Der Unfallchirurg
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Alloarthroplasty has largely replaced traditional procedures in arthrosis of hip and knee joints. In contrast the role of alloarthroplasty in comparison to traditional procedures in hand surgery has been uncertain. To evaluate this question every registered hand surgery department (n=307) in Germany received a questionnaire requesting information on number and type of implanted prostheses and traditional procedures concerning the wrist joint, distal radioulnar joint (DRUJ), first carpometacarpal joint (CMC), metacarpal phalangeal joint (MP), interphalangeal joint (PIP), and preferred characteristics of the prostheses. ⋯ The results confirm that alloarthroplasty in hand surgery is of minor importance. Thus, the role of alloarthroplasty differs depending on the joint involved. Traditional procedures except for the MP joint continue to be of major importance in hand surgery.
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Initial treatment of pelvic ring fractures with involvement of the iliosacral complex is directed at bleeding control and fixation of the pelvic ring. However, long-term outcome is determined by persisting neurological deficits, malunion of the posterior pelvic ring with low back pain, and urological lesions. Between 1991 and 2000, 173 patients with sacral fractures were treated at our institution. ⋯ Chronic low back pain was rarely observed (n=8, 7%) and only in type C injuries. The low incidence of chronic low back pain justifies conservative treatment of minimally (<1 cm) displaced sacral fractures. Long-term outcome is largely determined by neurological deficits, which persist in 30% of all patients with sacral fractures.
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Cell culture studies have shown that NSAID may influence osteogenic activities of osteoblast cultures. However, these studies did not consider long-term effects on differentiating cells. The influence of Voltaren with the non-steroidal agent diclofenac on proliferation and gene expression of the osteoblast-like cell line SaOS-2 was investigated 2, 9, and 16 days after incubation. ⋯ Lower concentrations (< or =25 microg/ml) had a lower or no influence. The findings indicate that the NSAID impairment depends on cellular differentiation stage and is not confined to the time during or immediately after NSAID incubation. According to these results in vitro testing of drugs should be performed over a longer time period to detect possible long-term impacts.