[New assessment recommendations for disability in private accident insurance, part 4 : An interdisciplinary consensus approach-Disability outside the compensation scheme]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 4 : Ein fachübergreifend konsentierter Ansatz ­ Invalidität außerhalb der Gliedertaxe.

The following article is an element of a 4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.

[New assessment recommendations for disability in private accident insurance part 3 : An interdisciplinary consensus approach-Lower extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 3 : Ein fachübergreifend konsentierter Ansatz ­ untere Extremitäten.

The following article is an element of a 4-part series on the presentation and discussion of new assessment recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations of the upper extremities have already been published in Die Unfallchirurgie (previously Der Unfallchirurg) on 17 February and 31 August 2022 [2, 3]. The topic of the third part published here is the assessment recommendations for disability in the lower extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 2 : An interdisciplinary consented approach-upper extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 2 : Ein fachübergreifend konsentierter Ansatz ­ Obere Extremitäten.

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 1 : An interdisciplinary consented approach-Basics]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 1 : Ein fachübergreifend konsentierter Ansatz ­ Grundlagen.

The centerpiece of a private accident insurer is the benefit promise in cases of disability, which must be determined by a doctor in due time. The insurer specifies the rates of the compensation scheme for loss or inability to function and the medical expert must then fall back on generally recognized, revised or updated assessment recommendations in order to be able to apply the given framework to the specific, individual situation of the insured person. In four steps (basics, upper and lower extremities [disability within the compensation scheme] and disability outside the compensation scheme) interdisciplinary consensus benchmarks for disability assessment are presented, which should form the basis of a uniform medical assessment of accident-related functional disorders in private accident insurance compensation.

[Intraoperative 3D imaging : Diagnostic accuracy and therapeutic benefits]. / Intraoperative 3­D-Bildgebung : Diagnostische Genauigkeit und therapeutischer Nutzen.

Intraoperative 3D imaging has a marked impact on the surgical treatment of articular fractures. In theory, insufficient reduction of fracture fragments and malpositioning of implants can be corrected in the same session so that unnecessary secondary imaging and revision surgery can be avoided. Current evidence on the accuracy of 3D scans, however, relies on heterogeneous preclinical data and must be interpreted with caution. Every fourth 3D scan seems to lead to a repositioning of fracture fragments or implants, despite unproven sensitivity and specificity. The interaction between diagnostic accuracy and therapeutic consequences needs exploration before any conclusions on the (additional) benefits of intraoperative 3D imaging can be drawn.

[Design of distal radius volar locking plates : Anatomical, surgical and biomechanical aspects]. / Design distaler volarer Radiusplatten : Anatomische, operationstechnische und biomechanische Gesichtspunkte.

The operative treatment of unstable distal radius fractures primarily aims for the anatomical reduction of the joint while addressing accompanying injuries. Anatomical reduction, stable fixation and early functional movement of the joint are the three cornerstones of modern treatment concepts of distal radius fractures. Distal radius volar locking plates play a major role in the treatment and rehabilitation of the most commonly occurring fracture in humans. This article outlines the different principles in the current design of available distal radius volar locking plates. The biomechanical aspects, anatomical findings and clinical evaluation that have influenced current design features and trends in new developments of the latest plates are emphasized. This is an ongoing process that is supported through the investigation and feedback of clinical science.

[The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery]. / Die klinische Wertigkeit des ISO-C(3D) bei der Osteosynthese des Fersenbeins.

We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.

[Intraoperative imaging with the ISO C(3D)]. / Intraoperative Bildgebung mit dem ISO C(3D).

Computed tomography (CT) scanning is the gold standard for displaying and visualizing complex anatomic structures such as the calcaneus, pelvis, and spine, etc. In orthopedic surgery CT scanning is unfortunately not available in the OR where it would be highly effective if scans could be done prior to wound closure. The reasons are high costs, need for constructional changes in the OR, and additional staff (radiologic technologist), etc. For the first time the ISO C(3D) enables the surgeon to generate multiplanar reconstruction (MPR) pictures during surgery within an acceptable time frame at a reasonable price with a familiar instrument (a modified C-arm). Since February 2001 we have been able to use the ISO C(3D) in our hospital and meanwhile we have scanned 442 surgical sites including the calcaneus, cervical spine, and acetabulum, etc. The intraoperative scans revealed fracture gaps and steps, unsatisfactory fragment alignment, or incorrectly positioned implants, leading to an overall revision rate of 7.3%The ISO C(3D) is a first step towards a new future for bone visualization. The next steps will bring an increase in scan area and resolution, and the high-contrast pictures will be replaced by ones very similar to modern CT slices showing certain soft tissue structures.

[Shoulder joint endoprosthesis in the treatment of multiple fractures of the humeral head. Development and value]. / Schultergelenkendoprothetik in der Behandlung von Humerkuskopf-Mehrfragmentfrakturen. Entwicklung und Stellenwert.

Fractures of the humeral head are still challenging to decisions of indications, surgical skills and physiotherapy. 3- and 4-part-fractures of the humeral head in younger adults are still dominated by reconstructive osteosynthesis. New developments in osteosynthesis materials allow the surgeon to make use of minimal invasive techniques more often. Treatment of elderly patients with these injuries has changed within the last years. When it is obvious that the goal of a stable osteosynthesis can not be reached, shoulder prosthesis has become a primary treatment in elderly patients. New designs in shoulder prosthesis seem to lead to better functional results.

[Early death of the severly injured patient--A retrospective analysis]. / Die Frühletalität des Schwerstverletzten - Eine retrospektive Ursachen-Analyse -

With 44.9 % trauma is the main cause of death in men under 40 years. From September 3(rd) 1997 to June 30(th) 1998 174 patients with severe injuries or polytrauma were treated in our hospital. The mean ISS was 29 (18-75). 15 (8.75 %) patients died within the first 24 hours. The mean age was 34.5 (2-85) years. The mean ISS of these patients was 48 (25-75). In a retrospective study we analyzed the pattern of injury as well as the preclinical and clinical management. The fact that orthopedic surgery still has got a poor position within the patient's satisfaction-scale and that 15 of 174 analyzed patients had to die within the first 24 hours points out the importance of internal and external quality improvement measurements.

Testosterone is required for corticosteroid-binding globulin upregulation by morphine to be fully manifested.

We previously reported that morphine increases the concentration of corticosteroid-binding globulin (CBG) in blood of male, but not female, rats. This pronounced sexual dimorphism suggested that CBG upregulation by morphine might be androgen-dependent. In the current studies, we found that castration, whether performed just before or just after puberty or in adulthood, increased the concentration of CBG in adult male rats. Naltrexone did not prevent this increase and, therefore, it does not appear to be attributable to the release of endogenous opioids. Exposure to morphine for 1 week in adulthood increased ( approximately 100%) the concentration of CBG in intact, i.e., sham-castrated, males. The CBG levels of castrated rats treated with morphine did not differ from those of intact rats treated with morphine. However, because castration increased the concentration of CBG, the difference between the placebo and morphine groups decreased with time after castration. At 4 weeks after castration, the difference between the morphine and placebo groups (19%) was no longer statistically significant. Testosterone replacement prevented the rise in CBG levels following castration and maintained the magnitude of the difference between placebo and morphine-treated rats within the normal range. Thus, testosterone appears necessary for morphine effects on CBG to be fully manifested.

[Multidimensional corrective osteotomy of the distal femur using a retrograde femoral nail]. / Mehrdimensionale Korrekturosteotomie des distalen Femur unter Verwendung des retrograden Femurnagels.

We report the case of a 62-year-old woman with marked valgus and limitation of extension of the right knee joint as the result of a supracondylar fracture of the femur, originally treated by internal fixation with a dynamic condylar screw. Two years later, revision osteotomy with retrograde femoral nailing was carried out to achieve variation and improve extension. Within a week of operation the patient's right leg was fully weight bearing with normal axial positioning. A retrograde locking nail provides satisfactory and stable internal fixation in cases of revision.

Chronic exposure to morphine decreases physiologically active corticosterone in both male and female rats but by different mechanisms.

We previously reported that chronic exposure of male rats to morphine markedly increases the concentration of corticosteroid-binding globulin (CBG) in blood. This in turn appears to greatly reduce the amount of corticosterone available to intracellular receptors. In the study reported here, we found that in contrast to the effect in males, morphine has no apparent effect on CBG in females. This pronounced sex difference does not appear to be attributable to differences in morphine pharmacokinetics, short-term actions of gonadal hormones in adulthood or sex differences in CBG or corticosterone levels. In any case, it is evident that morphine does not decrease the level of physiologically active corticosterone through CBG in females as it appears to do in males. On the other hand, we also found a distinct sex difference with regard to the effects of morphine on corticosterone. Chronic exposure to morphine had no apparent effect on corticosterone levels in males but resulted in markedly lower levels in females. Thus, morphine appears to cause a deficit in physiologically active corticosterone in both sexes but by different mechanisms.

[Multidimensional corrective osteotomy of the proximal femur using the gamma-nail]. / Mehrdimensionale Korrekturosteotomie des proximalen Femurs unter Verwendung des gamma-Nagels.

We report on a 57-year-old patient suffering from a complex malposition of proximal femur after osteosynthesis using a condylar plate. For polyaxial correction of the proximal femur we successfully used an intramedullary hip screw system.

Chronic exposure to morphine increases corticosteroid-binding globulin.

Although it appears that corticosterone may play an important role in determining vulnerability to drugs of abuse, few studies have examined drug effects on factors that affect corticosterone efficacy. Thus, studies were carried out to assess the effects of morphine on corticosteroid-binding globulin (CBG), the major glucocorticoid binder in blood. Since CBG-bound hormone is thought to be physiologically inactive, changes in CBG levels could affect corticosterone action independently of hormone levels per se. We found that morphine caused a marked naltrexone-preventable increase (approximately 160%) in CBG in adult male rats. Elevated levels were seen by three days and were maximal at seven days after morphine pellet (75 mg) implantation. CBG levels remained elevated while morphine was detectable in blood and returned toward normal as the drug cleared from the system. A single morphine pellet was sufficient to induce a marked increase in the concentration of CBG and two or more pellets caused maximal upregulation. Baseline and stress levels of total corticosterone (bound and unbound) were normal after chronic exposure to morphine. However, due to the elevated level of CBG, the amount of free, physiologically active hormone was dramatically reduced. These results suggest that morphine may exert potent effects on corticosterone action that are not revealed by measurement of corticosterone alone. Furthermore, the increase in CBG resulting from chronic exposure to morphine might contribute to the perpetuation of drug use and to adverse effects of drug exposure by impairing normal functions of corticosterone.

Extracti-Gel D chromatography is a simple, efficient method for removing digitonin during receptor purification: application to the kappa 1 opioid receptor.

Digitonin is widely used for extracting active neurotransmitter receptors from membranes. However, its low critical micellar concentration has made its removal from samples problematic. Here we report that digitonin can be efficiently removed (> 90%) from solution using Extracti-Gel D, a detergent-absorbing matrix. Active kappa 1 opioid receptors solubilized from brain survive Extracti-Gel D chromatography with a recovery of 50-55% and 25% dilution by added volume. The loss of receptor and the dilution, however, are compensated for to a large extent by the disinhibition of binding that results from the removal of digitonin. Extracti-Gel D chromatography had little or no effect on the apparent equilibrium dissociation constant for [3H]U-69,593 binding to the kappa 1 receptor. We conclude that Extracti-Gel D column chromatography is a simple, highly efficient and practical method for markedly reducing the concentration of digitonin in biological samples. Application of the procedure should allow characterization of digitonin-solubilized receptors with minimal complications from bound digitonin and extend the usefulness of digitonin to studies going beyond the initial stages of receptor purification.