Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions

Recent studies have provided evidence that the number and proliferation capacity of bone marrow-derived mesenchymal stem cells, as well as the number of osteoprogenitor cells are reduced in patients with fracture non-unions. For fracture non-unions that do not heal after appropriate surgical intervention, the question arises as to what extent systemic cellular dysfunctions should be considered as being pathogenetic factors. For this purpose, we have examined the hypothesis that the cell function of osteoblasts isolated from patients with fracture non-unions may differ from those of normal control individuals in an identical and controlled in vitro situation. We analyzed the osteoblast cell …

Bilaterale Acetabulumfrakturen der vorderen Pfeiler und Wirbelkörperfraktur nach alkoholinduziertem Krampfanfall

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

The influence of bone allograft processing on osteoblast attachment and function

In order to assess the influence of eight different sterilisation and disinfection methods for bone allografts on adhesion, proliferation, and differentiation of human bone marrow stromal cells (BMSC), cells were grown in culture and then plated onto pieces of human bone allografts. Following processing methods were tested: autoclavation (AUT), low-temperature-plasma sterilisation of demineralised allografts (D-LTP), ethylene oxide sterilisation (EtO), fresh frozen bone (FFB), 80 degrees C-thermodisinfection (80 degrees C), gamma-irradiation (Gamma), chemical solvent disinfection (CSD), and Barrycidal-disinfection (BAR). The seeding efficiency was determined after one hour to detect the num…

Acetabulumfrakturen im Alter

Acetabular fractures in elderly patients are rare injuries, but their incidence is increasing. Poor bone quality due to osteoporosis and an increased operative risk due to concomitant disease are factors complicating surgical therapy. Literature does not provide generally accepted treatment protocols. In a 4-year period, 27 patients who were 65 years or older and who had an acute displaced fracture of the acetabulum were admitted to our department. Four minimally displaced and stable fractures were managed conservatively. Internal fixation was performed in 16 cases. According to the Merle d'Aubigne score, in 15 out of 18 surviving patients excellent or good results were found. Treatment str…

Volar and dorsal mid-shaft forearm plating using DCP and LC-DCP: interference with the interosseous membrane and forearm-kinematics.

Purpose To clarify if dorsal plate osteosynthesis of the forearm shaft is associated with impingement of the interosseous membrane (IOM) and if rotational kinematics of the forearm are influenced. Background Forearm fractures are treated by separate incisions. Osteosynthesis via one approach in proximal forearm fractures was associated with higher rates of synostosis. It has been claimed that this is due to IOM impingement. Materials and methods 16 forearms of fresh frozen cadavers were dissected until only radius, ulna and the IOM remained. To preserve physiological forearm rotation, the elbow joint, the distal radio-ulnar joint and the carpus remained intact. In group 1, LC-DC and DC plat…

Transverse fracture-dislocation of the sacrum: a diagnostic pitfall and a surgical challenge.

Transverse fracture-dislocations of the sacrum are rare. Associated lesions of the lumbosacral spine as well as neurological injuries are common. Conventional radiographs of the pelvis often fail to clearly visualize the fracture. Delayed diagnosis increases the risk of progressive neurological disfunction. True lateral sacral views and CT-scans with 3-dimensional reconstructions are very helpful in establishing the full extent of the injury. These examinations should be considered in all patients with a history of high energy trauma and clinical signs indicating lumbosacral injury, such as severe low back pain and neurological disturbances of the lower extremities. The management of transv…

Der Fixateur externe in der Stabilisation der Beckenringfrakturen

Die Behandlung der Beckenfrakturen hat in den letzten Jahren eine sturmische Entwicklung erfahren. Wo fruher kaum eine Indikation bzw. Moglichkeit zur Fixierung der Fraktur gesehen wurde, bestand die einzig mogliche Therapie in einer konservativen Behandlung durch Hangematte, ggf. kombiniert mit einer Extension [2a, 11]. Nachteile waren die langfristige Immobilisatiion mit allen ihren Folgen sowie die schwierige Nachbehandlung [5,7].

Verbesserung der postoperativen Thromboseprophylaxe in der Unfallchirurgie durch Dosisanpassung niedermolekularen Heparins anhand TAT- und D-Dimer-Verlauf

Von Februar 197 bis Februar 1998 wurde bei 518 Patienten die postoperative Thromboseprophylaxe mit niedermolekularem Heparin anhand der Laborparameter TAT und D-Dimer dosisadaptiert vorgenommen. Es traten vier Thrombosen (1,6%) ohne embolische Komplikation auf. Die praoperativen TAT- und D-Dimer-Werte aller im Gesamtverlauf dosisangepasten lagen im Mittel signifikant hoher als die der ubrigen Patienten. 83% aller Adaptierungen erfolgten dabei zwischen dem vierten und siebten postoperativen Tag.

Callus distraction of the femur and tibia. Experience with the Monofixator - indications for reosteosynthesis

In a 4-year period, 18 patients underwent callus distraction of the femur or tibia with the use of a unilateral external fixator. Twelve patients had post-traumatic bone loss resulting from complex lower-limb fractures. The bony defect was located in the tibia in 11 cases and in the femur in one case. All patients had major associated soft-tissue lesions. The length of the bony defect averaged 6.25 cm. Eight fractures were infected at the beginning of treatment. Six other patients underwent callus distraction for reasons of limb shortening. Five femora and one tibia were lengthened. The average increase in length was 6.5 cm. There were no fixator-related complications during distraction. Th…

Die intramuskuläreInjektion von Actovegin und Traumeel beschleunigt die Muskelregeneration in vivo

Fraktur des Os capitatum bei einem 11-jährigen Jungen

We report the case of an isolated non-displaced fracture of the capitate in an 11-year-old boy. On the basis of the relevant literature we present a survey of the diagnostic and treatment options. To the best of our knowledge this is the first description of a paediatric capitate fracture in the German-speaking area.

Die proximale extraartikuläre Tibiafraktur

Die Stabilisierung proximaler extraartikularer Tibiafrakturen stellt unter Verwendung der gebrauchlichen Osteosyntheseverfahren unverandert ein Problem dar. Die Wahl des Operationsverfahrens hangt unter anderem von der Situation der oftmals erheblich kompromittierten frakturumgebenden Weichteile ab. An der proximalen Tibia besteht zusatzlich das Problem von Fehlstellungen der Fraktur. Neben der Gefahr einer intraoperativen Frakturdislokation durch Muskelzug und den operativen Zugang kommt es gehauft zu sekundaren Fehlstellungen durch relative Implantatinstabilitat. Es wurden verschiedene Verfahren zur Versorgung dieser Frakturen entwickelt; sie zeichnen sich durch differierende biomechanisc…

Influence of implant and screw type on local bone strain field: a preliminary study

Osteosynthesetechniken bei proximalen Humerusfrakturen

Proximale Humerusfrakturen sind haufige Verletzungen. Die Frage der optimalen osteosynthetischen Behandlung instabiler und dislozierter 2- bis 4-Segmentfrakturen ist nach wie vor nicht einhellig geklart. Die operative Therapie befindet sich in der Konfliktsituation zwischen der Forderung einer anatomischen Reposition und stabilen Frakturretention auf der einen Seite und der Notwendigkeit einer maximalen intraoperativen Schonung der periglenohumeralen Weichteilstrukturen und Blutversorgung des Oberarmkopfs, mit dem Ziel das iatrogene Risiko der avascularen Kopfnekrose zu minimieren, andererseits. Wahrend Minimalosteosynthesen, bei denen die Reposition indirekt oder percutan erfolgt, Vorteile…

Primäre Ellenbogenprothese bei distalen Humerustrümmerfrakturen

The use of hip- and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is being more and more accepted. Total elbow replacement (TER) has not been considered as an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is not predictable after TER generally. On the basis of a Medline literature research of this issue and the documented results based on the improvement of the designs of the implants, operative technique and the selection of patients, TER has a definite role in the treatment of some fractures of the distal humerus. We retrospectively reviewed forty-nine acute distal humeral fra…

Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and cor…

Locking plates for corrective osteotomy of malunited dorsally tilted distal radial fractures: a biomechanical study.

The purpose of the study was to compare the biomechanical properties of five different palmar fixation plate designs in a distal radius osteotomy cadaver model. A 1 cm metaphyseal osteotomy gap was made to simulate a corrective osteotomy and the osteotomy plated. Axial load was applied to the distal end of each construct by a material testing machine under control of a motion analysis video system. The specimens were arranged into five implant groups of eight specimens each. No test group developed deformity and movement of the fracture gap greater than 2 mm with a load of 100 N. Increasing the load to 250 N revealed statistically significant differences in stiffness and failure load betwe…

Pr�vention thromboembolischer Komplikationen in der Unfallchirurgie durch Dosisanpassung von niedermolekularem Heparin anhand TAT- und D-Dimer-Werten

Bei unfallchirurgischen Patienten tritt in bis zu 40% eine tiefe Beinvenenthrombose auf. Das individuelle Risiko kann kaum kalkuliert werden. 518 unfallchirurgische Patienten mit Prophylaxe durch eine tagliche Einzeldosis eines niedermolekularen Heparins (NMH) wurden praoperativ und bis zu 10 Tage postoperativ in einer prospektiven Untersuchung beobachtet. Sie wurden in 2 Gruppen unterteilt: Gruppe I mit Huft- und Oberschenkeloperationen sowie Kniegelenkprothesen und Gruppe II mit Knie- und Unterschenkeloperationen. Bestimmt wurden Thrombin-Antithrombin-Komplex und D-Dimer. Eine 2. Dosis NMH wurde bei Uberschreiten des D-Dimer-Cut-off-Wertes verabreicht. Bei sonographischem Verdacht auf ein…

The efficiency of lead thyroid shield in trauma surgery

Die Strahlenbelastung der Operateure bei unfallchirurgischen Eingriffen hat in den letzten Jahren durch den Trend zu biologischen Osteosyntheseverfahren, insbesondere der Marknagelung, zugenommen, da geschlossene Reposition und distale Verriegelung radiologisch kontrolliert werden. Wir wollten jetzt uberprufen, welchen Einflus der Schilddrusenbleischutz auf die Strahlenbelastung der Operateure bei operativen Eingriffen an den unteren Extremitaten hat. Mit Hilfe eines Unterschenkelphantoms wurden unterschiedliche intraoperative Durchleuchtungssituationen simuliert und die Strahlenbelastung der Schilddruse mit und ohne Bleischutz des Operateurs uber ein Dosismesgerat (Szintomat) festgestellt.…

Mortalit�t, Morbidit�t und funktionelles Endergebnis nach "Open-book-Verletzungen" und lateralen Kompressionsverletzungen des Beckenringes

In einer retrospektiven Studie wurden die Begleitverletzungen, Behandlungsmerkmale, Morbiditat, Mortalitat und das radiologische und funktionelle Endergebnis von 222 Patienten mit einer Beckenringverletzung vom Typ B oder vom Typ C nach der Klassifikation von M.Tile eruiert. 52 Patienten wiesen eine "Open-book-Verletzung" auf (Typ B1), 48 Patienten eine laterale Kompressionsverletzung (Typ B2/B3), 122 Patienten wiesen eine C-Verletzung auf. Die Zahl der neurologischen bzw.urologischen Begleitverletzungen lag bei den B1-Patienten mit 21% bzw. 9,6% deutlich hoher als bei den B2/B3 Patienten mit 12% bzw.2,1%.66% der Patienten mit einer B-Verletzung wurden mit einem Fixateur externe entversorgt…

Magnetresonanztomographie des Kniegelenks mit einem Niederfeldsystem

Ziel der vorliegenden Untersuchung ist die Evaluierung der Niederfeldmagnetresonanztomographie an einem offenen System unter Berucksichtigung des Erfahrungsstands des Untersuchers. In einer prospektiven Studie wurden von August 1995 bis Mai 1997 75 Patienten der Klinik fur Unfallchirurgie der Universitat Mainz mit einem akuten Trauma des Kniegelenks nach klinischer und konventionell-radiologischer Diagnostik magnetresonanztomographisch untersucht und anschliesend diagnostisch und therapeutisch arthroskopiert. Die Auswertung der MRT-Untersuchungen erfolgte hierbei durch 2 unabhangige Untersucher unterschiedlichen Erfahrungsstands ohne Kenntnis der Anamnese bzw. des klinischen Befunds. Sensit…

Finger injuries caused by power-operated windows of motor vehicles: an experimental cadaver study.

The aim of this experimental cadaver study was to investigate which kinds of lesions could occur in jam events between the glass and seal entry of power-operated motor vehicle side door windows at two different closing forces. Ten hands of fresh cadaver specimens were used. Three different hand positions chosen to simulate real events in which a finger is jammed between the glass and seal entry of the window of a current motor vehicle were examined. The index, middle, ring, and little finger of each hand were separately jammed both at the proximal and distal interphalangeal joint at closing forces of 300 and 500 N with a constant window glass closing speed of 10 cm/s. Macroscopically visibl…

Treatment of femoral fractures after hip prosthesis

Im Zeitraum von 1995 bis 1997 wurden in unserer Klinik 24 huftprothetische Operationen durchgefuhrt mit Implantation eines Prothesenspezialschaftes aufgrund erheblichen Knochenverlustes sowie aufgetretener Frakturen des proximalen Femurs. Bei sechs Patienten erfolgte ein primarer Prothesenwechsel, sechsmal lag bereits praoperativ eine Femurfraktur bzw. eine Fraktur der bisherigen femoralen Prothesenkomponente vor, bei funf Patienten war es im Rahmen der Wechseloperation zu Frakturen gekommen. Pathologische Frakturen lagen funfmal vor, einmal erfolgte beim Prothesenwechsel eine femorale Korrekturosteotomie, einmal wurde eine Pseudarthrose bei implantierter Prothese behandelt. Defekte des Ace…

Tuberkulöse Destruktion des Iliosakralgelenkes

In dieser Kasuistik wird der Fall einer tuberkulosen Destruktion des rechten Sakroliakalgelenks eines 56-jahrigen Patienten vorgestellt. Auffallig sind die verspatete Diagnose durch Verwechslung der Beschwerdesymptomatik mit einer Lumbalgie durch Bandscheibenprolaps und die Abszedierung entlang der Psoasmuskulatur und in die umgebende intra- und extrapelvine Muskulatur. Die Therapie ist eine chirurgische, die durch eine einjahrige medikamentose Kombinationstherapie erganzt wird.

Rationelle bildgebende Diagnostik von Becken- und Azetabulum- verletzungen

In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetab…

Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis?

From 1985 to 1995, 417 patients with dislocated medial femoral neck fractures (Garden III–IV) were treated with hemiarthroplasty using a Biolox ceramic head. The average patient age at the time of operation was 81.5 years. A total of 140 survivors was available for follow-up examination with a mean prosthesis longevity of 55.8 months. The Harris hip score recorded a mean of 70.6 points. At the time of follow up, 5 patients had severe hip pain, and in 8 the roentgenographic examination revealed protrusio acetabuli. Five of these 8 patients underwent revision surgery for replacement of the cup, leaving the stem in situ.

Pigmented villonodular synovitis of the shoulder: review and case report

Pigmented villonodular synovitis (PVNS) as reviewed in detail elsewhere most frequently involves the knee and finger synovial structures; shoulder involvement is rare: A search through the English literature yielded 18 publications describing 25 cases of PVNS affecting the shoulder joint. Analyzing these reports we found the clinical and radiological findings generally to be nonspecific, often mimicking a malignancy, as in the case presented here of a 16-year-old boy with painful swelling in the area of the left proximal humerus. Magnetic resonance imaging showed a suspected malignant soft tissue mass involving the shoulder capsule and measuring 7.5 x 6 x 4 cm. Preoperatively the patient co…

Photocrosslinkable dextran hydrogel films as substrates for osteoblast and endothelial cell growth

Functional hydrogel films on solid supports are versatile materials with large potential for cell growth and tissue engineering. Here, we report on a modular approach to generate functional hydrogel composite films for endothelial and osteoblast cell co-culture. The polymer network of the parent hydrogel was formed by a dextran derivative (BP-CMD), which contained carboxymethyl (CM) groups for further chemical functionalization and benzophenone (BP) moieties as a photocrosslinkable unit. BP-CMD could be synthesized by three different routes, first with the benzophenone unit attached via an amide bond, or second by an ether bond, or third as an ion pair between the benzophenone ammonium salt…

Konzepte zur Behandlung von Kniegelenkluxationen und Ergebnisse

Grundlagen: Luxationen des Kniegelenkes sind seltene, jedoch sehr schwere Verletzungen. Daher ist zur optimalen Behandlung ein uberpruftes Konzept notwendig.

Endoscopic carpal tunnel release: results with special consideration to possible complications.

Single-portal endoscopic carpal tunnel release (Agee technique) was carried out in 148 patients. Of these, 100 were examined clinically and electrophysiologically 1 day before surgery and 1 and 3 months thereafter. Ten patients experienced transient ulnar neuropraxia and two patients complained postoperatively of intense pain in the middle and ring fingers. Three patients suffered residual symptoms. In one of these an incomplete release of the distal portion of the retinaculum flexorum was suspected and later confirmed by magnetic resonance imaging. Another patient had applied for pension due to problems associated with a vertebral fracture in addition to his carpal tunnel symptoms. A third…

Traumatic damage to the cartilage influences outcome of anatomically reduced acetabular fractures: A medium-term retrospective analysis

We reviewed 77 patients with an acetabular fracture, treated operatively through a non-extensile approach after an average time of 45 months. The ilioinguinal approach was chosen in 41, the Kocher-Langenbeck approach in 36 patients. Following the Letournel classification, the most frequent lesions were posterior wall (26%), two-column (22.1%) and anterior column (14.3%) fractures. Subchondral impaction, intra-articular fracture fragments and fracture comminution, called modifiers, could be identified in the preoperative CT-data of 38 patients (49.4%). Patients were operated after an average of 4 days. Average hospital stay was 19 days. Sciatic nerve and peroneal nerve palsy were registered …

Paradoxical embolism after a femoral fracture

The foramen ovale is anatomically open in 25 % of individuals, but functionally closed by the higher pressure in the left antrum. Right-to-left shunt and subsequent paradoxical embolism may occur when pressure in the left antrum rises, for example, as a result of pulmonary embolism. In the present case we demonstrate a patient who presented 20 days after osteosynthetic treatment of a femoral fracture with word-finding deficits. Cerebral MRT revealed a fresh ischemic insult. Duplex ultrasound of the legs showed a fresh thrombosis of the superficial femoral vein and scintigraphy of the lungs detected pulmonary embolism. Transesophageal contrast echocardiography trapped a hemodynamically spont…

Vorbereitung und Technik der operativen Behandlung von 225 Acetabulumfrakturen

Between December 1986 and November 1995, 222 patients with 225 acetabular fractures were treated operatively by three surgeons in the Department of Traumatology and Emergency Surgery of the University Hospitals of the Catholic University of Leuven. Indications for surgery were unstable fracture, displaced fracture through the acetabular dome and fracture with intra-acetabular fracture fragments. There were 37.3% A-fractures, 49.7% B-fractures, and 13% C fractures according to the AO Classification. In 16.4% of fractures there were primary neurological deficits. Patients were treated operatively after an average of 5.0 days. The Kocher-Langenbeck approach was used in 56.9% of cases, the ilio…