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Introduction: This study was undertaken to analyse the outcome of 1-stage exchange in the management of streptococcal periprosthetic joint infection (PJI) of the hip at a single hospital. Methods: We identified 30 patients with a streptococcal PJI of the hip who had been treated by 1-stage exchange at our hospital between 2002 and 2017. Postoperative complications and the need for any subsequent re-revision for infection or other reasons were analysed. The Harris Hip Score (HHS) was evaluated at final follow-up. Results: The mean follow-up was 8.2 years (SD 4.1). The overall re-revision rate for any reason was 53% (16/30) at a mean 5.3 years (SD 0.68 years). Re-revision for infection was 20% (6/30) at a mean 1.8 years (SD 0.74 years). All re-revisions for PJI (6/6; 100%) were for relapse of the streptococcal infection. At final follow-up, the mean HHS was 68 points (SD 20). Conclusions: The rate of re-revision after 1-stage exchange for streptococcal PJI is high. Eradication of a streptococcal PJI of the hip remains challenging. Further extensive and comparative studies between 1-and 2-stage exchange are encouraged.

Background Dual-mobility cups have been shown to reduce the dislocation risk after THA. Although dual-mobility cups can be a useful strategy to mitigate against recurrent dislocation after revision surgery, few clinical studies have focused on the results of complex revision THAs with extensive bone and soft-tissue loss or in patients who have undergone more than one previous surgical procedure. Questions/purposes (1) What is the survival free from revision for dislocation of dual-mobility cups used in complex revision THAs? (2) What is the survival free from any dislocation? Methods Between January 1, 2009 and December 31, 2013, 327 patients underwent a complex revision THA that included an acetabular revision, defined as preexisting massive bone loss in the acetabulum (at least Paprosky Type 2B) and/or proximal femur (at least Paprosky Type 3), substantial gluteal soft-tissue involvement, at least two previous surgical procedures or a one-stage septic revision, or history of dislocation. All 327 complex revision patients received a dual-mobility cup. Of those, 34% (111) were lost to follow-up before 5 years and were not known to have reached a study endpoint (revision for dislocation, and any dislocation) before then, leaving 216 patients for analysis. For patients with bilateral hip surgeries only the first operated hip was included for analysis. The median (range) follow-up duration was 69 months (60 to 110). The primary endpoint was dislocation or re-revision for dislocation. Fifty-six percent (120 of 216) of the patients were women and 44% (96 of 216) were men. The mean age of the patients was 69 ± 9 years. The patients underwent a median of four surgical procedures (1 to 4) before the index procedure (the revision evaluated in this study). A survival analysis was performed using the Kaplan-Meier method; any dislocation or revision for dislocation was determined as the endpoint. Results The dislocation-free survival rates were 96% (95% confidence interval 92 to 98) at 5 years and 82% (95% CI 72 to 89) at 9 years. The overall dislocation rate was 11% (24 of 216 patients) at the final follow-up interval. Survival free of revision for dislocation was 99% (95% CI 96 to 100) at 5 years and 85% (95% CI 75 to 92) at 9 years. Conclusions Dual-mobility cups used in complex revision THA in this series had a higher rate of dislocation and revision than expected, based on earlier studies of dislocations of these components. Although we believe dual-mobility cups are still the first choice of implant if the patient has instability, these cups should be used cautiously if severe bone loss or soft-tissue involvement is present. Level of evidence Level III, therapeutic study.

The use of tantalum cones to reconstruct extensive bone defects in revision total knee arthroplasty has been established. We aimed to evaluate the midterm results after 1-stage knee exchange for periprosthetic joint infection using tantalum cones.Seventy-two patients (mean age, 70 ± 8.2 years) treated with a 1-stage exchange for infected total knee arthroplasty using porous tantalum cones, between 2011 and 2016, were retrospectively included. Either rotating or pure hinge system in combination with femoral and/or tibial cones was used. Survivorship analysis (septic and aseptic) was performed. Prospectively, functional outcome was assessed at a mean follow-up of 49.9 ± 18.8 months (range, 24-88).A total of 15 patients (21%) were rerevised, 8 (11.1%) for infection and 7 (10%) for aseptic loosening, requiring cone exchange in 12 patients (17%). Cone-related survival free from any revision was 83% ± 3.8 standard deviation (95% confidence interval, 74-90), and infection-free survival was 89% ± 4.2 standard deviation (95% confidence interval, 76-93). No significant correlation was reported between the types of prosthesis used (P = .8) or implanted cones and failure (P = .6). History of a previous septic revision increased the risk of cone revision after the index surgery (P.001). Preoperative Hospital for Special Surgery knee score improved from 47 ± 16 (range, 14-87) to 60 ± 17 (range, 24-84) points at the latest follow-up.First study reports on outcomes of the 1-stage exchange using tantalum cones for knee periprosthetic joint infection with additional severe bone loss. Midterm cone-related and infection-free survival offered good results and provided reasonable functional outcomes.

Die Endoprothetik ist zu einer auserst erfolgreichen Operationsmethode mit hervorragenden Langzeitergebnissen geworden. Die gezielte Diagnostik zum Ausschluss einer Osteoporose vor einem Gelenkersatz und der Einsatz von Medikamenten zur Verbesserung des Ergebnisses bei Gelenkersatz konnen derzeit nicht empfohlen werden. Im Bereich der Knieendoprothetik sollte bei bekannter Osteoporose immer zementiert werden. Gleiches ist fur die Hufte zu empfehlen, auch wenn fur die acetabulare Komponente zementfrei gute Ergebnisse erzielt werden. Die zugige Belastung und Mobilisierung erscheinen vorteilhaft, auch mit Blick auf die Osteoporose und ihre systemische Behandlung.

Introduction The Kellgren-Lawrence score helps the orthopedic surgeon to classify the severity of knee osteoarthritis (OA) before total knee arthroplasty (TKA). There might be a discrepancy between subjective complaints of the patients and radiologically visible changes of the knee joint in many cases. In this context, we performed a prospective clinical study to compare the preoperative degree of knee OA using the Kellgren-Lawrence score with the intraoperative extent of cartilage damage during primary TKA. Materials and methods A total of 251 primary TKA surgeries due to a primary knee OA were prospectively included. Preoperative Kellgren-Lawrence score was determined using standardized preoperative plain radiographs of three views; anteroposterior, lateral and skyline of the patella by a senior radiologist. Intraoperatively, in all cases, photographs of the medial, lateral, and patellofemoral joint compartments were taken. Using the International Cartilage Repair Society (ICRS) score, the degree of chondromalacia was assessed. Subsequently, correlation analysis was performed using the Pearson-Clopper 95% confidence interval (CI). Results There were higher intraoperative scores compared to the preoperative scores in 160 of all cases (63.7% of 251, 95% CI 57.5-69.7%). A mismatch of two score grade points was found in 8.4% (95% CI 5.3-12.5%). The most common mismatch was noted in patients with preoperative Kellgren-Lawrence score of 3 and an intraoperative score of 4 in 48.2% (95% CI 41.9-54.6%). Conclusions The preoperative radiographs using Kellgren-Lawrence underestimate the severity of knee osteoarthritis. The true extent of articular cartilage damage can be better appreciated intraoperatively. In patients undergoing primary TKA, the correlation of clinical symptoms with radiological findings is crucial in deciding when to perform the surgery. Besides, other imaging modalities may be used as an adjunct when the clinical findings and plain radiographs do not correlate.

Little is known about the relationship between the virulence of pathogens in periprosthetic joint infection (PJI) and C-reactive protein (CRP) levels. In this context, we assessed the performance of CRP for PJI. We collected the following data from 987 cases of total joint revision due to PJI and 386 cases of aseptic revision: age, gender, comorbidities, values for serum CRP, leukocytes, microbiology for preoperatively taken aspirations and at least 2 intraoperative biopsies, and presence or absence of a draining sinus. The mean CRP value in the PJI group was 50.2 mg l−1 (sd=62.2), while a lower CRP value of 11.6 mg l−1 (sd=25.3) was found in the control group. There were no significant differences for the CRP values between patients with and without draining sinus (P=0.4423). The difference in CRP between high-virulence and low-virulence micro-organisms was significant for both the hip and the knee (P

Background: While there is an enormous amount of data on various surgical aspects of total hip arthroplasty (THA), there is only limited literature on the health hazards incurred by the surgical team. Since THA surgery produces noise, exposure over a long period of time may lead to gradual hearing loss which is known as noise-induced hearing loss. Methods: We investigated the noise levels during THA and compared it with the maximum allowed limits at the workplace in the United Kingdom. In collaboration with specialised audio engineers, we analysed the noise levels during various steps of performing 7 uncemented THA. Results: The results showed that the noise levels were close to the allowed limits for a workplace in the UK. Conclusion: Hospitals and staff who work in orthopaedic operating theatres should be aware of this risk and precautions should be put in place.

Purpose Bone loss is a challenging problem during revision total knee arthroplasty (TKA). Several studies have been published on the use of metaphyseal sleeves during revision TKA. Therefore, the aim of this systematic review was to summarize the clinical and radiographic outcomes of the use of metaphyseal sleeves in the setting of revision TKA. Methods A comprehensive search of PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar was performed, covering the period between January 1, 2000, and August 12, 2017. Various combinations of the following key words were used: “metaphyseal,” “sleeves,” “knee,” and “revision.” A total of 10 studies were included in the present systematic review. Results A total of 904 patients with 928 implants were recorded with a mean age of 69 years. They were evaluated at a mean follow-up of 45 months. Overall 1,413 sleeves, 888 in the tibia and 525 in the femur, were implanted. There were 36 septic re-revisions of the prosthetic components (4%). Five sleeves were found loose during septic re-revision; therefore, the rate of septic loosening of the sleeves was 0.35%. An aseptic re-revision of the prosthetic components was performed 27 times (3%). Ten sleeves were found loose during aseptic re-revision; therefore, the rate of aseptic loosening of the sleeves was 0.7%. Intraoperative fractures occurred 44 times (3.1%). Finally, clinical outcome was improved at final follow-up. Conclusion Metaphyseal sleeves demonstrate high radiographic signs of osteointegration, low septic loosening rate, low intraoperative fractures rate, and a good-to-excellent clinical outcome. Hence, they are a valid option to treat large metaphyseal bone defect during revision TKA. Level of Evidence This is a systematic review of level IV studies.

Different approaches have been proposed for bacterial identification in patients with a suspected periprosthetic joint infection (PJI). If a one-stage procedure is considered, a higher rate of preoperative bacterial identification can be achieved if biopsy is included in the diagnostic work-up. The performance of open biopsy (OB) in the context of PJI has not been clearly determined yet. The purpose of this study was to determine the value of an OB added to two consecutive culture-negative joint aspirations during PJI workup. We retrospectively analyzed the OB data from a single institution. Patients under PJI work-up of the hip or knee with two culture-negative periprosthetic aspirations who underwent OB were included. Sensitivity and specificity were calculated using the musculoskeletal infection society (MSIS) criteria as gold standard. Patients undergoing urgent irrigation and debridement and patients with history of surgery to the affected joint in the prior 6 weeks were excluded. 126 patients were included in this study. 62 (49.2%) patients had prior revisions, 48 of them due to PJI. The sensitivity and specificity of OB was 69.4% and 89.1%, respectively. The OB procedure led to the identification of the causative germ in 50 out of 126 (40%) cases so they could undergo one-stage (septic) exchange. The OB is a valuable resource if preoperative synovial fluid cultures are negative, a high suspicion of infection persists and a one-stage procedure is preferred. It intends bacteria identification and allows surgeons to evaluate prosthetic complications for further surgical procedures.

In recent years, the minimally invasive joint-preserving implant system has been developed. The main goal of this device is to unload the medial knee compartment without affecting the lateral compartment. The current authors describe a severe metallosis and elevated chromium in serum following implantation of the joint unloading implant system of a 50-year-old male patient, presented to our hospital 3 years after implantation of a KineSpring System into his left knee due to unicompartmental medial osteoarthritis (OA) in an external hospital. Radiographs showed radiological signs for loosening of the screws in the tibia and a progressive OA on the medial and patellofemoral compartments. Revision surgery with removing of the unloading device was performed at our hospital. The intraoperative situs presented a severe metallosis around the device. Five days after revision surgery, the laboratory parameters revealed an elevated value for chromium in serum, while nickel and cobalt values in serum were normal. Reliable clinical data about the long-term results of the KineSpring System is desperately needed. Further studies are warranted to work out the effects of cobalt and chromium levels and further side effects following the implantation of the extra-articular absorber system.

Background The use of hinged designs is usually reserved for severe deformities or instability in contemporary total knee arthroplasty (TKA). Results have been mixed with some authors reporting relatively high incidences of complications. The aim of this study is to present the results of primary TKA performed with a hinged prosthesis with a minimum 10-year follow-up. We also examined the factors that influence survivorship of this prosthesis. Methods A total of 238 primary TKA procedures were performed using hinged prostheses. Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis. Clinical outcomes were assessed using the Hospital for Special Surgery score. Radiologic assessment was performed at each follow-up. Survivorship was calculated based on the Kaplan-Meier method. All complications were documented. Results Mean follow-up was 13.5 years (standard deviation [SD], 3.4). Mean flexion at final review was 118° (SD, 20°). Fifty-four percent and 20% reported excellent and good functional scores, respectively. Survivorship was 94% at 13.5 years in patients over 60 years of age and 77% in patients less than 60 years of age. Survivorship in patients with preoperative varus deformity was 96% and that in valgus knees was 79%. Conclusions The results of this study suggest that when rotating hinges are used for primary TKA, the best results are achieved in patients over 60 years old. The indications for this design in the setting of primary TKA include significant deformities, severe bone loss, and ligamentous laxity.

Extensive acetabular defects with combined pelvic discontinuity is a surgical challenge. The ideal treatment choice is not adopted, yet. We here introduce the 3D-printed custom acetabular component in the management of extensive acetabular defect with combined pelvic discontinuity. The article presents the surgical technique and and discuss the advantages and disadvantages of this method. Furthermore, we present a successful treatment of a 64-year old using this construct.

Background Interprosthetic femoral fractures in patients with ipsilateral stemmed total hip arthroplasty (THA) and total knee arthroplasty (TKA) can be technically demanding to treat surgically. Nonunion and implant failure are among the main complications following fixation of interprosthetic femoral (IF) fractures. Total femoral arthroplasty (TFA) is associated with a high incidence of infection and instability. IF sleeves have been designed to avoid the disadvantages of these techniques and to provide a stable construct. The aim of this study was to present the results with this device from a single center. Methods We reviewed 26 patients who underwent revision arthroplasty procedures, using custom-made cemented IF sleeves between 1997 and December 2017 in our institution. Two-part sleeves were used in 18 patients and one-part sleeves in 8 patients. The most common indication was an IF fracture (18 patients). Patients were monitored for postoperative complications, implant failure, and re-revision. The minimum follow-up of the survivors with nonrevised sleeves was 12 months. Results Twenty-three patients were included for the final analysis. The mean survivorship of the IF sleeve was 4.6 years at latest follow-up (mean 48.5 months; range 12 to 156). The overall rate of complications was 47.8%. The rate of mechanical failure was 21.7%. Late infections occurred in 3 patients (13%). At the latest follow-up, the mean Harris Hip Score was 69.9 points (range 39 to 94), and the mean functional Knee Society Score was 42.5 points (range 0 to 90), with average knee flexion of 95° (range 90° to 100°). Conclusion The IF sleeve is a valid technique for the management of selected patients with IF fractures, particularly when a stable fracture fixation is not possible. Hip instability is not a concern, and functional improvement is achievable. Careful planning is required preoperatively to avoid mechanical failure.

Stem loosening in both cemented and uncemented total hip arthroplasty is the hallmark of the Vancouver type B2 classification of periprosthetic hip fractures. We discuss the technique we use at our institution for treating these fractures. Periprosthetic femoral-shaft fractures are associated with a relatively high mortality rate, approximating that of patients with hip fractures. Outcomes are directly associated with early mobilisation and construct stability. We recommend performing the procedure only when the surgeon is proficient in revision hip surgery and trauma care. A well-selected portfolio of different stem designs and an array of osteosynthesis devices should be available, as well.

Dwarfism is a challenge in arthroplasty. The anatomical features provide a lot of pitfalls. The aim of this study was to follow-up growth-restricted patients after endoprosthetic treatment. 138 knee arthroplasties in patients with a height ≤150 cm between January 1, 2000 and May 5, 2013 at our institution were enrolled in this study. 124 cases were available for 1-year follow-up. Out of these, 43 cases were available for 5-year follow-up so far. 14 patients were lost to follow-up. IKS score increased from 35 ± 16 on admission to 67 ± 22 (p

Cemented total hip arthroplasty (THA) has become an extremely successful operation with excellent long-term results. Although showing decreasing popularity in North America, it always remained a popular choice for elderly patients in Europe and other parts of the world. Previous and recent studies presented excellent long-term results for cemented fixation of the cup as well as the femoral stem. Besides optimal component orientation, a proper cementing technique is of major importance to assure longevity of implant fixation. Consequently a meticulous bone bed preparation assures the mechanical interlock between the implant, cement, and the final bone bed.

Near-Infrared Spectroscopy (NIRS) could be of clinical relevance in modern cartilage regeneration.In a miniature pig model correlation of measurements and histologic scores have never been used before. The data analysis was part of an animal project that investigated the effects of seeding a chondrogenic and osteogenic scaffold with a bone-marrow-derived cell concentrate and reports the histological and mechanical properties. We created 20 osteochondral defects in the femoral condyles of 10 miniature pigs.The defects were left empty (E), filled with the grafted cylinder upside down (U), or with a combined scaffold (S) containing a spongy bone cylinder covered with a collagen membrane. In the fourth group, the same scaffolds were implanted but seeded with a stem cell concentrate (S+BMCC). The animals were euthanized after 3 months, and histologic and spectrometric analyses were performed. NIRS measurements were significantly higher in the central area of the defects of group S+BMCC compared to the central area of the defects of group U. In all groups, a correlation between NIRS and the histologic scores could be demonstrated though on different levels. In the central area, a good NIRS measurement correlates with low (good) histologic scores. In group E and group S, this negative correlation was significant (p=0.01). For the first time, NIRS was successfully used to evaluate osteochondral constructs in a miniature pig model.

127 patients with a height ≤ 150 cm (non metric ≤ 4 feet and 11 inches) who received hip arthroplasty surgery between July 1, 2006 and May 30, 2013 at our institution were enrolled. Retrospective data evaluation was performed for two different times of follow-up (1 year and 5 years respectively). 115 patients were evaluated for 1-year follow up. Out of these, 27 patients were available for 5-year follow up. The mean Harris Hip Score increased from 40 ± 13 on admission to 82 ± 20 (P

Thoracic injuries are common in vehicle crashes, but only a few studies thus far have analysed the relationship between injury characteristics and collision details and discussed the possible implications for future vehicle design and prevention. In this study, the crash details were prospectively collected at the scene of injury between 2004 and 2009 for severely injured patients. The collected data included the type of collision, angle of impact and change of velocity on impact as well as injury characteristics and patient demographics, including abbreviated injury scale (AIS) and injury severity score (ISS).There were 5998 accidents involving 8830 patients over this five-year period; 31 met the inclusion criteria (23 males and eight females). The mean ISS was 37 ± 12.68, the mean AIS Thorax was 4.0. Lung contusions were found in 90% of the patients, pneumothoraces in 58% and rib fractures in 81%. There was a significant relationship between accident deceleration speed (ΔV), AIS Thorax (p = 0.02) and the incidence of pneumothoraces (p = 0.046). The analysis showed a high overall incidence of thoracic injuries in car passengers. Future improvements in automobile safety and design should seek to reduce the incidence of thoracic injuries by uniform vehicle deformation and further implementation of side airbags.

The purpose of the current study was to evaluate the influence of internal and external knee rotation on tibial tunnel position measurements in anterior cruciate ligament reconstruction using the Amis and Jakob line. Anatomic double bundle ACL reconstruction was performed in seven cadaveric knees. Afterwards, the knees were CT scanned, and 3D CT models were established. Utilizing these models, strict lateral and radiographs with the knees in 5°, 10°, and 20° of internal as well as external rotation were established. Using these radiographs, the positions of the anteromedial (AM) and posterolateral (PL) tibial tunnels were measured using the Amis and Jacob line. The tunnel positions of the strict lateral were compared to the rotated radiographs. To assess the inter- and intraobserver reliability, two independent observers measured the tunnel positions, and one observer measured twice. Significant differences for the AM tunnel position were observed if more than 10° of external or 20° of internal rotation were applied. For the PL tunnel position, no significant differences were found between the strict lateral and the rotated radiographs. Inter- and intraobserver reliability was good. The accuracy of the Amis and Jakob line is dependent on the degree of knee rotation and the position of the measured tunnel. Therefore, when using the Amis and Jakob line to determine the tibial tunnel position during surgery, attention should be paid to rotational alignment of lateral radiographs. However, the maximum rotation tested in the present study (20°) showed only a difference in tunnel position of 3.3 % compared to optimal rotational alignment. Thus, in most cases, the effects of minor malrotation on tunnel position measurement should be of minimal clinical significance. Diagnostic study.

Although traumatic osteochondral fractures of the knee represent a common pathology of the knee joint, there is no general agreement concerning specific treatment of this entity. This meta-analysis was initiated in order to evaluate scientific evidence on different treatment options for acute osteochondral fractures of the knee.For this purpose an OVID-based systematic literature search was performed including the following databases: MEDLINE, MEDLINE preprints, Embase, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled Trials. The literature search period was from 1946 to January 2012, which led to the identification of 1,226 articles. After applying study-specific inclusion criteria a total of 19 studies with clinical follow-up of 638 patients were included. The methodology of these studies was systematically analysed by means of the Coleman Methodology Score. Outcome and success rates were evaluated depending on treatment applied.All studies (n = 19) identified represent case series (evidence-based medicine level IV) and included a total of 638 patients. The average post-operative follow-up was 46 ± 27 months (range 3.75-108). The mean number of study subjects per study was 33 ± 44 patients (range 4-169). The average Coleman Methodology Score was 29 ± 17 points (range 5-72). Six different scoring systems were used for clinical assessment. The overall clinical success rate was 83% and varied between 45 and 100%.This meta-analysis reveals a significant lack of scientific evidence for treatment of osteochondral fractures of the knee. No valid conclusion can be drawn from this study concerning the recommendation of a specific treatment algorithm. Nevertheless, the overall failure rate of 17% underlines that an acute osteochondral fracture of the knee represents an important pathology which is not a self-limiting injury and needs further investigation.

In the setting of end-stage osteoarthritis of the knee, total knee arthroplasty is the gold-standard treatment. Recently, a minimally invasive, joint preserving treatment option in the treatment of medial osteoarthritis of the knee has been developed. It is called the KineSpring(®) (Moximed(®) International GmbH, Zurich, Switzerland). The goal of this novel device is to reduce medial compartment loading without significantly affecting the loading of the lateral compartment. In this context, the current authors present a case of device failure using these new implants, which at 7 months post-op necessitated revision surgery with complete removal of the device.

Background and purpose — Substantial bone loss in revision total knee arthroplasty (TKA) is a challenging problem. We studied whether impaction bone grafting provides long-term restoration of bone stock in the treatment of major bone defects in revision surgery of rotational and hinged knee arthroplasties (LINK Endo-Model). Patients and methods — Between 1996 and 2006, 29 knees in 29 patients underwent revision procedures of rotational and hinged knee arthroplasties using impaction bone grafting (IBG) to reconstruct major bone defects. At the latest follow-up, the clinical examination included the Knee Society score (KSS), standardized radiographs, and a questionnaire for the WOMAC score. Results — After a mean follow-up of 10 (6–13) years, 14 knees with 19 IBG reconstructions (5 total, 9 partial revisions) had failed. 12 knees were treated with re-revision surgery mean 5 (1–12) years after the first revision, due to mechanical failure and aseptic loosening of the components. In all these failed cases, th...

Treating patellofemoral articular cartilage lesions remains a challenging task in orthopedic surgery. Whereas microfracture and autologous chondrocyte implantation yield good results on femoral condyles, the therapeutic state of the art for treating patellofemoral lesions is yet to be determined. In this study, we compared the CaReS technique, which is a matrix-associated autologous chondrocyte implantation technique, to microfracture for treating patellofemoral articular cartilage lesions.Between May 2003 and December 2005, 17 patients with an isolated patellofemoral cartilage defect (International Cartilage Repair Society III/IV) were treated with the CaReS technique at our department. After adjusting for inclusion and exclusion criteria, ten of these patients could be included in this study; ten patients treated with microfracture were chosen as a matched-pair group. Clinical outcome was evaluated 3 years after surgery by the 36-item Short Form Health Survey Questionnaire (SF-36), International Knee Documentation Committee (IKDC) subjective evaluation of the knee, Lysholm Score, and Cincinnati Modified Rating Scale scores.Patients treated with CaReS had statistically significantly improved IKDC, Lysholm, and Cincinnati scores 36 months after surgery compared with preoperatively. When comparing outcome between groups 36 months after surgery, there was no statistically difference in IKDC, Lysholm, and Cincinnati scores.This is the first trial comparing the CaReS technique and microfracture for treating patellofemoral articular cartilage lesions, and results show that CaReS(®) yields comparable results to microfracture. The small number of patients is a limiting factor of the study, leading to results without statistical significance. A multicentric prospective randomized study comparing the two procedures is desirable.

Background While cyclists and pedestrians are known to be at significant risk for severe injuries when exposed to road traffic accidents (RTA) involving trucks, little is known about RTA injury risk for truck drivers. Objectives The aim of this study was to analyze the injury severity in truck drivers following RTAs. Patients and Methods Our local accident research unit prospectively documented 43000 RTAs involving 582 trucks between 2000 and 2011. Injury severity, including the abbreviated injury scale (AIS) and the maximum abbreviated injury scale (MAIS) were analyzed. Technical parameters (e.g. delta-v, direction of impact), the location of accident, and its dependency on the road type were also taken into consideration. Results Thirteen percent (77/582) of truck drivers were injured. Extremities were found to be at highest risk of injury with the lower extremities (36x) being injured most severely (10x: AIS 2 and 3). Death occurred only after collisions with other trucks, and severity of injuries increased with an increased speed limit. The maximum abbreviated injury scale was higher in the crash opponents (56x MAIS ≥ 3) compared to the truck drivers (8x MAIS ≥ 3). Overall, 82% of the crash opponents were injured. Conclusions The safety of truck drivers is assured by their vehicles, the consequence being that the risk of becoming injured is likely to be low. However, the legs especially are at high risk for severe injuries during RTAs. This probability increases in the instance of a collision with another truck. Nevertheless, in RTAs involving trucks and regular passenger vehicles, the other party is in higher risk of injury.

Background and Purpose:Ceramic heads are widely used in modern total hip arthroplasty (THA). Although a rare complication, fractures of ceramic heads are described in the literature, evoking uncertainties regarding thein vivostability of this material, especially when impaction of a fractured ceramic head can lead to disastrous results.Methods:In this case report, we present a fracture of a ceramic head after trauma. A misinterpretation of the initial radiographs led to severe fragmentation of the ceramic head two weeks after the incident, later resulting in complete destruction of the arthroplasty.Results and Interpretation:Remarkably, radiographs obtained more than one year after the trauma led to this delayed diagnosis. A single radiographic evaluation, especially in patients with persistent pain after major trauma, with a ceramic head in a THA, seems to be insufficient

Computer assisted surgery (CAS) was first used in neurosurgery. Currently, CAS has gained popularity in several surgical disciplines including urology and abdominal surgery. In trauma and orthopaedic surgery, computer assisted systems are used for fracture reduction, planning and positioning of implants as well as the accurate implantation of hip and knee prostheses. The patient’s anatomy is virtualized and the surgical instruments integrated into the digitized image background, thus allowing the surgeon to navigate the surgical instruments and the bone in an improved, virtual visual environment. CAS improves overall accuracy, reducing intraoperative radiation exposure and minimizing unnecessary surgical dissection combined with increased patient and surgeon safety. However, limitations include prolonged surgical time, technical errors and cost implications. This article will outline the current state of computer assisted trauma surgery including its implications and specific challenges in orthopaedic trauma surgery.

Hintergrund: Wechseloperationen nehmen aufgrund der steigenden Primärimplantationszahlen, durchschnittlich jüngeren Patienten und der dabei immer älter werdenden Bevölkerung auch in der Knieendoprothetik zu. Der technische Anspruch dieser Operationen ist ungleich höher als beim Ersteingriff. Das zu erwartende klinische Ergebnis ist in den meisten Fällen auch schlechter als bei der Primärimplantation. Strategien zur Qualitätssteigerung bei den Primäroperationen sind daher wünschenswert. Patienten/Material: 203 ungekoppelte Knieprothesen wurden 2009 im Rahmen von Wechseloperationen in einem Zentrum explantiert. Bei 150 handelte es sich dabei um einen sogenannten Oberflächenersatz bzw. eine bandgeführte, bikondyläre Prothese. Diese Fälle wurden hinsichtlich der Versagensursache analysiert. Ergebnisse: Die durchschnittliche Standzeit der explantierten Prothesen betrug 55 Monate (Spannweite 0,5–125 Monate). Ursächlich waren intraoperativ 46 Komponenten aseptisch gelockert (30,7 %), 37 Knie klinisch instabil (24,7 %), 26 hatten eine Bewegungseinschränkung (17,3 %), 9 Fehlimplantation (5 femoral, 2 tibial, 2 kombiniert; insg. 6 %), 3 Materialschäden (2 %). In 25 Fällen lagen Infektionen (16,7 %) zugrunde und 4 Patienten hatten einen unspezifischen vorderen Knieschmerz (2,6 %). Drei Prothesen wurden zum mehrzeitigen Vorgehen bei Infekt entfernt, in 5 Fällen erfolgte ein Inlaywechsel, ebenfalls 5-mal wurde konvertiert von kreuzbanderhaltend auf kreuzbandersetzend. In 60 Fällen wurde eine teilgekoppelte Prothese (40 %) und bei 42 eine Scharnierprothese (28 %) implantiert. In 45 Fällen kam ein kondylär geführtes System (30 %) zum Einsatz. Das Bewegungsausmaß wurde verbessert. Schlussfolgerung: Bei der Analyse zeigte sich, dass wahrscheinlich in ⅓ der Fälle aufgrund technischer Fehler bei der Primärimplantation der Wechsel vermeidbar gewesen sein könnte. Infektionen und Arthrofibrose waren neben unklarem Beschwerdebild weniger vertreten, auch wenn sie in der Literatur als Hauptversager aufgeführt werden. Diese Arbeit unterstützt den hohen Qualitätsanspruch an die Primärimplantation, die in die Hände des routinierten Operateurs gegeben werden sollte.

Press-fit fixation of patellar tendon bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary. To date, no biomechanical data exist describing an implant-free double-bundle press-fit procedure. The purpose of this study was to characterize the biomechanical properties of three double-bundle press-fit fixations.In a controlled laboratory study, the patellar-, quadriceps- and hamstring tendons of 10 human cadavers (age: 49.2 ± 18.5 years) were used. An inside out press-fit fixation with a knot in the semitendinosus and gracilis tendons (SG) combined with an additional bone block, with two quadriceps tendon bone block grafts (QU) was compared with press-fit fixation of two bone patellar tendon bone block (PT) grafts in 30 porcine femora. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclical loading were investigated.The maximum load to failure was 703 ± 136 N for SG fixation, 632 ± 130 N for QU and 656 ± 127 N for PT fixation. Stiffness of the constructs averaged 138 ± 26 N/mm for SG, 159 ± 74 N/mm for QU, and 154 ± 50 N/mm for PT fixation. Elongation during initial cyclical loading was 1.2 ± 1.4 mm for SG, 2.0 ± 1.4 mm for QU, and 1.0 ± 0.6 mm for PT (significantly larger for PT and QU between the first 5 cycles compared with cycles 15-20th, P 0.01).All investigated double-bundle fixation techniques were equal in terms of maximum load to failure, stiffness, and elongation. Unlike with single-bundle press-fit fixation techniques that have been published, no difference was observed between pure tendon combined with an additional bone block and tendon bone grafts. All techniques exhibited larger elongation during initial cyclical loading. All three press-fit fixation techniques that were investigated exhibit comparable biomechanical properties. Preconditioning of the constructs is critical.

Press-fit-Fixierungen sind interessant, da diese einen zirkularen Kontakt zwischen Knochen und Transplantat ermoglichen und Fremdmaterial vermeiden. Diese Ubersichtsarbeit vergleicht etablierte mit neu entwickelten Press-fit-Fixierungen aller gangigen Transplantate und vergleicht das biomechanische Verhalten mit fremdmaterialhaltigen Fixierungen wie der Interferenzschraube. Fur die Versuche wurden 168 humane Kadavertransplantate entnommen (Alter 49,2±18,5 Jahre). Funfzehn verschiedene Fixierungen wurden miteinander verglichen. Die Konstrukte wurden zyklisch gedehnt und dann bis zum Versagen getestet. Die submaximale Versagenslast, Steifigkeit, Elongation und Versagensart wurden verglichen. Insgesamt zeigen einige Techniken vergleichbare biomechanische Qualitaten wie Fixierungen mit Implantaten. Einige Press-fit-Fixierungen erreichen eine ahnliche Primarstabilitat wie eine Transplantatverankerung mit Implantaten. Durch die gelenknahe Verpressung mit korpereigenem Material erhalt das Transplantat einen engen Kontakt zum gelenknahen kortikalen Knochen.

Shape memory orthopaedic implants made from nickel–titanium (NiTi) might allow the modulation of fracture healing, changing their cross-sectional shape by employing the shape memory effect. We aimed to show the feasibility and safety of contact-free electromagnetic induction heating of NiTi implants in a rat model. A water-cooled generator–oscillator combination was used. Induction characteristics were determined by measuring the temperature increase of a test sample in correlation to generator power and time. In 53 rats, NiTi implants were introduced into the right hind leg. The animals were transferred to the inductor, and the implant was electromagnetically heated to temperatures between 40 and 60°C. Blood samples were drawn before and 4 h after the procedure. IL-1, IL-4, IL-10, TNF-α, and IFN-γ were measured. Animals were euthanized at 3 weeks. Histological specimens from the hind leg and liver were retrieved and examined for inflammatory changes, necrosis, and corrosion pits. Cytokine measurements and histological specimens showed no significant differences among the groups. We concluded that electromagnetic induction heating of orthopedic NiTi implants is feasible and safe in a rat model. This is the first step in the development of new orthopedic implants in which stiffness or rigidity can be modified after implantation to optimize bone-healing. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1671–1676, 2010

Large segmental defects of the weight bearing long bones are very difficult to reconstruct. Current treatment options are afflicted with several limitations and disadvantages. We describe a novel approach to regenerate a segmental long bone defect in a patient using a multiple disc graft. Decellularized bovine trabecular bone discs were seeded with autologous bone marrow cells and cultured in a perfusion chamber for three weeks. Multiple cell-seeded discs were implanted to close a 72 mm defect of the distal tibia in a 58-year-old woman, and fixed by an intramedullary nail. Bone formation was assessed non-invasively by plain radiographs and 18F-labeled sodium fluoride-based co-registration of positron emission- and computed tomography (PET/CT). Bone was actively formed around the grafted defect as early as six weeks after surgery. Because the tibia was sufficiently stabilized, the patient was able to freely walk with full weight bearing 6 weeks after surgery. The uneventful two-year follow-up and the satisfaction of the patient demonstrated the success of the procedure. Therefore the use of multiple cell-seeded disc grafts can be considered as a treatment alternative for patients with segmental long bone defects.

Der Verletzungsmechanismus ist der haufigste Grund fur die Aktivierung der Traumateams und einer Behandlung im Schockraum. Es ist jedoch unklar, in wieweit der Unfallmechanismus das Verletzungsmuster und die -schwere beeinflusst. Es wurde eine umfassende Literaturrecherche bzgl. der Fragestellung durchgefuhrt. Erganzt wurde die Suche durch eine Handrecherche nichtindizierter Quellen. Insgesamt finden sich nur wenige Untersuchungen, die sich mit dem Einfluss des Unfallmechanismus auf Verletzungsmuster und -schwere beschaftigen. Anhand der identifizierten Studien lassen sich fur Verletzungen des Schadels und der Wirbelsaule keine bestimmten Mechanismen erkennen. Thorakale und abdominelle Verletzungen im Rahmen von Verkehrsunfallen treten am haufigsten bei Insassen auf, die auf der Seite des Aufpralls sitzen. Dabei korreliert die Verformung des Lenkrads mit der Verletzungsschwere. Auch Beckenfrakturen treten mit der hochsten Inzidenz nach Verkehrsunfallen auf, wobei die Schwere der Verletzung mit der Kollisionsgeschwindigkeit steigt. Die Aufprallrichtung hat dabei Einfluss auf den Frakturtyp. Die hochste Mortalitat besteht fur von einem Fahrzeug angefahrene Fusganger und bei Tod eines Mitinsassen. Die Ergebnisse der Literaturrecherche erbringen widerspruchliche Resultate, in wieweit sich der Verletzungsmechanismus auf Verletzungsmuster und -schwere auswirkt. Dementsprechend sollte ein vom Unfallmechanismus unabhangiger Algorithmus bei der Versorgung schwerstverletzter Patienten genutzt werden. Dies wird in verschiedenen Ausbildungssystemen, wie z. B. ATLS® und PHTLS®, bereits propagiert. Trotzdem kann der Unfallmechanismus die Aufmerksamkeit des behandelnden Teams fur die Verletzungsschwere und das Verletzungsmuster beeinflussen.

Purpose The aim of this study was to analyze the relation between bone mineral density (BMD) and femoral tunnel enlargement (TE) in a previously validated sheep model of soft-tissue anterior cruciate ligament (ACL) reconstruction. Methods Thirty sheep underwent ACL reconstruction by use of a soft-tissue graft at the age of 4 months. Graft fixation was achieved with the EndoButton (Smith & Nephew Endoscopy, Andover, MA) and Suture Washer (Smith & Nephew Endoscopy). Six animals were killed at 0, 3, 6, 12, and 24 weeks postoperatively. Each ACL-reconstructed knee was examined both by computed tomography to analyze the bone tunnel cross-sectional area and by dual-energy x-ray absorptiometry to analyze BMD. Results There was a significant increase in tunnel cross-sectional area. BMD decreased significantly within the first 3 weeks after surgery and increased thereafter. A positive correlation between TE and BMD was found. However, a subgroup analysis showed that there is no influence of BMD on the development of a tunnel widening. Conclusions The hypothesis that a TE would be associated with a loss in BMD was not confirmed. Tunnel widening during the first 6 months after ACL reconstruction is not affected by the transient changes in BMD. Clinical Relevance There is no correlation between TE and BMD in an experimental sheep model of ACL reconstruction. Translational investigations will determine whether this is also true in humans.

Background Press-fit fixation of a tendon graft has been advocated to achieve tendon-to-bone healing. Hypothesis Fixation of hamstring tendon grafts with a porous bone scaffold limits bone tunnel enlargement compared with a biodegradable interference screw fixation. Study Design Randomized controlled trial; Level of evidence, 1. Methods Between 2005 and 2006, 20 patients (17 men, 3 women) with a primary reconstruction of the anterior cruciate ligament (ACL) were enrolled in this study. Patients were randomized to obtain graft fixation in the tibial tunnel either by means of an interference screw (I) or a press-fit fixation with a porous bone cylinder (P). At 3 months after surgery, a computed tomography (CT) scan of the knee was performed, and tunnel enlargement was analyzed in the coronal and sagittal planes for the proximal, middle, and distal thirds of the tunnel. After 6 months and 1 and 2 years, radiographs of the knee in the sagittal and coronal plane were analyzed for bone tunnel widening. The International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores of both groups were compared after 1 and 2 years. Results The bone tunnel enlargement determined by CT was 106.9% ± 10.9% for group P and 121.9% ± 9.0% for group I (P < .02) in the anteroposterior (AP) plane and 102.8% ± 15.2% versus 121.5% ± 10.1% in the coronal plane (P < .01). The IKDC, Tegner, and Lysholm scores improved in both groups from preoperatively to postoperatively without significant differences between the 2 groups. There was a trend to higher knee stability in group P after 3 months (0.6 ± 1.4 mm vs 1.8 ± 1.5 mm; P = .08). Conclusion Both interference screw and a press-fit fixation lead to a high number of good or very good outcomes after ACL reconstruction. Tibial press-fit fixation decreases the amount of proximal bone tunnel enlargement.

Controversy exists in the literature regarding the most appropriate treatment for anterior cruciate ligament (ACL) ruptures in the skeletally immature patient. To study the histological and biomechanical stages following ACL reconstruction during growth, it is necessary to establish an equivalent model to replicate the situation of an immature skeleton. In the present study we evaluated a large animal model of ACL reconstruction during growth using skeletally immature sheep. In contrast to existing models we did not intend to provoke growth disturbances. Instead, we identified those criteria known to be essential to prevent growth disturbances in the human situation and transformed them into an animal model. Applying those criteria to skeletally immature sheep at an age of four months, we performed a fully transphyseal ACL reconstruction of their right knee. The contralateral knee served as a control. The sheep were then sacrificed 3, 6, 12 and 24 weeks after surgery. This animal model is described in detail in the present manuscript. Basic science data are presented in order to 1) make it easier for other research groups to study ACL reconstruction during growth using our model and 2) to improve this model by modifying the one or other detail of the proposed technique. Using this model, remaining open questions concerning ACL reconstruction during growth can be addressed in future studies.

The management of polytraumatised patients remains challenging in spite of advances and improvements in trauma care in recent decades. Trauma systems require enormous staff resources as well as technical equipment. Internal and external quality management processes are necessary to identify weak points and improve treatment quality. Continuous training of all professionals involved in trauma care is necessary to assure high quality, up-to-date therapy in patients with multiple injuries. Standard operating procedures such as prehospital trauma algorithms and clinical management protocols (ie, ATLS) can help to standardise and compare treatment of patients suffering from major trauma. In this overview, we describe the development and current state of our trauma department. Differences in our cohort of polytraumatised patients compared to other facilities and current strategies for initial treatment of these patients are also discussed.

Today universities can offer a variety of educational resources to their students through the internet. These may include lecture notes, PowerPoint presentations, or even an entire recording of a lecture in video format. At the Hannover Medical School (Hannover, Germany), the Trauma Surgery Department in collaboration with the Institute of Medical Informatics has developed an alternative method of "E-learning". We created a web-based multimedia resource center for Trauma Surgery using the Content-Management-System (CMS) Schoolbook application, which was initially developed by the Institute of Medical Informatics. The so called "Trauma Surgery Schoolbook" was first adopted in October of 2005 and has since been used and evaluated by medical students at our institution. The evaluation results for the academic year 2005/06 are reported in this paper. The majority of students enrolled in the Trauma Surgery rotation utilized the Schoolbook, which they regarded as a helpful and effective study tool. Our students embraced the possibility of being able to prepare for lectures and use the Schoolbook for independent home studying purposes. Over time, there was a steady increase in the utilization of the Schoolbook by the students from 67% in the first trimester to 93% in the third trimester. The majority of the surveyed students (79.6%) found the Schoolbook to be constructive and helpful. 8.1% did not have any opinion, and only 12.3% found it to not be helpful. The instructors also found this web-based training program to be both constructive and practical, and were able to utilize its multimedia components to complement their lectures. Overall, our experience with this computer-aided learning program demonstrated that web-based technologies can improve the quality of medical education, benefiting both the students and the instructors.

Osteochondral lesions are often seen in orthopedics, but the available treatment strategies are limited in success. Regenerative medicine provides novel concepts for curing them. The purpose of this study was to test the effects of perfusion and cyclic compression on cell differentiation and mechanical properties using a custom-made biomechanoreactor in a recently established system of human bone marrow stromal cells (hBMSC) cultured in a 3-D collagen I-bone hybrid matrix out of commercially available and separately in human-certified products. Seeded hBMSC were viable for 88 +/- 8.9% during the entire experimental period in the constructs. GAG and DNA levels did not change. Perfusion induced collagen II and cyclic compression increased collagen X expression. Matrix stiffness was significantly increased after 28 days of cyclic compression. Cyclic compression of cell-loaded hybrid constructs enhanced chondrocyte differentiation and matrix stiffness. This system is a promising tool with a view to a later clinical application.

Das patellofemorale Gelenk ist beim Kraftsport hohen Belastungen ausgesetzt. Diese sind von den individuellen Voraussetzungen beeinflusst. Die Krafte treten dabei winkel- und ubungsabhangig auf. Tendinopathien und Gelenkknorpelschaden sind im Kraftsport die haufigsten Erkrankungen, begunstigend wirken patellofemorales Malalignment, Uberlastung und Steroide. Gunstig wirkt sich ein individuelles Trainingskonzept mit kontrollierten Bewegungsablaufen, bei dem Spitzenbelastungen vermieden werden, aus. Die Therapie reicht von der Gabe von Antiphlogistika bis zur Rekonstruktion von Sehnen und Gelenkknorpel.

The purpose of this study was to estimate the prevalence of knee injuries in real world car crashes in Germany. Restrained car drivers (RCD) were included in a medical and technical analysis to create a basis for preventive measures.Technical and medical data were collected at the scene, shortly after the crash. Two time periods (group A, 1985-1993; group B, 1995-2003) were compared focusing on knee injuries [abbreviated injury scale (AISKnee)]. Technical analysis included type of collision, impact angle, and relative velocity. Medical analysis included injury pattern and severity (AIS, maximum AIS).About 5,972 RCD were included in this study from a total of 22,804 victims involved in 16,563 crashes. In total, severe injuries (AISKnee 2/3) occurred in 1.2% (82 patients) of all RCD. The knee injury prevalence significantly decreased over time (group A vs. B, p0.0001). A so-called dashboard injury was registered in 5.8% (n = 5).The overall prevalence for knee injuries in RCD involved in road traffic accidents was low and decreased over time. Higher loads were necessary to cause ligamentous injuries of the knee than fractures in the knee region. Because direct impact caused most of the injuries, modifications of the interior and exterior design should reduce the incidence of these injuries. A dashboard injury was very rare.

Two major concepts have been established to treat infected knee arthroplasties (TKA) in terms of one- or two-stage exchanges. A single-stage TKA exchange offers some advantages: the need for only one operative procedure without spacers, a general reduced hospitalization time, reduced overall cost (specific reimbursement system) and potential of improved patient. The presence of an organism culture with a sensitivity antibiogram is mandatory for a successful revision. Implant fixation using antibiotic loaded cement is, we believe, the current gold standard for single-stage procedure. A defined period of systemic antibiotic therapy follows and early mobilization should be started as soon as possible.

Osteochondral transplantations, albeit technically challenging, appear promising not only in knee joint lesions, but also in the treatment of talus lesions. We hypothesized that in patients suffering osteochondral lesions of the talus, favorable outcomes are obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty.Over a 3-year period (1998-2001), 14 patients (six male, eight female, median age 22 years) were treated with an autologous osteochondral transplantation of the talus. Eight patients were previously untreated (group I). Six patients had previous ankle procedures, such as microfracturing (group II). The median follow-up was 24 months and 100% complete at 12 months. The functional outcome was evaluated at least at 6 weeks, 12 weeks, and 1 year after surgery using pain on a visual analog scale (VAS) and sports activity was recorded at 1 year after surgery. In ten patients, magnetic resonance imaging (MRI) of the ankle was performed at 1 year after surgery (group I/II: 7/3).Overall ankle pain was decreased from 6.9 +/- 2.1 to 4.0 +/- 2.8 postoperatively. The mean knee pain for the donor knee was 2.6 +/- 2.4. We found no significant difference between the primary mosaicplasty group and the secondary mosaicplasty group with regard to pain. MRI scans of ten patients showed a complete incorporation of the osteochondral cylinders at 1 year after surgery.Favorable outcomes were obtained in patients undergoing primary mosaicplasty as compared to patients undergoing secondary mosaicplasty. We found no significant difference among patients with previous ankle surgery in contrast to those without, with a median 24-months follow-up.

Mehr als 9 Mio. Personen erleiden in Deutschland jahrlich eine Verletzung und >30.000 sterben an Verletzungen. Nach Schatzungen konnten durch Praventionsmasnahmen die Halfte aller Unfalle verhindert und die andere Halfte so beeinflusst werden, dass leichtere Verletzungen entstehen. Das Ziel einer Initiative der Arbeitsgemeinschaft Pravention von Verletzungen der Deutschen Gesellschaft fur Unfallchirurgie e.V. (DGU) ist eine moglichst umfassende Bestandsaufnahme bestehender Praventionsprogramme verschiedenster Expertengruppen und eine Zusammenfassung der Erkenntnisse als Basis fur weitere interdisziplinare Praventionsbemuhungen. Besonderes Merkmal ist die konsequente interdisziplinare Ausrichtung unter Einbeziehung der Fachgebiete Unfallchirurgie, Orthopadie, Kinderchirurgie, Kinder- und Jugendmedizin, Epidemiologie und „Public Health“, Soziologie, Rechtsmedizin, Psychologie, Sportmedizin, Geriatrie und Gerontologie, Anasthesiologie, und anderer. Spezielles Augenmerk wurde auch auf das Kindes- und Jugendalter und das hohere Lebensalter gelegt.

The purpose of the study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures.Technical and medical data were prospectively collected shortly after the crash at the crash scenes.Included were 4,264 injured bicyclists from 1985 to 2003. Fifty-five percent of the bicyclists were male and 45% were women. The mean age of bicyclists was 52.0 years. The crashes took place in urban areas in 95.2% of the cases, and in rural areas in 4.8% of the cases. Collision opponents were cars in 65.8%, trucks in 7.2%, bicyclists in 7.4%, standing objects in 8.8%, multiple opponents or objects in 4.3%, and others in 6.5%. The mean collision speed was 21.3 km/h. The helmet use rate was 1.7%. Fifty-five percent of bicyclists used bicycle traffic lanes before the crash. The mean Maximum Abbreviated Injury Scale/Injury Severity Score (ISS) was 1.45 of 3.9. The incidence of multiple injuries (ISS16)/death was 2.0%/1.5%. The ISS/Maximum Abbreviated Injury Scale score was higher in bicyclists without a helmet than in bicyclists with a helmet, and in bicyclists who had not used bicycle traffic lanes than in bicyclists who had used bicycle traffic lanes (t test, p0.05).In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets. More consequent helmet use and an extension of bicycle traffic lanes for a better separation of bicyclists and motorized vehicles would be simple but very effective preventive measures.

Das Internet bietet in der universitaren Lehre viele Moglichkeiten, Lehrinhalte fur die Studierenden zur Verfugung zu stellen. Neben dem Angebot, Vorlesungsfolien oder Skripte als pdf-Dateien uber das Internet abzurufen, werden zunehmend ganze Vorlesungen als Video aufgezeichnet und ins Web gestellt. Als Alternative zu diesen beiden Ansatzen wurden von der Klinik Unfallchirurgie und dem Institut fur Medizinische Informatik der Medizinischen Hochschule Hannover (MHH) die Vorlesungsmaterialien in ein multimediales Webangebot umgesetzt, das sowohl als Prasentationsgrundlage fur die Vorlesung als auch als Lernangebot fur zuhause dienen sollte. Umgesetzt wurde das E-Learning-Angebot zur Unfallchirurgie mit dem „Content-Management-System- (CMS-)Schoolbook“, das vom Institut fur Medizinische Informatik entwickelt wurde.