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Osteocytes are the most abundant bone cells, playing important roles in tissue maintenance. Little is known of how they react in vivo to cancer stress. Here we present a comparative study of the effect of a bone-residing tumour (myeloma) and metastases of bone-remote cancers on osteocytes. While no differences in morphology of the bone are seen, the changes in the transcriptome of osteocytes are specifically related to the tumour stress present. Screening approximately 22 000 genes in osteocytes prepared from cryosections of native bone using laser-supported microdissection, we observed approximately 1400 and approximately 1800 gene expression differences between osteocytes dissected from normal bone compared with those associated with metastases and multiple myeloma, respectively. The genes up-regulated due to the stress exerted by metastases were repressed by multiple myeloma and vice versa, indicating stress-specific footprints in the transcriptome of osteocytes. Functionally, the stressors seem to impose selective pressures on signalling pathways such as that of TGFbeta, a major player in bone biology. Our data show for the first time that the transcriptome of osteocytes in vivo becomes strongly affected by cancer stress, generating gene expression footprints which, in contrast to comparable morphological changes, appear to relate to the nature of cancer and might thus become helpful in distinguishing different bone diseases.

Ziel: Wertigkeit der MDCT bei Verlaufsbeobachtung der Wirbelkorperarchitektur nach Ballonkyphoplastie. Beobachtung der morphologischen Wirbelkorperveranderungen. Material und Methoden: In einem Zeitraum von 26 Monaten wurden 66 osteoporotische Wirbelkorperfrakturen mittels perkutaner Kyphoplastie behandelt. Computertomographisch wurden die Wirbelkorperhohen, Spinalkanalweite, sagittale Indizes, Kyphose- und COBB-Winkel sowie die Zementleckagen vor, nach und im Langzeitverlauf evaluiert. Die statistische Auswertung erfolgte mittels Berechnung quantitativ-stetiger Grosen deskriptiver Kennzahlen sowie fur alle Fragestellungen durch Anwendung eines parametrischen und eines verteilungsfreien Verfahrens. Ergebnisse: Nach Kyphoplastie zeigten therapierte Wirbelkorper einen signifikanten Hohengewinn an Vorderkante (0,15 cm; p < 0,0001) und Wirbelkorpermitte (0,17 cm; p < 0,0001). Es ergab sich kein signifikanter Hohengewinn an der Hinterkante. Korrelierend zeigte sich eine Zunahme des sagittalen Index, der in der Langzeitbeobachtung konstant erhalten blieb. Referenzwirbelkorper und therapierte Wirbelkorper zeigten im Verlaufe eines Jahres gleichermasen eine Hohenminderung bei insgesamt erhaltener Wirbelkorperform. Therapierte Wirbel zeigten im Vergleich einen weniger starken Hohenverlust. Eine signifikante Veranderung von Kyphose- und COBB-Winkel wurde registriert. Bei 66 therapierten Wirbelkorpern wurden insgesamt 47 Zementleckagen (71 %) in der MDCT detektiert. Schlussfolgerung: Die MDCT ist eine prazise Methode zur Beurteilung der Wirbelkorperarchitektur nach Ballonkyphoplastie, sie ermoglicht eine exakte Verlaufsbeobachtung morphologischer Wirbelkorperveranderungen, die exakte Dokumentation von Behandlungskomplikationen (Zementleckagen) und eine genaue Beschreibung der Progression der Grunderkrankung. Ein signifikanter Hohengewinn zeigt sich in der Zunahme des sagittalen Index und der Abnahme von Kyphose- und COBB-Winkel. Therapierte Wirbelkorper zeigen im Einjahresverlauf einen signifikant geringeren Hohenverlust. Purpose: To evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. Material and Methods: During a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions. Results: After kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p < 0.0001) and in the central part of the vertebral body (0.17 cm; p < 0.0001). The height of the trailing edge did not change significantly. A corresponding gain in the sagittal index was found. The index remained stable during follow-up. Treated vertebral bodies as well as untreated references showed a comparable loss of height over the period of one year. The shape of the vertebral bodies remained stable. In comparison to these findings, treated vertebral bodies showed a reduced loss of height. A significant change in kyphosis und the COBB angle was noted. In total, pallacos leakage was detected in 71 % of cases. Conclusion: MDCT is an accurate method for evaluating vertebral body architecture after treatment with balloon kyphoplasty. Morphological changes in the vertebral bodies, and complications such as pallacos leakage and progression of osteoprosis can be accurately documented. The significant increase in the vertebral body height after treatment is closely correlated with a gain in the sagittal index and reduced kyphosis and COBB angle.

Die Schmerzreduktion bei Patienten mit osteoporotischen Wirbelkorperfrakturen ist fur die Vertebroplastie und Kyphoplastie zweifelsfrei dokumentiert. Im Folgenden soll die Effektivitat der beiden Verfahren hinsichtlich der Aufrichtung der Wirbelkorper gegenubergestellt und eventuelle die Aufrichtung beeinflussende Faktoren diskutiert werden. In einer Reihe von Studien konnte gezeigt werden, dass nicht nur bei der Kyphoplastie sondern auch bei der Vertebroplastie bei Vorliegen einer dynamischen Mobilitat des Wirbelkorpers eine Aufrichtung von osteoporotischen Wirbelkorperfrakturen moglich ist. Analog zur Vertebroplastie konnte kurzlich fur die Kyphoplastie gezeigt werden, dass ein Teil der erfolgten Aufrichtung alleine durch die Lagerung der Patienten erreicht wird. Durch Inflation der Ballonkatheter kommt es jedoch zu einer weiteren zusatzlichen Reduktion der Kyphose. Das Ausmas der praoperativen Kyphose, das Frakturalter, das Frakturniveau und das Vorhandensein eines Vakuumphanomens gelten als Faktoren, welche die Aufrichtung beeinflussen. Die klinische Bedeutung der Aufrichtung der Wirbelkorper kann derzeit noch nicht abschliesend beurteilt werden, da ein Zusammenhang zwischen dem Grad des Hohengewinnes und der Lebensqualitat der Patienten bisher nicht nachgewiesen werden konnte. Minimally invasive vertebral augmentation techniques (vertebroplasty and kyphoplasty) can provide dramatic pain relief in patients with osteoporotic vertebral compression fractures. In the following both procedures are compared regarding restoration of vertebral body height and factors affecting reduction of the vertebra are discussed. Recently some studies documented height restoration not only in patients treated with kyphoplasty but also in patients with vertebroplasty due to dynamic fracture mobility. According to the results obtained with vertebroplasty it has been shown in patients treated with kyphoplasty that about 50 % of height restoration is due to prone positioning of the patient, but inflation of the inflatable bone tamp results in a further reduction of the fracture. Significant factors affecting height restoration are the degree of the kyphotic deformity, the level and age of the fracture and the presence of an intravertebral vacuum cleft sign. The clinical impact of height restoration on the quality of life is poorly defined and needs to be elucidated in further studies.

In der vorliegenden Studie werden die Behandlungsergebnisse der offenen transthorakalen und der endoluminalen stentgestutzten Versorgung bei polytraumatisierten Patienten mit traumatischer Aortenruptur hinsichtlich der Versorgungsqualitat (Dauer bis zur Operation, Dauer der Operation, Transfusionsbedarf) und Letalitat dargestellt. Die Datenauswertung erfolgte retrospektiv auf Grundlage des Traumaregisters der Deutschen Gesellschaft fur Unfallchirurgie (DGU) zwischen 1993 und 2002. Anhand des „Abbreviated Injury Score-“(AIS-)Codes wurden zunachst alle polytraumatisierten Patienten mit einer Aortenruptur ermittelt und in die Analyse [“Injury Severity Score“ (ISS), Blutdruck, Hb, AISThorax/Abdomen/Schadel, Alter] eingeschlossen. Innerhalb dieses Patientenkollektivs wurde dann fur 41 Patienten der Jahre 1998–2002 die Versorgungsqualitat (Dauer bis zur Operation, Dauer der Operation, Transfusionsbedarf) und Letalitat zwischen offen-chirurgischem und endovaskularem Verfahren verglichen. Von insgesamt 14.110 wiesen 100 (0,7%) Patienten mit einem Durchschnittalter von 38 (±19) Jahren eine Aortenlasion mit einer innerklinischen Gesamtletalitat von 39% auf. Der mittlere ISS betrug 41 (±14). Bei 36 Patienten wurde die Ruptur offen transthorakal und bei 5 Patienten endovaskular mittels Aortenstentimplantat versorgt. Die Letalitat in der Stentgruppe war mit 0% deutlich niedriger als in der offen operierten Gruppe (17%). Verletzungen der thorakalen Aorta stellen eine seltene aber schwerwiegende Begleitverletzung bei schwer- und schwerstverletzten Patienten dar. Die Krankenhausletalitat der traumatischen Aortenruptur scheint durch die Anwendung endovaskularer Stentverfahren deutlich gesenkt werden zu konnen. Da die Methode ein gering invasives und sicheres Verfahren darstellt, ist sie in Zentren mit entsprechender Erfahrung eine wichtige Alternative zum offenen transthorakalen Vorgehen.

Previously it has been shown that recombinant human bone morphogenetic protein (rhBMP-2) can be chemically immobilized by “anchor molecules” on titanium surfaces for serving as a drug delivery device. This opened the question of whether the insoluble immobilized rhBMP-2 retained its activity in comparison to the same amount of soluble rhBMP-2 included with the implant samples. Electropolished titanium miniplates (10 × 6 × 0.8 mm) were “surface-enhanced” by a novel treatment with chromosulfuric acid and then coated with a total amount of 150–200 ng rhBMP-2 prepared by recombinant technology. Periosteal flaps (7 × 20 mm) were detached and isolated from the anterior surface of the tibiae of adult rabbits and wrapped around the titanium sample plates which were then implanted in the M. gastrocnemius. In the first experimental group various controls without rhBMP-2 were combined (n = 12). In the second experimental group implants with chemically immobilized rhBMP-2 (n = 8) were compared with implants to which non-immobilized soluble rhBMP-2 was added (n = 8). Animals were sacrificed after 28 days and a quantitative evaluation was carried out by means of serial sections. Untreated control plates showed bone formation in 2/12 implants, rhBMP-2 coated implants in 6/8 and implants with free rhBMP-2 administered subperiostally in 8/8 cases. In the case of rhBMP-2 coated implants the induced bone had direct contact to the implant in all cases while in the group with free administered rhBMP-2 the bone had no contact to the implant in two cases, but was separated by a fibrous capsule. Bone volume, bone surface area, and trabecular number displayed no difference between the two rhBMP-2-groups. However, in the biocoated group a tendency to an increase in the bone-implant contact area was evident. No differences in osteoid area, osteoid perimeter and eroded perimeter were detected. We conclude that in the case of non-immobilized rhBMP-2 there is the danger for formation of fibrous tissue between the implant and the newly formed bone and in addition the generation of ectopic bone at inappropriate places. In contrast chemically immobilized rhBMP-2 does not have these drawbacks and at the same time displays a biological activity on surfaces similar to that of soluble rhBMP-2 demonstrating that biomaterial surfaces can be tailored for a selective and specific interaction with the target tissue. Abschatzung der biologischen Aktivitat von chemisch immobilisiertem rhBMP-2 auf Titanoberflachenin vivo In bisherigen Arbeiten konnte gezeigt werden, dass rekombinantes humanes Bone Morphogenetic Protein (rhBMP-2), welches in vitro aktiv ist, kovalent auf Titanoberflachen immobilisiert werden kann. Es erhebt sich die Frage, ob das in dieser Form immobilisierte rhBMP-2 seine biologische Aktivitat in vivo behalt. Die Oberflache von elektropolierten Titanplattchen (10 × 6 × 0.8 mm) wurde durch Behandlung mit Chromschwefelsaure veredelt und die Plattchen wurden anschliesend mit einer Gesamtmenge von 150–200 ng rhBMP-2 beschichtet, das mittels rekombinanter DNA-Technologie in E. coli gewonnen wurde. Von der Vorderkante der Tibia erwachsener Kaninchen wurde ein 7 × 20 mm groser Perioststreifen entnommen, die Titanplattchen damit umwickelt und das Komposit dann in den M. gastrocnemius implantiert. Die Experimente wurden in zwei Hauptgruppen aufgeteilt. In der ersten Versuchsgruppe wurden verschiedene Kontrollen in Abwesenheit von rhBMP-2 zusammengefasst (n = 12). In der zweiten Versuchsgruppe wurde die biologische Reaktion auf chemisch immobilisiertes rhBMP-2 (n = 8) mit nicht-immobilisiertem loslichem rhBMP-2 in der Periosttasche (n = 8) verglichen. Die Versuchsdauer betrug 28 Tage. Die quantitative Analyse der Knochenneubildung wurde an Serienschnitten durchgefuhrt. Wahrend es in der ersten Versuchsgruppe bei Implantaten ohne rhBMP-2 wie zu erwarten nur in 2/12 Fallen zu einer ganz geringen Knochenneubildung kam, zeigte sich eine deutliche Knochenneubildung bei 6/8 Implantaten mit chemisch immobilisiertem rhBMP-2 und bei 8/8 Implantaten mit freiem rhBMP-2. Bei immobilisiertem rhBMP-2 hatte der neugebildete Knochen in allen Fallen einen unmittelbaren Kontakt zur Implantatoberflache, wahrend bei freiem rhBMP-2 der Knochen in 2 Fallen keinen Kontakt zum Implantat aufwies, sondern von einer Bindegewebsschicht getrennt war. Hinsichtlich Knochenvolumen, Knochenoberflache und Trabekelzahl ergab sich kein Unterschied zwischen immobilisiertem und freiem rhBMP-2. Die Parameter Osteoidflache, Osteoidumfang und erodierter Umfang zeigten ebenfalls keine Gruppenunterschiede. Wir schliesen, dass im Falle des nicht-immobilisierten rhBMP-2 die Gefahr eines fibrosen Interfaces zwischen Implantat und neugebildetem Knochen und der Induktion von ektopischem Knochen an ungewollter Stelle besteht. Im Gegensatz dazu zeigt kovalent immobilisiertes rhBMP-2 auf Titanoberflachen eine ahnlich hohe biologische Aktivitat wie losliches rhBMP-2 ohne die obengenannten Gefahren. Oberflachen von Biomaterialien konnen somit durch rhBMP-2 Beschichtungen so verandert werden, dass eine spezifische Interaktion mit dem Zielgewebe induziert wird.

The immuno-inflammatory response to titanium plates used for the internal fixation of long bones was studied histologically. The soft tissue adjacent to the surface of titanium plates was examined by means of immunohistochemical methods in ten patients. The tissue was discoloured black as a sign of metallosis in 7 patients. Titanium particles located in macrophages ( CD68 +) were observed in all patients. Some of them expressed MHC class II molecules. T-lymphocytes (CD45RO +) were detected in the vicinity of titanium particles. CD8 positive cells were also observed, whereas B-lymphocytes (CD79a +) were absent. The presence of titanium was confirmed by energy-dispersive X-ray analysis.

Einleitung: Es soll in diesem Beitrag die in der Diagnostik und Behandlung von Osteoidosteomen gemachte Erfahrung weitergegeben und besonders auf diagnostische und therapeutische Irrwege eingegangen werden. Patienten und Methode: Zwischen 1985 und 1996 wurden 14 Osteoidosteome operativ behandelt. Alle bis auf einen Tumor waren an der unteren Extremitat lokalisiert. Fuhrendes Symptom waren nicht belastungsabhangige spontane Schmerzen, die vor allem nachts auftraten und gut auf Acetylsalicylsaure ansprachen (10/14 Patienten). Die Anamnesen in unserem Krankengut waren, wie auch in anderen publizierten Kollektiven inakzeptabel lang (im Mittel 24 Monate). Oft wurde eine geradezu klassische pathognomonische Symptomatik verkannt, was zu frustranen konservativen oder sogar operativen Therapieversuchen fuhrte. Ergebnisse: Bei eindeutiger Klinik und Rontgenmorphologie erfolgte als gleichzeitig diagnostisch-therapeutische Masnahme die gezielte Excision des Nidus, wodurch eine sofortige postoperative Beschwerdefreiheit erreicht wurde. Bei nicht typischer Rontgenmorphologie in den Standardaufnahmen wurden fruhzeitig eine Knochenszintigraphie, konventionelle Tomogramme oder eine computertomographische Untersuchung durchgefuhrt. Alle Patienten waren im Mittel 6,6 Jahre nach der Operation beschwerdefrei. Rezidive sind nicht aufgetreten. Schlussfolgerung: Bei nicht belastungsabhangigen spontanen Schmerzen, die vor allem nachts auftreten und gut auf Acetylsalicylsaure ansprechen, sollte an das seltene Osteoidosteom gedacht werden. Bei eindeutiger Klinik und Rontgenmorphologie erfolgt als gleichzeitig diagnostisch-therapeutische Masnahme die gezielte Excision des Nidus.

Die Therapie maligner Knochentumoren umfast heute in der Regel ein multimodales Therapiekonzept. Aus diesem Grunde sollte die Therapie und Behandlung dieser Tumoren am besten in geeigneten Tumorzentren erfolgen. Neben der Klassifikation und Stadieneinteilung soll anhand verschiedener Lokalisationen das Therapiemanagement aufgezeigt werden

The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights > 4 m. 211 patients with an injury severity score (ISS) > 17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (I: 28 ± 1; A: 30 ± 1), ventilation time (I: 16 ± 2; A: 15 ± 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27 %), fractures of lumbarspine (I: 34; A: 15 %), pelvis (I: 51; A: 38 %), lower leg (I: 47; A: 20 %), pilon (I: 15; A: 5 %), and os calcis (I: 17; A: 9 %). Liver lacerations occured more often after intentional fall (I: 16; A: 6 %). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A (I: 1; A: 8 %). Main cause of death in both groups was single or multiple organ failure (MOF: I: 47; A: 69 %) or related to brain-injuries (I: 35; A: 19 %). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.

The benefit of early operative stabilization of femoral fractures is established in patients with multiple injuries. In the last few years the unreamed femoral nail is favoured for internal fixation of femoral fractures despite pathophysiological concerns. The foremost advantage of femoral nails compared with plate fixation is the possibility of early full weight bearing. The aim of this retrospective study was to investigate, under consideration of the severity of injury, the extent of injury, and the clinical course, if multiple injured patients with concomitant femoral fractures benefit from the preferred intramedullary nailing with early weight bearing. Three hundred and two (23.8 %) out of 1271 multiple injured patients (ISS > 17) had a concomitant femoral fracture. Fourty-seven out of 302 patients were children under 16 years of age, remaining 255 patients. Eighteen out of 255 patients died within the first 21 days after trauma and 66 patients required mechanical ventilation for more than three weeks (171/255). Thirty patients suffered from severe head injury (AIS-head > 3) and seven from severe pulmonary contusion with concomitant abdominal injury (134/255). Two patients had grade III open femoral fractures with vascular injury. Ipsilateral unstable pelvic fratures were seen in 11 patients, seven patients had ipsilateral intraarticular femoral fractures, and ipsilateral intraarticular fractures of the lower leg or foot were observed in 40 patients (74/255). The results demonstrate, that only 74 (29 %) out of 255 multiple injured patiens ( > 16 years of age) had a theoretical benefit of early weight bearing. Seventy percent of the patients did not benefit from intramedullary nailing considering full weight bearing. With regard to pathophysiological concerns alternative methods of fracture fixation should be discussed for these patients. Primary fracture fixation with external fixators and secondary internal fixation proved to be a save alternative method. The complication rate of plating is comparable to intramedullary nailing but associated with less severe systemic risks. Primary plating of femoral fractures would not delay mobilization of most multiple injured patients.

Die Versorgung polytraumatisierter, alterer Patienten ist aufgrund vielfaltiger Probleme besonders aufwendig und mit einer hohen Letalitat bei diesen Patienten verknupft. Der Verlauf und die Prognose alterer polytraumatisierter Patienten sollte durch Vergleich mit jungeren Patienten untersucht werden. Dazu wurden 2 Gruppen gebildet: Gruppe J: 16 – 64 Jahre, n = 1022, Gruppe A: 65 – 94 Jahre, n = 132. Altere Patienten wurden haufiger als Fusganger (69%), jungere Patienten vor allem als PKW-Insassen (41%) verletzt. Die Verletzungsschwere im ISS (J: 28±1, A: 27±1) war in beiden Gruppen gleich. Im Verlauf traten ARDS (J: 10%, A: 11%), MOV (J: 6%, A: 9%) und Pneumonien (J: 17%; A: 21%) in beiden Gruppen gleichhaufig auf, wahrend septische Komplikationen bei den alteren Patienten signifikant haufiger beobachtet wurden (J: 19%, A: 27%). Altere Patienten verstarben signifikant haufiger (J: 16%, A: 58%) an der Sepsis (J: 15%, A: 31%), jungere Patienten dagegen haufiger an den Folgen des Organversagens (J: 54%, A: 29%). Die Intensiv-(J: 19±2, A: 18±1) und Beatmungsdauer (J: 17±1, A: 14±2) war bei den alteren Patienten nicht verlangert. Zusammengefast haben altere Patienten nach schweren Unfallverletzungen bei vergleichbarer anatomischer Verletzungsschwere eine deutlich hohere Letalitat als jungere Patienten, wobei diese auf der Entwicklung septischer Komplikationen beruht.

We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the THR and one fracture of an osteolytic lesion of the femoral shaft during nail insertion. Both were managed successfully. The hybrid osteosynthesis which we describe is an alternative to the use of tumour or long-stem prostheses; it has the advantage of preserving bone stock and muscle attachments.

From 1981 to 1993, 21 patients received intercalary bone allografts for reconstruction of the extremity after en bloc tumor resection (15 malignant and 6 benign tumors). The allografts were collected from multiorgan donors and cryopreserved at -70 degrees C. The mean follow-up was 4.4 (range 1-13) years. The fate of the grafts was followed by conventional radiography, bone scintigraphy, and functional assessment. The overall survival rate of the 7 patients with high-grade malignancies was 86%. Solid union of the graft-host sites in less that 15 months occurred in 85%. An increased isotope uptake of the graft indicates that incorporation at the osteotomies as well as remodelling is still continuing at 9 years after operation. The overall complication rate was 43%; 3 patients had two or more complications. Complications were related to the allograft in 6 (infection or fatigue fracture in 1 and delayed healing in 4 cases) and to the osteosynthesis in 3 patients. The definitive results after treatment of complications show that satisfactory results have been obtained in all but 2 patients: 62% had excellent, 19% good, and 10% fair results. Intercalary allografts therefore provide a valuable solution for large skeletal defects after resection of bone tumors.

The aim of this study was to evaluate the reduction of pain, improvement of sagittal alignment, complications and intermediate term results of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (VCF). The study group consisted of 87 patients with 145 VCFs which were not responsive to non-operative treatment. All data were collected prospectively. Improvement of sagittal alignment (Cobb and kyphotic angles, anterior, middle and posterior height) was determined from CT scans. Pain was evaluated by means of a visual analogue scale (VAS). Postoperative CT scans revealed a significant reduction of the mean kyphotic angle of 5.7 degrees (range 2-24 degrees ) and a significant reduction of pain from 7.8+/-2.4 to 2.0+/-1.5 in the VAS (improvement of pain in 95.5% of patients). An asymptomatic leakage of cement was observed in 28 out of 145 vertebrae (19.3%). The outcome of 35 patients with 51 VCFs was evaluated after a mean of 13 (range 12-70) months (CT and VAS) and there was a persisting reduction of pain and no loss of reduction. In this group of patients new symptomatic fractures were evident in 4 and clinically asymptomatic (only seen on CT) fractures were detected in 5 out of 35 patients, 7 fractures were adjacent to and 2 fractures were remote from the initially treated level. In two patients an asymptomatic moderate loss of reduction was detected. These intermediate term results indicate that kyphoplasty reduces pain and improves sagittal alignment in patients with VCF. However, in 26% of patients new fractures occurred, predominantly in adjacent levels but approximately 50% of these fractures were clinically asymptomatic.

Patients in extremis because of trauma-related massive chest injury require expedient evaluation and prompt intervention. The initial pathophysiology relates to the significant intrapulmonary shunting caused by disruption of pulmonary capillaries and extravasation into the alveolar spaces. Disproportionate or unilateral lung involvement needs measures more technical than general supportive care. Independent lung ventilation (mostly with unilateral lung involvement) and other strategies, such as inhaled nitric oxide, prone positioning, partial liquid ventilation, and extracorporeal membrane oxygenation (ECMO), have had good results. Intensivists confronted with this clinical subset may consider using these strategies as alternative/adjunctive options for optimising respiratory and haemodynamic status in the supportive management of trauma-related acute lung injury (ALI) and adult respiratory distress syndrome (ARDS).

Osteocytes are the most abundant bone cells, playing important roles in tissue maintenance. Little is known of how they react in vivo to cancer stress. Here we present a comparative study of the effect of a bone-residing tumour (myeloma) and metastases of bone-remote cancers on osteocytes. While no differences in morphology of the bone are seen, the changes in the transcriptome of osteocytes are specifically related to the tumour stress present. Screening approximately 22 000 genes in osteocytes prepared from cryosections of native bone using laser-supported microdissection, we observed approximately 1400 and approximately 1800 gene expression differences between osteocytes dissected from normal bone compared with those associated with metastases and multiple myeloma, respectively. The genes up-regulated due to the stress exerted by metastases were repressed by multiple myeloma and vice versa, indicating stress-specific footprints in the transcriptome of osteocytes. Functionally, the stressors seem to impose selective pressures on signalling pathways such as that of TGFbeta, a major player in bone biology. Our data show for the first time that the transcriptome of osteocytes in vivo becomes strongly affected by cancer stress, generating gene expression footprints which, in contrast to comparable morphological changes, appear to relate to the nature of cancer and might thus become helpful in distinguishing different bone diseases.

To evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body.During a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions.After kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p0.0001) and in the central part of the vertebral body (0.17 cm; p0.0001). The height of the trailing edge did not change significantly. A corresponding gain in the sagittal index was found. The index remained stable during follow-up. Treated vertebral bodies as well as untreated references showed a comparable loss of height over the period of one year. The shape of the vertebral bodies remained stable. In comparison to these findings, treated vertebral bodies showed a reduced loss of height. A significant change in kyphosis und the COBB angle was noted. In total, pallacos leakage was detected in 71 % of cases.MDCT is an accurate method for evaluating vertebral body architecture after treatment with balloon kyphoplasty. Morphological changes in the vertebral bodies, and complications such as pallacos leakage and progression of osteoprosis can be accurately documented. The significant increase in the vertebral body height after treatment is closely correlated with a gain in the sagittal index and reduced kyphosis and COBB angle.

Das Ziel dieser Untersuchung ist es, die Schmerzreduktion, die Verbesserung der Wirbelkorperdeformitat, unerwunschte Wirkungen sowie die mittelfristigen Behandlungsergebnisse nach Ballonkyphoplastie bei osteoporotischen Wirbelkorperkompressionsfrakturen darzustellen. Es wurden 87 Patienten mit 145 osteoporotischen Wirbelkorperfrakturen, bei denen eine medikamentose Therapie fehlschlug, mittels Ballonkyphoplastie behandelt und samtliche Daten prospektiv erfasst. Die Verbesserung der Wirbelkorperhohe wurde in CT-Untersuchungen mittels Messung von Cobb- und Kyphosewinkel, anteriorer, mittlerer sowie posteriorer Wirbelkoperhohe ermittelt. Das Schmerzausmas wurde anhand einer visuellen Analogskala (VAS) erfasst. Der Vergleich der praoperativen mit den postoperativen CT-Untersuchungen zeigte eine signifikante Reduktion des Kyphosewinkels von im Mittel 5,7° (2°–24°). Die Schmerzen besserten sich in der VAS signifikant von 7,8±2,4 auf 2,0±1,5 (Schmerzverbesserung bei 95,5% der Patienten). Ein symptomfreier Austritt des Knochenzements aus dem Wirbelkorper wurde in 28/145 Fallen (19,3%) beobachtet. Nach im Mittel 13 Monaten (12–16 Monate) konnten bisher 35 Patienten mit 51 Wirbelkorperfrakturen nachuntersucht werden (CT und VAS). Es zeigten sich eine anhaltende Schmerzreduktion und kein signifikanter Korrekturverlust des Kyphosewinkels. Erneute Frakturen mit Symptomen sind in diesem Kollektiv bei 4 Patienten, klinisch stumme neue Frakturen bei 5/35 Patienten aufgetreten. Sieben Frakturen lagen dabei im Anschluss an die initiale Fraktur, 2 Frakturen an einer entfernten Lokalisation. Bei 2 Patienten konnte im CT ein symptomfreier Hohenverlust des mittels Kyphoplastie versorgten Wirbels beobachtet werden. Mit Hilfe der Ballonkyphoplastik kann bei Patienten mit schmerzhaften osteoporotischen Wirbelkorperfrakturen mittelfristig eine erhebliche Besserung der Schmerzsymptomatik und eine Aufrichtung der Wirbelkorper erreicht werden. Bei 26% der Patienten traten jedoch vermehrt in Nachbarsegmenten neue Frakturen auf, von denen ca. 50% symptomfrei verlaufen.

Herein we report our results of treatment of traumatic aortic ruptures in severely injured patients with either open surgery or endovascular stent graft repair. Data were analyzed retrospectively from the trauma registry of the DGU (Deutsche Gesellschaft fur Unfallchirurgie) over a time period from 1993 through 2002. All patients with traumatic rupture of the aorta were included and analyzed for injury severity (ISS), blood pressure (mmHg), hemoglobin (mg/%), and AIS (Abbreviated Injury Score) of the thoracic, abdominal, and upper extremity regions. Patients treated between 1998 and 2002 were further examined (operation within 24 h, duration of intervention, blood transfusion, and lethality with regard to either open surgical or endoluminal stent graft repair). Of 14,110 patients, 100 (0.7%) suffered from acute aortic rupture. Mean age was 38 years (+/-19) with an inhospital lethality of 39% (n=39). Mean ISS was 41 (+/-14); 36 patients were treated by open surgery and 5 patients by a stent-assisted endoluminal procedure. Lethality was 17% for open surgery and 0% for stent graft repair. Endovascular approach to traumatic rupture of the aorta is feasible and safe. It has been shown to reduce inhospital lethality and may offer an alternative to open surgery for severely injured patients.

Injuries to the chest contribute significantly to the morbidity and mortality in multiple injured patients. This systematic review focuses on evidence based initial diagnostics and emergency room management of chest trauma.Clinical trials was systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).There are only a few studies that document the impact of injury mechanism and clinical examination of the patient. There is a positive correlation between crash severity or lateral impact with injury severity. Auscultation was found to be very sensitive in the detection of pneumothorax. Helical CT of the chest is most important in the initial work-up. Aortography is only indicated in selected cases. Whether tube thoracostomy is necessary in patients with occult pneumotharaces is still a matter of discussion. Indications for endotracheal intubation are poorly investigated and predominantly based on expert opinion.Numerous comparative studies (LE 2) dealing with emergency diagnostics and therapy of chest trauma are available, however only a few randomized studies do exist. Based on the available data a rational therapy of chest trauma is possible.

Extrapulmonary metastasis is more common in liposarcoma than in other soft tissue sarcomas. However, osseous metastases are rare.We report the case of a 61-year-old woman with a solitary histologically proven bone metastasis of the right femur from primary myxoid liposarcoma of the left thigh. In September 2000 resection of the primary tumor was performed. Histology showed a high-grade liposarcoma with round cell differentiation. Postoperative radiotherapy with 60 Gy was performed. In a follow-up MRI examination 11 months after initial diagnosis, a suspicious formation in the marrow space of the right proximal femur was detected. CT-guided biopsy was performed and histology showed a metastasis from liposarcoma. PET examination confirmed the metastasis as solitary. Curettage of the metastasis was performed followed by radiotherapy with 60 Gy. The patient was without evidence of disease in the last follow-up.No standard treatment exists for the management of solitary extrapulmonary metastases from soft tissue sarcoma. Interdisciplinary cooperation is advised and the therapy concept should be chosen individually.

Es wurden prospektiv neben den Behandlungsergebnissen insbesondere auch unerwunschte Wirkungen und Komplikationen der Ballonkyphoplastik zur Behandlung von osteoporotischen Wirbelkorperfrakturen untersucht.

The influence of the reduction of proinflammatory cytokines on the osteoinductive capacity of demineralized bone matrix (DBM) was investigated. Cytokine synthesis was reduced by repeated injections of lipopolysaccharide (LPS). Induction of endotoxin tolerance increases bone induction in isogeneic DBM. By means of TNF-α synthesis a linear relationship between the reduction of cytokine synthesis and bone formation has been detected.

Titanium as a material for bone plates used in trauma surgery is supposed to be biologically inert. Since we were able to observe metallosis when removing titanium plates, we decided to study the tissue reaction histologically and to compare it to the reaction to stainless steel. We examined the immuno-inflammatory response to titanium plates by means of immunohistochemical methods in 15 patients with implants made of titanium and in 20 patients with implants made of stainless steel. No patient had an infection during fracture healing. In the soft tissue adjacent to the surface of titanium implants and to the surface of implants made of stainless steel, particles were observed in all cases, which were located in macrophages (CD68+). Most of them expressed MHC class II as a sign of activation. T-lymphocytes (CD45RO+) were detected in the vicinity of titanium particles and some of them were also CD8-positive. B-lymphocytes (CD79α+) were absent. This tissue reaction could be observed both in the case of titanium implants and in the case of steel implants. We were able to detect the same kind of immunocompetent cells and semiquantitative analysis showed no differences either. The presence of titanium and stainless steel was confirmed by energy-dispersive X-ray analysis. The observed tissue reaction to bone plates made of titanium shows that titanium is not really inert. The question of whether such bone plates should be removed has to be discussed for each patient individually. In the future, further improvement of the materials used in trauma surgery is necessary.

A concept and methodology were developed for the direct biocoating of implantable metals, like titanium and stainless steel, with bioactive factors such as bone morphogenetic proteins (BMP) for future application as cementless bone prostheses. Recombinant human BMP-2 (rhBMP-2) was expressed in E. coli and purified in biologically active form. Small electropolished titanium plates were “surface-enhanced” by a novel treatment with chromosulfuric acid and then coated with rhBMP-2. Treatment with chromosulfuric acid led to a very hydrophilic surface with a five-fold higher binding capacity for protein. In vivo testing was initated employing a periostal flap test model in rabbits. In the animal model it could be shown that the biocoated implants are non-toxic and the overall in vivo biological activity of rhBMP-2 biocoated implants (insoluble BMP-2) is so high that it is comparable to that of soluble rhBMP-2 controls, only that in the latter case the BMP effect is neither limited nor targeted and poses the danger of ectopic bone formation. We conclude that surfaces of biomaterials can be tailored by our method in such a way that a selective and specific interaction (“biological recognition”) with the target tissue can be induced by immobilized rhBMP-2 with minimal danger of ectopic bone formation and without eliciting a significant inflammatory response.

The aim of the following article is to summarize our experience in the treatment of osteiod osteomas, with special emphasis on diagnostic and therapeutic pitfalls.A consecutive series of 14 patients with osteoid osteomas was treated surgically between 1985 and 1996. All tumors but one were located in the lower limb. The main symptom was pain, being worse at night and being responsive to oral salicylates (10/14 patients). As reported in other studies, the duration of symptoms was unacceptably long (mean 24 months). The classical pathognomonic symptoms were misinterpreted in many cases, leading to frustrating conservative and even operative therapies.Open biopsy prior to surgical excision is not indicated because of the typical clinical and roentgenographic imaging of these lesions. Surgical excision of the nidus is the treatment of choice and gives immediate pain relief. If the characteristic morphology is not evident in plain roentgenograms, conventional tomograms, radionuclide scans and computerized tomography are reliable tools. All patients were free of disease at a mean of 6.6 years after operation.In symptomatic patients with osteoid osteomas the excision of the nidus is the established diagnostic/therapeutic modality. Minimally invasive procedures seem to be alternatives to classical surgery.

Hintergrund: Nachteile der bisher verwendeten Knochenersatstoffe sind das komplizierte Herstellungsverfahren, die fehlende oder schlechte Resorbierbarkeit und der hohe Preis. Vor diesem Hintergrund haben wir einen porosen Knochenersatzstoff aus Kalziumsulfatenwickelt und tierexperimentell untersucht.

The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights4 m. 211 patients with an injury severity score (ISS)17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (I: 28 +/- 1; A: 30 +/- 1), ventilation time (I: 16 +/- 2; A: 15 +/- 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27%), fractures of lumbarspine (I: 34; A: 15%), pelvis (I: 51; A: 38%), lower leg (I: 47; A: 20%), pilon (I: 15; A: 5%), and os calcis (I: 17; A: 9%). Liver lacerations occurred more often after intentional fall (I: 16; A: 6%). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A(I: 1; A: 8%). Main cause of death in both groups was single or multiple organ failure (MOF: I: 47; A: 69%) or related to brain-injuries (I: 35; A: 19%). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.

Ninetten consecutive patients with bone and soft tissue tumors of the shoulder girdle were treated with interscapulothoracic resection (Tikhoff-Linberg procedure) over a 10-year period. Twelve patients were alive with no evidence of disease at a mean follow-up of 6.3 (1-11) years and one patient is alive with local recurrence and pulmonary metastases after 15 months. Six patients died due to pulmonary metastases. Despite these complications, the Tikhoff-Linberg procedure proved to be a valuable operation for extended tumors of the shoulder girdle in terms of functional and oncological outcome and is clearly superior to forequarter amputation.

Neben seiner Bedeutung in der Organtransplantation, verbessert das T-zell spezifische Immunsuppressivum Cyclosporin A (CsA) die osteoinduktiven Eigenschaften allogener und xenogener Knochenmatrix (DBM) [3]. Daruber hinaus gibt es eine Reihe von widerspruchlichen Untersuchungen uber die Auswirkungen von CsA auf den Knochenmetabolismus. Zum einen wird aufgrund einer Steigerung des Knochenumbaus mit uberwiegender resorptiver Komponente eine Osteopenie mit einem Anstieg des Serumosteocalcins und des 1,25 Dihydroxyvitamin D beschrieben [I]. Zum anderen zeigten Orcel et al. [6] eine Abnahme der Knochenresorption und eine Zunahme der Knochenneubildung. Ekelund und Nilson fanden nach CsA Applikation bei gesteigertem Knochenstoffwechsel keine Anderung des Mineralgehaltes [3].

The benefit of early operative stabilization of femoral fractures is established in patients with multiple injuries. In the last few years the unreamed femoral nail is favoured for internal fixation of femoral fractures despite pathophysiological concerns. The foremost advantage of femoral nails compared with plate fixation is the possibility of early full weight bearing. The aim of this retrospective study was to investigate, under consideration of the severity of injury, the extent of injury, and the clinical course, if multiple injured patients with concomitant femoral fractures benefit from the preferred intramedullary nailing with early weight bearing. Three hundred and two (23.8%) out of 1271 multiple injured patients (ISS17) had a concomitant femoral fracture. Fourty-seven out of 302 patients were children under 16 years of age, remaining 255 patients. Eighteen out of 255 patients died within the first 21 days after trauma and 66 patients required mechanical ventilation for more than three weeks (171/255). Thirty patients suffered from severe head injury (AIS-head3) and seven from severe pulmonary contusion with concomitant abdominal injury (134/255). Two patients had grade III open femoral fractures with vascular injury. Ipsilateral unstable pelvic fractures were seen in 11 patients, seven patients had ipsilateral intraarticular femoral fractures, and ipsilateral intraarticular fractures of the lower leg or foot were observed in 40 patients (74/255). The results demonstrate, that only 74 (29%) out of 255 multiple injured patients (16 years of age) had a theoretical benefit of early weight bearing. Seventy percent of the patients did not benefit from intramedullary nailing considering full weight bearing. With regard to pathophysiological concerns alternative methods of fracture fixation should be discussed for these patients. Primary fracture fixation with external fixators and secondary internal fixation proved to be a save alternative method. The complication rate of plating is comparable to intramedullary nailing but associated with less severe systemic risks. Primary plating of femoral fractures would not delay mobilization of most multiple injured patients.

Primary intramedullary nailing of femoral fractures is well known to increase the risk of pulmonary complications, especially in multiple-trauma patients with severe thoracic injuries. Aim of this study was to investigate the influence of primary plate osteosynthesis of femur fractures on major complications after trauma. This retrospective study based on the records of 325 multiple trauma patients (Injury severity score ISS18, no lethal brain injury, age 16-65). According to the abbreviated injury scale of the Thorax (AIS T) patients were divided in groups without (AIS T3, "N") or with relevant thoracic injury (AIS T= 3, "T"). Both groups were additionally divided in subgroups without severe trauma to the extremities (AIS E3, "O") or primary plate-osteosynthesis of femur fractures (24 h, "I"). 4 groups were performed: NO (n = 39, ISS 25 +/- 1, pneumonia 10%, ARDS 5%, lethality 10%); NI (n = 55, ISS 27 +/- 1, pneumonia 4%, ARDS 5%, lethality 4%); TO(n = 137, ISS 28 +/- 1, pneumonia 21%, ARDS 15%, lethality 16%); TI (n = 94, ISS 31 +/- 1, pneumonia 21%, ARDS 17%, lethality 15%). Primary plate-osteosynthesis of femur fractures did not increase lethality or incidence of pulmonary complications in patients with or without severe thoracic injuries. Also complication rate after primary plate-osteosynthesis was less compared to published results after intramedullary nailing. For this, primary plate-osteosynthesis is recommendable in case of multiple trauma with thoracic injuries.

Innerhalb eines Zehnjahreszeitraums wurden 19 Patienten mit Knochen- und Weichteiltumoren des Schultergurtels mittels einer interskapulothorakalen Resektion (Tikhoff-Linberg Operation) behandelt. Nach einem mittleren Nachuntersuchungszeitraum von 6,3 (1–11) Jahren waren 12 Patienten tumorfrei. Nach 15 Monaten ist ein Patient mit pulmonalen Metastasen und Lokalrezidiv am Leben und 6 Patienten sind an pulmonalen Metastasen verstorben. Trotz dieser Komplikationen ist die Operation nach Tikhoff-Linberg ein exzellenes Verfahren fur die Behandlung ausgedehnter Tumoren des Schultergurtels und der interskapulothorakalen Amputation klar uberlegen.

Multiple injuries in elderly patients are still a common problem. The present study was performed to investigate mortality and complications in multiple trauma patients aged 65 years or more. A total of 1154 multiple trauma patients with an injury severity score (ISS) of at least 18 points were divided in two age groups: Y: 16-64 years, n = 1022; O: 65-94 years, n = 132. Older patients were injured as pedestrians in most cases (69%), while younger patients were more frequently injured as car and drivers passengers (41%). ISS was comparable in both groups (Y 28 +/- 1, O 27 +/- 1). During ICU-therapy incidence of ARDS (Y 10%, O 11%), multiple organ dysfunction syndrome (MOF; Y 6%, O 9%) and pneumonia (Y 17%, O 21%) were comparable. In contrast, septic complications were more frequent in older patients (Y 19%, O 27%). Length of ICU stay (Y 19 +/- 2, O 18 +/- 1) and ventilation time (Y 14 +/- 2, O 17 +/- 1) were comparable. Mortality was significantly higher in older patients (Y 15%, O 53%). The major cause of death was sepsis in older patients (Y 15%, O 31%) and MOF in younger patients (Y 54%, O 29%). In conclusion, older trauma patients had a higher mortality due to the development of septical complications.

Bei 33 polytraumatisierten Patienten wurden unter definierten Kriterien insgesamt 71 CT-Untersuchungen des Thorax angefertigt, die Befunde mit den konventionellen Rontgenthorax-Aufnahmen verglichen sowie die therapeutischen Konsequenzen aus den CT-Untersuchungen festgehalten. Die Effektivitat des Thorax-CT betrug beim Intensivpatienten bei Sepsis mit in der Lunge vermutetem Fokus 82% und bei pulmonaler Verschlechterung unter kontrollierter Beatmung 87%. Das Thorax-CT hat daher besonders unter diesen Indikationen seine Berechtigung und ist eine wesentliche Entscheidungshilfe in der Intensivtherapie dieser Patienten.

Between 1988 and 1994, 295 patients with blunt chest trauma were treated. Forty-two patients had flail chest, requiring mechanical ventilation. Open reduction and osteosynthesis (ASIF reconstruction plates or isoelastic rip clamps) of the chest wall were performed in 20 patients. For the purpose of analysis we separated the patients into five groups: group I (n = 10) had chest wall stabilization in flail chest without pulmonary contusion (average ISS 31.0, AIS-thorax 4.1); group II (n = 10) had chest wall stabilization in flail chest with pulmonary contusion (average ISS 37.0, AIS-thorax 4.3); group III (n = 18) had fail chest without pulmonary contusion (average ISS 36.3, AIS-thorax 4.2); group IV (n = 4) had flail chest with pulmonary contusion (average ISS 37.8, AIS-thorax 4.0); group V (n = 29) had pulmonary contusion without flail chest (average ISS 34.5. AIS-thorax 4.1). With open reduction and internal fixation of unstable chest wall segments, the duration of ventilatory support, mortality and pneumonia were significantly reduced to 6.5 (1-25) days in group I (mortality rate 0%, incidence of pneumonia 10%) compared to group III (duration of ventilatory support 26.7 days, mortality rate 39%, incidence of pneumonia 16%). Eighty percent of the patients in group I were extubated within 5 days postoperatively. In group II 4 patients underwent emergency thoracotomy for intrathoracic injuries (3 of them died between 4 h and 31 days) and 2 patients for laceration of the lung. In all these cases the chest wall was stabilized after thoracotomy. One patient was stabilized for a deformation of the chest wall and two for paradoxical movement of the chest wall during weaning from the respirator. The mean duration of ventilation in group II was 30.8 (10-112) days (mortality rate 30%, incidence of pneumonia 30%). No complications related to the osteosynthesis arose during the follow-up. In conclusion, the best indication for early operative chest wall stabilization is flail chest without pulmonary contusion, leading to a significant reduction in the duration of ventilatory support. Secondary stabilization is recommended in patients with pulmonary contusion showing paradoxical movement of the chest wall during weaning from the respirator.

We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the THR and one fracture of an osteolytic lesion of the femoral shaft during nail insertion. Both were managed successfully. The hybrid osteosynthesis which we describe is an alternative to the use of tumour or long-stem prostheses; it has the advantage of preserving bone stock and muscle attachments.

Bedingt durch die zunehmende Gefahr einer Virusubertragung durch allogene Knochentransplantate [4, 7] werden vermehrte Anforderungen an die Organisationsstrukturen einer Knochenbank gestellt. Da der damit verbundene organisatorische Aufwand jedoch erheblich ist, und ein theoretisches Restrisiko fur die Virusubertragung bestehen bleibt, wird zunehmend die Sterilisation von Knochentransplantaten klinisch angewendet, da sie das Restrisiko eliminieren und den organisatorischen Aufwand senken kann. Doch trotz der raschen Verbreitung solcher sterilisierter Knochentransplantate in der klinischen Anwendung ist bislang nur sehr wenig uber die biologischen Eigenschaften so behandelter Transplantate bekannt. Es war daher das Ziel unserer Untersuchungen, die biologischen Einbauvorgange von steriliserten allogenen Kortikalistransplantaten (Tx) mit dem Einbauverhalten konventionell konservierter Tx zu vergleichen.