Stumpfe Schultergelenkverletzungen und ihre Begutachtung

It is difficult to assess blunt injuries in the region of the shoulder girdle because of the overlying acute and chronic processes. In assessments of rotator cuff ruptures in particular, in over 50% of cases the rupture could be explained by a degenerative process. This makes the assessment difficult, and also the decision as to whether or not the injury is due to an occupational accident. The diagnostic procedures applied should exclude a degenerative aetiology immediately after an accident in all cases. Rupture of the rotator cuff is often associated with an impingement syndrome and leads to corresponding symptoms in the subacromial space. Treatment of a rotator cuff rupture always involves a diagnostic arthroscopy as the first step, after which a reconstruction can be undertaken, either by way of the anterolateral approach after Neer or, in many cases, arthroscopically. Reconstruction of the rotator cuff must include outward mobilization of the muscles and a secure, mostly transosseous suture. Transference of a pedunculated tendon is indicated for large defects in the rotator cuff. In the case of dislocation of the shoulder with subsequent shoulder instability degenerative change and any possible multidirectional instability should be defined. Unidirectional instability with a demonstrable Bankart lesion has a good prognosis when surgery is performed without delay. In view of the high recurrence rate early treatment is indicated especially in young persons and in patients with a high activity level. Following detection of the Bankart lesion an arthroscopic procedure with refixation of the capsule–labrum complex is the method of choice.     

Accuracy of Drager and Wright ventilation meters.

Simple compact mechanical ventilation meters for bedside monitoring are in wide-spread use in this country. We investigated the accuracy of two such ventilation meters, the Drager Volumeter and the Wright Respirometer. Volume measurements on 16 units were made at fixed flow rates between 6 and 12 l/min. Both types of spirometer showed similar magnitudes and patterns of inaccuracy. For 14 used units, the mean deviation from the actual value was the smallest between the flow rates of 15 and 30 l/min, with a mean systematic underestimation of about 15 per cent and maximum variability among individual units (S.D. 10--12 per cent) at lower flow rates. Measurements at flow rates above 120 l/min were unsatisfactory due to locking of the ventilation meter mechanism. The single new Drager Volumeter tested was relatively accurate at all flow rates measured, whereas the single new Wright Respirometer tested showed inaccuracies comparable to the mean values of the used units. We conclude that these devices are satisfactory to monitor patients on continuous mechanical ventilation but may not be adequate for bedside spirometry.     

Zulassung einer klinikeigenen Knochenbank

The new tissue laws of 2007 created a completely new situation for German musculoskeletal tissue banks. The objective of the new regulations in the recent German tissue act is to improve safety by reducing the risk of transmission of viral and nonviral diseases. Since 2007 tissue banks have to declare their intention to continue providing allografts to the local authorities until August 2011 based on the guidelines of the Federal Medical Association (Bundes?rztekammer 2001) and according to § 144 of the Pharmaceutical Products Act (Arzneimittelgesetz). The Orthopedic University Clinic in Ulm applied for registration according to § 20 b and c of the Pharmaceutical Products Act in 2010. After submitting all the required documents, government officials controlled the equipment, distribution of responsible personnel, location of operating theatres and the laboratory and quality assurance documentation. After alluding to the lack of validation for the use of a hemoculture medium for testing ringer lactate solutions, permission according to § 20 b and c was granted with the obligation to transfer all serological and microbiological testing of tissue donors to another laboratory with its own approval under § 20 c of the Pharmaceutical Products Act.     

Significantly Reduced Leg Length Discrepancy and Increased Femoral Offset by Application of a Head–Neck Adapter in Revision Total Hip Arthroplasty

Head–neck adapters in total hip arthroplasty (THA) promise the reconstruction of optimal femoral offset and leg length in revision THA while retaining stable implants. Radiological parameters after adapter implantation in THA revision were determined in 37 cases. Significant reduction of leg length discrepancy and improvement of femoral offset (P < 0.001) were found. Clinical endpoints were determined in 20 cases (mean follow-up 4.0 years). Clinical scores were rather poor (median Harris hip score 54, WOMAC score 41) due to age and comorbidities, postoperative dislocation occurred in 3 cases. Only one stable femoral stem had to be revised due to recurrent postoperative dislocation. In conclusion, a head–neck adapter can be a valuable tool in certain cases of revision THA with acceptable dislocation rates while allowing the retention of stable implants.     

Minimalinvasive H��ftendoprothetik �C nur Trend oder schon Standard?

Minimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.     

The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting

Introduction  

Myocardial dysfunction necessitating inotropic support is a typical complication after on-pump cardiac surgery. This prospective, randomized pilot study analyzes the metabolic and renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support after coronary artery bypass grafting (CABG).