C. Rangger

The sheep as a knee osteoarthritis model: early cartilage changes after meniscus injury and repair

The purpose of this study was to analyse cartilage changes after traumatic meniscal lesions and to provide a detailed description of the model used with a view to reducing the number of animals used in future studies. The sheeps knee was chosen, as ovine biomechanics are similar to that of humans. In two groups of 10 animals each, a radial tear in the medial meniscus was either sutured with polydioxanone (PDS) or left untreated (sham-operated). Half of the animals in each group were sacrificed after six months, the other half after one year. The time periods to achieve weight bearing, meniscus healing, joint effusion (magnetic resonance imaging scan) and knee cartilage in the medial, lateral and patellofemoral compartments were evaluated in comparison to the opposite knee (control). Osteoarthritis (OA) was assessed by a modified Outerbridge classification and confirmed by scanning electron microscopy. Only one sutured meniscus remained completely adapted. In all other meniscus lesions, the rupture healed with a scar. In the PDS and sham-operated groups, OA was significantly higher in the medial knee compartment than in the lateral compartment and in controls (P < 0.001). In the operated groups, joint effusion was higher in the right hindlimb knee than in the normal left hindlimb knee (control) after six and 12 months (P < 0.001). Non-treated, displaced and even adapted sutured radial ovine meniscus tears produced intense OA within less than six months. Therefore, this animal model is suitable for assessment of new therapeutic regimens in meniscal surgery.

Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years.

Background Osteosynthesis of clavicular fractures is sometimes indicated. Since plate fixation may lead to complications, we have used elastic stable intramedullary nailing and report our experience of midclavicular fractures in 32 adults. Patients and methods From 2000 to 2005, we treated 32 adults (26 men), median age 40 (19–66) years, by intramedullary nailing with a titanium elastic nail (TEN). All patients were re-examined after median 27 (12–59) months. Results Nonunion was not observed. 20 clavicles healed without shortening. 12 clavicles healed with shortening of more than 5 mm. Migration of the TEN in 8 patients required secondary shortening of the nail in 5 of them. Nail breakage after fracture healing was observed twice. The nails were removed in 29 patients after a median of 6 (1.3–15) months postoperatively. No patient sustained a re-fracture after TEN removal. The mean Constant score was 95 (SD 1.9) points and the mean DASH score was 5 (SD 2.3) points. Interpretation Intramedullary stabilization of midclavicular fractures with a titanium elastic nail is a minimally invasive technique with good cosmetic and functional results. Intramedullary fixation can be seen as an alternative to plate fixation and nonoperative treatment.

Retropatellar Chondromalacia Associated with Medial Osteoarthritis after Meniscus Injury

Background/Aims: In an ovine meniscal repair model, the patellofemoral (PF) osteoarthritis due to a non-sutured tear or failed repair was investigated. Methods: A radial meniscus tear was either sutured with polydioxanone (PDS), with a slow degrading polylactide long-term suture(LTS) or left without treatment. Knee joint cartilage in the PF and medial compartment was evaluated compared to normal knees (healthy controls). Results: Retropatellar osteoarthritis in the non-sutured and sutured animals was intense in contrast to the control knees after 6 months in all groups (p < 0.001), and after 12 months in the PDS group (p < 0.001), LTS group and non-sutured animals (p < 0.05). Conclusion: Non-sutured meniscus tears and failed repair lead fast to intense PF osteoarthritis corresponding with tibial damage of the injured compartment.

Implantation of an inverse prosthesis after management of an infected subcapital humerus fracture initially treated with osteosynthesis

ZusammenfassungNach mehrfachem Versagen der Osteosynthese bei subkapitaler Humerusfraktur kam es zu einer Infektion. Durch konsequentes chirurgisches Débridement, Verwendung eines temporär implantierten Palacos-Refobacin-Spacers und sekundärem Einbau einer inversen Schulterprothese konnten Schmerzfreiheit und ein befriedigendes funktionelles Ergebnis erzielt werden.AbstractAfter repeated failure of osteosynthesis of a subcapital humerus fracture, the humeral joint got infected. Radical surgery, use of a temporary Palacos-Refobacin spacer, and secondary implantation of an inverse prosthesis achieved painlessness and satisfying functional results.

Gipsen oder schrauben

ZusammenfassungNicht dislozierte unkomplizierte Brüche ohne Gelenkbeteiligung können zum Teil konservativ versorgt werden. Doch der Vorteil einer operativen Behandlung nach einer Fraktur ist, dass der Patient nicht wochenlang mit dem Gips liegt, sondern ohne äußere Fixation rasch wieder mobil ist. Gerade bei älteren Patienten lassen sich so das Thromboembolie risiko und der Pflegeaufwand erheblich reduzieren.

Reponieren, ruhig stellen und den Schmerz behandeln

The initial care of a fractured bone provided by the general physician includes reduction followed by immobilization and the treatment of pain. Open fractures must be covered by a sterile dressing, prior to the transportation of the patient to a hospital. Depending upon the severity of the injury, further treatment is provided by an orthopedic surgeon or in an appropriate hospital.ZusammenfassungDie Erstversorgung eines Bruches übernimmt meist der Hausarzt. Danach muss er abwägen, ob er den Patienten zu einem niedergelassenen Unfallchirurgen überweisen oder gleich ins Krankenhaus schicken soll. Unsere Autoren haben für Sie die typischen Frakturzeichen, ein Diagnoseschema sowie die wichtigsten Punkte bei der Erstversorgung eines Patienten mit einer Extremitätenfraktur zusammengefasst.

Implantation einer inversen Schulterprothese nach Sanierung einer primär osteosynthetisch versorgten, infizierten, subkapitalen Humerusfraktur

ZusammenfassungNach mehrfachem Versagen der Osteosynthese bei subkapitaler Humerusfraktur kam es zu einer Infektion. Durch konsequentes chirurgisches Débridement, Verwendung eines temporär implantierten Palacos-Refobacin-Spacers und sekundärem Einbau einer inversen Schulterprothese konnten Schmerzfreiheit und ein befriedigendes funktionelles Ergebnis erzielt werden.AbstractAfter repeated failure of osteosynthesis of a subcapital humerus fracture, the humeral joint got infected. Radical surgery, use of a temporary Palacos-Refobacin spacer, and secondary implantation of an inverse prosthesis achieved painlessness and satisfying functional results.

Benignes desmoplastisches Fibroblastom am Unterschenkel

ZusammenfassungBei dem desmoplastischen Fibroblastom („Kollagenfibrom“) handelt es sich um einen benignen, kollagenfaserreichen Bindegewebetumor. Es wird über den seltenen Fall eines Kollagenfibroms bei einem 56-jährigen Patienten am linken proximalen Unterschenkel berichtet. Die klinischen, radiologischen und pathologisch-anatomischen Befunde werden dargestellt. Das operative Vorgehen erfolgte gemäß den allgemeinen Prinzipien der chirurgischen Therapie von Weichgewebetumoren.AbstractDesmoplastic fibroblastoma (“collagenous fibroma”) is a benign fibrous soft tissue tumor. We report a rare case of a “collagenous fibroma” located in the proximal lower leg in 56-year-old man. The clinical, radiological, and pathological-morphological findings are documented. The operative treatment was performed according to general principles of surgical management of benign soft tissue tumors.

Migration of bioabsorable meniscus arrows

Abstract We report outside protrusion of resorbable Biofix arrows after repair of a medial meniscus tear in a 10-year-old boy. One arrow protruded spontaneously. At surgery the other partially resorbed arrow was found subcutaneously. The tear of the medial meniscus had healed.