[The acquired flatfoot: mid-term results of the medial displacement calcaneal-osteotomy with flexor digitorum longus transfer]. / Der erworbene Plattfuss: mittelfristige Ergebnisse der medialisierenden Kalkaneusosteotomie mit Flexor digitorum longus-Sehnentransfer.

AIM: The present retrospective study investigates the mid-term results after medial displacement calcaneal osteotomy combined with flexor digitorum longus transfer for the treatment of acquired flatfoot deformity due to posterior tibial tendon insufficiency at stage II (Johnson and Strom Classification). METHOD: 30 feet in 29 patients (6 male, 23 female) with an average age of 58 years (from 43 to 68 years) had surgery between 1995 and 2001. All feet were examined at an average follow-up of 58.5 months (range 35-97 months) and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score. RESULTS: The average AOFAS-Score was 88.8+/-10.7 points (range 48 to 100) at final follow-up. The AOFAS-pain-subscale score was 34+/-6.2 points. At the latest follow-up were 14 feet (47%) painfree, 14 feet (47%) noted mild pain and 2 feet (6%) had daily pain. One foot (3%) had pain due to subluxation of the musculus flexor digitorum longus tendon, in another one pain was caused by a contract Chopart joint (3%). Further complications were painful prominent hardware (17%) and neuralgia of the sural nerve (7%). CONCLUSION: The authors conclude that the combination of the medial calcaneal displacement osteotomy with flexor digitorum longus transfer may provide optimal results in patients with adult acquired flatfoot deformity and posterior tibialis tendon dysfunction.

[Intermittent compression devices for swelling reduction and thrombosis prophylaxis--a pilot study after total hip replacement. Is the 2 hour daily minimum application sufficient?]. / Die intermittierende Impulskompression zur Abschwellung und Thromboseprophylaxe--Pilotstudie nach Hüft-TEP. Ist die Minimalanwendungsdauer von 2 h täglich ausreichend?

BACKGROUND: The use of intermittent compression devices for thrombosis prophylaxis and the reduction of postoperative swelling are widely accepted. The recommended minimum application of 2 h daily has never been statistically verified. Without evidence based data, the benefit of this costly equipment cannot be maximized. PATIENTS AND METHODS: A randomized clinical trial on 41 patients after total hip replacement was performed. The A-V Impulse System was applied for 2 h a day during the first 5 postoperative days to observe whether this time was sufficiently effective. RESULTS: In the control group, two deep vein thromboses occurred postoperatively, but there were none in the treatment group. Even though two patients from the treatment group had to be excluded from the study because of severe pain, all other parameters including visual analogue pain scale results and limb circumferences were comparable in both groups. CONCLUSION: These preliminary results suggest that pump systems can prevent deep venous thrombosis after hip surgery even when applied for only short intervals over a short period of time. However, large scale confirmatory studies are needed.

[Stress fractures of the tarsal navicular bone. Causality, diagnosis, therapy, prophylaxis]. / Die Stressfraktur des tarsalen Os naviculare. Ursache - Diagnostik - Therapie - Prophylaxe.

Stress fractures of the tarsal navicular bone are a challenge in diagnosis and therapy. First and foremost you have to think about this fracture. The origin of the injury can be detected in a wrong or too heavy strain of the bone especially in long distance runners and recruits. The MRI is the diagnostic tool of first choice. Therapy of displaced or comminuted fractures as well as pseudarthrosis is best done with surgical procedures like direct screw fixation or interposition of autologous bone depending on the circumstances and the age of injury. Conservative treatment with a plaster of Paris is useful in non-displaced and non-comminuted fractures. Prophylaxis with technical aids and a changing habits is recommended.

[Prevention of epidural fibrosis. Initial experiences with non-resorbable membrane]. / Prävention der epiduralen Fibrose. Erste Erfahrungen mit einer nicht resorbierbaren Membran.

Scars around the neural structures after opening the spinal canal are common and severe problems in spine surgery. This paper presents the use of a special membrane to avoid epidural scarring in two cases.

[Airlimb. Initial experiences with a new immediate early management prosthesis with individually adjustable air chambers]. / Airlimb. Erste Erfahrungen mit einer neuen Sofort-Frühversorgungsprothese mit einzeln ansteuerbaren Luftkammern.

Amputations of the lower extremity are still a common problem in diabetic feet and peripheral vasculopathies. The presented paper introduces a new device for an easier and faster mobilization of below-the-knee amputees. It is based on a new modular prostheses with individual inflatable air bladders. The compliance rate is higher with this device and it could be used from the day of surgery until the definitive prostheses is made. A biomechanical cadaver study with the prostheses will also be presented.

The post-discectomy syndrome. Aetiology, diagnosis, treatment, prevention.

The post-discectomy syndrome (PDS) is a common diagnosis in patients with problems following a disc operation. The different causes of PDS make the establishment of the correct diagnosis and its corresponding efficient treatment difficult. A general overview published in the bibliographical data covering the entity of PDS is rare. The following paper aims to specify PDS according to its aetiology, diagnosis, treatment and prevention. The diagnosis should be made efficiently, so that the patient can receive prompt adequate therapy.

[Post-traumatic metatarsalgia. Early results of treatment with a new insole]. / Die posttraumatische Metatarsalgie. Erste Behandlungserfahrungen mit einer neuen Einlage.

Injuries of the forefoot are a challenge for orthopaedic surgeons. After healing of bone and soft tissue damage, posttraumatic metatarsalgia can persist. The paper presents a therapy algorithm with newly designed insoles, which consist of the common orthopaedic adaptations like a rocker bottom and a stiffening of the sole. The therapy is shown on two cases. With these orthotics adequate is possible and pain relief realistic.

[Vascular lesions in surgery of the hip joint]. / Gefässläsionen in der Hüftgelenkchirurgie.

The vascular anatomy in the acetabular region involves a certain risk of arterial and venous injuries complicating orthopaedic surgery. These complications have been grouped into four categories: lacerations, thrombosis, pseudoaneurysms and arteriovenous fistula. In a period of 5 years, three injuries of the external iliac artery and four lesions of the femoral artery associated with total hip arthroplasty were treated surgically at the Department of Vascular Surgery of the University Hospital in Graz. In one case a concomitant lesion of the pelvic vein was observed. The incidence of iatrogenic vascular injuries in total hip surgery is 0.3%. Combined injury of the external iliac artery and vein led to a life-threatening bleeding complication. The vascular lesion became manifest as acute ischaemia of the lower extremity or as an acute haemorrhage 30 min to 2 h after primary surgery. The late complication of a false aneurysm of the femoral artery occurred in one patient 3 weeks after total hip replacement. Reconstruction of the vascular lesions was performed by direct suture, except that two arterial lesions required the use of polytetrafluoroethylene (PTFE) vascular grafts. Vessels in the pelvic region are at high risk if screw fixation acetabular components are used. Perforation of the iliac artery by protruded methylmethacrylate polymer components of cement has been documented. The obturator vessels are in a vulnerable position if the acetabular floor has been broached by operative instruments or eroded by loosening of the prosthesis facilitated by osteoporosis, steroids or sepsis. Femoral vessels are endangered by Hohmann retractors that are not placed directly on bone. Though vascular injury during hip operations is rare, recognition of such complications is important as safe and satisfactory treatment can be achieved. Rapid identification and immediate surgical repair of these lacerations are essential for their management.