[Prioritization or unlimited resources in orthopedics and trauma surgery?].

The development of the healthcare system in Germany is increasingly approaching human and economic limits. A social consensus and a political concept at which point priorities are promoted and for which services the money should be primarily spent, do not exist on the whole. As soon as it becomes clear that resources are limited and that is now, prioritization has to be introduced to avoid the alternative threat of rationing of treatment benefits.

[Injuries in elderly patients: maximal management versus minimal osteosynthesis depending on active life style and economic resources].

The increasing expenses of health care maximize the costs for the whole of society. Nobody is able to pay them any longer. There are two reasons for this expansion: 1.

[Three-dimensional computerized tomography in trauma surgery. A case presentation].

Three-dimensional images of bone structures can easily be reconstructed from computed tomography data. The technique and the advantages of contemplating reconstructions of bone defects in different directions are described. A special software programme allows to combine all data which are given by the standard CT.

[Regeneration capacity of the iliac crest after spongiosa removal in humans--induction by phosphate ceramics?].

The starting point for the investigation of calcium phosphate ceramics is given by the bone regeneration, including osteo-conduction, osteo-stimulation and osteo-induction. The amount of the autogenous bone, which can be used for transplantation to induce the organo typical regeneration, is a small one. Based on animal experiments we created a standardized model for investigation of bone regeneration, using the human iliac crest.

[The regenerative ability of the iliac crest following spongiosa removal in man--induction by phosphate ceramics? I].

The starting point for the investigation of calcium phosphate ceramics is given by the bone regeneration, including osteoconduction, osteostimulation and osteoinduction. The amount of the autogeneic bone, which can be used for transplantation to induce the organo typical regeneration, is a small one. Calcium phosphate ceramics are used as bone substitute.

[Standardized bone model for incorporation of bone, bone ceramics or other materials into the implant bed].

To investigate the regeneration of human bone in a good and firm layer, a new model is introduced. It has been developed by us because of therapeutical necessity, but then is continued in the course of further investigations independent from further therapeutical procedure. We use the iliac crest as a bony layer for implants that are the object of research.

[Reconstruction of large femoral defects in exchange operations following artificial hip replacement].

Loosening of the implant is one of the most serious complication in case of total hip replacement. It is caused by the growth of a secondary cancellous channel and in destroyed bone cement. From 1981 to 1986 we operated 63 patients to exchange a loosened hip prosthesis.

Post-traumatic osteomyelitis. Pathophysiology and management.

Osteomyelitis is one of the most severe complications that can arise following operative treatment of bone. It requires a long-term treatment. The patient can never be sure that it heals completely.

[Clinical problems in fracture of the scaphoid bone].

Unlabelled: The following specific characteristics of injury cause the problems that occur in scaphoid bone fractures: 1. Mechanisms of accident: There are only a few typical circumstances that cause the injury: as there are false winding of a shrankshaft handle or a fall on the extended hand. In all the other cases the accident is neither realized by the injured person himself or by the physician.

Standard method for the investigation of bone transplants, ceramics, or other material in a human bony layer.

A new model for the investigation of human bone regeneration is introduced. We use the iliac crest as a bony layer for implants, which are the object of research. For therapy in cases of delayed bone healing the cancellous bone is removed.

Corrective osteotomy of the distal radius after fracture to restore the function of wrist joint, forearm, and hand.

Eighty-two patients suffering from a severe deformity of the distal radius were operated on in the course of the past 7 years. The corrective osteotomy was done by implanting a corticocancellous bone graft to restore the correct angle of the joint surface and the correct length of the radius. In addition to this, a buttress T-plate was used, which could be removed 6 months later.

[Technic of synovectomy in the infected knee joint].

In case of early diagnosis as well as correct indication and operation technique, synovectomy is an essential part in the treatment of an infected knee joint. The new formation of the synovia has been demonstrated by clinical/empirical as well as experimental studies, so that the alimentation of the cartilage can be normalized. Postoperative scarring due to adherence has to be prevented by continuous therapeutic exercises.

[Tension band osteosynthesis--a method fraught with complications in surgical fracture treatment?].

Tension-band osteosynthesis is a simple and well-known procedure in the surgical treatment of fractures. An analysis of 180 patients, operated on in our hospital or admitted for corrective osteosynthesis, showed 23 mistakes of a minor degree and 20 major mistakes. Malpositioning of K-wires or cerclages caused the minor mistakes.

[Expert testimony on rotator cuff rupture].

In giving an expert opinion, it is difficult to differentiate between the two possible causes of damage of the rotator cup, degeneration and trauma. After description of the anatomical problems, different causes for degenerative changes, especially of the supraspinatus tendon, are discussed. Various possibilities of accidents are analysed if they can cause damage of the rotator cup.

[Lymphatic pseudocyst as complication of a petty injury].

Diagnosis in another hospital primary failed; preliminary treatment unsuccessful; punction, operatively revision for 3 times and attempt at obliteration gave no improvement; systematically diagnostic procedure after the fourth relapse with lymphography and presentation of a lymphatic pseudocyst; identification of the feeding vessels; colouring with blue solution; operation with medial incision, ligature of the lymphatic vessels and exstirpation of the cyst wall; histologically investigation shows synovial cells; healing with solid cicatricial tissue.