Summary Statement

Tibia plateau split fracture fixation with two cancellous screws is particularly suitable for non-osteoporotic bone, whereas four cortical lag screws provide a comparable compression in both non-osteoporotic and osteoporotic bone. Angle-stable locking plates maintain the preliminary compression applied by a reduction clamp.

Background: Lapidus (first metatarsocuneiform joint) arthrodesis is an established procedure for the management of hallux valgus. This study investigated the utility of fixation with a medial locking plate with adjunct compression screw versus fixation with two crossed screws.

Methods: Eight pairs of fresh-frozen human specimens were used in a matched paired test. Bone mineral density (BMD) was measured with peripheral quantitative computed tomography (pQCT). Fixation with two 4-mm-diameter crossed screws was compared versus a medial locking plate (X-Locking Plate 2.4/2.7; Synthes, Solothurn, Switzerland) with adjunct 4-mm-diameter compression screw. The specimens tested in a four-point bending test. Parameters obtained were initial stiffness; plantar joint-line gapping after one cycle, 100 and 1000 cycles; and number of cycles to failure. Failure was defined as ≥ 3 mm plantar gapping displacement.

Results: The groups did not differ significantly with regard to BMD (p = 0.866) and initial stiffness (p = 0.889). The plate-and-screw construct showed significantly less movement during testing, and significantly (p = 0.001) more cycles to failure than did the crossed-screw construct. There was a significant correlation (crossed-screw construct: p = 0.014; plate-and-screw construct: p = 0.010) between BMD and the number of cycles to failure.

Conclusions: Under cyclic loading conditions, the construct using a medial locking plate with adjunct compression screw was superior to the construct using two crossed screws.

Clinical Relevance: The medial locking-plate technique described holds promise for shortening the time off weight-bearing and for reducing the risk of non-union.

Objective: Metastases in the spinal column are a common manifestation of advanced cancer disease. Severe pain, pathologic fracture and neurologic deficit due to spinal metastases need adequate treatment. Considering oncologic aspects as well as quality of life, treatment decision should also include prediction of the survival period. In this study we analysed the scoring systems of Bauer, Bauer modified, Tokuhashi, Tokuhashi revised, Tomita, van der Linden and Sioutos, as well as the parameters they consist of, for their predictive value.

Methods: Two-hundred and fifty four patients with confirmed spinal metastases were investigated retrospectively (treatment 1998–2006; 62 received surgery, 189 only conservative therapy). The following factors were analysed: primary tumor, general condition (Kar-nofsky Performance Scale), neurological deficit, number of spinal and extraspinal bone metastases, visceral metastases, pathologic fracture. Survival period was calculated from date of diagnosis of the spinal metastases until date of death or last follow up (minimum follow-up: 12 months). For statistical analysis univariate and stepwise multivariate Cox regression analyses were performed.

Results: Median overall survival for all patients was 10.6 months. The following factors showed significant influence on survival in multivariate analysis: primary tumor (p< 0.0001), status of visceral metastases (p< 0.0001), and systemic therapy (p< 0.0001). Cox regression proved all scores significant in metric analysis. Distinguishing between the prognostic subgroups, only Bauer and Bauer modified showed significant results for this classification into good, moderate and poor prognosis. The other systems failed to distinguish significantly between good and moderate prognosis.

Conclusion: In our collective, Bauer and Bauer modified score prove to be the most reliable systems for predicting survival. We therefore want to propose the Bauer modified score (consisting of only four positive prognostic factors, excluding pathologic fracture) as valid for predicting survival and practicable for clinical use.

Introduction: The debridement of deep cartilage defects is one of the most frequently used Methods: in arthroscopic surgery.

This randomized study was undertaken to compare the effectiveness of simple mechanical debridement and the 52°C-controlled bipolar chondroplasty.

Materials and Methods: A total of 60 patients (28 male, 32 female, average age 43.3 years, range 20 to 50 years) who were suffering from a grade III cartilage defect of the medial femoral condyle were included. Exclusion criteria were revision arthroscopy, injury or osteoarthritis (grade II or higher).

After randomization, 30 patients underwent simple debridement of the cartilage defects, which was performed with a mechanical shaver (MSD = mechanical shaver debridement). The remaining patients underwent thermal chondroplasty, which was performed with a temperature-controlled bipolar device with a constant thermo-application of 51°C (RFC = Radio-Frequency-based Chondroplasty).

The patients were evaluated by the Knee-injury and Osteoarthritis Outcome Score (KOSS) preoperatively and at time of follow-up. Activity levels were measured by the Tegner score (activity level before onset of the symptoms and at time of follow-up). Follow-up was undertaken 4 years after the arthroscopy.

Results: No significant differences between the preoperative findings for the two groups were observed.

One patient from the MSD group had died, and one female patient in the RFC group was lost to follow-up. A total of 18 patients had undergone revision operations due to persistent knee problems: in the MSD group, there were 8 endoprostheses, 4 osteotomies, and 2 revision arthroscopies; in the RFC group there was 1 one replacement, 2 osteotomies, and 1 revision arthroscopy with subtotal medial meniscectomy. The proportion of revisions was significantly higher in the MSD group (p=0.006). These patients were excluded from the evaluation.

The remaining 40 patients from both groups benefited from the operation. The preoperative KOOS was 11.3 points in the MSD group and 15.5 points in the RFC group (p=0.279). Patients from the MSD group had a KOOS of 53.2 at the time of follow-up. In the RFC group the KOOS (71.8) was significantly higher (p< 0.001).

Patients from both groups had to accept a decrease in their level of physical activity. However, patients from the RFC group had a significantly improved (p=0.005) Tegner activity score in comparison to the patients from the MSP group.

The radiographic and MRI findings in the MSD group were also worse than in RFC patients.

Conclusion: RFC is a potential method for the treatment of deep cartilage defects. The 4-year outcome is better than after MSD. Long-term results are still lacking.

Introduction: Breast cancer is the most frequently diagnosed cancer in western countries and bone metastases of breast cancer cause significant morbidity. Tumor growth and progression requires the formation of new blood vessels, a process called angiogenesis. Angiogenesis is a complex multifactorial process involving a variety of proangiogenic and proteolytic enzyme activators and inhibitors. The most important regulator of angiogenesis is vascular endothelial growth factor (VEGF), which is overexpressed in several tumor tissues. The single nucleotide polymorphism 1498 C/T of VEGF was associated with increased plasma levels of VEGF. In this case controlled study, we analyzed the role of this polymorphism in bone metastasis of breast cancer.

Material and Methods: We genotyped 839 female breast cancer patients. The study was performed according to the Austrian Gene Technology Act and has been approved by the Ethical Committee of the Medical University Graz. According to breast cancer staging, patients were divided in three groups, representing patients without metastases (n = 708), those with metastases other than bone (n = 69), and those with bone metastasis (n = 62). Results: Frequency of the 1498 CC genotype of VEGF was significantly lower among patients with bone metastases (6.5%) than among those with other metastases (23.2%; p=0.005) or no metastases (23.4%; p=0.002). Odds ratio of the CC genotype for bone metastases was 0.22 (95% CI 0.08 – 0.61; p = 0.004). Conclusion: We conclude that the homozygous 1498 C genotype of VEGF may be protective against development of bone metastasis in breast cancer patients.