[Results after Judet radial head prosthesis for non-reconstructable radial head fractures]. / Ergebnisse der Radiusköpfchenprothese von Judet bei nicht rekonstruierbaren Radiusköpfchenfrakturen.

BACKGROUND: With regard to the treatment of non-reconstructable radial head fractures, both the resection and the implantation of a prosthesis are considered. Various studies have shown poor results concerning the resection of the radial head with accompanying osteoligamentous injuries. Due to these experiences, different types of prosthesis have been developed. However, the majority of them were not convincing. Judet developed a type of a bipolar prosthesis which had been modeled on the anatomy of the radial head. The aim of our retrospective study consists in examining the results of the Judet prosthesis. PATIENTS AND METHODS: Between 1995 and 2007, 50 patients were treated with an arthroplasty. These were, corresponding to the classification by McKee and Jupiter, 19 type III and 31 type IV fractures. Thirty patients were available for a follow-up after 2.5 years on average. RESULTS: According to the Morrey Score, 16 very good, 7 good, 3 fair and 4 bad results could be obtained. Following the criteria of Radin and Riseborough, 17 patients achieved a good, 9 a fair and 4 a bad result. The complications which appeared were: one patient with aseptic loosening, one patient with luxation of a prosthesis, one persistent radial joint instability, three patients with heterotopic ossification and four patients with protrusion relative to the capitulum humeri.

[The scaphocapitate fracture syndrome (Fenton)]. / Die skaphokapitale Fraktur der Hand (Fenton-Syndrom).

The scaphocapitate fracture syndrome as a greater arc injury is a special form of the perilunate fracture dislocation. It is a combination of fractures of the scaphoid and capitate bones. This severe injury of the carpus is rare and therefore difficult to diagnose. We report the case of a 22-year-old handball player, who fell on the outstretched hand with the wrist in extension. Open reduction was performed via a dorsal approach and both fractures were treated operatively with Herbert screws. After three months the patient was able to play handball again with a good functional result.

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials.

We conducted a systematic review and meta-analysis of randomized controlled trials that compared second-generation antipsychotic (SGA) drugs with placebo in schizophrenic patients and which considered 13 different outcome measures. Thirty-eight randomized controlled trials with 7323 participants were included. All SGA drugs were more effective than placebo, but the pooled effect size (ES) for overall symptoms (primary outcome) was moderate (-0.51). The absolute difference (RD) in responder rates was at 18% (41% responded to drug compared with 24% to placebo, number needed to treat=6). Similar ESs were found for the other efficacy parameters: negative symptoms (ES=-0.39), positive symptoms (ES=-0.48), depression (ES=-0.26), relapse (RD 20%) and discontinuation due to inefficacy (RD 17%). Curiously, the efficacy of haloperidol for negative and depressive symptoms was similar to that of the SGA drugs. In contrast to haloperidol, there was no difference in terms of EPS between any SGA drugs and placebo, and there was also no difference in terms of dropouts due to adverse events. Meta-regression showed a decline in treatment response over time, and a funnel plot suggested the possibility of publication bias. We conclude that the drug versus placebo difference of SGA drugs and haloperidol in recent trials was moderate, and that there is much room for more efficacious compounds. Whether methodological issues account in part for the relatively low efficacy ESs and the scarcity of adverse event differences compared with placebo needs to be established.

[Value of a combined ossification prophylaxis with indomethacin and radiotherapy for acetabular fractures]. / Wertigkeit einer kombinierten Ossifikationsprophylaxe mit Indometacin und Bestrahlung bei Azetabulumfrakturen.

BACKGROUND: Heterotopic ossification is a complication in patients with surgically treated acetabular fractures. The incidence is related to the surgical approach (extended iliofemoral, posterior or a combined approach). The objective of this study was to evaluate the incidence of heterotopic ossification in patients with acetabular fractures who received a combined prophylaxis with both a single dose of radiation and indomethacin compared to those who received only a prophylaxis with radiation or indomethacin. PATIENTS AND METHODS: A total of 24 patients with a combined prophylaxis after surgery were examined retrospectively 24 months after trauma. A systematic literature review was performed and our own results were compared with different methods for prophylaxis of heterotopic ossification from the literature. RESULTS: Only one patient developed a heterotopic ossification. In accordance with the literature, combined prophylaxis showed the least incidence of ossification compared to the other methods. Differences in incidence frequencies were significant between the different prophylaxis methods. CONCLUSION: A combined prophylaxis for heterotopic ossification in surgically treated acetabular fractures seems to be a better alternative than a prophylaxis with radiation or indomethacin alone.

Blood vessel reactivity on noradrenaline, vasopressin, and prostaglandin F2 alpha, resp., in the isolated perfused hind legs of rats with edemas or adjuvant arthritis.

In the isolated perfused hind legs of rats with enemas induced by carrageenin, dextran or Freund's adjuvant in both paws, resting perfusion pressure was slightly increased whereas the vasopressor action of noradrenaline, lysine-vasopressin and prostaglandin F2 alpha, was decreased. Admixture of indomethacin (3 micrograms.ml-1) to the perfusion fluid led to a decrease of resting perfusion pressure whereas its influence on EAmax of noradrenaline was only weak under these conditions. Concomitantly, the contents of prostaglandin E-like substances in the perfusate decreased. Prostaglandin F2 alpha exhibits only weak vasopressor activity in isolated perfused hind legs of rats with carrageenin edema. Altogether, the effect of indomethacin on resting perfusion pressure as well as on EA and EAmax, resp., of agonists is difficulty to explain by its effect on arachidonic acid cascade. The pD2-value of noradrenaline (4.68 - 4.87) and lysine-vasopressin (6.02 - 6.04) was apparently not changed, at least not decreased, in the acute phase of inflammation indicating no impairment of receptor affinity of noradrenaline and vasopressin in inflammation. Blood vessel reaction is apparently influenced in inflammation mechanically by the increased tissue pressure as well as by molecular mechanisms consisting in the presence of inflammatory mediators and/or particularly in a reduced intrinsic sensitivity of the blood vessel muscle itself.