Fracture of the distal humeral chondroepiphysis in the neonate. A case report.

A neonatal fracture-separation of the distal humeral chondroepiphysis occurred associated with a difficult footling breach delivery. The diagnosis can be predicted when a physical examination of an apparently "dislocated" elbow reveals a normal triangular relationship between the olecranon process and the medial and lateral epicondyles. The injured epiphysis tethered on a wide-based periostium.

Use of cefamandole in the treatment of soft tissue and skeletal infections.

In review of our data, 12 of 38 patients (31.5 percent) had adverse drug reactions, a somewhat bothersome factor. Disturbing side effects of leukopenia and pancytopenia were seen in two patients, respectively, who were receiving cefamandole 12 g/d.

[Biomechanics, technique and results of fibular ligamentous grafting at the ankle joint (author's transl)].

The grafting operations according to Watson-Jones and Evans in old fibular capsular ligament lesions of the ankle joint have the effect of tenodesis as far as the talo-calcaneo-navicular joint ist concerned, since especially the natural course of the ligamentum calcaneofibulare, which requires substitution, is not considered. The authors conducted a search for the most favourable course when replacing the ligamenta talofibulare anterius and calcaneofibulare, using a thread model on ankle joint preparations. It is only the direct replacement of these ligaments which is most likely to ensure free mobility of ankle joint and the talo-calcaneonavicular joint with optimal joint stabilization.

Meniscus repair.

The rationale and technique for surgical repair of the meniscus of the knee are presented with a report of the results in ten cases. Contraindications to meniscus reapir include peripheral vascular disease, metabolic disorders disrupting collagen synthesis, renal disease, and "collagen-vascular" disorders. The synovium adjacent to the injured meniscus must be gently handled and preserved.

[Connection between Böhler's angle and subtalar arthrodesis after calcaneal fracture (author's transl)].

Subtalar arthrodesis is a common intervention after comminuted fractures of the calcaneum. To clarify the connection between fracture of the calcaneum and the negative late results, all 81 subtalar arthrodeses following calcaneal fracture which had been carried out from 1959-1980 in the Munich Orthopedic Hospital were classified according to type of treatment of calcaneal fracture, radiological signs of arthrosis, Böhler's angle and the interval between fracture and arthrodesis. It can be shown that subtalar arthrodesis after comminuted fractures of the calcaneum may be necessary, irrespective of the Böhler's angle and the signs of arthrosis visible in the röntgen picture.

Neuropathic spinal arthropathy. A review of the Charcot spine.

The historic, pathogenetic, and clinical aspects of neuropathic spinal arthropathy are reviewed. The disorder is characterized by biologic inflammation and repair reaction to injury. In the absence of adequate pain perception, splinting of the injured portion of the spine does not occur.

Biomechanic studies reinserting the medial collateral ligament to correct a chronic anteromedial instability of the knee joint.

One possibility to correct a chronic anteromedial instability of the knee joint is the osseous reinsertion and tightening of the medial collateral ligament. In experiments with a string model and strain gauges attached to the ligaments we investigated the advantages and/or disadvantages of the femoral and tibial reinsertion. Regarding the tension mechanism the medial collateral ligament reacts considerably more sensitivity to the femoral reinsection in proximal-dorsal direction than to the tibial-reinsertion in distal-ventral direction.

[Gonarthrosis following persisting knee joint instability (author's transl)].

It is frequently assumed that persisting instability of the knee joint leads to gonarthrosis. We have reviewed recent and primary radiograms of 32 patients with old knee trauma resulting in prolonged capsular and ligamentous instability in order to study the eventual development of secondary gonarthrosis. Our results were as follows: All primarily intact joints developed gonarthrosis after an average of 46 months of permanent instability.

[Experiences with the condition of resection of the hip joint following removal of the alloarthroplastic implantate (author's transl)].

30 patients whose total endoprosthesis of the hip joint had been removed without any replacement, thus creating a so-called state of secondary resection, were followed up 6 months to 6 years after the operation. It was found that in almost two-thirds of the cases a subjective feeling of improved mobility was reported. The objective findings consisted in restrictions of the total rotation, abduction and adduction of 1/3 rd of the normal extent of mobility.

[Intra-articular or extra-articular substitution of cruciate ligament--a critical study (author's transl)].

Intra- and extra-articular methods of cruciate ligament substitution are available for treating old anteromedial knee-joint instability. Twelve patients with intra-articular cruciate ligament substitution (median third of the patellar ligaments as free transplant) and 24 patients with extra-articular cruicate ligament substitution (operation according to Nciholas) were examined with particular reference to improved stability as follow-up examinations, the results being subjected to comparative evaluation. Intra-artricular cruciate ligament substitution reduces or eliminates the pre-operative instability of the joint which is due to insufficiency of the cruciate liagment, whereas the extra-articular cruciate ligament substitution produces a significantly more frequent reduction of elimination of the instability of the valgus position and of the anteromedial instability.

[Isolated rupture of the anterior cruciate ligament. Clinical and experimental study (author's transl)].

The isolated rupture of the anterior cruciate ligament is possible. 5 own cases are described and compared with those of other authors. The mechanism of the injury is a forced inward rotation- and varus-stress of the knee joint under full pressure as a deceleration-twisting motion.