[Fracture-related infections in traumatology : Current standards and new developments in diagnostics and treatment]. / Implantatassoziierte Infektionen in der Traumatologie : Aktuelle Standards und neue Entwicklungen in der Diagnostik und Behandlung.

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.

[Temporary arthrodesis of the knee in two-stage septic prosthesis exchange : In vitro analysis of adhesion of Staphylococcus aureus on steel and carbon fiber rods]. / Temporäre Arthrodese des Kniegelenks bei zweizeitigem septischen Prothesenwechsel : In-vitro-Analyse der Adhäsion von Staphylococcus aureus auf Stahl- und Kohlefaserstäben.

BACKGROUND: In two-stage septic revision arthroplasty of the knee, a temporary intramedullary fixation with an antibiotic-containing polymethyl methacrylate (PMMA) spacer is often performed in cases of extensive bone defects after endoprosthesis explantation. A common method is the use of conventional steel or carbon fiber rods, which are connected via a tube-to-tube connector and finally reinforced near the joint with bone cement. OBJECTIVE: As the surface of foreign materials plays a critical role in the colonization and biofilm formation in the treatment of periprosthetic joint infections (PJI), the steel and carbon fiber rods were examined and compared with respect to bacterial surface adhesions. MATERIAL AND METHODS: Carbon fiber and steel rods of external fixator systems were used for this experimental study. The sample material was placed in a substrate enriched with S. aureus. The adherent bacteria were examined both by fluorescence microscopy and quantitatively after ultrasonic detachment (sonication) in a smear preparation. In addition, scanning electron micrograph (SEM) images were taken to analyze the topography of bacterial adhesions. RESULTS: The fluorescence microscopy revealed a uniform surface distribution for both materials. The observation of the SEM images showed that for carbon fiber rods the growth of bacteria ran in unison with the direction of the fiber, while for the steel rods an arbitrary arrangement was found. With the help of sonication a significant difference in the number of adherent micro-organisms between the two materials could not be determined using the Wilcoxon test (significance level p < 0.05). CONCLUSION: Both materials can be used to perform PMMA-reinforced intramedullary fixation without fear of sacrificing therapeutic success. From an economic point of view, the use of steel rods seems reasonable as the material costs are significantly lower.

[Thrombosis of the subclavian vein after conservative treatment of a clavicular fracture: A rare complication]. / Thrombose der V. subclavia bei konservativ therapierter Klavikulaschaftfraktur: Eine seltene Komplikation.

We report the case of a 16-year-old male patient who presented with a clavicular fracture that was conservatively treated with a redressment bandage. After a few days the patient developed deep vein thrombosis of the subclavian, axillary and brachial veins, which was successfully treated with nadroparin. Conservative treatment of clavicular fractures is a common procedure in modern traumatology. Continuous, close monitoring and knowledge of rare but severe complications are necessary to avoid further complications.

[Blood vessel and nerve damage in total hip arthroplasty]. / Gefäß- und Nervenverletzungen in der Hüftendoprothetik.

Blood vessel and nerve damage are uncommon complications in total hip arthroplasty (THA). With an incidence between 0.1 and 0.2 % in primary THA these complications are rare but can be serious with a high mortality risk. The individual risk is determined by multiple factors depending on the surgeon's skills, the number of previous surgeries and the approach itself. The anatomy of the defect is an essential risk factor. Some procedures, such as the use of screws for cup fixation are associated with a higher risk of vascular and neural damage. The acetabular quadrant system of the hip as described by Wasielewski et al. is a useful tool to visualize the neurovascular anatomy of the hip, to detect the safe zone and subsequently prevent complications. Sciatic nerve palsy after total hip replacement is the most common nerve damage followed by femoral nerve damage. Previous surgery, a posterior approach and excessive leg extension are the most common risk factors for nerve damage. In order to diagnose nerve palsy after orthopedic surgery an electromyogram can be of use to assess the extent and prognosis. This article focuses on vascular and neural complications after total hip arthroplasty and the options for diagnosis, treatment and prevention.

[Operative treatment of pediatric open fractures of the lower limb using the Taylor spatial frame fixator]. / Versorgung der kindlichen offenen Unterschenkelfraktur mit dem Taylor-spatial-frame-Fixateur.

The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications. Acute angular shortening of the fracture enabling primary soft tissue closure is still an uncommon operative technique because of difficulties in correcting the secondary deformity. The case of a pediatric open fracture of the lower limb (Gustilo type IIIa) is described, which was treated with acute angular shortening followed by gradual correction using the Taylor spatial frame (TSF).

[Correction of supramalleolar deformities with the Taylor spatial frame]. / Korrektur von sprunggelenksnahen Deformitäten mit dem Taylor Spatial Frame.

BACKGROUND: Post-traumatic supramalleolar deformities and malunions of ankle fusion require mostly a multiplanar correction. In cases of severe soft tissue damage, external fixation and gradual correction is a definite treatment alternative. METHOD: Between 2003 and 2007 a correction of supramalleolar deformities was performed in 9 patients with the Taylor spatial frame external fixator. The mean age was 30 years (min. 12, max. 68). There were 6 patients with deformities after malunion of supramalleolar fractures and 3 patients with malunion after ankle fusion. The mean angular deformity was 30 degrees and 5 patients had a rotational malposition of 13.6 degrees (min. 5 degrees, max. 25 degrees). 5 patients needed also lengthening (min. 10 mm, max. 40 mm) of the post-traumatic deformed tibia. The mean time of the follow-up examination was 23 months (min. 12, max. 41). RESULTS: Anatomic correction could be achieved in all patients. The average correction time was 36 days (min. 10, max. 82) with an average time period of 163 days (min. 130, max. 218) until the fixator was removed. The healing index of the leg lengthening cases was 77 d/cm. There were 2 pin-tract infections, 1 prolongated callus formation and 1 insufficient callus formation. CONCLUSION: In cases of post-traumatic supramalleolar deformities with poor soft tissue and bone quality the Taylor spatial frame is a useful tool. Angular, axial, translational and rotatory deformities are corrected simultaneously without complex and time-consuming fixator reconstructions.

[The Taylor spatial frame fixator. Soft-tissue distraction for post-traumatic varus deformities of the hindfoot]. / Der Taylor-spatial-frame-Fixateur. Weichteildistraktion bei posttraumatischer Varusdeformität des Rückfusses.

Despite adequate primary treatment many ankle fractures result in post-traumatic deformities and arthrosis. Revision mostly requires a multidirectional correction whereas internal fixation procedures are often not applicable due to soft tissue damage and the extent of deformity. The Taylor spatial frame enables simultaneous correction of multidirectional deformities through a virtual hinge using the same ideas of distraction osteogenesis as the Ilizarov fixator. The presented case demonstrates minimally invasive correction of a complex deformity of the ankle with the Taylor spatial frame fixator. Orthogonal alignment was achieved and a stabilizing tibiotalar arthrodesis was performed achieving a good functional and pain-free result.

[Operative management and fracture care of the lower leg with the Ilizarov fixator in morbidly obese patients: literature review and results]. / Operatives Management und Frakturversorgung der unteren Extremität bei morbider Adipositas : Literaturübersicht und Erfahrungen mit dem Ilizarov-Ringfixateur.

Given the rising prevalence of obesity, surgeons and hospitals must become more familiar with the treatment and operative management of obese patients. Several additional pre- and postoperative considerations must be involved such as appropriate assessment of comorbidities and requirements for special equipment. There are still very few data regarding morbidly obese patients with BMIs >50 kg/m(2). After a general literature review of operative management of obese patients, we report on fracture care of the lower limb in such patients with custom-made Ilizarov ring fixators. We found them suited to bear enormous weight-loading but that associated comborbidities can limit successful fracture care.