[Intermediate and long-term outcome after total joint replacement for hallux rigidus : a retrospective analysis]. / Mittel- und langfristige Ergebnisse nach endoprothetischer Versorgung des Hallux rigidus : Eine retrospektive Analyse.

BACKGROUND: The treatment options for advanced hallux rigidus include arthrodesis, excision arthroplasty (Keller-Brandes) and joint arthroplasty and based on the literature, arthrodesis still appears to be the gold standard. In recent years, technical advances and higher patient demands have led to an increasing use of total joint replacement but comparative data on patient satisfaction and clinical outcome of different forms of treatment are rare. MATERIAL AND METHODS: Between 1995 and 2005 a total of 27 patients were treated with 28 joint replacements of the first metatarsophalangeal joint (MTPJ) in a surgical practice (Bio-Action Great Toe Implant, OsteoMed, Addison, TX). The mean age of the patients was 63.7 years. In a retrospective analysis patients were examined clinically and radiologically after a mean follow-up period of 8.8 years and asked about their satisfaction with surgical results using a questionnaire. RESULTS: After joint replacement 15 patients (53.6%) were free of pain, 8 (28.6%) reported marked improvement, 12 (42.9%) had no limitations in any activity and another 5 (17.9%) had no restrictions in activities of daily life. The maximum walking distance was improved in 21 patients (75%) and walking on rough ground in 24 (85.7%). Of the patients 11 (39.3%) had a good range of motion in the MTPJ, 13 (46.4%) reported a slight restriction, 24 (85.7%) were satisfied or very satisfied with the postoperative result and 22 stated that they would undergo joint replacement again. The results of the Wilcoxon test showed a significant increase in postoperative modified American Orthopaedic Foot and Ankle Society (AOFAS) scores compared with preoperative scores. There was loosening of the phalangeal component in 3 patients (11%), and 2 had to undergo revision. CONCLUSIONS: Many recent studies reported good to excellent long-term results of arthrodesis of the MTPJ for stage III and IV hallux rigidus. The results of this study suggest that similar results can be achieved by an experienced foot surgeon with total joint replacement in strictly selected patients.

Replacement arthroplasty for hallux rigidus. 21 patients with a 2-year follow-up.

21 patients underwent replacement arthroplasty of the metatarsophalangeal joint of the great toe. The indication for surgery was hallux rigidus in 16 patients and failed resection arthroplasty in 5 patients. The minimum follow-up period was 24 months. Clinical review showed an increased range of passive dorsiflexion from 10 degrees to 50 degrees postoperatively. 17 patients reported less pain or no pain and activity levels that were increased or maintained. Functional complications such as lack of toe purchase (n=5) or metatarsalgia (n=4) were successfully treated with orthotics.

[Ceftazidime with and without tobramycin versus azlocillin plus tobramycin in the therapy of bronchopulmonary infections in intensive care patients]. / Ceftazidim mit und ohne Tobramycin versus Azlocillin plus Tobramycin in der Therapie bronchopulmonaler Infektionen bei Intensivpatienten.

In a still ongoing open, randomized prospective trial the preliminary data of 50 intensive care patients on artificial ventilation were analysed. The evaluation included clinical and bacteriological efficacy and tolerance of ceftazidime alone or in combination with tobramycin versus azlocillin plus tobramycin. Artificially ventilated patients who had been treated in an intensive care unit for at least five days were selected to enter the study because of a high probability of colonisation with gram-negative bacteria. 16 patients were treated for bronchopulmonary infection with ceftazidime alone, and 17 each were treated with ceftazidime plus tobramycin or with azlocillin plus tobramycin. In the ceftazidime group nine patients were cured and three were improved (75% clinical success). Of the patients treated with ceftazidime plus tobramycin, 11 were cured and one was improved (75% clinical success); one patient died from very severe multiple trauma. In the azlocillin-tobramycin group, six patients were cured and two were improved (57% clinical success). Two patients from this group died from their underlying disease and another died from multiple organ failure due to septicemia.

[Arterial occlusions following Ender nailing of proximal femoral fractures]. / Zur Problematik der arteriellen Verschlüsse nach Endernagelung proximaler Femurfrakturen.

On assessing the 160 cases of nailing according to the method of Ender and Simon-Weidner ("Ender Nailing") during a five-year period we noticed three cases (1.8%) where arterial occlusion had occurred postoperatively on the operated side. The article describes the cases and discusses the possible aetiological factors and consequences which may result therefrom with regard to therapy. Particular attention is given to a discussion on the possible influence exercised by the form of thromboembolism prophylaxis.

[Roentgenologic aspects of bone healing in pathological fractures]. / Röntgenologische Aspekte der Knochenheilung bei pathologischen Frakturen.

Under operative or non-operative treatment bone healing of pathological fractures acts the same way as in case of traumatic fractures which is shown by several examples. Depending on the degree of the fracture stability the response of bone is either primary or secondary healing reaction.