Aims

Intra-articular ⁹⁰Yttrium (⁹⁰Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with ⁹⁰Yttrium.

Introduction: After whiplash injuries the majority of patients complain of pain, muscular dysfunctions and restricted movement of the cervical spine, however, the cause of these symptoms cannot be diagnosed.

Against this background, the hypothesis is formulated that functional disturbances in the form of pathological activities of the neck muscles occur as a result of a whiplash injury of the cervical spine. These pathological muscle activities can be demonstrated electromyographically and differ from the patterns of activity of healthy subjects.

Study Objective: Thus, the aim of this study was to establish an electromyographical method for the diagnosis of functional disturbances of the neck muscles after whiplash injuries of the cervical spine.

Material/Method: Primarily, an intramuscular recording of the electromyographical activity of the semispinalis capitis muscle was performed during flexion/extension and axial rotation in 46 patients with chronic symptoms after a whiplash injury of the cervical spine (QTF grade II) and 29 healthy subjects. The movement was controlled with techniques of virtual reality. The subject is immersed into a virtual outer space environment with a head-mounted display (HMD). In this virtual scene, the patient follows paths of motion of a signal (globe) with his/her gaze.

A subsequent study was conducted to validate the results that had been obtained. For this purpose, the electromyographical activity of the semispinalis capitis muscle was recorded in another subject group (n=20) and patients with acute symptoms as a result of a whiplash injury of the cervical spine (QTF grade II) (n=35).

Results: Compared to the physiological muscle activities that were established in the first subject group, changes could be observed in the chronic patient group.

Subjects in our study, for instance, show a decrease in electrical activity during flexion and the resulting stretching of the semispinalis capitis muscle, while the same movement causes an increase in activity in patients. On the basis of these differences, 93 % of subjects (specificity) and 83 % of patients (sensitivity) could be classified correctly with a discriminance analysis.

In the second study, the specificity was 88 % while a sensitivity of 86 % was determined in the acute patient population.

Conclusion: The results of these investigations enable a highly specific and sensitive diagnosis of muscular dysfunctions on the basis of the intramuscular recordings of the electromyographical patterns of activity of the semispinalis capitis muscle.

Background: In a car-to-car collision, an adequate force has to be exerted to produce an injury of the cervical spine. This force is often described with the parameter delta-V. Limits for delta-V were defined for rear-end, frontal and side collisions on the basis of dummy experiments and volunteer crash tests under laboratory conditions, and then transformed for the road accident situation. According to this definition, an injury in a rear-end or side collision is unlikely at delta-V< 10km/h and probable at delta-V> 15km/h. For frontal collisions, the values are 20 km/h and 30km/h. To this day, there is no data to confirm these limits in the actual road accident situation.

Objective: Our objective was to compare clinical data and data from accident analyses of individuals after actual car-to-car collisions in a prospective study. We intended to check the validity of the delta-V limits on the basis of this data.

Methods: 57 individuals (25 males/32 females) were included in the study. The delta-V was calculated by a technical expert on the basis of photographs of the two cars involved. The individuals who had been in an accident were evaluated with regard to their history. Those reporting symptoms underwent a radiological and clinical examination.

Results: Rear-end collisions (n=21): The median delta-V for rear-end collisions is 13 km/h (min=3 km/h; max=58 km/h). 7 individuals reported symptoms. Both patients had delta-V values< 9km/h. Delta–V 10km/h.

Frontal collisions (n=13): The median delta-V for frontal collisions is 24 km/h (min=8 km/h; max=50 km/h). 4 individuals reported symptoms. Under delta-V 20, one individual had a fractured cervical vertebra (QTF IV).

Conclusions: The existing limits for delta-V cannot be transferred without reservation from the laboratory test situation to the actual road accident situation. Injuries and even fractures of the cervical spine can occur at a delta-V < 10km/h, particularly with side collisions. At the same time, delta-V values > 15km/h do not necessarily result in an injury of the cervical spine.

In recent years advances in operative techniques have allowed surgeons to perform total hip arthroplasty (THA) through incisions much smaller than those used previously. Potential advantages of these techniques include the reduction of blood loss and pain in the immediate postoperative period and preserving muscle function.

Potential disadvantages might include increased wound infection rate due to skin ischemia, intraoperative neurovascular injuries, and component malposition. This in turn may lead to long term complications, such as instability, osteolysis, and loosening.

The purpose of this study is to present our results with total hip arthroplasty performed through a minimal invasive technique which is a modification of the standard posterolateral approach.

Methods: In this retrospective study 91 consecutive patients underwent primary total hip arthroplasties were reviewed. The surgeries were performed at our institution from January 2001 to December 2003.

Surgical indications included primary osteoarthritis, subcapital fractures, malignancy, hip displasia, Otopelvis, rheumatoid arthritis and AVN. Exclusion criteria included revision hip arthroplasty, and cemented operations.

A modification of the standard posterlateral approach was used. Standard hip arthroplasty instruments along with curved acetabular reamers and impactor were used. Incision extent was determined by the size of the acetabular component. A fully Hidroxyapetite coated stem, and porous coated acetabullar component were used. Immediate full weight bearing postoperative regimen was allowed in all cases.

Results: In 17 patients (group A) the indication for surgery was a recent subcapital fracture. 74 patients (group B) had no trauma. The average age was 64.2 in group A and 65.1 in group B. No case of deep infection was documented in either group. 5 patients in group B had a single event of a posterior dislocation that was treated successfully with closed reduction. No dislocation occurred in group A. 35% (4) of group A and 41% (22) of group B did not require postoperative blood transfusions. 47% (6) and 36% (14) respectively needed transfusion of 3 blood units or more. Average hospitalization time was 6 days. None of the patients in both groups needed re-operation.

Conclusions: Minimally invasive total hip arthroplasty is associated with a short hospitalization period and relatively low rate of blood transfusion. No major wound healing problems were documented in our series. It appears that the relatively high dislocation rate might be explained partly due to the common use of ceramic inserts. Further modification of the technique for proper acetabular component orientation is needed. However, more prospective with longer follow-up research must be conducted before definitive recommendations can be made.