Mutational Studies of Aldose Reductase to Trace a Transient Pocket Opening and to Explain Ligand Affinity Cliffs.

Human aldose reductase, a target for the development of inhibitors for preventing diabetic complications, displays a transient specificity pocket which opens upon binding with specific, potent inhibitors. We investigated the opening mechanism of this pocket by mutating leucine residues involved in the gate keeping mechanism to alanine. Two isostructural inhibitors distinguished only by a single nitro to carboxy group replacement, have a 1000-fold difference in their binding affinity to the wild type.

Connection of a hip prosthesis and an intramedullary nail as a special solution in a subtrochanteric femoral fracture with fibrous dysplasia.

Treatment of fractures associated with fibrous dysplasia is difficult because of poor bone quality. In a brief report we present a case in which a hip prosthesis is connected with the distal part of a broken cannulated intramedullary femur nail. Postoperatively, the patient was mobilized with full weight bearing.

Effects of a WLAN-based real time location system on outpatient contentment in a Level I trauma center.

Background: Pre-existing wireless local area network (WLAN) infrastructures enable the implementation of a real-time location system (RTLS) in the clinical setting. RTLS enable clinics to capture and process patient position data and link it with clinical data. The improvements in workflow and treatment brought about by RTLS may improve patient satisfaction.

Improvement in the workflow efficiency of treating non-emergency outpatients by using a WLAN-based real-time location system in a level I trauma center.

Background: Patient localization can improve workflow in outpatient settings, which might lead to lower costs. The existing wireless local area network (WLAN) architecture in many hospitals opens up the possibility of adopting real-time patient tracking systems for capturing and processing position data; once captured, these data can be linked with clinical patient data.

Objective: To analyze the effect of a WLAN-based real-time patient localization system for tracking outpatients in our level I trauma center.

Development of a WLAN-based real time localization system for patient tracking in a Level I Trauma center.

Background: Patient tracking helps improve workflow, decrease wait times, optimize costs, and enhance medical treatment in the outpatient setting. In that regard, real-time patient tracking may serve as a potential way to perform efficient patient care. In recent years, the increasing popularity of wireless local area networks (WLANs) has led to a growing number of devices utilizing wireless fidelity (WiFi) networks.

Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta.

Objective: We report a case of multilevel spondylectomy in which resection and replacement of the adjacent aorta were done. Although spondylectomy is nowadays an established technique, no report on a combined aortic resection and replacement has been reported so far.

Methods: The case of a 43-year-old man with a primary chondrosarcoma of the thoracic spine is presented.

[Handling modern imaging procedures in a high-tech operating room].

Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s.

Navigated femoral shaft fracture treatment: current status.

Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision.

[The isocentric C-arm. Visualization of fracture reduction and screw position in the radius].

In addition to conventional C-arms which can be used for intraoperative imaging, C-arm image amplifiers with an option for three-dimensional imaging (ISO-C3D) are available to visualize reduction of fragments and positions of implants. In ten cadaver wrists intra-articular steps and intra-articular screw positions were simulated. Images obtained by conventional two-dimensional C-arm image amplifier, computed tomography and ISO-C3D were evaluated by four investigators using a questionnaire.

The aseptic femoral and tibial shaft non-union in healthy patients - an analysis of the health-related quality of life and the socioeconomic outcome.

Unlabelled: Long bone non-unions may lead to recurrent surgical procedures and in-hospital stays. Thus, restrictions of the health-related quality of life and of socioeconomic parameters might be expected. Knowledge of the impact on several parameters of professional life is sparse.

Are polymorphisms of molecules involved in bone healing correlated to aseptic femoral and tibial shaft non-unions?

Fracture healing is a well-organized process between several molecules and mediators. As known from other diseases, genetic polymorphisms may exhibit different expression patterns in these mediators. Concerning fracture healing, this may lead to an extended healing process or non-union.

Femoral malrotation after unreamed intramedullary nailing: an evaluation of influencing operative factors.

Objective: The objective of this study was to determine which clinical factors influence the presence and extent of femoral malrotation during unreamed nail insertion performed without a fracture table.

Design: Retrospective chart review.

Setting: Academic trauma center.

Femoral malrotation following intramedullary nailing in bilateral femoral shaft fractures.

Introduction: This study was designed to evaluate the incidence of femoral malrotation in bilateral femoral shaft fractures.

Materials And Methods: All closed bilateral femoral shaft fractures in patients aged 18 or over treated between April 2000 and December 2009 were included in the current study. All patients received a postoperative CT-scan to estimate femoral antetorsion and leg length.

Mechanical stability analysis of reference clamp fixation in computer-assisted spine surgery.

Background: Pedicle screw misplacement is a common complication, while 7% may result in neurological complications. Computer-assisted navigation improves the rate of ideally placed screws. Inappropriate reference marker attachment can cause major problems in the outcome and duration of surgery.

Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures.

Introduction: The standard treatment of femoral diaphyseal fractures is intramedullary nailing. Torsion error remains a largely unsolved problem. We hypothesized that femoral malrotation would change the coronal alignment of the lower extremity and the center of force (COF) in the tibiofemoral joint as compared to the native state.

[Surgical treatment of Achilles tendon rupture].

The open tendon suture is the most commonly used method of treatment for Achilles tendon rupture in Germany. Over the last decade the therapeutic spectrum of operative methods has been further enlarged by the development of new minimally invasive surgical techniques. Important criteria for planning treatment are the location and age of the rupture and comorbidities.

[Conservative treatment of Achilles tendinopathy].

Hind foot tendinopathies mainly involve the Achilles tendon. Color and Power-Doppler ultrasound visualizes pathological neovessels in painful tendons, which are associated with pain mediating nerve fibres. These neovessels are characterized by an increased capillary blood flow at the point of pain.

[Conservative functional treatment of Achilles tendon ruptures].

The conservative functional treatment of Achilles tendon ruptures has developed further over the last 20 years and is basically possible for 60-80% of patients. The treatment leads to success if the indications obtained by dynamic sonography are correctly interpreted (adaptation of the tendon ends up to 20 degrees plantar flexion), if the patient presents sufficient compliance and the physiotherapy is increasingly intensified depending on tendon healing. Modern ortheses allow an increased equinus position and therefore improved protection of the healing tendon.

[Surgical treatment for pain syndromes of the Achilles tendon].

Pain syndromes of the Achilles tendon (AT) include both insertional and non-insertional tendinopathy, two distinct disorders with different underlying pathophysiologies and management options, characterized by pain, impaired performance and swelling in and around the tendon. This article gives an overview of the operative treatment of pain syndromes of the Achilles tendon, including both insertional tendinopathy of the AT and tendinopathy of the main body of the AT. New minimally invasive techniques for the management of this condition, including endoscopy are also reported.

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy.

Background: Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously the leg during surgery.

Questions: The aim of the study is to evaluate the accuracy of CAS with respect to preoperative planning and postoperative deviation from the planned leg axis in HTO. In addition, the influence of surgeon experience as well as operation time and perioperative complications are analyzed.

Navigated reconstruction of a tibial plateau compression fracture post-virtual reconstruction: a case report.

Post-traumatic arthrosis is a common problem following tibial plateau fractures. Computed tomography (CT) with 3D reconstruction is essential in facilitating accurate analysis of the fracture type and depth of compression, but is typically only available pre- or postoperatively. Special reconstruction software tools, based on 3D imaging, have been developed.