[Measuring intracranial pressure after trepanation in traumatized patients]. / Die Hirndruckmessung nach Trepanation bei traumatisierten Patienten.

Between 1.1.1990 and 30.9.1991 32 neuro-traumatological operations were carried out. With 22 patients the intracranial pressure probe was used. With 11 injured persons the ICP (intracranial pressure) values were unchanged. Within this group a computer tomography of the skull around the fifth postoperative day was indicated. Unlike this group, injured persons without a monitoring of intracranial pressure had to undergo a computer tomography on the first postoperative day. After craniotomies, measurements of the intracranial pressure should be carried out as in case of severe head injuries. In this way expansive intracranial changes which occur postoperatively can immediately be seen and diagnosed or treated. On the other hand, if the intracranial pressure values are unchanged, postoperative computed tomography may be carried out later i.e. after the vulnerable phase. Further advantages result from monitoring the patients in the intensive care unit.

[Scapholunar dissociation--when an accident sequela, when a normal congenital variant?]. / Scapholunäre Dissoziation--wann Unfallfolge, wann angeborene Normvariante?

The scapholunate dissociation is an instability of the wrist which shows characteristic signs in the X-rays. It is commonly believed to be caused by trauma. During the past two years four cases of idiopathic scapholunate dissociations were identified by the typical radiologic signs on both sides without any trauma or symptoms. Before operative treatment of an injured hand X-rays of the uninjured side should be examined.

Reaction of the bone structure to methotrexate-Palacos flow y. Experimental investigations in animals.

With the combined osteosynthesis of pathological fractures in association with tumors and/or metastases in mind, E. Merck (Darmstadt, FRG) developed a bone cement containing a cytostatic agent, methotrexate-Palacos flow y (MTX-Pf). The animal-experimental study presented here investigates the tolerability of MTX-Pf in the femurs of rabbits with lateral comparison. In these investigations we used both the concentration of 0.63% MTX, as is currently used in standard clinical surgery, as well as a much higher concentration of 2.5% MTX. The histological sections were investigated using microradiographic methods and provided no indication of any significant differences between the femora with the MTX-Pf implantation and those into which standard Palacos flow y had been implanted.

[A rare muscle abnormality of the hand: a 2-headed abductor digiti minimi muscle with an unusual course and innervation]. / Eine seltene Muskelanomalie an der Hand: Ein zweiköpfiger M. abductor digiti minimi mit besonderem Verlauf und Innervation.

Unique variations of the origin, course, and innervation of a second belly of the abductor digiti minimi muscle in both hands of a 77 year-old man are reported. Similar anomalies have not previously been described in the literature. The possibility of such variations should be taken into consideration in surgery of the flexor side of the wrist.

[Surgical correction of congenital bilateral dislocations of the extensor tendons of the thumb]. / Zur operativen Korrektur angeborener beidseitiger Luxationen der Daumenstrecksehnen.

A congenital bilateral thumb-contracture due to dislocation of both extensor tendons over the metacarpophalangeal joint was treated in a fourteen-year-old boy. Intraoperatively the extensor tendons were shifted to a dorsal position and restrained over the center of the metacarpophalangeal joint of the thumb. By this method the previously useless thumbs were given normal function and cosmetic appearance. This congenital anomaly could not be classified as any known syndrome.

Pharmacokinetics of methylmethacrylate monomer during total hip replacement in man.

The concentration of methylmethacrylate monomer (MMA) in the blood stream after implantation of the components of 15 total hip prostheses using bone cement was determined in the pulmonary artery, the radial artery, and the superior vena cava after cement application, and correlated with the observed drop in blood pressure and the increase in the pulmonary arterial pressure. In all samples MMA was found. The values ranged from 0.02 micrograms/ml to 59 micrograms/ml. The mean maximum value after implantation of the stem was measured to be 7.8 micrograms/ml in the pulmonary artery, 4.6 micrograms/ml in the radial artery, and 1.75 micrograms/ml in the superior vena cava. After implantation of the cup the values were clearly lower. The simultaneously recorded blood pressure decreased slightly during the first 3 min and then returned to previous values. The pulmonary arterial mean pressure increased from 18 to 20 mmHg during the first 10 min. Although in some patients a drop in blood pressure started at the same time as MMA reached maximum values, high concentrations did not result in a greater effect on the circulatory parameters. Statistical analysis by the Spearman test revealed no correlation between MMA concentrations and the decrease in blood pressure or the increase in the pulmonary arterial pressure.

[Potentialities of MR tomography in monitoring the therapy of malignant bone tumors]. / Möglichkeiten der MR-Tomographie in der Therapiekontrolle maligner Knochentumoren.

The value of MRI as a method for controlling treatment quantitatively was studied in four osteosarcomas and one Ewing sarcoma. Histologically proven change resulting from chemotherapy (2 patients) correlated with a significant increase in T2 of tumour tissue. In three other patients who did not respond to therapy, no change could be demonstrated. MRI appears to be valuable as a non-invasive method for monitoring treatment.

[Expanded roentgen diagnosis of the lower ankle joint]. / Erweiterte Röntgendiagnostik des unteren Sprunggelenkes.

The standard radiographs in two planes of the ankle joint and of the foot do not allow an exact evaluation of the subtalar joint. Two additional views are proposed. With a dorsal flexion of the ankle joint one radiograph is obtained in 60 degrees internal rotation and the other in 60 degrees external rotation. The medial-oblique and lateral-oblique views considerably increase diagnostic information with a minor effort compared to tomography.

[Distal type I arthrogryposis--surgical possibilities of the hand]. / Distale Arthrogryposis Typ I--operative Möglichkeiten im Bereich der Hand.

Distal arthrogryposis as a special form of arthrogryposis multiplex congenita is a rare malformation syndrome associated with contractures of the hands. A special case demonstrates the possibilities of treating flexion contractures of the hand. This procedure is compared with the treatment of other contractures of the hand. One possibility is the shortening of the metacarpals by osteotomy and shortening of extensor tendons.

[Replacement of the upper arm flexor muscles by m. latissimus dorsi in partial paralysis of the arm plexus]. / Ersatz der Oberarmbeugemuskulatur mit Hilfe des M. latissimus dorsi bei partieller Armplexusparese.

Different methods of muscle transfer are described for restoration of elbow flexion. The most important procedures are: Proximal transposition of the origin of forearm flexor muscles to the distal humeral shaft as described by Steindler, transfer of the triceps muscle to the flexor side of the upper arm, and biceps-replacement by transfer of pectoralis major muscle. Besides these methods transposition of the latissimus dorsi muscle to the flexor side of the upper arm provides good restitution of elbow flexion. In case of concurrent non-functioning shoulder muscles a shoulder arthrodesis performed as a second intervention is useful. The combination of a shoulder-arthrodesis and a latissimus-dorsi-transfer are demonstrated in a typical case.

[Difficulties in the diagnosis of osteoid osteoma]. / Schwierigkeiten bei der Diagnostik des Osteoidosteoms.

The difficulties arising in diagnosing osteoidosteoma are demonstrated by means of 30 surgically treated cases and the results are compared with those available from the literature. The value of bone scintigraphy and of tomography within the framework of a diagnostic concept is underlined. Diagnosis is confirmed and treatment is effected by the successful surgical removal of the nidus.

[Therapeutic concepts in neurologic damage following severe soft tissue and bone injuries of the distal lower leg and foot]. / Therapeutisches Konzept bei neurologischen Schäden nach schweren Weichteil- und Knochenverletzungen am distalen Unterschenkel und fuss.

In less than 1% of the cases nervous lesions after severe lower leg lesions demand surgical treatment: Neurosurgical Clinic: 28 reconstructive interventions on the lower leg, however, 362 on the forearm in 15 years; Clinic of Accident Surgery: 264 severest lower leg- and foot-injuries, among them only two nervous lesions. The n. peronaeus is more frequently affected than the n. tibialis. Even if continuity of the nerve is maintained, endoneural bleeding and internal ruptures can lead to extensive axonal lesions. The kind of nervous lesion (neurapraxia, axonotmesia, neurotmesia) should be clarified during the first three months, if possible, since it determines the prognosis as well as the kind of operative treatment during the first six months.

[Median nerve--compression syndrome caused by atypical palm muscle]. / Nervus medianus--Kompressionssyndrom durch atypischen Hohlhandmuskel.

A compression syndrome of the median nerve was caused by an atypical M. flexor digiti indicis in the palmar area and carpal tunnel. Apart from its anomalous anatomy, this muscle showed an abnormal histological structure. A persistent median artery was also seen in the carpal canal.

[Paranasal sinus reconstruction with bioactive bone cement--a 5-year animal experiment study]. / Stirnhöhlenrekonstruktion mit bioaktivem Knochenzement--5 Jahre tierexperimentelle Erfahrungen.

The newly developed bioactivated bone cement Palavital is composed of polymethylmethacrylate, glass fibers and bioactive glass ceramic. The superficially located glass ceramic particles offer the possibility of true bonding of the bone cement to the bony implantation bed. Reconstruction of the frontal sinuses and the skull was performed on 9 dogs. The follow up was 14 days to 5 years. The implants were checked by tomography and histology. All implants were tolerated without any inflammatory reaction. The bond between bone and implant was demonstrated. Palavital seems to be an improvement on bone cement on a polymethylmethacrylate base.