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Durch die Zulassungsbeschrankungen zum Medizinstudium, sich andernde Anspruche an die „Work-Life-Balance“ und eingeschrankte langfristige berufliche Perspektiven kampfen insbesondere chirurgische Facher mit einem Nachwuchsmangel. Ziele der chirurgischen Abteilungen in der studentischen Ausbildung an den Universitatskliniken sind einerseits die konkrete Wissensvermittlung von fachlichen Zusammenhangen und andererseits das Wecken des Interesses fur die Chirurgie. Ziel der vorliegenden Studie war es, die Etablierung eines studentischen unfallchirurgischen Rufdienstes (RD-Stud) zu evaluieren und den Nutzen wissenschaftlich auszuwerten. In der vorliegenden Studie wurde der RD-Stud durch eine Pra-/Postevaluation anhand von Fragebogen mit der unterstutzenden Projektion von Rontgenbildern im Rahmen eines Lehrmoduls vergleichend mit Studierenden des 4. Fachsemesters und PJ-Studierenden untersucht. Die Rufdienststudierenden wiesen dabei sowohl vor der Lehreinheit als auch danach bessere Testergebnisse auf als die beiden anderen Gruppen. Durch die Etablierung eines RD-Stud zur Assistenz im Schockraum und bei operativen Notfalleingriffen konnen die Studierenden das Verstandnis fur chirurgische Diagnosestellung und Therapiekonzepte verbessern. Gleichzeitig erlernen sie eine zunehmende Sicherheit bei fachlichen Entscheidungen. Bei einem nur geringen Zusatzlehraufwand wird hierdurch eine erfolgreiche Nachwuchsforderung realisiert. Durch den RD-Stud konnte die Arbeitsbelastung der arztlichen Kollegen reduziert werden. Aufgrund einer geminderten Inanspruchnahme des arztlichen Rufdienstes konnten Personalkosten in Hohe von 23.659,86 Euro jahrlich eingespart werden. Es zeigt sich in der vorliegenden Analyse eine hervorragende Aufwand-Nutzen-Bilanz dieses Modells, das sich an der Universitatsmedizin Gottingen in mehreren chirurgischen Kliniken inzwischen erfolgreich etabliert hat. Es kommt neben der praxisorientierten Vermittlung von chirurgischen Lehrinhalten zu einer erfolgreichen Nachwuchsforderung sowie Ressourceneinsparung der arztlichen Rufdienste.

Hintergrund: Ca. 30 % aller knochernen Verletzungen des Fuses sind Mittelfusfrakturen. Mittelfusknochen V-Basisfrakturen treten dabei am haufigsten auf. Die Einteilung erfolgt nach Avulsionsfrakturen der Tuberositas, Jonesfrakturen und Stressfrakturen der proximalen Diaphyse. Die Behandlung der nicht dislozierten Frakturen erfolgt verbreitet konservativ. Die Indikation zur operativen Therapie wird abhangig von der Belastung und der damit verbundenen Refrakturrate jedoch groszugig gestellt. Es gibt sehr verschiedene Behandlungsalgorhythmen in der Therapie der Metatarsale V-Basisfrakturen. Wir stellen ein mogliches Konzept zur konservativen Behandlung vor und zeigen, wie sich verschiedene Therapieformen auf die Frakturheilung und soziale Reintegration der Patienten auswirken. Material und Methode: Eine retrospektive Analyse umfasst 68 und eine prospektive Analyse 18 konservativ behandelte Patienten mit einer Metatarsale-V-Basisfraktur in einem Zeitraum von 9 bzw. 3 Jahren. Die Behandlung erfolgte im gespaltenen bzw. geschlossenen Sprunggelenksverband oder in einem Gottinger Anklesplint mit jeweiliger sofortiger schmerzorientierter Vollbelastung in allen Gruppen. Die subjektiven und objektiven Therapieresultate wurden mittels Gottinger Phillipsscore erfasst. Ergebnisse: Retrospektiv betrachtet war die Frakturkonsolidierung nach 8,1 Wochen erreicht mit voller Belastbarkeit nach 6,3 Wochen. In der prospektiven Auswertung waren die knocherne Konsolidierung bereits nach 6,2 Wochen und die volle Belastbarkeit nach 1,7 Wochen eingetreten. Die Behandlung mit dem Gottinger Anklesplint ergab nach 10 Wochen bei der Auswertung des Phillipsscores mit 105 von maximal 110 Punkten das beste Ergebnis und war im Kostenvergleich die preiswerteste Variante. Schlussfolgerung: Nur durch die Ruhigstellung der Supinationskette kann die Metatarsale-V-Basisfraktur mit dem Gottinger Anklesplint regelhaft heilen. Das funktionelle Outcome ist im Vergleich zum Geishaschuh und Sprunggelenksverband besser und die Therapieform soziookonomisch gunstiger.

Due to restrictions on admission to medical school, changing claims to an optimized work-life balance and occupational perspectives, surgical professions in particular are struggling with strategies to motivate young academics. Surgical disziplines aim towards a profound transfer of knowledge and pique student's interest by ensuring a sustainable education at university.The goal of this study was to evaluate a Students-On-Call System (SOCS) and to identify a financial benefit.In this study the SOCS was compared pre-/postevaluation using questionnaires and the supporting X‑rays within a curricular teaching module of orthopedic trauma surgery, with students in the fourth semester of specialism and those in the practical semester at medical school.The students of SOCS showed significantly better results prior to the course and afterwards than the two other groups. By establishing SOCS medical students get involved into the treatment of emergency patients in the trauma resuscitation unit (TRU) and operating room (OR). Students get the chance to enhance their comprehension of diagnostics, therapy and decision making in surgical context. This highly valuable traineeship combines a minimized teaching effort with an effective motivation of young academcis for the surgical profession. A SOCS has reduced the workload of medical colleagues. Establishing SOCS spare the residents being on call and results in reduced costs of 23,659.86 Euro per year.The results presented show that the SOCS leads to an excellent cost-benefit balance, which has been established in multiple surgical departments at the medical school of the University of Göttingen. Apart from practice-oriented surgical teaching, the SOCS is a way of promoting successful young talent saving resources in the medical on-call services.

Weichteilschonende geschlossene Reposition oder kurzstreckig offene Rekonstruktion der Lange, Rotation und Gelenkstellung des Mittelhandknochens (MHK). Ubungsstabile Osteosynthese in Kombination mit postoperativer additiver Orthese. Geschlossene oder erstgradig offene MHK-Frakturen mit deutlicher Dislokation, Rotationsabweichung oder Langenverlust. Metaphysare Frakturen und langstreckige Schrag- oder Spiralfrakturen. Distale intraartikulare Frakturen, die ohne Gelenkstufe geschlossen reponiert werden konnen. Proximale nicht mehrfragmentare intraartikulare Frakturen, die sich in Mini-open-Repair-Technik ohne Gelenkstufe offen reponieren lassen. Offene Grad-2- und Grad-3-Frakturen. Mehrfragmentare proximale und distale metaphysare Frakturen, die sich geschlossen nicht reponieren lassen. Intraartikulare Frakturen, die geschlossen nicht stufenfrei reponiert werden konnen. Relative Kontraindikation: Schaftquerfrakturen der Randstrahlen. Intramedullar anterograd oder perkutan eingebrachte K-Drahte oder Mini-open-Repair-Schrauben/K-Draht-Osteosynthese bzw. K-Draht-Transfixation. Wattegepolsterte 2- bzw. 3-Finger-Unterarmgipsschale fur ca. 3–4 Tage, anschliesend Mittelhandorthese, bevorzugt SoftCast™ mit Hardcast-Kombination bei Mobilisation der Finger. In einer retrospektiven Studie wurden die mit einer Minimalosteosynthese versorgten MHK-Frakturen der Jahre 2009–2010 analysiert. Es handelte sich um 65 Patienten (Durchschnittsalter 34,8 Jahre, 13 weiblich, 52 mannlich) mit 75 MHK-Frakturen. Die Frakturen betrafen MHK II (9-mal), MHK III (5-mal), MHK IV (15-mal) und MHK V (46-mal). Die Entfernung des Osteosynthesematerials erfolgte bei 44 Patienten zwischen der 6. und 12. postoperativen Woche. Rontgenologisch waren alle Frakturen bis auf eine diaphysare Querfraktur durchbaut. Nach durchschnittlich 8 (6–12) Wochen wurde das subjektive Ergebnis von 61 Patienten und nach durchschnittlich 27 (15–37) Monaten von 34 Patienten mittels DASH-Score beurteilt. Die medianen Resultate im DASH-Score nach 2 Monaten betrugen 16 (SD 49, n = 61) und nach 27 Monaten 5 Punkte (SD 23, n = 34). Die Beweglichkeit der Fingergrundgelenke war nach 8 Wochen bei 6 Patienten mit einem durchschnittlichen Beugedefizit von 1 cm (0,5–1,5 cm) zur distalen Hohlhandfurche eingeschrankt, 2 Patienten wiesen gleichzeitig ein Streckdefizit von 10° im Fingergrundgelenk auf, bei den ubrigen Patienten waren Faustschluss und Streckung der Finger frei. Ein Patient wies nach stattgehabter Sehnenruptur und -rekonstruktion ein Streckdefizit im Fingermittelgelenk von 15° auf. An Komplikationen traten bei 2 Patienten Wundrotungen an der Eintrittsstelle der K-Drahte auf, sodass diese vorzeitig entfernt wurden. Einmal zeigte sich eine Perforation der K-Drahte am Mittelhandkopf bei subkapitaler und gleichzeitiger diaphysarer Fraktur, die einen Verfahrenswechsel auf eine Plattenosteosynthese erforderte; eine Refraktur bei diaphysarer Querfraktur heilte durch Verfahrenswechsel auf eine Plattenosteosynthese aus. Umschriebene Sensibilitatsstorungen am Handrucken ulnarseitig traten 3-mal auf, 1-mal an der Eintrittsstelle der K-Drahte, 2-mal in Hohe der Mittelhandfraktur.

The aim of the present study was to study the effect of combined therapy of teriparatide (PTH) or strontium ranelate (SR) with whole-body vibration (WBV) on bone healing and muscle properties in an osteopenic rat model. Seventy-two rats (3 months old) were bilaterally ovariectomized (Ovx), and 12 rats were left intact (Non-Ovx). After 8 weeks, bilateral transverse osteotomy was performed at the tibia metaphysis in all rats. Thereafter, Ovx rats were divided into six groups (n = 12): (1) Ovx-no treatment, (2) Ovx + vibration (Vib), (3) SR, (4) SR + Vib, (5) PTH, and (6) PTH + Vib. PTH (40 μg/kg BW sc. 5×/week) and SR (613 mg/kg BW in food daily) were applied on the day of ovariectomy, vibration treatments 5 days later (vertical, 70 Hz, 0.5 mm, 2×/day for 15 min) for up to 6 weeks. In the WBV + SR group, the callus density, trabecular number, and Alp and Oc gene expression were decreased compared to SR alone. In the WBV + PTH group, the cortical and callus widths, biomechanical properties, Opg gene expression, and Opg/Rankl ratio were increased; the cortical and callus densities were decreased compared to PTH alone. A case of non-bridging was found in both vibrated groups. Vibration alone did not change the bone parameters; PTH possessed a stronger effect than SR therapy. In muscles, combined therapies improved the fiber size of Ovx rats. WBV could be applied alone or in combination with anti-osteoporosis drug therapy to improve muscle tissue. However, in patients with fractures, anti-osteoporosis treatments and the application of vibration could have an adverse effect on bone healing.

Purpose Management of hypogonadism-induced osteoporosis in elderly men is still a challenge. We investigated the short-term effects of parathyroid hormone (PTH) treatments on strength, micro-architecture, and mineral density of trochanteric region of orchiectomized rat femur. Methods Eight-month-old male Sprague–Dawley rats (n = 44) were divided into two groups: (1) orchiectomized (ORX) and (2) sham group. Twelve weeks after orchiectomy, half of the orchiectomized animals were treated with daily subcutaneously injected PTH (0.040 mg/kg/BW) (ORX-PTH) for 5 weeks. The other half remained untreated (ORX). The sham-operated group was divided and treated in the same way (sham, sham-PTH). After 5 weeks, both femurs were excised for biomechanical and histomorphometric analysis, trabecular measurements, mineral content assessment, and immunofluorescence analysis. Results The femoral trochanteric strength after PTH treatment was enhanced in the breaking test (ORX-Fmax = 158.7 N vs. ORX + PTH-Fmax = 202 N). Stiffness of treated ORX animals reached nearly the levels observed in untreated sham rats. PTH therapy improved the trabecular connectivity, width, and area (ORX-Tb.Ar = 47.79% vs. ORX + PTH-Tb.Ar = 68.47%, P

The healing of predominantly metaphyseal fractures in postmenopausal osteoporosis is delayed and comparatively poor. Due to the potential side effects of HRT, natural alternatives are appealing. The aim of this study was to determine whether Cimicifuga racemosa extract BNO 1055 improves metaphyseal fracture healing in severe osteopenic bone in rats. Thirty-three 12-week-old female rats developed severe osteopenia during 10 weeks after ovariectomy. After metaphyseal tibial-osteotomy and standardized T-plate-osteosynthesis, the healing periods in ovariectomized rats (C), 17-α-estradiol (E) and Cimicifuga racemosa (CR) supplemented diets were assessed for 35 days. Changes in callus morphology were evaluated qualitatively by biomechanical testing and quantitatively in microradiographies and fluorochrome-labeled histological sections. The CR-supplementation slightly improved callus quality and trabecular bone formation. It significantly enhanced the endosteal callus density compared to C group (Cl.Dn.e C: 59.08 ± 21.89, E: 45.95 ± 18.39, CR: 60.85 ± 18.66*), though most of the other morphological parameters examined showed no improvement. The time course of fracture healing did not change due to CR. Estrogen-supplementation enhanced the biomechanical properties of the fracture site. Trabecular bone was improved indicating the physiological endosteal healing process. The CR-supplementation did not exhibit positive effects in severe (senile) osteopenic fracture healing as seen in early (postmenopausal) osteoporosis in rats. Callus formation was slightly improved under CR. Estrogen improved fracture healing in severe osteopenic bone, while the extent of callus formation played a minor role.

Phytoestrogens might be an alternative medication in prophylaxis and treatment of osteoporosis. In this study, the osteoprotective effects of genistein (GEN) and equol (EQO) were evaluated. After ovariectomy, 44 rats received soy-free food (Control, C) and developed substantial osteoporosis over the course of two months. After that period, the rats were divided into different groups and fed estradiol (E), GEN or EQO for 35 days. To analyze the osteoprotective effects of the tested substances, bone biomechanical properties and histomorphometric changes of the lumbar vertebrae were evaluated. In analyzing the vertebral body compression strength, we found that the EQO (103.8%) and GEN (96.8%) groups reached similar levels relative to the E group, while the C group reached 77.7% of the biomechanical properties of the E group. EQO was significantly superior to C. The histomorphometric evaluation demonstrated an increased number of nodes in EQO- and E-treated rats compared to GEN- and C-treated rats. E led to an improvement of cortical as well as trabecular bone, an advantage that was only partly seen in the other groups. Treatment with phytoestrogens induced improved bone quality. EQO and GEN might be alternatives for hormone replacement therapy, although further studies are needed to elucidate possible side effects.

Osteoporosis is accompanied by predominantly metaphyseal fractures with a delayed and qualitatively reduced healing process. This study addressed the question of whether fracture healing in the context of osteoporosis prophylaxis is improved with estrogen (E) or alendronate (ALN). Thirty-six ovariectomized and 12 sham-operated 12-week-old rats received soy-free (osteoporotic C, sham), E-, or ALN- supplemented diets. After 10 weeks, a metaphyseal tibia osteotomy and standardized T-plate fixation were performed. After a 5-week healing process, the fracture callus was evaluated qualitatively by biomechanical bending test and quantitatively in microradiographic sections. The time course of callus formation was examined using fluorochrome-labeled histological sections. Administration of E improved the biomechanical properties of callus (stiffness [N/mm]: sham: 110.2 + or - 76.07, C: 41.28 + or - 33.70, E: 85.72 + or - 47.24, ALN: 72.07 + or - 34.68). The resistance to microfracturing seen in E-treated animals was significantly enhanced and even superior to sham (yield load [N] sham: 27.44 + or - 9.72, C: 21.04 + or - 12.47, E: 42.85 + or - 13.74(Delta), ALN: 25.28 + or - 6.4(.)) (* P0.05 vs. sham group, (Delta) P0.05 vs. C group, (*) P0.05 vs. E group). Trabecular bone in particular was improved, indicating the presence of physiological endosteal bridging (Tr.Dn [%] sham: 10.53 + or - 18.9, C: 1.01 + or - 0.14, E: 24.13 + or - 34.09(Delta), ALN: 3.99 + or - 8.3(.)). ALN did not help bone healing, as shown by mechanical tests. Compared to the C group, statistically, ALN did not show worse properties. The induction of callus formation under ALN treatment was slightly delayed (Tt.Cl [mm(2)] sham: 3.68 + or - 0.66, C: 3.44 + or - 0.42, E: 3.69 + or - 0.58, ALN: 3.06 + or - 0.56). Osteoporotic metaphyseal fracture healing was qualitatively and quantitatively improved by E prophylaxis. The process of fracture healing occurred nearly physiologically (shamlike). Notably, ALN hardly improved metaphyseal callus properties when assessed as osteoporosis prophylaxis, but to a lesser extent than E.

Study Design. This study is an experimental study in the rat osteopenia model. Objective. The aim of this study was to evaluate the short-term effects of daily application of parathyroid hormone (PTH) on bone quality and quantity using a new biomechanical compression test for intact rat lumbar vertebrae. Summary of Background Data. Because of their high clinical relevance, trabecular content and thick cortical shell vertebrae are of high interest for osteoporosis research. Biomechanical stability depends on both trabecular and cortical bone. Anabolic effects on bone after long-term application of PTH have already been proven. Methods. After an intraindividual comparison (n = 20), the capability of a new test to identify biomechanical properties of the mature rat model was assessed. In the following, 33 three-month-old rats were ovariectomized. After 10 weeks, the animals were divided into 3 groups. The control group (C) received no additional food supplementation. The other groups received hormone treatment with either estradiol (E) or PTH for another 5 weeks. The effects on bone biomechanical properties and bone microstructure were analyzed. Results. After establishing the new biomechanical test for intact rat lumbar vertebrae, PTH-treated (yield stress: 2.95 N/mm 3 , elastic limit: 2.39 N/mm 3 ) and then E-treated (yield stress: 2.13 N/mm 3 , elastic limit: 1.68 N/mm 3 ) animals showed superior biomechanical results. Compression strength was significantly improved in these rats in comparison to the control group rats (yield stress: 1.86 N/mm 3 , elastic limit: 1.38 N/mm 3 ). In the microradiographic evaluation, PTH significantly improved the morphologic results to produce thicker trabeculae. E led to a more densely branched trabecular network, which was not as important as trabecular thickness for bone stability. Conclusion. After a short-term application, PTH is superior to E in recreating bone biomechanical properties and lumbar vertebral microstructure in advanced osteoporosis. The cortical shell and trabecular thickness are primarily responsible for the biomechanical strength of vertebrae.

Healing of predominantly metaphyseal fractures in postmenopausal osteoporosis is delayed and comparatively poor. Hormone replacement therapy could improve fracture healing, but, because of its potential side effects, natural alternatives are more appealing. The aim of this study was to determine if the soy metabolite equol and the native isoflavone genistein, in comparison to 17beta-estradiol, improve metaphyseal fracture healing in ovariectomy-induced osteoporotic bone of the rat. Forty-eight 12-week-old female rats developed severe osteoporosis ten weeks after ovariectomy. After metaphyseal tibial osteotomy and standardized stable internal fixation, changes in callus morphology were evaluated biomechanically, qualitatively and quantitatively in fluorochrome-labeled histological sections and microradiographs in ovariectomized rats (C) and under standardized 17beta-estradiol (E), equol (EQ) and genistein (G) supplemented rats over a period of five weeks. Estrogen and equol were able to improve the elasticity of callus formation significantly in postmenopausal osteoporotic bone (stiffness of C: 121.40 +/- 47.08 N/mm, E: 147.90 +/- 39.38 N/mm, EQ: 167.8 +/- 59.90 N/mm). The effects of estrogen were more anabolic than those of equol and were visible in changes to the trabecular bone (N.Nd of E: 6.47 +/- 7.68, EQ: 4.25 +/- 3.96). However, in terms of the whole body, equol seemed to induce less of an adverse reaction than estrogen (body weight of C: 342.20 +/- 19.91 g, E: 280.25 +/- 12.05 g, EQ: 308.75 +/- 24.28 g). Genistein as an osteoclast inhibitor influenced callus stiffness (G: 144.50 +/- 61.52 N/mm) and negatively impacted trabecular structure (N.Nd of G: 0.59 +/- 1.01) in severely osteoporotic bones. Estrogen and equol were able to improve fracture healing in ovariectomy-induced osteoporotic bones, and the extent of callus formation played only a minor role. Genistein rather negatively influenced fracture healing. The metaphyseal osteotomy model in ovariectomized rats allows an accurate study of the therapeutic effects of antiosteoporotic substances on the fracture healing process.

Introduction Currently, osteoporosis research is rarely undertaken in males but an increase in male life expectancy in the company of hypogonadism suggests the necessity for potential therapeutic options. Materials and methods In this study, the changes in bone structure under standardized testosterone- (T), raloxifene- (R) and estrogen (E)-supplemented diets were analyzed in osteoporotic castrated male rats. Results Unexpected biomechanical results could be only explained by the histomorphometry, but not by BMD measurements obtained from the qCT. All tested substances showed a significant improvement in the trabecular network (trabecular bone area for C: 2.55 mm2, T: 4.25 mm2, R: 4.22 mm2 and E: 4.28 mm2), and suggests that the bone structure was preserved. For the metaphyseal cortical bone, a significant loss was detected in T (CBP: 18.7%) compared to R (CBP: 30.0%), E (CBP: 26.8%) and even to the osteoporotic control (CBP: 28.6%). This explains the observed early mechanical final failure after T supplementation. However, due to the preserved trabecular bone in T, the occurrence of the first microfractures (yL: 49 ± 21.4 N) was significantly later than in the osteoporotic control (yL: 39.5 ± 15.5 N). Raloxifene performed well in hindering the bone loss associated with osteoporosis. However, its effect (yL: 83.3 ± 16.5 N) did not approach the protective effect of E (yL: 99.2 ± 21.1 N). Conclusion Testosterone only preserved the deterioration of the trabecular bone but not of the cortical bone. Raloxifene prevented the bone loss associated with osteoporosis at all bony structures. This effect did not approach the protective effect of estrogen on trabecular bone, but it is more suitable for male individuals because it has no feminizing effects on the subject. peerReviewed

Osteoporosis research undertaken in males is rare and there are only a few therapeutic options. Phytoestrogens might be a safe alternative for prophylaxis. Sixty 3-month-old male rats were orchidectomized and divided into five groups. The groups either received soy-free food (C), estradiol (E), testosterone (T) or Vitex agnus castus in different concentrations (AC high/AC low) for 12 weeks. The tibia metaphysis was tested biomechanically and histomorphometrically. The AC high group reached 87% of the biomechanical values of the estradiol group and was significantly superior to the control group. Testosterone supplementation resulted in poor biomechanical properties. The cortical bone parameters of the AC group were similar to the control group, while supplementation with estradiol and testosterone demonstrated a reduction of cortical bone. The AC high group reached 88.4% of trabecular bone area, 80.7% of trabecular number and 66.9% of the number of trabecular nodes compared with estradiol supplementation. Vitex agnus castus demonstrated osteoprotective effects in males. It preserves the cortical as well as the trabecular bone and might be a safe alternative for HRT. Testosterone supplementation has positive effects on trabecular bone, which are concurrently counteracted by the loss of cortical bone.

UNLABELLED Our study focuses to determine the medium range results of function and radiological findings of operatively treated fractures of the talus. Furthermore we had the intention to investigate risk-factors for posttraumatic arthrosis and necrosis of the talus. MATERIAL AND METHODS We included all 41 patients (w/m: 13/28) operated between 1995-2000 with talus neck, corpus or dislocated fracture of the talus edge (open/closed: 11/30). Fractures were classified according to Hawkins: type 1: 6 x, type II: 17 x, type III: 7 x, type IV: 3 x, 8 x dislocated peripheral fractures. 39 x screw osteosynthesis, 2 x K-wire fixation were done and 12 additive transfixation with fixateur externe. Score: AOFAS Ankle-Hindfoot-Scale, radiological assessment according to the Bargon score. 34 patients, mean age 35 years (12-60), were followed up clinically with an average of 4 years (24-72 months). RESULTS AOFAS Score: pain (40 points): diameter 31 [10-40]; function (50 points): diameter 39 [14-50]; alignement (10 points):diameter 7 [0-10]; degree of arthritis due to the Bargon scale: 0 degree: 5x,1 degree: 8x, 2 degrees: 7 x, 3 degrees: 7 x. COMPLICATIONS 4 x necrosis of margin of the wound, 1 deep infection, 5 necrosis of the talus bone. The severity of the fracture was 1 x type II according to Hawkins 3 x type III and 1 x type IV. 3 of the 5 patients who developed a talus necrosis had 28 or 38 soft tissue damage. One patient had an imminent compartment syndrome. One patient who suffered a polytrauma was operated six days post injury. Second operation: 1 Syme amputation due to necrosis of the talus subsequent to an infection. 4 x arthrodesis of the upper ankle joint and 5 x arthrodesis of the subtalar joint due to posttraumatic arthritis. CONCLUSION Primary screw osteosynthesis is the treatment of choice depending on the lesions of the soft-tissue and accompanied injuries in combination with a fixateur externe. Nevertheless the primary osteosynthesis is not able to prevent necrosis of the talus completely, that occurs in a frequency of 15%. Risk factors for a posttraumatic arthritis in addition to the type of fracture and the result of reconstruction are an accompanied soft tissue defect and local capsule-band complex with necessary temporary transfixation. Early plastic reconstruction of defects can reduce the time of immobilisation and allows motion therapy. The functional results are positive compared with the radiological results that showed arthritis in 70%.

Approximately 30 % of all bone injuries are foot metatarsal fractures. Metatarsal V basis fractures occur most frequently. The classification is done into the tuberosity avulsion fractures, Jones fractures and stress fractures of the proximal diaphysis. The treatments of non-displaced fractures are generally conservative. The indication for surgical treatment depends on the load and the associated refracture rate. There are different types of treatment of these fractures. We present a possible approach to conservative treatments and show how different therapies affect healing of metatarsal V basis fractures and social reintegration of patients.A retrospective study consisted of 68 patients analysed during a 9-year period, whereas for a prospective analysis 18 patients were included for a period of 3 years. The treatment was performed using either a splint, closed bandage of the ankle or special Göttinger Anklesplint bandage, with immediate pain-oriented full load in all groups. The subjective and objective treatment results were analysed accoding the Göttinger Phillips score.In retrospect, the fracture consolidation was observed after 8.1 weeks full load-bearing was achieved after 6.3 weeks on average. In the prospective analysis, the osseous consolidation occurred after 6.2 weeks, and the full load was applied after 1.7 weeks. After 10 weeks the treatment with the Anklesplint bandage was assessed with 105 points of a maximum 110 points of the Phillips score. The Anklesplint bandage was also the cheapest option in the cost comparison.Using the immobilisation of the metatarsal supination with the Anklesplint bandage the metatarsal V basis fractures can heal in a regular way. The functional outcome is better in comparison to the that with other treatments and it is a cost-effective treatment.

Introduction: Most people suffering from osteoporosis are undiagnosed: the first osteoporotic fracture strikes an untreated organism. Therefore implant fixation often fails and bone healing is disturbed. In this basic research project, we explore possibilities to improve the quality of the osteopenic[for full text, please go to the a.m. URL], 130. Kongress der Deutschen Gesellschaft für Chirurgie

Soft tissue protection, closed reduction or short open reconstruction of length, rotation and articulation of metacarpals. Aftercare: early active exercises protected by additive orthesis.Closed or grade 1 open fractures with significant dislocation, deviation of rotation or loss of length. Fractures of the metacarpal, metaphyseal and extensive oblique or spiral fractures. Intra-articular fractures of the distal metacarpal that can be reduced without a step in articular surface. Proximal partial articular fractures that can be reduced without a step in articular surface in the mini-open technique.Grade 2 and 3 open fractures, extensive bending fractures in the middle third and absence of the palmar bony restraint. Multifragmentary proximal and distal metaphyseal fractures that cannot be reduced by closed methods. Intra-articular fractures that cannot be reduced without a step in articular surface.Intramedullary antegrade or percutaneous K-wires or mini-open repair screw/K-wire osteosynthesis.Two or three finger forearm cast for about 3-4 days, subsequent metacarpal orthesis, an integrated hard cast Longuette (Combicast) SoftCast™ is preferred beginning with active and passive exercises of the fingers.In this retrospective study we analyzed metacarpal (MC) fractures that were treated with minimally invasive osteosynthesis during the period 2009-2010 and 65 patients (mean age 34.8 years, female/male 13/52) with 75 metacarpal fractures were enrolled. Fractures affected MC-2 (n=9), MC-3 (n=5), MC-4 (n=15) and MC-5 (n=46). Removal of implant was performed after 6-12 weeks in 44 patients. All fractures except one showed bony healing in x-ray. At 2-months follow-up 61 patients could be evaluated and at 27-months (15-37) follow-up 34 patients could be evaluated according to the DASH score. Median DASH score results were 16 points (SD 49, n = 61) after 2 months and median DASH score results were 5 points (SD 23, n = 34) after 27 months (15-37). Range of motion was limited in 6 patients after 8 weeks (range 6-12 weeks) with a deficit in flexion of finger to distal palmar crease of 1.0 cm (range 0.5-1.5 cm), 2 patients showed a deficit in finger extension of 10° in the metacarpophalangeal joint. One patient showed restricted finger extension of 15° in the proximal phalangeal joint after tendon rupture and tendon reconstruction. Complications were observed, such as circumscribed redness in two patients at the entry point of k-wires which was managed by early removal of the implant. Perforation of the k-wire occurred in one patient with subcapital and diaphyseal fracture and was managed by plate osteosynthesis. One diaphyseal transverse refracture healed after plate osteosynthesis, three circumscribed cases of paresthesia occurred, one at the entry point of the K-wires and two at the level of fracture.

Minimally invasive osteosynthesis of talar fractures.Minimally displaced fractures of the lateral process of the talus and talar neck fractures type 1 according to Hawkins classification.Dislocated peripheral fractures. Displaced fractures of the talar neck or body.For factures of the lateral process of the talus: short incision of skin over the lateral process of the talus. Gentle preparation and contact with the bone with scissors. Fragment reposition using a dentist's hook and Kirschner wire in a joy-stick technique under C-arm imaging. Stabilization with a miniscrew. For talar neck fracture Hawkins type 1: short incision of skin ventromedially and ventrolaterally. Blunt preparation of soft tissue and safe bone contact. Introduction of one small-fragment corticalis screw both medially and laterally under C-arm imaging. As an alternative, cannulated screws can also be used.For fractures of the lateral process of the talus: postoperative protection in an ankle splint (air cast, gel cast) for 4 weeks. During this time moderate weight bearing is possible. For talar neck fractures Hawkins type 1: physiotherapy and only floor contact for 6 weeks.From January 1996 to December 2002, 44 talar fractures were operatively treated in our department. Six patients had talar neck fractures type 1 according the Hawkins classification and 3 patients showed fractures of the lateral process of the talus. From those injuries, 3 Hawkins type 1 fractures and 2 fractures of the lateral process were stabilized using minimally invasive osteosynthesis. The clinical outcomes were assessed using the Ankle Hindfoot Scale of the American Orthopedic Foot and Ankle Society. Both groups reached good cosmetic and functional results. We did not observe any avascular talar necrosis or nonunions in the two groups.

This study aims to investigate the effects of two application frequencies of parathyroid hormone on the trochanteric region of rat femur. Forty-three-month-old female Sprague-Dawley rats were divided into 4 groups (n=10/group). Three groups were ovariectomized, and 8 weeks later they were administered the following treatments (5 weeks): soy-free diet (OVX), subcutaneously injected PTH (0.040 mg/kg) 5 days a week (PTH 5x/w), subcutaneously injected PTH (0.040 mg/kg) every 2 days (PTH e2d), and a sham group. The values of the biomechanical and histomorphometric parameters showed higher results in 5x/w animals in comparison to the OVX and PTH 2ed groups. The ratio between bone diameter/marrow diameter (B.Dm/Ma.Dm) in subtrochanteric cross sections did not show any significant differences between PTH 5x/w and PTH e2d. The increased bone formation rate was observed under PTH treatment in both groups mainly at the endosteal side. The endosteum seems here to be one of the targets of PTH with an accelerate bone formation and a pronounced filling-in of intracortical cavities with higher intensity for the PTH 5x/w in comparison to PTH e2d rats.

Osteoporosis and its accompanying, predominantly metaphyseal, fractures are a major health problem. Black cohosh (Cimicifuga racemosa) and estrogen positively influence osteoporotic bone. Both substances may improve fracture healing in early osteoporosis as well. In 48 twelve-week-old ovariectomized or, respectively, sham-operated (SHAM) rats, a standardized metaphyseal tibia osteotomy with bridging T-plate fixation was performed. During the healing process of 35 days, rats received soy-free (SHAM, osteopenic C), estrogen- (E) or Cimicifuga racemosa- (CR) supplemented diets. After sacrifice, the callus formation was analyzed with regard to biomechanical quality, morphology, quantity, time course of new bone built and gene expression. CR induced a high rate of metaphyseal callus formation. The biomechanical properties and the amount of new callus formation indicated that fracture healing was still in progress. Therefore, gene expression of osteoblasts was comparatively high. Body weight and the trabecular structure were influenced little by CR. Estrogen improved the biomechanical properties of the callus. Resistance to microfracturing was significantly enhanced in the E group and even superior to SHAM. Remodeling of the callus formation had already begun. The trabecular network and the typical endosteal fracture healing were especially improved. Osteoporotic metaphyseal fracture healing was improved by estrogen more than by Cimicifuga racemosa. The process of fracture healing occurred nearly physiologically. The generation of callus formation was supported by Cimicifuga racemosa as well, but the five-week duration of application was too short for Cimicifuga racemosa to show its complete potential. Already-initiated Cimicifuga racemosa therapy for menopausal symptoms could be continued during fracture healing without hesitation.

The treatment and prevention of osteoporosis involve great challenges. Nonpharmacological and supportive therapy procedures, sport, and physical exercises seem to prevent bone loss and improve bone mass. In the present study, we examined the effect of whole-body vertical vibration (WBVV) on femoral intertrochanteric bone quality in the rat osteoporosis model. Sixty female Sprague–Dawley rats, 3-month old, were ovariectomized (OVX) or sham-operated. After 3 months, each group was divided into two subgroups. In one of the subgroups, rats were treated with WBVV at 90 Hz (3.9 g) for 35 days; the second subgroup remained untreated. After killing the animals, biomechanical strength and trabecular bone architecture of the proximal region of femurs were analyzed. New cortical bone appositions and mineral density of femurs were additionally measured. Treatment with WBVV resulted in improved biomechanical properties. Maximal load and stiffness of the intertrochanteric region of femurs after WBVV were significantly enhanced. Maximal load and stiffness in treated OVX animals reached the levels observed in untreated sham rats. WBVV significantly improved all measured histomorphometric parameters in the trabecular area. Treated rats showed significantly improved mineral content in ashed femurs compared to untreated animals. A comparison of widths of fluorescence bands in cortical bone of subtrochanteric cross sections did not show any significant differences between the groups after WBVV. Low-magnitude, high-frequency mechanical stimulation improves bone strength in the proximal femur and may be a possible nonpharmacologic treatment option for postmenopausal osteoporosis. peerReviewed

Phytoestrogens might be an alternative medication in prophylaxis and treatment of osteoporosis. In this study, the osteoprotective effects of genistein (GEN) and equol (EQO) were evaluated. After ovariectomy, 44 rats received soy-free food (Control, C) and developed substantial osteoporosis over the course of two months. After that period, the rats were divided into different groups and fed estradiol (E), GEN or EQO for 35 days. To analyze the osteoprotective effects of the tested substances, bone biomechanical properties and histomorphometric changes of the lumbar vertebrae were evaluated. In analyzing the vertebral body compression strength, we found that the EQO (103.8%) and GEN (96.8%) groups reached similar levels relative to the E group, while the C group reached 77.7% of the biomechanical properties of the E group. EQO was significantly superior to C. The histomorphometric evaluation demonstrated an increased number of nodes in EQO- and E-treated rats compared to GEN- and C-treated rats. E led to an improvement of cortical as well as trabecular bone, an advantage that was only partly seen in the other groups. Treatment with phytoestrogens induced improved bone quality. EQO and GEN might be alternatives for hormone replacement therapy, although further studies are needed to elucidate possible side effects.

In the literature, an acute colonic pseudo-obstruction (Ogilvie's syndrome) is frequently observed as a complication after hip arthroplasty. It results in a massive colon dilatation without mechanical obstructions and can lead to a life-threatening colon perforation with a high mortality.We report on a 81-year-old male patient who suffered from an acetabular fracture after falling down with a concomitant coxarthrosis at the same hip side. A total hip arthroplasty was performed using a Müller cap. Postoperatively, he developed an acute colonic pseudo-obstruction that was treated conservatively with multiple colonoscopic decompressions. The importance of prompt recognition, careful monitoring and appropriate management to reduce morbidity and mortality are supported by this case.Early diagnosis and colonoscopic decompressions play a key role in the therapy for Ogilvie's syndrome. In case of a failure of conservative treatment or peritonism, an early laparotomy and coecostomy are necessary.

Healing of predominantly metaphyseal fractures in postmenopausal osteoporosis is delayed and comparatively poor. Hormone replacement therapy could improve fracture healing, but, because of potential side effects, natural alternatives are appealing. The aim of the study was to determine if the soy metabolites equol and genistein, in comparison to 17-β-estradiol, improve metaphyseal fracture healing in postmenopausal osteoporotic bone.

In this study, short-term, whole-body vertical vibration at 90 Hz improved trabecular bone quality. There was an improvement of bone quality and density in both osteoporotic and control rats. This treatment may therefore be an attractive option for the treatment of osteoporosis. Introduction Aside from pharmacological treatment options, physical exercise is known to augment bone mass. In this study, the effects of whole-body vertical vibration (WBVV) on bone quality and density were evaluated using an osteoporotic rat model. Methods Sixty female Sprague Dawley rats were ovariectomized (C) or sham (SHAM) operated at the age of 3 months. After 3 months, both groups were divided into two subgroups that received either WBVV at 90 Hz for 35 days or no treatment. After sacrificing the rats, we evaluated vertebral bone strength, histomorphometric parameters, and bone mineral density (BMD). Results Treatment with WBVV resulted in improved biomechanical properties. The yield load after WBVV was significantly enhanced. According to yield load and Young’s modulus, the treated OVX rats reached the level of the untreated SHAM animals. In all measured histomorphometric parameters, WBVV significantly improved bone density. Treatment with WBVV demonstrated greater effects on the trabecular bone compared to the cortical bone. The ash-BMD index showed significant differences between treated and untreated rats. Conclusion Using WBVV as a non-pharmacological supportive treatment option for osteoporosis demonstrated an enhancement of bone strength and bone mass. This procedure may be an attractive option for the treatment of osteoporosis. peerReviewed

Osteoporosis research undertaken in males is rare and there are only a few therapeutic options. Phytoestrogens might be a safe alternative for prophylaxis. Sixty 3-month-old male rats were orchidectomized and divided into five groups. The groups either received soy-free food (C), estradiol (E), testosterone (T) or Vitex agnus castus in different concentrations (AC high/AC low) for 12 weeks. The tibia metaphysis was tested biomechanically and histomorphometrically. The AC high group reached 87% of the biomechanical values of the estradiol group and was significantly superior to the control group. Testosterone supplementation resulted in poor biomechanical properties. The cortical bone parameters of the AC group were similar to the control group, while supplementation with estradiol and testosterone demonstrated a reduction of cortical bone. The AC high group reached 88.4% of trabecular bone area, 80.7% of trabecular number and 66.9% of the number of trabecular nodes compared with estradiol supplementation. Vitex agnus castus demonstrated osteoprotective effects in males. It preserves the cortical as well as the trabecular bone and might be a safe alternative for HRT. Testosterone supplementation has positive effects on trabecular bone, which are concurrently counteracted by the loss of cortical bone.

Our study focuses to determine the medium range results of function and radiological findings of operatively treated fractures of the talus. Furthermore we had the intention to investigate risk-factors for posttraumatic arthrosis and necrosis of the talus.We included all 41 patients (w/m: 13/28) operated between 1995-2000 with talus neck, corpus or dislocated fracture of the talus edge (open/closed: 11/30). Fractures were classified according to Hawkins: type 1: 6 x, type II: 17 x, type III: 7 x, type IV: 3 x, 8 x dislocated peripheral fractures. 39 x screw osteosynthesis, 2 x K-wire fixation were done and 12 additive transfixation with fixateur externe. Score: AOFAS Ankle-Hindfoot-Scale, radiological assessment according to the Bargon score. 34 patients, mean age 35 years (12-60), were followed up clinically with an average of 4 years (24-72 months).AOFAS Score: pain (40 points): diameter 31 [10-40]; function (50 points): diameter 39 [14-50]; alignement (10 points):diameter 7 [0-10]; degree of arthritis due to the Bargon scale: 0 degree: 5x,1 degree: 8x, 2 degrees: 7 x, 3 degrees: 7 x.4 x necrosis of margin of the wound, 1 deep infection, 5 necrosis of the talus bone. The severity of the fracture was 1 x type II according to Hawkins 3 x type III and 1 x type IV. 3 of the 5 patients who developed a talus necrosis had 28 or 38 soft tissue damage. One patient had an imminent compartment syndrome. One patient who suffered a polytrauma was operated six days post injury. Second operation: 1 Syme amputation due to necrosis of the talus subsequent to an infection. 4 x arthrodesis of the upper ankle joint and 5 x arthrodesis of the subtalar joint due to posttraumatic arthritis.Primary screw osteosynthesis is the treatment of choice depending on the lesions of the soft-tissue and accompanied injuries in combination with a fixateur externe. Nevertheless the primary osteosynthesis is not able to prevent necrosis of the talus completely, that occurs in a frequency of 15%. Risk factors for a posttraumatic arthritis in addition to the type of fracture and the result of reconstruction are an accompanied soft tissue defect and local capsule-band complex with necessary temporary transfixation. Early plastic reconstruction of defects can reduce the time of immobilisation and allows motion therapy. The functional results are positive compared with the radiological results that showed arthritis in 70%.

We have examined the changes induced in the trochanteric region of femur of ovariectomized rat after administration of estradiol and p.arathyroid hormone. We have developed a reproducible biomechanical test and produced trochanteric fractures to evaluate stiffness and strength of this region in addition to histomorphometry. Introduction We investigated the short-term effects of parathyroid hormone (PTH) and estrogen (E) on the strength of the rat trochanteric region in a new mechanical test. Methods Forty-four 3-month-old female Sprague–Dawley rats were ovariectomized and 8 weeks later treated with soy-free diet (C), daily applications of orally supplied E (0.5 mg/kg food) or subcutaneously injected PTH (0.014 mg/kg), for 5 weeks, and an additional untreated group was added as sham-operated. The femurs were examined for biomechanical and histomorphometric changes. Results Our new mechanical test was validated in a right–left comparison. The PTH treatment induced significantly superior biomechanical results (F max = 225.3 N, stiffness = 314.9 N/mm) compared to E (F max = 182.9 N, stiffness = 237.2 N/mm), C (F max = 166.03 N, stiffness = 235.56 N/mm), and sham (F max = 192.1 N, stiffness = 267.2 N/mm). Animals of the PTH group demonstrated a significantly improved trabecular bone structure and area (75.67%) in comparison to the E (61.04%) and C (57.18%) groups. Conclusion Our new biomechanical test is valid and produces trochanteric fracture. Our results show that the short-term antiosteoporotic effects of PTH are in the trochanteric region of ovariectomized rat superior to E. peerReviewed

SummaryUrocortin (UCN) is a member of the cortico tropin-releasing factor family. UCN enhances osteoblast differentiation and inhibits osteoclasts in vitro. In the present study, the effect of UCN on spine was assessed in the rat osteopenia model.Sprague Dawley rats (3 month old) were either ovariectomized (OVX, n = 48) or sham operated (n = 12). After 9 weeks, OVX rats were divided into 4 groups (n = 12): OVX, UCN low (3 µ/kg BW), UCN high (30 µ/kg BW), estradiol-17β-benzoate (0.2 mg/kg BW). UCN was administered daily s. c., estrogen was supplied with food for 35 d. Thereafter, the lumbar vertebral bodies were analyzed by biomechanical test, micro-CT, pQCT, gene expression and ashing analyses. Serum alkaline phosphatase (AP), beta-Crosslaps, calcium, leptin levels were assessed.Stiffness, BMD, BV/TV, trabecular parameters improved in UCN high group. UCN low dose had less effect on spine. AP was enhanced in UCN high group, leptin increased in both UCN groups, other serum parameters and expression of bone genes did not change. UCN high dose showed osteoprotective effect in spine.Further studies are needed to understand mechanism of UCN action on bone and to reveal potential side effects.