To prevent nosocomial transmission (NT) of multiresistent germs (MRG) the German Robert Koch Institute (RKI) recommends to isolate patients with MRG.

At a so-called normal ward isolating patients is a challenging and stressful procedure for both patients and hospital staff.

The present study proposes the hypothesis that, compared to normal wards, an isolation ward reduces the nosocomial infection rate.

After an isolation ward with twelve beds has been established in 2005, patients with MRG on the wards of the department for spinal cord injury as well as on the isolation ward were monitored using a prospective screening and meeting the requirements of the RKI. Apart from detecting transmitter of MRG the NT of these bacteria was identified and registered between 2006 and 2013.

The total length of a patients stay in the hospital, the number of isolation days and the rate of NTs were documented. The quotient of MRG load per ward and the number of NTs per ward were compared.

In the investigation period of eight years 262175 patient days, 33416 isolation days and 33 transmissions were registered.

On the spinal cord injury ward 223167 of the patient days, 1120 of the isolation days and 29 of the NTs were documented. On the isolation ward 39008 of the patient days and 32296 of the isolation days with four of the transmissions were registered.

The mean load of MRG resulted from the quotient of the number of days with MRG per 100 patient days.

The effective nosocomial frequency of transmission resulted from the quotient of the mean load of MRG to the number of transmissions.

As a result, the frequency of transmission on the isolation ward was significantly lower (p=0,001) in comparison to the spinal cord injury ward.

The presented results suggest that, despite multiple higher loads of MRG, constructional measures combined with contact isolation facilitate a reduction of NT rates of MRG.

The reservation must be made, however, that in case of known MRG the screening was performed under isolation conditions, with unkown MRG without meeting requirements of isolation.

The present comparison of NT rates on an isolation ward and a normal spinal cord injury ward emphasizes the importance and function of an isolation ward through constructional (physical) separation and pooling of professional competency for successful management of MRG in healthcare facilities.

Hypothesis

The proximal geometry and design of trochanteric nails affects initial construct stiffness, fatigue survival, and preservation of biomechanical stability over time.

Alpine ski sports changed rapidly in the last decade. Complex fractures of the proximal tibia, typically seen in high energy trauma, has been seen more frequently and more often related to alpine skiing.

The aim of our study was to identify reasons for proximal tibia fracture in alpine skiing and observe the outcome.

All patients with proximal tibia fractures related to alpine skiing, which were treated in our two trauma centers were included. The patients received a questionnaire at the emergency department, dealing with accident details and the skiing habits. The fractures were classified according to the AO fracture classification scheme. The follow up was performed at least one year after trauma with the Lysholm, the Tegner activity, as well as the WOMAC VAS Score.

Between 2007 and 2010 a total of 188 patients with proximal tibia fractures caused by alpine skiing were treated. 43 patients had a type A, 96 patients a type B and 49 a type C injury. The incidence was increasing over the period continuously. The main trauma mechanism was an accident without a third party involvement with an increased rotational and axial compression impact. All outcome scores were related to fracture severity with significant worse results for the type C fractures.

In conclusion, proximal tibia fractures are an increasing and serious injury during alpine skiing. Further technical progress in skiing material should focus on these knee injuries in future.

Background

For the treatment of proximal humeral fractures two major therapeutic principles can be employed: Intramedullary nailing (PHN) or locking plate osteosynthesis. Aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. In addition, we discussed advantages and disadvantages of both techniques and aimed at establishing criteria which operative technique should preferentially be utilized for selected fracture configurations.

Goals: Advantage of the dorsal fixation of C1/2

Materials and Methods: From 01/2006 to 12/2006 22 patients with a traumatic fracture of C1/2 were operativly stabilized. The avarage age was 79 year (66–92). No neurological deficit. Diagnostic was always a CT-scan for classification of fracture typ. 7 patients were temporarily immobilized with HALO fixateur. Within th next 8 days final operation hab been carried out. 7 patients with Anderson fractures typ II were stabilized with open fixation from ventral (group 1). 4 Jefferson fractures and 2 combined C1/2 fractures were were stabilized with open fixation from dorsal (Magerl) (group 2). Percutanous fixation from dorsal was done in 5 patients with fractures of the atlas, 4 with Anderson fractures typ II (group3). Clinical and radiological follow up was done in 18 patients

Results: Duration for operation was in 64min in group1, 134min in group 2 and in 42min in group3. No neurological deficit or damage of A.vertebralis occurred. Blood loss was in group 1 and 3 under 50ml in group 2 750ml. In group3 one slightly dislocation of screw happened without need of revision. Movement of cervical spine was reduced in group 2 and 3. During follow up 3 of seven ventral stabilized Anderson fractures typ II (group1) were dislocated. Dorsal percutanous fixation for operatively revision was done.

Discussion: Percutanous dorsal transarticular screw fixation C1/2 is a challanging procedure for stabilization of atlantoaxial fractures. Main advantages compared to other operation techniques are less blood loss, short operation time, high rate of success.

Due to the fact that the treatment of distal femoral fractures is a therapeutic challenge, new specific implants were continuously developed. The techniques should guarantee a reliable bone healing for two different groups. For young patients with high energy trauma and more or less severe collateral injury and for old patients with osteopenic bone, weal soft tissue and a high rate of co-morbidity. Present widespread techniques are reduction and fixation with LISS plate or retrograde nails. In this clinical study from 2003 to 2006 we compared our supracondylar nail (SCN, Stryker) with the LISS plate. We were looking at a series of 77 patients (55 SCN and 23 LISS) with A (36) and C (41) fractures of the distal femur. 43 (78%) of the SCN group healed without complications, 1 malrotation, 1 case of infection, 2 pseudarthrosis and 5 problems with the distal locking screws were observed. In the LISS group only 23 (56%) healed primarily, whereas the complications occured more frequent. Beside radiographic control and clinical examination the success of operation was assessed with a standardised questionare (KOOS). The SCN group showed again a higher rate of satisfaction compared to LISS.

Conclusion: The SCN is working in A and also in complex C fractures. Furthermore we saw less rate of complications and more satisfied patients with the SCN.

Purpose: Chronic posttraumatic osteomyelitis of the femur is still a great challenge for medical treatment. Bacterial colonization after multi-fragment fractures often complicates and extends bone healing. Muti-modal management including hyperbaric oxygenotherapy and frequent lavage and debridement as well as use of systemically and locally applied antibiotics are needed to eradicate infection.

This study introduces our treatment regime for chronic posttraumatic osteomyelitis of the femur and presents our results.

Material and Method: We reviewed 24 patients with posttraumatic osteomyelitis after femoral shaft fractures treated at our trauma center. We analyzed the bacterial spectrum, changes in bacterial spectrum during treatment, numbers of operative revisions and hyperoxygenotherapy cycles, as well as over all hospitalisation time, and outcome concerning bone healing.

Results: Staphylococci were the most frequently found bacteria at first revision, followed by Enterobacter species. Average length of treatment was 8.3 (1–29) months.

An average of 11.5 (2–32) operative revisions including intramedullar debridement were performed, additionally 10 patients underwent a mean of 29 (3–81) hyperoxygenotherapy cycles.

Re-Infection after treatment occured in 7 cases, in 2 patients amputation was needed to eradicate infection.

Conclusions: Our results show, that the chronic post-traumatic osteomyelitis of the femur is an insistent disease that needs to be treated interdisciplinary over a long period of time. Our treatment regime produces satisfying results. Individual solutions are necessary to reach an infection-free status.

Object: We performed retrograde nailing of type C fractures and periprothetic percondylar fractures of the distal femur using a new dedicated femoral implant (T2 Supra-Condylar Nail). Herewith a powerful tool for the treatment of complex very distal femoral fractures was created. This nail has four distal locking holes placed from 6 to 32 mm at the end of the nail for a 3 plane fixation.

We present the new implant and the preliminary clinical outcome in 25 cases.

Methods: A consecutive series of 24 patients with 25 fractures of the distal femur (6 fractures AO type A, 1 type B, 12 type C fractures and 6 periprothetic fractures) was operated between January 2003 and September 2004. The epidemiology was typical for trauma patients with 18 male and 6 female patients. The mean age was 50.8 years (range 21–92 ys). The bone stock was osteopenic in 9 cases and regular in 16 cases. There were 6 patients who sustained polytrauma, 5 paraplegic patients fell out of their wheelchair. The remaining 13 patients suffered isolated injuries.

The patients were followed up clinically and radiographically.

Results: Seven patients were stabilized intramedullary at the day of the accident, 11 patients in the next 5 days. The remaining 6 fractures were initially stabilized with an external fixator in case of multiple injury. 7 percondylar fractures were stabilized with a short nail of 200 mm in cases of implants in the proximal femur (hip prosthesis: 3, DHS: 2, gamma nail: 2).

Mean duration of operation was 106 minutes.

The retrograde nailing using the T2 implant is a good suitable method performing a correct reposition of the fragments with high primary stability. There were no problems in woundhealing at all. Postoperatively a wheightbearing mobilisation with 20kg was possible and range of motion was unlimited.

Radiographs showed better ossification compared with plate osteosynthesis. Only one nail is broken out and needed a corrective operation with a plate. We saw no greater X- or O-deformity or rotation divergence. Only in 3 cases of delayed union, a spongioaplasty was indicated.

Conclusions: The retrograd nailing of distal femoral fractures type A is well accepted. After changing a C fracture in A fracture, it is also possible to stabilize complex intraarticular fractures intramedullarly. If a stabile metaphyseal block of minimal 3,5 centimeter is present after anatomical reconstruction of the joint, even in cases of osteoporotic bone stock, a intramedullary nailing is possible. Also in cases of periprothetic fractures with a short metaphyseal block of the distal femur, the T 2 supracondylar nail with its 4 locking screws at the end of the nail can stabilize this block in a 3 plane fixation.