Scintimetric evaluation of remodeling after bone fractures in man.

In a review of bone scans of 2000 post-trauma patients, the following rules of bone remodeling after fracture were found: different bones behave differently; lesions in the vicinity of joints show an early and high accumulation of the tracer within the first days after the trauma, whereas fractures of the axial skeleton and shafts of long bones sometimes need up to 12 days to appear on scan; all except skull fractures demonstrate a steady rise of accumulation intensity compared to normal bone for 2-5 wk; the steepness of increase and time of maximum differ significantly for different fracture sites. Calculating a ratio 24:4 hours after injection helps differentiate fractures from soft tissue lesions since fresh fractures show a ratio > 1:1. We found no clinically relevant dependence on sex and age.

[Clinical relevance of whole body skeletal scintigraphy in multiple injury and polytrauma patients].

The provision of care to polytraumatised patients is a particular diagnostic and therapeutic challenge. The examination data of 162 polytraumatised patients were retrospectively investigated to determine the diagnostic gain provided by skeletal scintigraphy with 99mTc-HMDP. It was found that every fresh fracture (with the exception of fractures to the skull) led to a scintigraphically clearly demonstrable remodelling reaction within ten to 14 days.

[The age dependence of traumatically induced bone remodeling as studied in the bone scintigram].

Two independent groups of patients were studied by bone scintigraphy to demonstrate age-dependent changes in the appearance time of fractures: 83 patients with 123 fractures of the spine showed neither by multiple regression analysis nor by separation into two subgroups (younger and older than 55 years) a clinically significant difference by scintimetric evaluation. A second group of 162patients with multiple trauma demonstrated no age dependence of the rate of additional bone lesions shown by scintigraphy. Instead a clear dependence on the site of the lesion and the time after trauma was found: fractures of the shafts of long bones and fractures of the pelvis and spine showed up significantly later than fractures in the neighbourhood of the distal joints.

[Experiences with the Spotorno expansion acetabulum].

At 53 hip joints a cupshell developed by L. Spotorno was practiced as replacement for the acetabular joint surface. This cementless CLS expansion-shell was always in combination with an also cementless femoral prosthesis applied in case of medial femur neck fractures, coxarthrosis, or the exchange operation to implantation.

[The effect of inactivity-induced osteoporosis on the scintigraphic image of bone lesions of the wrist].

In addition to its established oncological indications the sensitivity of bone scintigraphy is of steadily increasing significance in traumatology. Inactivity-induced osteoporosis plays a major role during the immobilization period in the plaster cast. In the region of the joints remodelling intensity may reach such a high level that the non-injured bone shows a higher rate of accumulation than the fracture.

VariDyne--new standards in postoperative wound drainage.

Conventional wound drainage systems operate at the beginning of the drainage procedure with a unilateral pressure of -0.9 bar. The system becomes static in case of no or only little secretion per unit of time.

[Medical peculiarities and social effects of accidents with motorcycles].

During the period 1976 until 1982, 133 accident patients with two-cycle motor vehicles were treated at the traumatological Department of the Dr. Horst Schmidt Hospital. 80% of those patients were below or 21 years of age, 58.

[Detection of ischemic muscle necroses using 99mTc perfusion scintigraphy of traumatized extremities].

In the Dr. Horst-Schmidt Kliniken Wiesbaden 19 patients with trauma of the inferior legs have been examined by means of perfusion-scintigraphy with regard to a compartmental syndrome. In the control group there were twelve Patients without trauma.

[Contributions of Max Bürger to the development of sports medicine].

The paper describes and appreciates the merits of Max Bürger who--as a clinician--realized very early the preventive and health-promoting role of regular physical training which can be principally carried out, from his point of view, up to the older age. He proved this opinion over more than 3 decades by numerous results of examinations especially in the field of the cardiopulmonary system and metabolism. Max Bürger became in several ways one of the forerunners of modern sports medicine by his important publications (among others "Normale und pathologische Physiologie des Blutkreislaufes bei sportlichen Anstrengungen", "Die Methodik der körperlichen Leistungsprüfungen mit Einschluss der Eignungsprüfungen für Beruf und Sport") by influencing the development of new research apparatuses and the installation of a larger performance diagnostic unit within his hospital as well as by the understanding between his aging research and sports medicine promoted by him and by his inititative to invite interested sports physicians to the foundation session of a "working group for sports medicine" the 13th and 14th November 1954.

[Complications in drug prevention of thromboembolism].

The possibility of complications during the thrombembolic prophylaxis with heparin-dihydroergotamine requests the observance of the application and the contraindications. The information of the patients and the continuous clinical control are absolutely necessary. The thrombembolic prophylaxis with less risk is given in a sufficient medication with Heparin in connection with early active exercising and correct positioning of the patient.

Measurement of knee-joint instabilities in the anterior-posterior plane.

The documentation of instabilities of the knee joint in sagittal direction by X-rays is usually inexact and incomplete by lack of rotational exertion. With a simple appliance instabilities of the knee joint in sagittal direction can be measured in mm within the examination. The difference between the injured and uninjured knee may show the importance of an instability of the knee joint.

[Fracture of the base of metatarsus V--conservative or operative treatment?].

A follow-up study is given of 138 fractures of the base of the metatarsale V. In the years 1976-1980 124 of these fractures were treated conservatively, 14 operatively. In 1982 all patients were examined personally to find out the treatment with the best results.

[Malrotation following intramedullary nailing of the femur].

77 patients with previous intramedullary nailing of the femur underwent detailed clinical and roentgenographical examination designed to show the frequency and extent of malrotation following this type of osteosynthesis. In 29% of the cases, more than 10 degrees of torsion deviation was detected on the roentgenogram using the Rippstein technique. An average outward rotation of three degrees was found after nailing.

[Muscular changes caused by suction drainage. Scanning electron microscopy, transmission electron microscopy, light microscopy and morphometric studies of dorsal muscles of the rat (Rattus rattus) using drainage].

Changes in the dorsal muscles of 22 rats (Wistar), resulting from surgical drain, have been studied under different morphological aspects. The lumen of drains were obstructed after a short time. In the drains without using low pressure, erythrocytes and fibrin network were seen by scanning microscopical investigation.

[Combined malleolar lesion in the growing skeleton].

Some examples are given in order to describe the combined lesion of the ankle joint in the growing skeleton after a supination trauma. This lesion in the growing skeleton is similar to the basic type A of luxation fractures according to Weber[4]: lateral ligament rupture or lysis of the fibular zone of bone growth, respectively, combined with fracture of the medial malleolus and involvement of the tibial zone of bone growth. In some cases, anteroposterior radiographs are necessary in order to establish a complete diagnosis.

[Therapy of hand joint fractures using the external fixator. Experiences - results].

In the treatment of multi-fragment fractures of the base of the radius plate osteosynthesis using the small-fragment instrument set is preferred to conservative treatment due to the superior results achieved. However, one still cannot dispense with an additional immobilization of the fracture in a plaster cast. The extension of intra-articular comminuted fractures of the base of the radius is a technically relatively simple procedure and does not require a supporting plaster cast.

[Disturbances in surgical wound drains--principles and means of correction (author's transl)].

Hydrodynamic studies of surgical drains are done in abundant quantities of isotropic liquids. In order to emulate the environment within the surgical wound one has to use a changeable or inhomogenous system. Consideration has to be given to the consistency and amount of wound secretion as well as to the size and shape of the wound itself.

[Treatment of injuries to the epiphyseal synchondrosis (author's transl)].

Treatment of epiphyseal injuries must take the pathophysiology of the epiphyseal synchondrosis into account. According to the present state of knowledge, type I and type V injuries according to Müller can be stabilized sufficiently by means of a plaster cast. All other types of epiphyseal injuries should be subjected to very accurate repositioning and stabilised in "waterproof" condition by means of osteosynthesis to avoid growth disturbance caused by periosteal interposition or callus bridge formation.

[Ender nailing - experiences and results (author's transl)].

The article reports on 69 patients with femoral fractures near the hip joint treated by means of Ender nails. The advantages of his method, which had already been reported earlier, are confirmed. Local complications occurring in our first follow-up group resulted in developing an operative technique which differs from the original method and is described in detail.