Non-unions treated with bone morphogenic protein 7: introducing the quantitative measurement of human serum cytokine levels as promising tool in evaluation of adjunct non-union therapy.

Background: In this study we sought to determine if application of bone morphogenic protein 7 (BMP-7) promotes physiological bone healing of non-unions and to investigate if serum cytokine analysis may serve as a promising tool in the analysis of adjunct non-union therapy. Therefore we analyzed the influence of BMP-7 application on the serum cytokine expression patterns on patients with impaired bone healing compared to patients that showed proper bone healing.

Methods: Our study involved analyzing blood samples from 208 patients with long bone fractures together with patients that subsequently developed non-unions.

Mimicry in older patients: tophaceous pseudogout as a tumorlike lesion: a case report.

Pseudogout is frequently seen in painful arthritis of larger joints, especially the knees and shoulders. This case report describes a rare clinical entity of soft-tissue calcium pyrophosphate dihydrate crystal deposition disease surrounding the second metatarsal bone of an 81-year-old man with moderate painful swelling of the right forefoot for 2 years. Diagnostic imaging demonstrated a calcified soft-tissue tumor adjacent to the second metatarsal bone by considering a neoplastic process in the differential diagnosis.

Autologous bone cylinder transplantation with cannulated screw re-stabilisation: a new treatment option for delayed fracture healing of the femoral neck.

Aim: Delayed fracture healing and non-unions of the femoral neck after lag screw osteosynthesis occur particularly in multiply injured young patients, and then surgical revision is often required. Currently no evidence-based treatment guidelines exist and therapeutic options include both hip arthroplasties and femoral head-maintaining operations. Here we report on young patients with delayed fracture healing of the femoral neck.

Intraoperative subcutaneous wound closing culture sample: a predicting factor for periprosthetic infection after hip- and knee-replacement?

Introduction: It is unknown whether intraoperative subcutaneous wound closing culture samples (WCCS) are useful to predict periprosthetic joint infection (PJI).

Method: Here we prospectively followed 167 out of a total of 175 consecutive patients with primary total hip (THR) or knee replacement (TKR) between 01/2002 and 12/2002 for a mean follow-up period of 5 years; of those patients, n = 159 (96.8%) underwent WCCS.

The surgical treatment of unstable distal radius fractures by angle stable implants: a multicenter prospective study.

Objectives: The goal of this study is to document the 2-year outcome after surgical treatment of distal radius fractures using an angle stable implant.

Design: Prospective case-series.

Setting: Multicenter study in nine trauma units with recruitment between December 2001 and May 2003.

TRACP 5b and CTX as osteological markers of delayed fracture healing.

Radiological studies are the standard method to monitor fracture healing but they do not allow a timely assessment of bone healing. Biochemical markers react rapidly to changes in bone metabolism during fracture healing and could be an additional tool to monitor this process. The goal of this study was to observe changes in serum biomarkers and evaluate the possible differences in the serum levels of tartrate-resistant acid phosphatase 5b (TRACP 5b), total N-terminal propeptide of type I collagen (PINP), bone-specific alkaline phosphatase (BAP), and C-terminal cross-linking telopeptide of type I collagen (CTX) in patients with normal and delayed fracture healing.

Comparison of angle stable plate fixation approaches for distal radius fractures.

Introduction: The aim of the study was to compare radiological and functional outcomes between volar and dorsal surgical fixation of distal radius fractures using low-profile, fixed-angle implants.

Patients And Methods: A total of 305 distal radius fracture patients were treated with Synthes locking compression plate (LCP) 2.4- or 3.

[Total hip replacement for coxarthrosis following acetabular fracture. Significance of age and injury severity].

Aim: this study analyzed factors influencing prosthetic hip function after total hip replacement surgery (THR) including the initial acetabular fracture type, patient age, and the acetabular reconstruction component.

Material And Method: a total of 45 patients with secondary arthritis due to acetabular fracture and THR were prospectively selected from our total hip arthroplasty register between July 1999 and December 2005. The initial acetabular fracture was classified according to the AO system and the statistical analysis of the preoperative and postoperative Harris hip score (HHS) was correlated with age, type of fracture and acetabular reconstruction component.

Cigarette smoking decreases TGF-b1 serum concentrations after long bone fracture.

TGF-b1 serum concentrations are considered to be one of the most promising markers of fracture healing. Previously, we demonstrated significant differences in the post-traumatic time courses of patients with timely and delayed fracture healing. The aim of this study was to evaluate possible differences in the serum concentrations of TGF-b1 in cigarette-smoking vs.

[Outpatient surgery in hospital. An instrument for resource optimization?].

The societies of western countries are facing enormous economic and social challenges. Despite a declining population size the number of elderly patients is growing and will lead to an increase in cases of trauma in the near future. In addition, the health care system will have to be financed by a reduced labor force.

Treatment of tibial shaft non-unions: bone morphogenetic proteins versus autologous bone graft.

Fractures of the tibial shaft are likely to result in delayed union or non-union; 10-30% of these fractures will not heal properly and are commonly treated with autologous bone grafting. BMP-7 is a recombinant bone growth factor that can be applied locally as an alternative or in addition to autologous bone grafting, and this study aimed to compare the efficiency of the two procedures. From January 1995 to December 2002, 82 people with delayed union of a tibial fracture at least 4 months after primary stabilisation underwent autologous bone grafting.

Clinical application of BMP 7 in long bone non-unions.

Background: Non-unions of long bone fractures are a therapeutic and economic problem of increasing frequency. Aside from conservative treatment options such as ultrasound, impulse waves, and casts, the basic surgical options are autogenous cancellous bone grafting, rod dynamization, reamed nailing, plate fixation, and bone transport techniques. If these methods fail to work, there is a need for alternative treatment options.

[Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support].

Introduction: Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases.

[The challenge of auditing by medical health insurance inspectors: development of individual case inspections according to 275ff SGB V].

Background: The German DRG (diagnosis-related groups) system has changed since the inauguration in 2005, whereby written inquiries and on-site auditing have been carried out by the medical inspection service for health insurance companies (MDK). Modifications in the G-DRG system are reflected in changes in the MDK visitations. This article describes exactly how these examinations have changed over time.

Cystic pseudotumours in both upper ankle joints in gouty arthritis.

This case demonstrates a yet unreported clinical entity of bilateral tophaceous cystic lesions of the tibiotalar joints of an 37-year-old white male who presents with moderate painful swelling in both upper ankle joints for 2 years. Radiodiagnostic studies show cystic lesions in both upper ankle joints and the right talus considering neoplastic processes in the differential diagnosis. The incisional biopsy reveals chalk-like material of the intraosseous lesions which was pathognomonic for tophaceous gout.

[Prosthesis after comminuted radial head fractures : midterm results].

Background: For many years, resection was the only therapy used for comminuted fractures of the radial head. When associated with an injury of the collateral ligament, the outcome was often unsatisfactory. Implantation of the modern radial head prosthesis promises a better outcome.

[Prehospital Trauma Life Support (PHTLS): An interdisciplinary training in preclinical trauma care].

Introduction: There is clinical evidence that standardized management of trauma patients in the emergency department improves outcome. Standardized prehospital management has been established for stroke patients and those suffering acute coronary syndrome. Prehospital treatment of trauma patients differs quite significantly from one system to another.

T lymphocytes in acute bacterial infection: increased prevalence of CD11b(+) cells in the peripheral blood and recruitment to the infected site.

T-cell activation, particularly of CD8(+) cells, is invariably associated with viral infections. We now provide evidence for the activation of T cells in patients with localized bacterial soft tissue infections. During acute disease we detected in the peripheral blood of these patients, small though conspicuous populations of CD4(+) CD28(+) CD11b(+) and CD8(+) CD28(+) CD11b(+) cells, indicative of an expansion of effector T cells.

[Determining the femoral antetorsion angle with a fluoroscopy-based optoelectronic navigation system: a precision analysis].

According to the literature, differences in torsion of 15 degrees and more develop in 20-30% of cases after intramedullary nailing of femoral shaft fractures. A computer-assisted method makes it possible to determine the antetorsion angle during surgery. In this experimental study, the precision of the measurements obtained with the navigation system were checked with a femur model and compared with a CT reference method.

[WDoku: computer-based documentation of continuing education curricula in orthopaedics and trauma surgery].

With the introduction of the new regulations governing the postgraduate training for qualification as specialist in orthopaedics and trauma surgery it has become a requirement, as in all surgical disciplines, that a logbook is kept to document the content of training courses. In it the basic steps and techniques carried out, but especially the list of operations performed, are recorded. To create a convenient option for standardised documentation of the content of training courses and to make a "medical journal" for all doctors possible, a special computer program has been developed within a project at the BG Trauma Clinic in Ludwigshafen.

[Therapeutic outcome in tibial pseudarthrosis: bone morphogenetic protein 7 (BMP-7) versus autologous bone grafting for tibial fractures].

Depending on the type and localisation, nonunions of tibial fractures will occur in 10-40% of cases. Bone morphogenetic protein 7 (BMP-7; Osigraft), a recombinant bone growth factor, can be implanted locally as an alternative to autologous bone grafting. The objective of our study was to compare the efficiency of the two procedures.

The value of laboratory and imaging studies in the evaluation of long-bone non-unions.

Delayed union and non-union are common but definitive diagnosis is difficult. Few studies have evaluated imaging methods and laboratory parameters in the distinction between normal and prolonged heating specifically of long-bone fractures. The values of newer imaging methods have been analysed in some cases and should be the subject of further clinical trials.