[Prevention of heterotopic ossification by radiotherapy following total hip prosthesis]. / Verhinderung ektoper Ossifikationen nach Totalendoprothese des Hüftgelenks durch Strahlentherapie.

BACKGROUND: Clinically relevant heterotopic bone formation (HBF) following total hip arthroplasty (THA) occurs in about one third of all high risk patients. HBF can reduce the functional result of surgery by pain and limited range of motion. The experience with patients treated with postoperative radiation therapy after THA with or without removal of HBF is reported. PATIENTS AND METHOD: Between November 1986 und June 1993, postoperative irradiation was performed on 238 hips of 216 patients (117 men, 99 women, median age 66 years, range 38-86 years) with defined risk factors using 10 Gy in 5 fractions (n = 176) or 7 Gy in one fraction (n = 62) with a cobalt unit. In general, irradiation was performed during the first four postoperative days after primary THA alone in 182 hips or removal of HTB in 56 hips with (n = 28) or without (n = 28) revision surgery. Risk factors for HBF were preexisting ipsi- or contralateral HBF in 105 hips (group 1) or hypertrophic osteoarthritis, previous operative procedures of the hip and others in 134 hips (group 2). After a follow-up of at least 6 months patients were examined and radiographs of the hip were performed to classify HBF. RESULTS: New or progressive ossifications had developed in the interval in 15 of 104 hips of group 1 (14.4%), compared with 19 of 134 hips in group 2 (14.2%). Clinically significant new HBF (grade 3 or 4) occurred in none of group 2, and in 3 hips of group 1 (2.9%). After radiation with 10 Gy HBF of all grades occurred in 23 of 176 hips (13.1%), and in nine of 62 hips after 7 Gy (14.5%). The lowest number of treatment failures was found in patients irradiated during the first 4 postoperative days. CONCLUSION: These results demonstrate that immediate postoperative radiation is efficacious for prevention of clinically relevant HBF following THA and removal of HBF.

[Highly malignant telangiectatic osteosarcoma. Long-term follow-up]. / Hochmalignes teleangiektatisches Osteosarkom. Langjährige Verlaufsbeobachtung.

The teleangiectatic osteosarcoma is an extremely malignant tumor of the bone with rapid progression and short time of survival. In a 57 y.o. male such a tumor in the right proximal femur was diagnosed. Previously for 13 years a cystic bony lesion was known and followed in consequent intervals radiologically and clinically. There was no change in appearance till all at once malignant change developed. Systemic bone disease as ethiopathogenetic factor (e.g. ostitis deformans Paget) could be excluded. This case demonstrates an uncommon development of a teleangiectatic osteosarcoma out of a radiologically benign bony cyst, consequently followed for 13 years.

[Standardized shoulder examination with reference to computerized isokinetic strength testing (Cybex II)]. / Standardisierte Schulteruntersuchung unter Berücksichtigung der computerisierten isokinetischen Kraftmessung (Cybex II).

The complexity of shoulder movement makes it difficult to test normal or pathological shoulder function, as well as therapy results after injury. There are also problems to classify therapy results and to compare those with the results of other persons or other treatment methods. The aim of this paper is to introduce a standardised examination method of the shoulder and a standardised score regarding "subjective feelings", "clinical examination", "technical examination" such as x-ray, CT, sonogram, and "computerised isokinetic strength test", which enables us to conduct a follow-up case study of different patient groups after shoulder injury. Standardised examination programmes of the most common shoulder injuries like AC separations, rotator-cuff tears and luxations of the shoulder are given in this paper. A retrospective study of surgically treated AC separations Type III at the Staatliche Orthopädische Klinik München/Harlaching showed that therapy results can be established with the help of this score. The efficacy of different treatment methods (e.g. Bosworth and tension-band wire) can be both elucidated and compared.