[Therapy-resistant periprosthetic abscess of the hip of unknown cause]. / Therapieresistente periprothetische Abszedierung der Hüfte unklarer Ursache.

Two months after total endoprosthesis of the hip (Spotorno) a 60-year-old obese female patient complained about increasing hip pain. Costly diagnostic measures could not clarify the cause. Analgesic therapy administered with local cortisone injections was not satisfactory. Upon deterioration of her general condition the patient was hospitalized. A periprosthetic abscess of the hip with atypical muscle necrosis could not be controlled after several interventions. Computed tomography of the abdomen and hip revealed a jejunoacetabular fistula after mesenteric perforation with small intestine diverticulosis. It seems to be the first published case. After abdominal and hip surgery the further course was good. There was no need to replace the prosthesis. Retroperitoneal abscess with purely coxal symptomatology has been described. Diverticulitis of the small intestine has a poor prognosis. When infections with unusual necrosis resistant to therapy after hip prosthesis surgery occur, consideration must be given to retroperitoneal abscess. Abdominal tomography allows the life-saving surgery.

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.

[Pertrochanteric femoral fracture in elderly patients--injury pattern and management with gamma nailing]. / Die peritrochantere Femurfraktur im Alter--Verletzungsmuster und Versorgung mit der Gammanagelung.

A group of 128 elderly patients (> 75 years) suffering from peritrochanteric fractures of the femur were treated by the gamma nailing procedure. Results were 81% very good to good and 7% fair. The lethality rate was 8% for the first 4 months. No cases of deep infection, no fractures of the femur following nailing, and no problems with the lag screw were noticed.

[Injuries of the bifurcate ligament]. / Die Verletzung des Ligamentum bifurcatum.

The bifurcate ligament is a central stabilizer of the carpus. It is the one of the structures concerned in chain of fibular injuries in supination traumas. Damage to the bifurcate ligament is often missed in clinical and radiological diagnosis. Hints are given on the mechanism of injury, staging and graded treatment of this ligamentous injury.

[Soft tissue swelling in sports traumatology. Comparative study of the effectiveness of 2 ointments]. / Die Weichteilschwellung in der Sporttraumatologie. Vergleichsstudie zur Wirksamkeit zweier Salbenpräparate.

An open randomized study design was used to compare the soft-tissue swelling in patients with fibular capsule injuries under therapy with Chomelanum (preparation A), Lasonil (preparation B) and ointment base of Chomelanum (preparation C). 90 patients were selected for participation in the study, and the results of 85 patients were available for evaluation. Concerning the initial condition there was no significant difference between the three therapy groups of the study. Assessment criteria were the difference of circumference in plane of ankle joint (injured/uninjured side) and the difference of soft-tissue above lateral malleoulus in sonography. The study showed that preparation A had a significantly larger influence on soft tissue detumescence than preparation B- and B larger than C. In observation period all patients of group B and C still showed soft tissue swelling. Between third and fourth day of treatment half of patients in group A did not need any treatment because of complete detumescence. In all assessment criteria significant differences in favor of preparation A were observed.