Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation.

Background And Purpose: After peripheral nerve lesions, surgical reconstruction facilitates axonal regeneration and motor reinnervation. However, functional recovery is impaired by aberrant reinnervation.

Materials And Methods: We tested whether training therapy by treadmill exercise (9 × 250 m/week) before (run-idle), after (idle-run), or both before and after (run-run) sciatic nerve graft improves the accuracy of reinnervation in rats.

The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on body involvement.

Background: A comprehensive system has been developed by the AO Classification Advisory Group to allow in-depth classification of scapular fractures for clinical research and surgical decision making. This paper evaluates a detailed classification system of scapular body fractures to better address the need for clinical relevance.

Methods: Seven experienced shoulder and orthopaedic trauma specialist surgeons participated in a follow-up series of agreement studies to specify and to evaluate the involvement of the body in scapula fractures.

The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement.

Background: Fractures of the glenoid frequently require surgical treatment. A comprehensive and reliable scapula classification system involving the glenoid fracture patterns is needed to describe the underlying pathology. The AO Scapula Classification Group introduces an appropriate novel system that is presented along with its inter-rater reliability and accuracy.

Midclavicular fracture: not just a trivial injury: current treatment options.

Background: Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants.

Transplantation of de novo scaffold-free cartilage implants into sheep knee chondral defects.

Background: New cell-based treatments for articular cartilage repair are needed. As the optimal scaffold for cartilage repair has yet to be developed, scaffold-free cartilage implants may remove the complications caused by suboptimal scaffolds.

Hypothesis: The implantation of a scaffold-free, autologous de novo cartilage implant into standardized full-thickness cartilage defects of femoral condyles in sheep leads to a qualitatively better regenerative tissue than does periosteal flap alone or no treatment.

Perilunate fracture-dislocations of the wrist: comparison of temporary screw versus K-wire fixation.

Purpose: Temporary intercarpal screw fixation has been suggested as an alternative to temporary K-wire fixation in the treatment of perilunate wrist dislocations. We compared the 2 treatment methods in 2 retrospective cohorts with a null hypothesis that there would be no difference in final wrist motion.

Methods: Eighteen patients with surgically treated perilunate wrist dislocations (9 treated with intercarpal screws, 9 with intercarpal K-wires) were evaluated an average of 44 months after injury.

Complete talar dislocation without late osteonecrosis: clinical case and anatomic study.

Avascular necrosis is a well-known, severe complication postfracture or subluxation of the talus. Type and localization of injury often permit conclusions regarding the probability of bone necrosis. In the following case, talar neovascularization was demonstrated after severe trauma, resulting in an open pilon fracture of the right tibia and complete talar dislocation with consequent destruction of the most relevant blood supply.

Malunion of the clavicle causes significant glenoid malposition: a quantitative anatomic investigation.

Objective: An experimental cadaver model was used to assess the effects of a malunited fracture of the middle third of the clavicle on the functional anatomy of the shoulder joint.

Method: Anatomic samples were prepared with simulated shortening and axial malposition of the clavicle. From these, alterations in glenoid fossa position were measured and depicted graphically.

The volar extension of the lunate facet of the distal radius: a quantitative anatomic study.

Purpose: To describe quantitatively the protrusion of the volar part of the lunate facet of the distal radius articular surface anterior to the volar metaphyseal cortex, which is susceptible to fracture and can be difficult to control with plates and screws alone.

Methods: Quantitative anatomic measurements of 48 3-dimensional computed tomography scans of the distal radius were analyzed to quantify the anatomy of the volar part of the lunate facet of the distal radius. The measurements were scaled to account for overall bone size.

Reduced collagen degradation in polytraumas with traumatic brain injury causes enhanced osteogenesis.

Patients with traumatic brain injury (TBI) and skeletal injuries have increased rates of excessive bone healing (EH = hypertrophic callus formation and/or heterotopic ossification). Polytrauma patients are often attributed higher rates of delayed fracture union. This study compares 182 total fractures in 29 isolated polytrauma patients (POLY) and 48 patients after TBI and polytrauma (TBI+POLY), examining the clinical parameters of EH versus delay.

Anatomy of the clavicle and the intramedullary nailing of midclavicular fractures.

Intramedullary fixation is used increasingly to treat clavicular fractures. Anatomical variations in the clavicle of relevance to this procedure are analyzed. The length, diameters and curvature of the clavicle were measured in 196 specimens from the dissecting room.

Augmentation of intraarticular calcaneal fractures with injectable calcium phosphate cement: densitometry, histology, and functional outcome of 18 patients.

Eighteen patients with intraarticular calcaneal fractures treated with open reduction and internal fixation and augmentation with an injectable carbonated apatite cement. Functional follow-up studies using the Zwipp Foot Score and densitometry were performed at 6-month intervals postoperatively. Histological samples of biopsies obtained at the time of hardware removal (6 months postoperatively) were also analyzed.

Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children.

This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 2001 for displaced diaphyseal forearm fractures with elastic stable intramedullary nailing. Forty-three patients included achieved excellent/good functional results at an average follow-up of 38 months. Four patients required open fracture-manipulation at surgery.

Degradation of poly-L/DL-lactide versus TCP composite pins: a three-year animal study.

Biodegradable polylactide implants allow secure fixation of osteochondral fractures. This quasirandomized parallel-group animal study investigates whether a composite implant of poly-L/DL-lactide (PLDLLA) with additional 10% beta-tricalcium phosphate produces an osteoconductive effect, whether the admixture positively influences implant degradation (assessed by comparing time to implant degradation), and whether the pin sites of degraded implants are replaced with bone tissue. On 36 medial femoral condyles of sheep, osteotomies were fixed with either three PLDLLA pins or three composite pins.

Dual mode of signalling of the axotomy reaction: retrograde electric stimulation or block of retrograde transport differently mimic the reaction of motoneurons to nerve transection in the rat brainstem.

Axotomy of a peripheral nerve causes a complex central response of neuronal perikarya, astroglia and microglia. The signal initiating this axotomy reaction is currently explained either by deprivation of target-derived trophic factors after interruption of transport (trophic hypothesis) or by electrophysiological disturbances of the axotomized neurons (electric hypothesis). In 108 adult Wistar rats we have compared the time course and intensity of the axotomy reaction in the hypoglossal nucleus after (1) resection of the nerve (permanent axotomy), (2) one-time electric stimulation (intact nerve, brief transient electric disturbance), and (3) colchicine block of transport (intact nerve, prolonged transient loss of trophic factors).

Immunologic alterations associated with high blood transfusion volume after multiple injury: effects on plasmatic cytokine and cytokine receptor concentrations.

The initial transfusion therapy after trauma has been identified as an independent risk factor for the incidence of multiple organ failure (MOF). Late occurrence of MOF in severely injured patients may be a clinical consequence of disturbed mediator homeostasis. For this reason, levels of interleukin (IL)-6, IL-10, and soluble tumor necrosis factor receptors (sTNFR) p55 and p75 were analyzed in the plasma of patients with comparable injury severity but with a different supply of packed red blood cells (PRBC).

Plasma levels of procalcitonin and neopterin in multiple trauma patients with or without brain injury.

Clinical and experimental evidence suggests that traumatic brain injury (TBI) leads to a systemic immune response. To examine whether TBI causes a release of procalcitonin (PCT) or neopterin (NT) into the circulation, we compared plasmatic mediator levels among multiple injured patients with or without TBI. In total, 98 trauma patients (24 with TBI only, 39 with extracranial injuries excluding TBI, and 35 with combined injuries) and 35 healthy volunteers were studied.

The clinical value of procalcitonin and neopterin in predicting sepsis and organ failure after major trauma.

We examined whether procalcitonin (PCT) or neopterin (NT) are useful in predicting sepsis, multiple organ failure (MOF), or death after multiple trauma (MT). In a prospective clinical study, a total of 137 consecutive trauma patients (mean age 39 years, median injury severity score [ISS] 27 points) and 34 healthy volunteers were enrolled. Blood samples were collected on arrival in the emergency room until day 28 after trauma.

Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail.

This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls.

Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase.

Background: Our knowledge about the bidirectional interactions between brain and whole organism after trauma is still limited. It was the purpose of this prospective clinical study to determine the influence of severe head trauma (SHT) as well as trauma in different anatomic injury regions on posttraumatic inflammatory mediator levels from patients with multiple injuries.

Methods: Thirty-five healthy controls, 33 patients with an isolated SHT, 47 patients with multiple injuries without SHT, and 45 patients with both SHT and multiple injuries were studied.