External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective,randomised study of 78 patients

Introduction We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included.Materials and methods Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails).Results Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year.Conclusion The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.     

Tropical rat mites (Ornithonyssus bacoti) – serious ectoparasites

In Germany there is limited information available about the distribution of the tropical rat mite (Ornithonyssus bacoti) in rodents. A few case reports show that this hematophagous mite species may also cause dermatitis in man. Having close body contact to small rodents is an important question for patients with pruritic dermatoses. The definitive diagnosis of this ectopara‐sitosis requires the detection of the parasite, which is more likely to be found in the environment of its host (in the cages, in the litter or in corners or cracks of the living area) than on the hosts’ skin itself. A case of infestation with tropical rat mites in a family is reported here. Three mice that had been removed from the home two months before were the reservoir. The mites were detected in a room where the cage with the mice had been placed months ago. Treatment requires the eradication of the parasites on its hosts (by a veterinarian) and in the environment (by an exterminator) with adequate acaricides such as permethrin.     

Viral exanthems in childhood – infectious (direct) exanthems. Part 2: Other viral exanthems

The group of the non‐classic infectious exanthems are mostly maculopapular or vesicular. The latter changes are typical for infections with varicella‐zoster virus and Coxsackie viruses. Congenital cytomegalovirus infections are characterized by petechiae and purpura, while the papular‐purpuric gloves and socks syndrome is usually associated with parvovirus B19. Aside from these, the non‐classic infectious exanthems diseases include nonspecific exanthems coupled with respiratory and enteric infections.     

Meniscus repair in knee ligament injuries

One hundred and fifteen primarily operated patients with medial collateral ligament tears of the knee have been reviewed. Two-thirds of the patients had associated cruciate ligament injuries.

In 59 knees, injuries of the medial meniscus were found. Suture of the medial meniscus was performed in 53 patients, while medial meniscectomy was done in only six cases.

Knee function was evaluated by follow-up after 4 (2-8) years. Excellent or good results as evaluated by the Lysholm knee score were obtained in 86 per cent of the patients, with equally good results in those with meniscus suture as compared to those without meniscus injury. No secondary men-iscectomies were performed.     

Strain shielding 12 weeks after femoral reaming and nailing in rats

The purpose of this study was to investigate the in vivo strain-shielding in rat femora 12 weeks after intramedullary nailing with either flexible or rigid implants. Five days prior to death, unidirectional strain gauge units were implanted on the anterior bone surface bilaterally. Median strain values of reamed only and polyacetal-nailed femora ranged from 67 to 90 percent of the intact side. Removal of polyacetal nails and sham operations gave negligible changes in strain. Strain of the steel-nailed femora was 51 percent of the intact side. Removal of nails increased strain to 91 percent of the intact side. Testing of femora after removal of implants revealed stiffness of 116 and 103 percent of normal in reamed-only and polyacetal-nailed groups, respectively. Stiffness in the steel-nailed group was reduced to 85 percent of normal. None of these changes were statistically significant. This study indicates that rigid intramedullary nails cause strain shielding at the anterior, mid-diaphyseal surface of rat femora 12 weeks after insertion. Removal of rigid implants seems to restore the loading configuration immediately.