere.

OBJECTIVE: The goal of excision of a subcutaneous abscess in the distal pulp of the fingertip is the fast and complete removal of the infected and devitalized tissue. INDICATIONS: Every acute infection of the fingertip. CONTRAINDICATIONS: Atypical infections, e.g., Herpes, Orf's disease, mycobacterial infections. SURGICAL TECHNIQUE: Excision of the infected area in the fingertip without damaging the digital nerves and their branches. POSTOPERATIVE MANAGEMENT: The wound is left open and is covered with a moist dressing. RESULTS: Early targeted incision brings good functional and cosmetic results.

[Treatment of paronychia]. / Die Nageltascheninfektionen der Finger - Behandlung der Paronychien.

OBJECTIVE: The procedure is selected based on the stage of infection with careful removal of the focal infection in the area of the nail fold. INDICATIONS: All infections of the periungual area. CONTRAINDICATIONS: Herpes infections [1, 12]. All purulent infections of the periungual area should be eliminated. SURGICAL TECHNIQUE: Opening of the abscess, excision of the eponychium, mobilization of the nail barrier away from the nail plate, inzision of the nail barrier at a defined place, necrosectomy, irrigation, and drainage. POSTOPERATIVE MANAGEMENT: Moist dressings and fingerbaths in the first few days. RESULTS: In most cases, the infection heals completely without substantial scar formation.

[Osteochondral reconstruction of the lunate fossa in proximal row carpectomy for Kienböck's disease early stage IV]. / Der osteochondrale Ersatz der Fossa lunata bei der Entfernung der proximalen Handwurzelreihe im frühen Stadium IV der Lunatumnekrose.

An osteochondral transfer of a scaphoid segment into the lunate fossa in proximal row carpectomy was performed in two female patients in stage IV of Kienböck's disease. Clinical and radiological follow-up at 18 and 6 months, respectively, showed results comparable to those of PRC in Lichtman stage III. This technique may serve as another option for salvage operations on the wrist.

[Robert Kienböck and Kienböck's Disease - A Historical Report]. / Robert Kienböck und seine Arbeit über die Lunatumnekrose - eine historische Würdigung.

Robert Kienböck is best known for his radiological identification and description of avascular necrosis of the lunate. But today there is only little knowledge of the man behind Kienböck's disease and his work. Kienböck's contributions to medicine, particularly the diagnosis of diseases of bones and as a pioneer in radiotherapy, were extraordinary. Indeed, there is no topic in the field of radiology that was not enriched by Kienböck through his gigantic scientific work. 204 references of Robert Kienböck are cited and the complete original publication on lunatomalacia from 1910 is added in the electronic version.

[Preformed plate-fixation system for type AO 13C3 distal humerus fractures: clinical experiences and treatment results taking access into account]. / Das präformierte LCP-Plattenfixateursystem bei distalen Humerusfrakturen AO-Typ 13C3 : Klinische Erfahrungen und Behandlungsergebnisse unter Berücksichtigung des Zugangsweges.

In distal intraarticular humerus fractures primary stable osteosynthesis is essential for early mobilization of the elbow joint. Double-plate osteosynthesis techniques using different configurations are the gold standard. In the literature plate position is sometimes discussed controversially. In cases of distal humerus fractures (type AO 13C3) with metaphyseal comminution, as well as in elderly patients with poor bone quality, utilizing locking plates with angular stability was found to have increased structural properties with regard to primary fixation stability. The dorsal approach with osteotomy of the olecranon seems to be very effective in open reduction and internal fixation of this type of fracture. One new development is the anatomically preformed plate-fixation systems such as the LCP-System for distal humerus (Synthes). This study presents our first experience with this system in 11 cases of open reduction and internal fixation of type AO 13C3 distal humerus fractures. The system-specific features and intraoperative options were analyzed.

Systemic versus local application of gentamicin in prophylaxis of implant-related osteomyelitis in a rat model.

Administration of perioperative antibiotic prophylaxis is a routine procedure in orthopedic surgery. Besides systemic prophylaxis, only few techniques are established for local application of antibiotics to reduce infection related to orthopedic implants. The aim of this study was to evaluate the efficacy of locally versus systemically applied gentamicin in a rat model (n = 60). For local application, the antibiotic was delivered from a biodegradable poly(D,L-lactide) (PDLLA) coating of titanium implants. The efficacy of local prophylaxis was compared to a systemic single shot application of gentamicin as well as a combination of both administrations. Half of the animals received a weight-adopted single shot application of gentamicin 30 min prior to surgery. At surgery, the medullary cavities of the tibiae were contaminated with Staphylococcus aureus (10(2) colony forming units /CFU) and titanium Kirschner wires were implanted into the medullary canals. The implants were either uncoated, PDLLA coated, or coated with PDLLA + 10% w/w gentamicin. The animals were followed up for 42 days. X-ray examinations were performed; body weight, temperature, and the clinical condition were determined. After sacrifice, infection was evaluated by histological and microbiological analysis. All animals treated with uncoated or PDLLA-coated Kirschner wires without systemic application of the antibiotic developed osteomyelitis and all cultures of implants were tested positive on S. aureus. Implant-related osteomyelitis could be prevented by prophylaxis of systemically applied gentamicin in 15% of animals. In contrast, local application of gentamicin delivered from a PDLLA coating was more effective. Onset of infection could be prevented in 90% of animals treated with gentamicin coated Kirschner wires, and in 80% of the animals that were treated with a combination of local and systemic application. The local application from PDLLA-coated implants might support systemic antibiotic prophylaxis in preventing implant-associated osteomyelitis.