Der Unfallchirurg
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Generalized severe trauma leads to an increased incidence of SIRS, sepsis, and MOF. The aim of this prospective study was to investigate the immunological parameters in terms of their predictive value for multiple organ failure (MOF). HLA-DR expression on peripheral monocytes was analyzed by flow cytometry, the ex vivo endotoxin-stimulated TNFalpha synthesis of whole blood, and the serum levels of IL-6, IL-10, procalcitonin (PCT), and CRP were analyzed by ELISA in 16 severely injured patients with an ISS >25. ⋯ However, the TNFalpha-producing capacity was even enhanced in patients with MOF in the 2nd week after trauma. Later PCT levels were also higher in patients with MOF. Monitoring of immunological parameters after severe injury is useful to identify mediator constellations that are associated with the development and clinical course of MOF even in extremely injured patients.
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Due to the advances in prosthesis design and standardisation of implant techniques, the maintenance of implants in arthroplasty of the knee joint has enormously increased during the past few years. Various arthroplastic designs enable an adjustment towards the patient's individual indiction and anatomy. ⋯ Prerequisite for mere joint resurfacing is an intact lateral ligament apparatus, whereas the the symmetrical ligament balancing is essential for long-term analgesia, joint stability and good flexion. Aseptic loosening, discreet infections, instabilities and patellar problems are common reasons for painful knee arthroplastics.
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Case Reports
[Late reconstruction of distal biceps tendon rupture with fascia lata graft and Mitek anchors].
Ruptures of the distal biceps tendon are rare but well documented. A technique for reinserting the distal biceps tendon into the radial tuberosity with two Mitek anchors and a fascia lata graft is presented and illustrated by a case report. Ectopic ossification as a complication after the procedure is discussed as well as the final outcome. It could be concluded that late reconstruction of the distal biceps tendon rupture with fascia lata and Mitek anchors is a safe procedure that can be advocated in a restricted number of cases where acute injury has been overlooked.