Archiv fur orthopadische und Unfall-Chirurgie最新文献

The authors report on their experience on 20 old lesions of the ulnar collateral ligament of the MP joint of the thumb. They used a modified technique according to Strandell.--Follow up investigations were made in an average range of 17.5 months after the operation. All the colateral ligaments were stable. The procedure is not to be used for heavy manual working persons. If there is an osteoarthritis in the MP joint, arthrodesis is the alternative method.

To prevent tendons from postoperative proliferation and adhesion to surrounding structures is still a main problem in handsurgery. In addition to numerous modifications of atraumatic handsurgical techniques which have been developed some sporadic attempts are made by animal experiments and clinical trials in order to avoid postoperative adhesive tenosynovitis by hormone therapy. Because of the high doses of cortisone which are required this method of treatment is generally not accepted. Using a new method of postoperative fixation of flexor tendon sutures in rabbits the possibility of a "hormonal tenolysis" by extremely high doses of cortisone could be confirmed. In a following study it is planned to perform breaking experiments on tendons after hormone therapy in order to determine the upper limit of the therapeutical range of cortisone medication.

7 new and 9 old injuries of the MP I joint primarily involving the ulnar capsule and ligaments have been reevaluated for treatnent and results. In old cases, the operative result could be classified as excellent and good in 7, while 2 were considered as failures. These results have been used to discuss the mechanism and diagnosis of ruptures of the MP I joint ligaments. Primary surgical treatment of fresh ligamentous injuries is far superior than plastic reconstruction of old injuries.

The treatment of this kind of fractures, especially involving the elbow-joint still is difficult and needs a thoroughly preoperative planning as well as an exact operative technique. Even in spite of optimal therapy failures are not avoidable in some cases, as our statistic shows.

The volume changes of hardening cements are measured with the buoyancy method. During hardening the polymerisation shrinkage runs through distinguished phases, totaling from setting in the bone to the final state 2 to 4 volume percents. Expansion and contraction because of temperature changes superimpose the measurements by a rate of 0, 21%/10 degrees C. - Factors influencing the volume changes are discussed.

During operative treatment for intraarticular fractures osteochondral fragments were retrieved in 12 cases and sent for histological evaluation. The histology showed microlesions of the articular cartilage and subchondral bone. An etiological connection between these histological changes and posttraumatic osteoarthritis is being discussed.

The "spontaneous" subcutaneous rupture of the tendon of the extensor pollicis longus is reported and the etiology and the pathologie are discussed. In our opinion is the transfer of the extensor indicis the only operation to do in this case and gives the best results.

This report describes the implantation of glass and glass-ceramics into soft tissues. These experiments revealed that our new glass and glass-ceramic materials are well compatible with soft tissues. The fibrous membrane surrounding such an implantat consists of normal dense collageneous connective tissue. The cells are fibroblasts and fibrocyt-like cells without any abnormal morphology. Macrophages could not be detected. However, the degree of implants solubility must be chosen with care, because high solubility of the implant increases the reaction of the surrounding soft tissues. The described materials are also compatible with osseous tissues. In our previous experiments we have already pointed out, that bonding developed between glass material and bone. Few weeks after implatation we have seen mature lamellar homegeneously mineralized bone opposed to the implant. There was no fibrous membrane between implant and bone. Longtime studies show that hitherto the described bonding exists about 2 years.

While there is no doubt that collagen is an important extra-cellular factor in the calcification of bone tissues, the exact nature of the process remains unclear. It has been explained in turn by the nucleation effect of corresponding lattice distances of apatite and collagen, that is, an oriented crystal overgrowth of the two substances which decreases the energy of nucleus formation, or by conformity between fibril-bundles and calciumphosphate crystal, or by the binding of phosphate to anionic positions of the collagen, as well as by the bone-forming effect of a non-collagen protein which is, however, separable from collagen. Because of their high viscosity proteo-polysaccharides inhibit crystal formation. Alkaline soluble proteo-pholysaccharides, however, appear to promote calcification in vitro and also in tissue of living bone. Lathyrogene and penicillamine impair the cross-linking in the bone collagen; this probably explains their disturbing effect on ossification. Diphosphonates would, like anorganic pyrophosphate, inhibit both the formation and dissolution of apatite crystal. Our research shows, however, that methanie-bis-phosphonate clearly promotes calcification, in vitro and in vivo. In vitro, and probably also in vivo, magnesium inhibits the formation of apatite crystal nucleus. Our research indicates moreover that magnesium also slows down the reduction of calcified bone tissue on account of its inhibiting effect on parathormone emission.

Following the destruction of the medullary vascular system the venous drainage takes place exclusively in a centrifugal direction through vessels leading transcortically to the periost. This is in accordance with the described observations made on the arterial vascular system under the respective conditions of destruction.