[Circular soft tissue defect after prolonged application of a strangulating compression stocking].

Wearing a compression stocking over a longer period of time can lead to deep skin and soft tissue defects. This article presents a case of a circular necrosis with an exposed tendon of the tibialis anterior muscle and the Achilles tendon. The use of a peroneus brevis muscle flap led to an adequate coverage of the exposed Achilles tendon.

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment.

Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function.

[Consequences of the Foundation of a University Centre for Orthopaedics and Accident Surgery].

Since the combination of orthopaedic and traumatology surgery as a single speciality, an extremely wide variety of orthopaedic and trauma surgery centres have been founded in Germany. The present investigation analysed the degree to which additional value has been generated by merging two previously independent university departments - one for orthopaedics, the other for trauma surgery - into a single orthopaedics and trauma surgery centre. The centre, merged in 1 June 2013, is led by two equal co-chairs (a full professor for orthopaedics and a full professor for trauma surgery).

[Injuries under the influence of alcohol].

Background: In Germany, an average of 9.5 L of pure alcohol is consumed per capita per year. Alcohol is known to negatively influence psychomotor abilities.

Joint-Sparing Corrections of Malunited Chopart Joint Injuries.

Treatment of malunion and nonunion at the Chopart joint aims at axial realignment of the midfoot to the hindfoot and restoration of the normal relationship of the lateral and medial columns of the foot. In carefully selected patients with intact cartilage, joint-preserving osteotomies are feasible at all 4 bony components of the Chopart joint to restore near-normal function. Priority should be given to the anatomic reconstruction of the talonavicular joint because it is essential for global foot function.

[Hip endoprosthetics in osteoarthritis after acetabular fractures].

Background: The incidence of post-traumatic osteoarthritis after acetabular fractures is between 26 and 57%. With total hip arthroplasty (THA), affected patients can achieve a clear functional improvement and pain reduction if specific conditions are heeded.

Objective: Depending on the degree and localisation of bone defects and deformities, scarring and the presence of remaining osteosynthesis material, different treatment strategies are available.

[Arthroplasty for osteoarthritis secondary to hip dysplasia: Problem-oriented treatment strategies].

Background: Because of anatomical variations total hip arthroplasty (THA) can be demanding in patients with osteoarthritis secondary to hip dysplasia.

Objectives: Depending on the degree of bony deformation, hip dislocation and soft tissue alteration numerous treatment strategies are available. This review describes current approaches that address frequent deformities.

Histological analysis of the structural composition of ankle ligaments.

Background: Various ankle ligaments have different structural composition. The aim of this study was to analyze the morphological structure of ankle ligaments to further understand their function in ankle stability.

Methods: One hundred forty ligaments from 10 fresh-frozen cadaver ankle joints were dissected: the calcaneofibular, anterior, and posterior talofibular ligaments; the inferior extensor retinaculum, the talocalcaneal oblique ligament, the canalis tarsi ligament; the deltoid ligament; and the anterior tibiofibular ligament.

[Anatomical reconstruction of malunited metatarsals and adjacent joints].

Background: Malunited fractures of the metatarsals seldom need correction because the adjacent joints proximally and distally are not axially loaded but they may cause significant pain when a subcapital fracture is malunited too far in a plantar direction.

Method: Even if a metatarsal head is malunited too dorsally the neighboring head signals transfer metatarsalgia. Therefore, reorientation osteotomy with the intraoperative help of a minidistractor and stable fixation with a small locking plate is needed.

[Joint-preserving osteotomy for calcanean malunions].

Background: Calcaneal malunions lead to a considerable loss of global foot function through the loss of the physiological hindfoot lever arm, bony and soft tissue impingement, and involvement of the subtalar joint. In the majority of cases correction of the malunion has to be combined with subtalar fusion because of a rapid development of posttraumatic subtalar arthritis.

Methods: Joint-preserving corrective osteotomy may be considered in carefully selected patients with intact joint cartilage, sufficient bone quality, and good patient compliance.

Increased bone remodelling around titanium implants coated with chondroitin sulfate in ovariectomized rats.

Coating titanium implants with artificial extracellular matrices based on collagen and chondroitin sulfate (CS) has been shown to enhance bone remodelling and de novo bone formation in vivo. The aim of this study was to evaluate the effect of estrogen deficiency and hormone replacement therapy (HRT) on the osseointegration of CS-modified Ti implants. 30 adult female, ovariectomized Wistar rats were fed either with an ethinyl-estradiol-rich diet (E) to simulate a clinical relevant HRT or with a genistein-rich diet (G) to test an alternative therapy based on nutritionally relevant phytoestrogens.

Comprehensive histological evaluation of bone implants.

To investigate and assess bone regeneration in sheep in combination with new implant materials classical histological staining methods as well as immunohistochemistry may provide additional information to standard radiographs or computer tomography. Available published data of bone defect regenerations in sheep often present none or sparely labeled histological images. Repeatedly, the exact location of the sample remains unclear, detail enlargements are missing and the labeling of different tissues or cells is absent.

[Elective and acute procedures in trauma surgery. Complications requiring revision].

Background: Using data between 2010 and 31 March 2012, a cohort study concerning complications of all discharged patients who had undergone surgery was performed.

Patients And Methods: In our detailed analysis, we defined two groups out of the 5,248 cases: an acute trauma patient group (n = 3,942) and an elective patient group (n = 1,306). Complications were divided into the following groups: (1) technical complications (failure of the implant, poor indication, instability or non-union), (2) local complication (hematoma or delayed wound healing), and (3) infection.

Impact of fluid therapy on apoptosis and organ injury during haemorrhagic shock in an oxygen-debt-controlled pig model.

Introduction: Apoptosis, or programmed cell death, seems to play a role in the physiology of shock. The influence of fluid resuscitation on the occurrence of apoptosis during haemorrhage is still unclear. Using an experimental randomised study, the goal of this investigation was to find a relation between different frequently used resuscitation fluids and evidence of apoptosis.

Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures.

Background: The treatment of displaced, intraarticular calcaneal fractures (DIACFs) remains challenging and the best treatment choices remain controversial. The majority of patients will have some lasting functional restrictions. However, it is unclear which patient- or surgeon-related factors predict long-term function.

Embroidered and surface coated polycaprolactone-co-lactide scaffolds: a potential graft for bone tissue engineering.

Tissue engineering and regenerative techniques targeting bone include a broad range of strategies and approaches to repair, augment, replace or regenerate bone tissue. Investigations that are aimed at optimization of these strategies until clinical translation require control of systemic factors as well as modification of a broad range of key parameters. This article reviews a possible strategy using a tissue engineering approach and systematically describes a series of experiments evaluating the properties of an embroidered and surface coated polycaprolactone-co-lactide scaffold being considered as bone graft substitute for large bone defects.

Surface modification of implants in long bone.

Coatings of orthopedic implants are investigated to improve the osteoinductive and osteoconductive properties of the implant surfaces and thus to enhance periimplant bone formation. By applying coatings that mimic the extracellular matrix a favorable environment for osteoblasts, osteoclasts and their progenitor cells is provided to promote early and strong fixation of implants. It is known that the early bone ongrowth increases primary implant fixation and reduces the risk of implant failure.

Healing properties of surface-coated polycaprolactone-co-lactide scaffolds: a pilot study in sheep.

The aim of this pilot study was to evaluate the bioactive, surface-coated polycaprolactone-co-lactide scaffolds as bone implants in a tibia critical size defect model. Polycaprolactone-co-lactide scaffolds were coated with collagen type I and chondroitin sulfate and 30 piled up polycaprolactone-co-lactide scaffolds were implanted into a 3 cm sheep tibia critical size defect for 3 or 12 months (n = 5 each). Bone healing was estimated by quantification of bone volume in the defects on computer tomography and microcomputer tomography scans, plain radiographs, biomechanical testing as well as by histological evaluations.

[Foot and ankle fractures in children].

Ankle fractures are the most frequent factures of weight-bearing joints in children while fractures of the hindfoot and midfoot are rare. Metatarsal fractures make up the greatest portion of foot fractures in children and mostly heal uneventfully. Generally, the fracture severity increases with increasing age and the fracture patterns in adolescents resemble those in adults but transitional fractures of the distal tibial epiphysis in adolescents between 12 and 14 years of age are an exception.

[Open reconstruction of radius head fractures with and without accompanying ligament instability. Treatment results].

Background: The treatment of fractures of the radial head is commonly based on the Mason classification. Fractures of the radial head caused by a dislocation of the elbow are summarized as Mason type IV fractures. The purpose of this study was to investigate the outcome and the influence of additional ligamentous injuries after reconstruction of fractures of the radial head.

Effect of chondroitin sulfate on osteogenetic differentiation of human mesenchymal stem cells.

Chondroitin sulfate (CS) has anti-inflammatory properties and increases the regeneration ability of injured bone. In different in vivo investigations on bone defects the addition of CS to calcium phosphate bone cement has lead to an enhanced bone remodeling and increased new bone formation. The goal of this study was to evaluate the cellular effects of CS on human mesenchymal stem cells (hMSCs).

[Minimally invasive fixation of calcaneal fractures].

Objective: Anatomic reduction of displaced calcaneal fractures with minimal soft tissue alteration.

Indications: Extra-articular and selected intra-articular calcaneal fractures (simple fracture pattern: Sanders type II, critical soft tissue conditions, contraindications to open reduction), temporary stabilization of complex injuries or polytraumatized patients.

Contraindications: Impossible percutaneous reduction and fixation.

[Ligamentous injuries to the ankle joint].

Injuries to the lateral ankle ligaments are the most common sports injuries. Determination of their severity and exclusion of relevant accompanying injuries requires a subtle clinical and a focussed radiological assessment. Treatment is non-operative and functional in the majority of cases.

Subcutaneous emphysema of the upper extremity after elbow arthroscopy.

Subcutaneous emphysema of the upper extremity is rare. Crepitation on physical examination and visible gas on radiographs raise the concern of gas gangrene due to gas-producing bacteria. Rapid establishment of a differential diagnosis is necessary to initiate proper treatment.

The influence of playing level on functional ankle stability in soccer players.

Objective: The aim of this study was to compare the functional ankle stability between professional and amateur soccer players as well as controls.

Materials And Methods: Thirty professional soccer players, 30 amateur soccer players and 30 controls were evaluated. All participants completed a questionnaire.