[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.

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.

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.

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.

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.

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).

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.

Anatomic Reconstruction of Malunited Chopart Joint Injuries.

Fractures and dislocations at the mid-tarsal (Chopart) joint are frequently overlooked or misinterpreted at first presentation. Inadequate joint reduction and stabilization almost invariably lead to painful malunions or nonunions, residual instability, and deformity. Because of the central position and the essential function of the mid-tarsal joint, malunions lead to a considerable impairment of global foot function and the rapid development of posttraumatic arthritis.

Fifth metatarsal avulsion fracture: a rational basis for postoperative treatment.

Background: Lacking rational basis for the postoperative treatment of fifth metatarsal avulsion fractures.

Methods: Biomechanical test of stability of tension banding and screw fixation of fifth metatarsal avulsion fractures in cadaver specimen, sonographic measuring of the maximum cross-section of the peroneus brevis muscle, electromyographic examinations of the activity of the peroneus brevis muscle at different loads and means of immobilization.

Results: The forces acting on the base of the fifth metatarsal bone during voluntary activation of the peroneus brevis muscle or activation in the gait cycle are of the same magnitude as the failure forces of internal fixation.

In vivo effects of modification of hydroxyapatite/collagen composites with and without chondroitin sulphate on bone remodeling in the sheep tibia.

The addition of chondroitin sulphate (CS) to bone cements with calcium phosphate has lead to an enhancement of bone remodeling and an increase in new bone formation in small animals. The goal of this study was to verify the effect of CS in bone cements in a large animal model simulating a clinically relevant situation of a segmental cortical defect of a critical size on bone-implant interaction and bone remodeling. The influence of adding CS to hydroxyapatite/collagen (HA/Col) composites on host response was assessed in a standard sheep tibia model.

Transsection of the rectus abdominis muscle in the treatment of acetabular fractures: operative technique and outcome in 21 patients.

Background: A standard ilioinguinal approach is often insufficient for reduction and stabilization of the medial acetabular wall and the dorsal column in acetabular fractures. To avoid extended approaches, we have used a medial extension of the approach by transverse splitting of the rectus abdominis muscle. We have thus been able to reduce and stabilize transverse and oblique fractures of the dorsal column and the medial acetabular wall and to fix plates in a mechanically better position below the pelvic brim.

Tissue inhibitor of metalloproteinase-1 (TIMP-1) polymorphisms in a Caucasian population with abdominal aortic aneurysm.

Background: The formation of a sporadic abdominal aortic aneurysm (AAA) is explained by the remodeling of the extracellular matrix (ECM) and breakdown of structural components of the vascular wall. Matrix metalloproteinases are the principal matrix-degrading proteases and are known to play a major role in the remodeling of the extracellular matrix in arterial vessels. Their activity is controlled by tissue inhibitors of metalloproteinases (TIMPs).

Results of dorsal or volar plate fixation of AO type C3 distal radius fractures: a retrospective study.

Purpose: The aim of this study was to define the outcome after dorsal or volar plating of Association for Osteosynthesis (AO) type C3 distal radius fractures based on the fracture morphology.

Methods: Twenty-nine patients with AO type C3 distal radius fractures were surgically managed between 1996 and 2005. Group 1 (n = 15) had volar plating.

Effect of chondroitin sulphate on material properties and bone remodelling around hydroxyapatite/collagen composites.

Chondroitin sulphate (CS) has an anti-inflammatory effect and increases the regeneration ability of injured bone. The goal of this study was to characterize the material properties and osteoconductive potency of calcium phosphate bone cements modified with CS. The early interface reaction of cancellous bone to a nanokristalline hydroxyapatite cement containing type I collagen (HA/Coll) without and with CS (HA/Coll/CS) in a rat tibia model was evaluated.

Risk-inducing activities leading to injuries in a child and adolescent population of Germany.

Background: Injuries are the most common cause of mortality in children, also accounting considerably for childhood morbidity. However, data on injuries only provide valid information on the actual risk of each injury-causing activity when taken in consideration of the relationship with actual activity exposure data. Therefore, the primary goal of this investigation is to determine the relative risk of normal child and adolescent activities.

Effect of modification of hydroxyapatite/collagen composites with sodium citrate, phosphoserine, phosphoserine/RGD-peptide and calcium carbonate on bone remodelling.

This study describes the early interface reaction of cancellous bone to a nanocrystalline hydroxyapatite cement containing type I collagen (HA/Coll) and its modifications with sodium citrate (CI), calcium carbonate (CA), phosphoserine (P) and phosphoserine plus RGD-peptide (RGD). Cylindrical implants of HA/Coll and its modifications were inserted into the tibia of Wistar rats. We analysed 6 specimens per group at days 2, 4, 7, 14 and 28.

Coating of titanium implants with collagen, RGD peptide and chondroitin sulfate.

Coating of orthopaedic implants with extracellular bone matrix components was performed to enhance bone healing. Titanium pins of 0.8mm diameter were coated with type I collagen (Ti/Coll), RGD peptide (Ti/RGD) or type I collagen and chondroitin sulfate (Ti/Coll/CS).