Effect of systemic hypothermia on local soft tissue trauma-induced microcirculatory and cellular dysfunction in mice.

Objective: Changes in body temperature occur as a systemic reaction to severe trauma; however, its role in the manifestation of injury remains unclear. Thermoregulatory responses vary considerably from fever to hypothermia. Although hypothermic trauma patients seem to have a worse prognosis, there is the question whether hypothermia per se or the severity of trauma producing the hypothermia is responsible for aggravated injury and increased mortality rate.

[Clinical gait analysis].

Clinical gait analysis comprises a well defined repertoire of various methods for valid and reliable assessment. The rapid development of corresponding hardware and software has substantially decreased the efforts necessary for data processing and has promoted the clinical applicability of the procedures. The clinical question defines the amount of methodological input.

Gene expression profile and synovial microcirculation at early stages of collagen-induced arthritis.

A better understanding of the initial mechanisms that lead to arthritic disease could facilitate development of improved therapeutic strategies. We characterized the synovial microcirculation of knee joints in susceptible mouse strains undergoing intradermal immunization with bovine collagen II in complete Freund's adjuvant to induce arthritis (i.e.

[Periprosthetic fractures after total knee joint arthroplasty].

Periprosthetic fractures of the femur, tibia and patella are being registered with increasing frequency due to the rising numbers of total knee replacements. Depending on the site of the fracture, apart from mere traumatic mechanisms, implant specific parameters and implant loosening may represent the main causes of periprosthetic fracture. Moreover, general risk factors promote the manifestation of a periprosthetic fracture.

Selective cyclooxygenase-2 inhibition reverses microcirculatory and inflammatory sequelae of closed soft-tissue trauma in an animal model.

Background: Despite the common use of nonsteroidal anti-inflammatory drugs in the treatment of closed soft-tissue injuries, our understanding of the effect of these medications on tissue healing is incomplete. Using high-resolution multifluorescence microscopy, we investigated the efficiency of preinjury and postinjury treatment with the selective cyclooxygenase (COX)-2 inhibitor parecoxib to improve compromised perfusion of traumatized muscle tissue and to minimize secondary tissue damage.

Methods: With use of a pneumatically driven and computer-controlled impact device, closed soft-tissue trauma of the left hindlimb was induced in anesthetized rats that had had intravenous administration of 10 mg/kg of either parecoxib sodium (seven rats) or an equal volume of saline solution (seven rats).

Acute effects of N-acetylcysteine on skeletal muscle microcirculation following closed soft tissue trauma in rats.

Trauma-induced microcirculatory dysfunction, formation of free radicals and decreased endothelial release of nitric oxide (NO) contribute to evolving tissue damage following skeletal muscle injury. Administration of N-acetylcysteine (NAC) known to scavenge free radicals and generate NO is considered a valuable therapeutic approach. Thus, the objective of this study was to quantitatively analyze the acute effects of NAC on skeletal muscle microcirculation and leukocyte-endothelial cell interaction following severe standardized closed soft tissue injury (CSTI).

In vivo evidence for apoptosis, but not inflammation in the hindlimb muscle of neuropathic rats.

Loose ligation of the rat sciatic nerve (chronic constriction injury (CCI) model) provokes signs and symptoms like those observed in complex regional pain syndrome (CRPS) patients. Neurogenic inflammation is a purported cause of neuropathic pain despite inconsistent evidence to support this hypothesis. To clarify this issue, we examined effects of CCI on microcirculation, inflammatory cell-cell interaction and cell integrity in muscle tissue using intravital fluorescence microscopic, molecular and immunohistochemical techniques.

[Tarsometatarsal injuries--an often neglected entity].

Tarsometatarsal dislocations or fracture dislocations represent infrequent, but severe injuries which endanger the structural and mechanical integrity of the midfoot if the diagnosis is missed initially. Delayed diagnosis may result in painful and disabling arthritis and the need for salvage reconstructive surgery. As such, the rationale of treatment should follow the principles of reconstruction of weight-bearing joint injuries.

Sesamoid and toe fractures.

Injuries of the toes and sesamoids of the first metatarsophalangeal joint comprise a wide spectrum of traumatic entities. Despite the fact that a majority of lesions may well respond to nonsurgical treatment and exhibit an excellent prognosis, appropriate clinical and imaging analysis is mandatory to select those injuries that require specific therapeutic and surgical measures to avoid long-term sequelae of functional disability.

[Acute CRPS I (morbus sudeck) following distal radial fractures--methods for early diagnosis].

Introduction: CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult.

[Radio-radial external fixation in the treatment of distal radius fractures allows for free wrist motion].

Introduction: Joint bridging external fixation in the treatment of distal radius fractures restores radial length, whereas anatomic reduction of articular fragments is difficult. Immobilisation of the wrist joint is a further disadvantage. An extraarticular hybrid fixation of distal radius fractures was introduced that facilitates fracture reduction, safe retention and allows for free wrist movement.

Efficiency of small-volume resuscitation in restoration of disturbed skeletal muscle microcirculation after soft-tissue trauma and haemorrhagic shock.

Background And Aims: Despite advances in primary care, trauma in conjunction with shock remains the leading cause for morbidity and mortality of young adults in western countries. Herein, we report on the efficiency of small-volume resuscitation to improve compromised perfusion of traumatised skeletal muscle tissue in shock.

Methods: In pentobarbital anaesthetised, mechanically ventilated rats, closed soft-tissue trauma of the right hind limb was induced, followed by induction of haemorrhagic shock [mean arterial blood pressure (MAP) 40 mmHg for 1 h].

Temporal profile of microvascular disturbances in rat tibial periosteum following closed soft tissue trauma.

Background And Aims: Bone devascularization due to impaired periosteal perfusion following fracture with severe soft tissue trauma has been proposed to precede and underlie perturbed bone healing. The extent and temporal relationship of periosteal microcirculatory deteriorations after severe closed soft tissue injury (CSTI) are not known. We hypothesized that periosteal microcirculation is adversely affected and the manifestation of trauma-initiated microvascular impairment in periosteum is substantially prolonged following CSTI.

Immediate microcirculatory derangements in skeletal muscle and periosteum after closed tibial fracture.

Background: Severe musculoskeletal soft tissue injury sustained after a closed fracture to the extremities significantly influences bone healing and determines the patient's prognosis. The present study was aimed at quantitatively assessing immediate microcirculatory changes in skeletal muscle and periosteum after standardized closed fracture.

Methods: Standardized closed fracture of the left tibia in isoflurane-anesthetized Sprague-Dawley rats (n = 14) was induced using a modified weight-drop technique.

Noninvasive analysis of conjunctival microcirculation during carotid artery surgery reveals microvascular evidence of collateral compensation and stenosis-dependent adaptation.

Objective: Hemodynamically relevant internal carotid artery (ICA) stenosis is a major cause of ischemic stroke. Despite its long-term benefit, carotid endarterectomy may also be associated with severe neurologic deficits. Intraoperative and early recognition of ischemia in the region of the ICA may reduce this risk.

Mild cervical spine trauma showing symptomatic calcified cervical disc herniation in a child: a case report.

Study Design: A case study was conducted.

Objective: A child with a previously unknown calcified cervical disc herniation experienced acute myelopathy after minor cervical trauma.

Summary And Background Data: Calcified cervical intervertebral disc herniations are rare in children.

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma.

A major pathway of closed soft-tissue injury is failure of microvascular perfusion combined with a persistently enhanced inflammatory response. We therefore tested the hypothesis that hypertonic hydroxyethyl starch (HS/HES) effectively restores microcirculation and reduces leukocyte adherence after closed soft-tissue injury. We induced closed soft-tissue injury in the hindlimbs of 14 male isoflurane-anaesthetised rats.

Late neurological deterioration 30 years following conservative treatment of a lower cervical spine fracture--a case report.

A today 44 years old man suffered from a compression and subluxation fracture of C 4 and C 5 vertebral body during a swimming accident in 1971. The primary therapy was conservative and the patient was rehabilitated. Since 1997 the patient showed a slowly progressive right hemiparesis with signs of cervical myelopathy.

IGF-I and TGF-beta1 application by a poly-(D,L-lactide)-coated cage promotes intervertebral bone matrix formation in the sheep cervical spine.

Study Design: A sheep cervical spine interbody fusion model was used to determine the effect of combined insulin-like growth factor-I (IGF-I) and transforming growth factor-beta-1 (TGF-beta1) applied by a poly-(D,L-lactide) (PDLLA)-coated cage.

Objectives: The purpose of this study was to determine the effect of a new PDLLA carrier system, and to evaluate the effect of combined IGF-I and TGF-beta1 application in a sheep cervical spine model.

Summary And Background Data: Growth factors such as bone morphogenic protein-2 have been shown to promote spine fusion and to overcome the disadvantages of an autologous bone graft.

Bone morphogenetic protein-2 application by a poly(D,L-lactide)-coated interbody cage: in vivo results of a new carrier for growth factors.

Object: Growth factors such as bone morphogenetic protein-2 (BMP-2) have been proven to promote spine fusion and to overcome the disadvantages of an autologous bone graft. The optimum method to deliver such growth factors remains a matter of discussion. The purpose of this study was to determine the safety and efficacy of a new poly(D,L-lactide) (PDLLA) carrier system for BMP-2 and to compare this carrier system with a collagen sponge carrier in a sheep cervical spine interbody fusion model.

Influence of cage design on interbody fusion in a sheep cervical spine model.

Object: The purpose of this study was to compare the characteristics of interbody fusion achieved using an autologous tricortical iliac crest bone graft with those of a cylinder- and a box-design cage in a sheep cervical spine model. This study was designed to determine whether there are differences between three interbody fusion procedures in: 1) ability to preserve postoperative distraction; 2) biomechanical stability; and 3) histological characteristics of intervertebral bone matrix formation.

Methods: Twenty-four sheep underwent C3-4 discectomy and fusion in which the following were used: Group 1, autologous tricortical iliac crest bone graft (eight sheep); Group 2, titanium cylinder-design cage filled with autologous iliac crest bone graft (eight sheep); and Group 3, titanium box-design cage filled with autologous iliac crest graft (eight sheep).