[Classification of haematogenous and post-traumatic osteomyelitis]. / Klassifikation der Osteomyelitis und Osteitis.

A classification of osteomyelitis must reflect the complexity of the disease and, moreover, provide conclusions for the treatment. The classification is based on the following eight parameters: source of infection (OM [osteomyelitis]/OT [post-traumatic OM]), anatomic region, stability of affected bone (continuity of bone), foreign material (internal fixation, prosthesis), range of infection (involved structures), activity of infection (acute, chronic, quiescent), causative microbes (unspecific and specific bacteria, fungi) and comorbidity (immunosuppressive diseases, general and local). In the long version of the classification, which was designed for scientific studies, the parameters are named by capital letters and specified by Arabic numbers, e.g., an acute, haematogenous osteomyelitis of a femur in an adolescent with diabetes mellitus, caused by Staphylococcus aureus, multi-sensible is coded as: OM2 Lo33 S1a M1 In1d Aa1 Ba2a K2a. The letters and numbers can be found in clearly arranged tables or calculated by a freely available grouper on the internet (www.osteomyelitis.exquit.net). An equally composed compact version of the classification for clinical use includes all eight parameters, but without further specification. The above-mentioned example in the compact version is: OM 3 S a Ba2 K2. The short version of the classification uses only the first six parameters and excludes causative microbes and comorbidity. The above mentioned example in the short version is: OM 3 S a. The long version of the classification describes an osteomyelitis in every detail. The complexity of the patient's disease is clearly reproducible and can be used for scientific comparisons. The for clinical use suggested compact and short versions of the classification include all important characteristics of an osteomyelitis, can be composed quickly and distinctly with the help of tables and provide conclusions for the individual treatment. The freely available grouper (www.osteomyelitis.exquit.net) creates all three versions of the classification in one step.

[Superinfected epidermal inclusion cyst of the thigh with development of squamous cell carcinoma--case report of a rare complication]. / Superinfektion einer epidermalen Inklusionszyste des Oberschenkels mit Ausbildung eines Plattenepithelkarzinoms--Fallbericht einer seltenen Komplikation.

Epidermal cysts (atheroma) are the most common benign tumours of the skin with ubiquitous localisation all over the body. However, rupture of the atheroma and formation of an inclusion cyst with additional superinfections are frequently seen. Malignant transformations have rarely been reported. Presented here is the unusual case of a 65-year-old woman with multiple atheromas and a distinctive tumour of the upper limb. Imaging diagnostics showed malignant deformation. Contrary to the imaging findings the histological/microbiological examination showed an enormous superinfected and ruptured epidermoid cyst with multiple abscess formation in the ventral upper limb. Radical surgical restoration with salvage of the limb was frustrated because of honey-combed anterior soft tissue and the changing bacterial spectrum. After resection of the complete ventral compartment, remission was realised approximately. In the follow-up there was a recurring infection with spontaneous fistula formation that histologically impressed as a squamous cell carcinoma. After proximal ablation of the upper limb, total rehabilitation of the infection as well as the malignoma could be achieved.

[Bone infections]. / Knocheninfektionen.

Even in recent traumatology and orthopedic surgery infectious diseases of the bone (i.e. osteomyelitis) and it's surrounding tissues remain serious complications. The therapy is demanding and oftenly does not lead to a complete restitutio ad integrum. In order to create the optimal treatment one has to have a profound knowledge about the "state of the art" therapy of bone infections and the basic phases: Reassurance of the local infection (bone and surrounding tissues) and reconstruction of the bone and surrounding tissues. The local infection treatment is based on the consequent surgical eradication of infected tissue. In addition (as a supportive therapy) antibiotics have to be applied according to the local and systemic response of the patient to the infection. Also further supportive methods like hyperbaric oxygenation may be taken into consideration. The following paper provides an overview of diagnostic features and the different surgical procedures as well as the current literature in order to reach the above mentioned goals.

Wound irrigation within the surgical treatment of osteomyelitis.

The basic treatment of osteomyelitis remains even today the surgical debridement in combination with a wound irrigation by lavage systems. Next to a comprehensive knowledge of the surgical techniques a profound knowledge of the lavage systems, the rinsing solutions used and the philosophies of revision programs are a must. In this article the typical hardware of modern lavage systems is analysed, their advantages and disadvantages are pointed out. In addition we investigate the value of common antiseptic wound irrigation solutions for their use in osteomyelitis therapy. Finally the two basic philosophies of wound revision and irrigation in the course of osteomyelitis therapy are presented and discussed.

Adult calcaneal osteitis: incidence, etiology, diagnostics and therapy.

Calcaneal osteomyelitis presents a complicated situation. The specific anatomy of the os calcis and its surrounding soft tissues plays an important role in the planning and realization of the procedures needed in order to eradicate the osteomyelitic focus. The calcaneus represents a spongious bone; a fact that supports the developement of an osteomyelitis. It is the strongest bone of the foot and is highly important for the biomechanical features of physiological walking. The surrounding soft tissues are thin and contain various important anatomical structures. These might be damaged during the treatment of the osteomyelitis. In addition the vascularization of the os calcis is delicate and may be compromized during the surgical osteomyelitis treatment. Calcaneus osteomyelitis may be classified based on the routes of infection into exogenous and endogenous forms. Additionally from the clinical point of view acute and chronic forms may be distinguished from an early and a late infection. Exogenous calcaneal osteomyelitis mostly is the result of an infection with S. aureus. The treatment is equal to the therapy in other locations and based on: Eradication of the bone infectionSanitation of the soft tissue infectionReconstruction of bone and soft tissue Especially the preservation and restoration of the soft tissue is important. Thus plastic surgical procedures play an essential role. The main object of treatment is the preservation of a biomechanical functioning foot. This may be impossible due to the local situation. Calcanectomy or even below knee amputation may be needed in those cases.

[Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)]. / Zur Definition der Diagnose Osteomyelitis - Osteomyelitis-Diagnose-Score (ODS).

AIM: The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. METHOD: For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. RESULTS: Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. CONCLUSION: The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis.

[Risk Assessment in the Therapy for Osteomyelitis using Immunological Parameters]. / Risikoeinschätzung bei der Therapie der Osteitis anhand immunologischer Parameter.

PROBLEM: The treatment of osteomyelitis is based on the surgical eradication of the septic focus and the additional administration of antibiotics (local and/or systemic). In some cases the course of the therapy may be prolonged without any obvious reason in terms of the quality of the surgical treatment, virulence and type of bacteria or the co-morbidities. ISSUE: Can these patients at risk be detected by immunological assessments? Will these immunological features lead to a more individualised therapeutic strategy? PATIENTS: 20 patients suffering from chronic osteomyelitis of the lower extremity were included in our study. Group 1: 15 patients showed a prolonged course of the disease and/or an abnormal high rate of surgery. These courses could not be correlated with the bacterial spectrum or the co-morbidities. Group 2: 5 patients showed a clinical course as expected. METHODS: Blood samples of all patients were analysed by immunological methods: lymphocytes were analysed by using 8 colour flow cytometry. CD4/8 ratio and double negative T cells were calculated. T cell response to recall antigens was determined by elispot testing. RESULTS: In group 1 double negative T cell and cytotoxic T cell counts were significantly lower in comparison to group 2. This was not the case for T cells and T helper cells. In ROC analysis, area under the curve (AUC) analysis revealed best discrimination by double negative T cells (0.88). At a cut-off of 60 double negative T cells/µL, discrimination of septic complications revealed 100 % specificity and 87 % sensitivity. In elispot testing, reactivity to tetanus toxoid established best results (AUC 0.76). CONCLUSION: The analysis of the above data shows that the detection of higk-risk patients during the therapy for osteomyelitis based on immunological features seems to be possible. Further studies are needed to verify the data collected from our pilot study.

[Imaging diagnostics of osteitis, osteomyelitis and joint infections]. / Bildgebende Diagnostik bei Osteitis/Osteomyelitis und Gelenkinfekten.

Imaging diagnostics and surgical treatment of bone and joint infections are of paramount interest. The main purpose of our survey is to give a detailed overview about methods, indications, image criteria and efficiency of imaging diagnostics as a state of the art presentation. In conclusion we attempt to give some recommendations for clinical scenarios and diagnostic procedures concerning bone and joint infections. This paper has been prepared under the patronage of the AG Septische Chirurgie of the Deutsche Gesellschaft für Unfallchirurgie in Germany. It is our aim to update the paper with respect to the technical and clinical improvements and to publish it again after a number of years.

[Infectious bone diseases]. / Infektiöse Knochenerkrankungen.

Bacterial infection of the bone is a severe disease with complications, potentially including long-term physical disability. The diagnosis and therapy of osteomyelitis include several elements: histopathology, microbiology, radiologic imagining, as well as antibiotic and surgical therapy. Histopathologists differentiate between acute osteomyelitis (infiltration of cancellous bone with neutrophil granulocytes); specific osteomyelitis (epithelioid-like granulomatous inflammation, tuberculosis, mycotic infections); primary/secondary chronic osteomyelitis (lymphocytic infiltration); and special forms of chronic osteomyelitis (varying histomorphology, Brodie abscess, SAPHO syndrome). Another important task in the histopathological diagnosis of inflammatory bone diseases is to differentiate osteomyelitis from malignant entities (sarcoma, lymphoma). Therefore, biopsy samples should be of sufficient size for safe diagnosis. Clinical information and imaging as well as interdisciplinary teamwork between radiologists, microbiologists, orthopedic surgeons and pathologists is mandatory to verify these diagnoses.

[Vacuum-assisted closure therapy for the treatment of acute postoperative osteomyelitis]. / Vakuumtherapie bei akuter postoperativer Osteitis.

AIM: Vacuum-assisted closure is used frequently for the treatment of posttraumatic osteomyelitis of the extremities. After debridement and repeated VAC dressing changes, the wounds are closed by secondary suture, split-thickness skin grafts or local flaps. However, no objective parameters describe the time point for secondary wound closure. Our thesis was that negative microbiological results from bone specimens can indicate the time for secondary wound closure. Moreover, treatment course and clinical outcome after 3.4 years should be compared to those of other surgical approaches for acute postoperative osteomyelitis from the literature. PATIENTS AND METHODS: 43 patients with acute postoperative osteomyelitis of the extremities and the pelvis were treated by serial bone and soft tissue debridements and VAC therapy and analysed prospectively. Debridements were repeated until the wounds were macroscopically free from signs of infection (good granulation/no necrosis). During each revision a bone specimen was taken for microbiological analysis. Number of revisions, bacterial cultures, type of wound closure and recurrence of infection after 3 years and 5 months on average after the last surgery was analysed. RESULTS: 9.8 debridements on average were performed until eradication of infection and secondary wound closure. Despite the absence of macroscopic infection, bacteria were still found in bone samples from 15 of 43 patients. Three biopsies were free of bacteria for the first time right before wound closure, 25 samples had become negative during the treatment. Six recurrences (19.3 %) were noted after 3.4 years on average. Four patients from the group of negative bone biopsies (19 %) and two patients from the group of persisting bacteria before secondary closure (20 %) had a recurrence of infection. CONCLUSION: In about one third of the bone biopsies bacteria persisted. This bacterial load had no correlation to wound healing and rate of recurrence after over 3 years. In conclusion, microbiological bone samples are not suitable as an indicator for the time point of secondary wound closure. Compared to other treatment options in acute postoperative osteomyelitis from the literature (especially implantation of local antibiotics), no advantage of vacuum-assisted closure could be shown concerning number of debridements and rate of recurrences.

[Vacuum-assisted closure therapy for the treatment of skin and soft-tissue infections. Are wound specimens of use in planning secondary wound closure?]. / Vakuumtherapie bei Haut- und Weichgewebsinfektionen der Extremitäten. Nutzen des Wundabstrichs bei der Planung des sekundären Wundverschlusses?

AIM: Vacuum-assisted closure is used frequently for the treatment of skin and soft-tissue infections (SSTI) of the extremities. After debridement and repeated VAC dressing changes, the wounds are closed by secondary suture, split-thickness skin grafts or local flaps. However, no objective parameters describe the time point for secondary wound closure. Our thesis was that negative microbiological results from wound specimens can indicate the time for secondary wound closure. PATIENTS AND METHODS: 24 patients with SSTI of the extremities were treated by serial debridements and VAC therapy and analysed prospectively. Debridements were repeated until the wounds were macroscopically free from signs of infection (good granulation/no necrosis). During each revision specimens were taken for microbiological analysis. Moreover, number of revisions, bacterial cultures, type of wound closure and wound status after 3 years and 5 months on average after the last surgery were analysed. RESULTS: 6.3 revisions on average were performed until secondary wound closure was possible. In spite of the absence of macroscopic infection, bacteria were still found in tissue samples from 14 of 24 wounds. 6 wounds were free of bacteria for the first time right before wound closure, 3 wounds had become negative during the treatment. After 3.4 years on average, the wounds of all 18 patients available for examination had healed well and were free from signs of infection. CONCLUSION: Vacuum-assisted closure resulted in clean, good granulating wounds without necrosis. However, in more than half of the wounds bacteria persisted. This bacterial load had no correlation to wound healing and outcome after over 3 years. In conclusion, microbiological tissue samples are not suitable as indicator for the time point of secondary wound closure in SSTI.

[Ligament healing results after type C pelvic ring fractures. Results of triangular vertebropelvic support]. / Ligamentäre Ausheilungsergebnisse nach Beckenringfrakturen Typ C. Ergebnisse der triangulären vertebropelvinen Abstützung.

BACKGROUND: Posterior pelvic ring fractures are often associated with injuries of lumbopelvic soft tissue structures. The aim of this prospective MR study was to examine whether ruptured iliolumbal ligaments could be diagnosed in types B and C pelvic ring fractures. The influence of triangular lumbopelvic stabilization (TLPS) was also investigated with respect to stiffening of the lumbopelvic region. MATERIAL AND METHODS: Using a 1.5 Tesla MRI, 20 patients with types B and C fractures were examined to identify ruptured iliolumbal ligaments. In a retrospective study of 30 patients previously stabilized with a TLPS, pain scores, clinical instability testing and measuring of the segmental dislocation in extension, flexion and lateral flexion based on x-rays were also investigated. RESULTS: Of the patients 3 (1 type B, 2 type C fractures) had incompletely ruptured iliolumbal ligaments. In five patients pain intensity and localization could be significantly correlated with clinical instability of the lumbopelvic region, segmental hypermobility and instability. CONCLUSION: Pelvic ring fractures types B and C can be associated with ruptured iliolumbal ligaments. Lumbopelvic instability can be correlated with early implant loosening of TLPS.

Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis.

INTRODUCTION: The differential diagnosis of osteolytic, destructive, and inflammatory processes around the symphysis, the os pubis, and the ramus ossis pubis includes infectious osteitis pubis, inflammatory osteitis pubis, posttraumatic benign pubic osteolyses in elderly women, and malignant neoplasia. Accurate diagnosis can be a challenge and requires a methodical approach and the use of a variety of diagnostic measures. MATERIALS: A case study of an 83-year-old female suffering from infectious pubis osteitis sheds light on the differential diagnosis of these conditions, particularly the distinction between infectious pubic osteitis and inflammatory pubis osteitis. In addition to the diagnostic indicators and methodologies, differential treatments are considered and a review of current literature on the topic is presented.

[Fatal risk thrombosis? A prospective study for the incidence of deep vein thrombosis in pelvic fractures]. / Tödliches Risiko Thrombose? Eine prospektive Studie zur Inzidenz von Becken- und Beinvenenthrombosen bei Beckenfrakturen.

AIM: The aim of the study was to determine the incidence of deep vein thrombosis (DVT) after pelvic trauma and surgical stabilisation of pelvic and acetabular fractures under medicamentous prophylaxis. PATIENTS AND METHOD: Within 20 months we prospectively included 50 patients. 25 had an isolated pelvic trauma, 25 patients had multiple injuries. 21 of them were polytrauma patients (average ISS: 31.4; min. 26 pts., max. 50 pts.), four patients had additional highly unstable spine fractures or fractures of the lower extremities. Low molecular-weight heparin (Enoxaparin 40 g/d) was administered on average within 24 hours of injury in 44 cases, one patient received low-dose heparin (Liquemin 15,000 to 22,500 I. E./d), five patients received both. 31 patients were treated operatively and 19 conservatively. Colour-flow duplex ultrasonography was performed within 72 hours of injury and stabilisation of the pelvic and acetabular fracture, or weekly. By means of ultrasound, 97 to 100 % of the deep and superficial leg veins could be examinated safely, as well as 88 to 89 % of the external iliac veins and 64 to 66 % of the common iliac veins. Only in 36 to 40 % of the patients the internal iliac veins were visible by ultrasound. RESULTS: Proximal DVTs were detected postoperatively in two patients (4 %), one patient (2 %) died after a fatal P. E. before the scheduled duplex scan. CONCLUSION: Early medicamentous prophylaxis can prevent deep vein thrombosis after pelvic trauma. Delayed applications due to pelvic operations are risk factors. In such cases duplex scanning should be performed routinely and postoperative medicamentous prophylaxis should be increased.

Strategies for the analysis of osteitic bone defects at the diaphysis of long bones.

Septic diseases of the bone and the immediate surrounding soft tissue, i.e., osteitis, belong to the most alarming findings in recent traumatology and orthopedic surgery. The paramount goal of this therapy is to preserve the stable weight-bearing bones while maintaining a correct axis and proper working muscles and joints, in order to avoid permanent disability in the patient. "State-of-the-art" therapy of osteitis/osteomyelitis therapy has two priorities: eradication of the infection and reconstruction of bone and soft tissue. Surgical treatment of the affected bone segments and soft tissue, followed by reconstructive methods, continues to be the main basic therapy. It is often extremely difficult to decide whether the affected bone segment has to be resected, or whether bone continuity can be preserved. The following paper provides strategies and guidance to help guide decisions in this complex and challenging area.

[Preservation of hip prosthesis with local surgical revision and creation of a fistula persistens : an option for palliative treatment of periprosthetic infection in old, polymorbid patients?]. / Hüftprothesenerhalt mit lokaler chirurgischer Revision und Anlage einer Fistula persistens : Ausnahmeoption zur palliativen Therapie des periprothetischen Infekts bei alten polymorbiden Patienten?

BACKGROUND: The number of implanted hip prostheses is increasing constantly. At the same time the patients are becoming older and older. Thus, also patients with periprosthetic infections are older and therefore sicker. Uniform guidelines for the treatment of infected arthroplasties are controversial. Empirical studies show that the explantation of the original prosthesis and implantation of a revision may be the option with the greatest chance of success. These very aggressive procedures may overburden the old, polymorbid patient. The aim of this study was to ascertain whether or not keeping the hip prosthesis in combination with local debridement, formation of a permanent fistula and long-term administration of antibiotics is a possible option for the treatment of infected hip prostheses in old and polymorbid patients. PATIENTS: Between 01.01.2004 and 28.01.2007, 12 patients with periprosthetic infection after hip arthroplasty (PIH) were treated. Their average age was 79.8 years. Eleven patients were rated ASA III preoperatively. The prostheses were on average 23.8 weeks old when the first signs of infection occurred. In 10 cases the infection was caused by Staphylococcus (MRSA 3x). The main comorbidities were hypertension, diabetes, coronary heart disease and thyroid malfunction. RESULTS: After a mean 8.83 months, six patients were deceased (average age 85.50 years). In five of the remaining six patients the fistula worked without any problem. In one case the fistula was occluded. None of the patients showed any sign of acute infection. All were able to walk with full weight-bearing on the affected hip. CONCLUSION: Restricting the indication to old, polymorbid patients, preservation of the arthroplasty in combination with local surgical debridement, permanent fistula and long-term systemic administration of antibiotics seems to be an alternative to explantation of the prosthesis with consecutive revision arthroplasty or resection arthroplasty.

[Use of the pelvic clamp in polytraumatised patients with unstable disruption of the posterior pelvic ring. Modified technique--risks--problems]. / Anwendung der Beckenzwinge beim polytraumatisierten Patienten mit instabilem Becken. Modifizierte Technik--Gefahren--Probleme.

BACKGROUND: Unstable fractures of the posterior pelvic ring are frequently combined with severe hemorrhage. In 80% of cases the bleeding originates in the ruptured presacral venous plexus or the fracture itself. Arterial bleeding is less common. The pelvic clamp introduced by Ganz can make it possible to stabilise the pelvis, with subsequent compression of the fracture planes and reduction of the intrapelvic volume in such cases, so improving the prognosis. Use of the pelvic clamp can be integrated into the management in the emergency room with no problem. METHODS: This paper presents the authors' own modification of the technique for using the pelvic clamp in the emergency situation when only a clinical examination of the patient has been possible and also analyses specific problems that arise in this situation. To this end, the data relating to 29 polytraumatised patients with unstable posterior pelvic ring fractures were analysed in a retrospective study. RESULTS: In all, 8 complications were seen in 6 patients. There were 2 cases of pin malposition and 2 of over-compression of the ossa coxae and local wound problems. Secondary pin dislocation was observed in 1 case. In all these cases it was possible to correct the pelvic clamp, so that emergency stabilisation was practicable without further surgical intervention. Minor complications were found in 2 patients. These took the form of bleeding at the pin-insertion site. In 1 case an unstable transiliacal fracture was found, and in this case it was not possible to stabilise the posterior pelvic ring with the pelvic clamp. No iatrogenic lesions were detected following application of the pelvic clamp. CONCLUSION: In the hands of an experienced and practised user application of the pelvic clamp is a safe method for emergency stabilisation of the posterior pelvic ring in polytraumatised patients, even without blood volume control. Problems can be solved and do not generally mean the pelvic clamp cannot be used. The immediate radiological check (e.g. during the emergency CT -scan performed for primary diagnosis) is a must, however.

[Use of the "c-clamp" in the emergency treatment of unstable pelvic fractures]. / Notfallbehandlung instabiler Beckenfrakturen - Stellenwert der "Beckenzwinge"

UNLABELLED: It was the objective of this investigation to describe the results after stabilisation of pelvic fractures with the pelvic clamp in polytraumatized patients with unstable pelvic ring fractures. PATIENTS: Between 1999 and 2001 11 polytraumatized patients with an average age of 38 years with unstable fractures of the pelvic ring were treated with the "pelvic clamp" (PC). METHOD: The patient's data were analysed retrospectively from the moment they were admitted to our department until 48 hours after the treatment with the pelvic clamp. The following data were observed: -- The time period until the pelvic clamp was placed. -- The mean blood pressure. -- The oxygenation level (PaO (2)/FiO (2) coefficient). -- The number of requested blood units. -- The time period until hemodynamic stabilisation took place. RESULTS: 8 patients survived their injuries. 5 of them were admitted primarily to our department (ISS 39.8, PTS 35), the other 3 were secondarily admitted to our department (ISS 48.3, PTS 39). 3 of 11 patients (27 %) died averaged within the first 45 minutes after admittance. They also were treated in other units before admittance to our department. 8 surviving patients showed -- a hemodynamic stabilisation 6 hours after the treatment with the PC. -- an increase of the mean blood pressure about 25 % 20 minutes after the treatment with the PC. -- a stabilisation of the oxygenation level 6 hours after the treatment with the PC. -- a decrease of the number of requested blood units 6 hours after treatment with the PC. CONCLUSION: Even if the number of patients who were treated is small, the study shows a positive trend in terms of stabilisation of the vital parameters after stabilisation of the pelvic fracture with the pelvic clamp.

[Triangular vertebropelvine stabilisation of unstable posterior pelvic ring fractures]. / Die trianguläre vertebropelvine Abstützung--Frühbelastbare Osteosynthese instabiler Frakturen des hinteren Beckenringes.

UNLABELLED: It is the objective of this investigation to describe the early results (2 years outcome) after triangular vertebropelvine stabilisation (TVPS) of unstable fractures of the posterior pelvic ring. PATIENTS: Between 1.1.1997 and 31.12.2000 35 patients were treated. C1 fractures occurred 9 times (25.7 %), C2 injuries 16 times (45.7 %) and 10 patients suffered fom C3 fractures (28.6 %). The mean age of the injured was 36.6 years (15 to 77 years). 22 patients (62.8 %) were treated with the TVPS. Suffering from a monotrauma, mobilisation with full weight bearing of the injured pelvis was resumed immediately on the first postoperative day. In case of polytrauma mobilisation was continued when the additional injuries allowed so, after 8.8 days on average. RESULTS: After an average of 23.4 months 18 of 22 patients with TVPS were controlled. Radiological criteria as well as quality of life were ascertained. It could be proved, that TVPS offered good reduction and stable retention of the pelvic fractures. 16 patients (89.0 %) suffered from moderate or mild pain, 15 (83.3 %) had slight problems in walking. No restriction in the range of motion of the lumbal vertebral column could be observed. CONCLUSION: The following advantages of the TVPS could be demonstrated: anatomical reduction and stable retention of instable pelvic fractures, full weight bearing from the first day after surgery, and only slight restriction of the quality of life two years after operation