Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management: The INSITE Randomized Clinical Trial.

Importance: Fractures of the hip have devastating effects on function and quality of life. Intramedullary nails (IMN) are the dominant implant choice for the treatment of trochanteric fractures of the hip. Higher costs of IMNs and inconclusive benefit in comparison with sliding hip screws (SHSs) convey the need for definitive evidence.

Clinical pathways for geriatric patients with proximal femoral fracture improve process and outcome.

Objective: The objective of the current study was to evaluate the implementation of clinical pathways (CPs) in hip fracture management.

Methods: Six hundred and five proximal femoral fractures were prospectively included into a hospital data-base. The effects of CPs were evaluated using a pre-during-post design.

Continuous improvement process: ortho-geriatric co-management of proximal femoral fractures.

Objective: The objective of the current study was to evaluate the effect of a quality management system on treatment and care delivery of proximal femoral fractures. Specifically, our hypothesis was that the "plan-do-check-act (PDCA)" philosophy of the ISO 9001 quality management system results in a continuous improvement process.

Methods: 1015 proximal femoral fractures were prospectively included into a hip fracture database over a 5-year period, after a restructuring process with implementation of clinical pathways and standard operation procedures.

Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment.

Background: The interpretation of CT scans for the evaluation of calcaneal fractures is difficult. Three-dimensional (3D) reconstruction (volume rendering technique [VRT]) has been valuable in the evaluation of irregularly shaped bones. However, their value for the analysis of calcaneal fractures is still debated.

[Modified Pirogoff's amputation].

Objective: The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel.

Indications: Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities.

Contraindications: Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel.

[Amputation and exarticulation of the lesser toes].

Objective: Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role.

[Orthotic Supply after Complex Trauma of the Foot].

Background: After complex trauma of the foot, patients frequently need orthotic care. There have been no systematic studies on the quality of care or patient satisfaction. Therefore the goal of this study was to evaluate patient satisfaction and the quality of orthotic care.

Bionic plate design for calcaneal fracture treatment. A biomechanical analysis and first clinical results.

Purpose: Calcaneal fracture treatment is challenging. Implant failure is one problem encountered with plate osteosynthesis. Therefore a new "bionic" plate was developed, which imitates the trabecular orientation of the human calcaneus.

[Unrecognised dissociation of the bipolar hip prosthesis Avantage® (Biomet®) after closed reduction of a dislocation: a rare complication].

An 84-year-old female patient was admitted to our emergency department with a periprosthetic fracture of the left femur with an implanted Avantage prosthesis (Biomet®). Conventional X-ray images revealed besides the fracture a lateralisation of the prosthesis stem. An additional CT scan showed a dissociation of the polyethylene inlay from the head of the prosthesis which took place 3 years ago in the course of a closed reposition of a postoperative luxation.

Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years.

Background: Prospective evaluation of atlanto-occipital dissociations (AODs) at a level 1 trauma centre within 5 years.

Methods: Over a period of 5 years (2005-2009), all CT scans of the skull base and the upper cervical spine due to traumatic injuries were prospectively entered into a database. Furthermore, in cases of confirmed AOD all empirical data were prospectively collected.

Occipital condyle fractures. Prospective follow-up of 31 cases within 5 years at a level 1 trauma centre.

Purpose: Prospective investigation of incidence and outcome of occipital condyle fractures (OCF) in a level 1 trauma centre.

Methods: Over a period of 5 years, we prospectively recorded all cases of OCF, and performed a 1-year post-injury radiological and clinical follow-up using CT imaging, SF-36 and Neck Disability Index, respectively.

Results: A total of 31 patients with OCF were identified.

How reliable are CT scans for the evaluation of calcaneal fractures?

Introduction: CT scans are deemed to be the gold standard for the evaluation of calcaneal fractures. However, the reliability of the interpretation has not been studied systematically.

Patients And Methods: In a prospective multicenter study, the CT data set of five different fractures was presented to 57 evaluators.

Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature.

Introduction: Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients.

Case Presentation: We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt.

Conclusion: Fat embolism syndrome may occur as a fulminant complication following femoral fracture repair in the presence of a concomitant atrial septal defect with right-to-left shunt.

Outcome after complex trauma of the foot.

Background: In 1997, H. Zwipp. proposed a 5-point scoring system for the classification of complex trauma of the foot.

Calcaneocuboid joint involvement in calcaneal fractures.

Background: The reported incidence of calcaneocuboid joint (CCJ) involvement in calcaneal fractures varies considerably. It is largely unknown to what extent CCJ involvement accounts for outcome in these fractures. Therefore, the goal of this study was to analyze the incidence and effects of CCJ involvement in calcaneal fractures.

[Sports and activities after achilles tendon injury of the recreational athlete].

Background: There is abundant literature on the treatment of Achilles tendon rupture; however data on sports and recreational activities after this injury is scarce.

Patients And Methods: 71 patients were assessed in a prospective cross-sectional study after an average of 3 years after Achilles tendon rupture. 44 patients were treated non-operatively, using a functional algorithm, and 23 patients were treated operatively.

Influence of the growth factors PDGF-BB, TGF-beta1 and bFGF on the replicative aging of human articular chondrocytes during in vitro expansion.

Decreasing replicative potential and dedifferentiation of articular chondrocytes during expansion in cell culture are essential limitations for tissue engineering and cell therapy approaches. Telomeres and telomerase play a key role in cell development, aging, and tumorigenesis. There is evidence that growth factors are involved in regulating telomerase activity.

The use of 'fasciocutaneous' and 'osteofasciocutaneous' parascapular flaps for lower limb reconstruction: a retrospective study of 20 patients.

Background: The parascapular flap is a widely accepted and suitable option for covering defects in almost all anatomical areas. Here, we report our experience with the microvascular transfer of parascapular flaps for the coverage of large lower leg defects with reference to our retrospective study.

Patients And Methods: Twenty patients with free parascapular flaps (17 male, three female, age: 43+/-17 years, BMI 26.

Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot.

Background: Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible.

A woman with a dangling digit.

Ainhum (dactylolysis spontanea) is a distinct clinical and radiological disorder of dark-skinned people characterized by a progressive development of a constricting band encircling the toe which usually results in spontaneous amputation. Ainhum mainly occurs in African natives, but in times of global migration and tourism, Ainhum is likely to be more often encountered outside Africa. Even though the clinical presentation can mimic more common entities such as arthritis and trauma, the correct diagnosis and treatment is easy if one knows this unusual entity.

Functional donor-site morbidity following (osteo-) fasciocutaneous parascapular flap transfer.

Problem: The parascapular flap is extremely versatile in the armamentarium of the plastic surgeon. However, little is known about the donor-site morbidity. Our purpose was to investigate limitations and problems arising at the donor site of parascapular flaps.

[Plantar Lisfranc dislocation fracture].

We report a 30-year-old patient suffering a plantar dislocation fracture after he dropped a heavy weight on his foot. The patient was treated immediately after diagnosis was secured by CT scan. Median approach and dermatofasciotomy of the foot were followed by anatomic reduction of the fractures and the Lisfranc dislocation and fixed by internal osteosynthesis.

[Training in sports medicine for medical students--Evaluation of a practice-oriented teaching concept].

Introduction: Education in Sports Medicine is offered heterogeneously in German medical schools. Efficacy and acceptance among medical students are unknown. The self-image of sports has changed from a traditional, competition-oriented way to adventure, entertainment, wellness and health.

[Ambulation training with bilateral limited weight bearing after foot injuries].

Aim: Bilateral foot injuries are not uncommon. Operative treatment usually requires partial weight bearing over several weeks. This is a challenge for physiotherapy especially for ambulation training.