[Integration of porous hydroxyapatite ceramic prosthesis at the distal radius in elderly patients. Radiological examination]. / Integration einer porösen Hydroxylapatitkeramik am distalen Radius älterer Patienten. Radiologische Untersuchung.

Between April 1994 and December 1995 14 patients (average age 56 (41-71) years, 13 women, one man) suffering from a fracture of the distal radius (Extensionsfracture, type 1B by Pechlaner, AO-classification A2 and A3) were treated by minimal invasiv procedure. The bone defect was substituted with hydroxylapatit ceramic. In a prospective study the osteointegration of the alloplastic bone graft was evaluated radiographically and on MRI. Up to week 12 X-ray revealed a radiolucenty around the allograft in all patients. After 6 months trabecular structure reached the alloplastic bone graft in 57% of the patients. After one year the surface of the hydroxylapatit ceramic was remodelled in 36% of the patients. At this time MRI examination with contrast agent demonstrated marginal integration of the alloplastic bone craft in 71%. X-ray follow up showed stageable integration of the porous hydroxylapatit ceramic. MRI examination demonstrated partial osteointegration. Hydroxylapatit ceramic was incorporated in radial metaphyse of elder patients without any complications.

[First experiences with the trauma radiologic PACS project at the University of Innsbruck Department of Radiology]. / Erste Erfahrungen mit dem unfallradiologischen PACS-Projekt an der Innsbrucker Universität für Radiodiagnostik.

Radiography in an emergency setting is a demanding task, in technical as well as in logistical terms. Rapid acquisition of high quality radiographs under difficult conditions, for example severely injured patients with multi-organ trauma is important. All image data and radiological reports must be transmitted to the trauma surgeon as soon as possible. To meet these needs with the promising means of modern X-ray technology, we decided to implement a completely digital X-ray division inside the new outpatient trauma department. In the setting of an outpatient emergency department digital radiography and PACS cannot be realised without problems. We present our first experience with the installation and 10 month filmless routine in the X-ray division for traumatology outpatients at the university of Innsbruck department of radiology.

[Acute compartment syndrome of the lower leg after ankle joint sprain. A case report]. / Akutes Kompartmentsyndrom des Unterschenkels nach Sprunggelenkdistorsion. Ein Fallbericht.

In the field of traumatology, compartment syndromes of the lower extremity are often seen after fractures and direct injuries, or after ischaemia. Other causes include over-exertion and non-traumatic causes such as acute rhabdomyolysis, drug-induced myositis and eosinophilic myositis. This paper describes the clinical and MR course of a compartment syndrome following an ankle sprain.

The interface between ionomer cement and bone in the porcine cervical spine.

The interface between bone and ionomer cement has been studied in twelve young adult pigs 1-6 months after anterior cervical discectomy, removal of adjacent end plates and grafting of the bone defect with ionomer cement. Methods used to study the interface were fluorescence microscopy, scanning electron microscopy, electron microprobe analysis and radiological investigation. The interface in all animals consisted of collagenous tissue. The amount of collagenous fibres was related to the amount of residual movement within the motion segment: animals undergoing anterior plating after reconstruction of the bone defect presented with more or less compactly organized collagenous tissue. Sequential fluorochromic marking of osteoid formation revealed a vital bone bed around the interface but no signs of direct bone apposition to the ionomer cement plug. No signs of toxicity or graft rejection were noted. Ionomer bone cement contrary to experimental and clinical experience induces the formation of a connective tissue layer of different density in the porcine cervical spine.

[Current status of spinal injuries in winter sports]. / Stellenwert der Wirbelsäulenverletzungen im Wintersport.

Parallel with a marked escalation in the number of injuries of the skull, shoulder girdle and upper extremities in recent years, the incidence of spinal injuries has also intensified. This is due to an increase in speed and deceleration traumas, such as are particular to collision accidents. Of all patients with winter sports injuries at the Department of Traumatology at Innsbruck University Hospital, 4.9% have a spinal trauma. A retrospective ten-year study was undertaken to analyze the surgically treated spinal injuries out of overall winter sports injuries. Between 1982 and 1992 862 spinal injuries were surgically treated, 10.9% (94) of which were suffered in winter sports accidents. Of these winter sports injuries, 81.7% (76) were due to skiing accidents. The age group 15 to 25 years made up the largest contingent at 39.8% (37). Most spinal traumas (47.3%), whether suffered in winter sports or not, were located in the thoracolumbar region or the lumbar part of the spine, followed by 38.7% at the cervical vertebrae. Serious snowboard accidents are especially predestined for injuries of the cervical vertebrae. The age group 51 to 60 years also shows a trend to injure the cervical vertebrae; degenerative changes present in this age span cause a high percentage of accompanying neurological injuries. More than half (52.7%) of all surgically treated spinal injuries showed some loss or impairment of neurological function at the time of admission; 17.2% of these cases showed symptoms of a complete transverse lesion of the cord. 36% of all serious spinal injuries are accompanied by secondary injuries (such as craniocerebral trauma, thoracic trauma and other fractures).(ABSTRACT TRUNCATED AT 250 WORDS)

[The value of closed reduction of fractures of the lower thoracic and lumbar spine and computerized tomography follow-up]. / Die Wertigkeit der gedeckten Reposition bei Frakturen der unteren Brust- und Lendenwirbelsäule und ihre computertomographische Kontrolle.

The objectives of this prospective study were to investigate the value of the immediate closed reduction following fractures of the thoracolumbar and lumbar region. To reach that goal we performed a two stage CAT scan procedure before and after the reduction maneuver in a distinct patient population. The aim was not only to investigate the biomechanical process but also to evaluate and describe certain fracture types which have a good prognosis due to closed reduction according to posttraumatic spinal stenosis because of protruding posterior wall fragments and those who fail, respectively.

[The value of sonography in ruptures of the rotator cuff]. / Die Wertigkeit der Sonographie bei Rupturen der Rotatorenmanschette.

In 375 patients ultrasonography of the rotator cuff was carried out before operation. All the patients underwent acromioplasty, either alone or with additional repair of a full-thickness tear. The ultrasound findings were then compared with the intraoperative findings. Two hundred and seventy-two tears of the rotator cuff were seen on ultrasonography, and in 262 cases this was confirmed at operation. In 103 patients no rupture was diagnosed by ultrasound, but in 26 of these cases a full-thickness tear was detected on operation. These figures yield sensitivity of 91%, specificity of 89% and accuracy of 90%; the positive predictive value was 96%, the negative predictive value 75%. In most cases of incorrect evaluation the size of the tears was underestimated by ultrasonography.

Application of posterior plating and modifications in thoracolumbar spine injuries. Indication, techniques, and results.

Out of 281 patients with recent injuries to the thoracic and lumbar parts of the spine, 243 underwent posterior plating. Of these, 172 patients had an average follow-up of 3.2 years. The consecutive analysis of morphologic results led to modifications of the original Roy-Camille technique. In analogy to the system developed by Zielke for anterior derotation spondylodesis, plates were used in combination with VDS screws, threaded rods, and nuts, thus creating an implant with initial angle variability but final angle stability. The development of transpedicular reduction and cancellous bone grafting for the treatment of vertebral body fractures, later supplemented by transpedicular discectomy and intercorporal cancellous bone grafting, effected a significant improvement in the results of posterior plating. Although the use of traditional plating was followed by correction losses of 14 degrees, the loss could be reduced to less than 6 degrees by the new system, which nearly corresponds to the physiologic anatomy of the spine.

[Rotational deformities following pediatric femoral shaft fracture]. / Der Rotationsfehler nach kindlicher Oberschenkelschaftfraktur.

At the beginning of 1983 65 children who had been treated at our hospital for fractures of the femoral shaft could be followed-up both clinically and radiologically at an average of 29 months after the injury. The radiological examination was performed with special regard to the rotational deformity; the torsion was measured using Rippstein's method. Out of 65 patients, 19 patients showed a difference between the angles of antetorsion of more than 10 degrees (29.2%) which we considered to be "rotational malpositions" (8 patients with endorotational and 11 patients with exorotational deformities). 40% of all fractures localized in the proximal third of the femur were accompanied by a rotational deformity of more than 10 degrees as compared to the other side. Exactly 4 years later a second examination of antetorsion was made using the same methodical procedure. 18 out of the 19 patients with rotational malpositions and 2 patients with a difference between the AT-angles of exactly 10 degrees could be re-examined. The average correction in the overall population was 3.4 degrees (-10 degrees to +5 degrees). In 15 cases we found a decrease in the difference between the angles of antetorsion by 5.8 degrees on an average, 1 patient showed no change in the difference, and in 4 patients the difference had increased by 3 degrees on an average. In 7 of the 20 patients (35%) the difference between the angles of antetorsion was less than 10 degrees, whereas the rotational malposition persisted in 13 cases. The extent of correction was much larger in patients with exorotational deformities than in those with endorotational deformities. A very close relation could be seen between the age of the children and the extent of correction. Furthermore, rotational deformities caused by fractures of the proximal third of the femoral shaft showed significantly less tendency towards correction than fractures with a more distal location.