Introduction

Primary malign tumors and solitary metastatic lesions of the thoracic and thoracolumbar spine are indications for radical en bloc resections. Extracompartimental tumor infiltration makes the achievement of adequate oncological resection more difficult and requires an extension of the resection margins. We present a retrospective clinical study of patients that underwent chest wall resection in combination with vertebrectomy due to sarcomas and solitary metastases for assessing the clinical outcome especially focusing on onco-surgical results.

Introduction: Different grafting materials for the filling of large bony defects are used in clinic. Aim of the present study was the comparative analyses of different bony grafting materials concerning their growth factor composition and osteoinductivity in vitro.

Materials & Methods: Different allograft preparations from the tissue bank of the Charité and two commercial demineralized bone matrices (DBM; DBX putty and Allomatrix) were analyzed. Using ELISA-kits following growth factors were quantified: VEGF, IGF-I, FGFa/b, TGF-β1, BMP-2/4, PDGF. Osteoinductivity was investigated by the induction of alkaline phosphatase activity in C2C12-cells.

Results: BMP-2 had the highest quantity within the different materials without differences between the materials. Differences in the quantity of the other growth factors were found between the investigated materials but also a high variability between the different batches was observable. The investigated materials showed individual differences which are donor related concerning their osteoinductive potential. A significant enhancement of osteogenic differentiation (AP) was seen for the two commercial DBM-products. For PES processed spongiosa from the tissue bank, 2 of the 5 materials had a negative effect on the AP-activity in the first incubation period but no effect in the second incubation period.

Discussion: The results of the present study revealed, that the different investigated grafting materials contain growth factors important for bone regeneration and an osteoinductive potential of the DBMs. A high batch/donor related variability, however, was detectable in both analysis. Important for the use in vivo is beside the osteoinductivity also the osteoconductivity and further comparative studies are necessary.

Introduction: Regarding operative treatment of proximal humeral fractures no current treatment guidelines have been established so far. Angular stable implant for stabilisation of proximal humerus fractures find increased spreading. Aim of the study was the evaluation of pain, function subjective contentment and especial the surgical complications after stabilization with the Proximal Humerus Plate.

Methods: 214 patients were treated with PHP from 8/2001 to 2/2005 and documented prospectively. The humeral head fragment was fixated with four angular stable self locking screws. Neer–Classification showed 102 2-part, 71 3-part and 41 4-part fractures. Follow up (x-ray, VAS, Constant Score) was performed after 6 and 12 months respectively.

Results: Until now 154 (72%) Patients were available for follow up. Complications were seen in 31 cases (20%). Leading were perforation of self locking screws of the humeral head (10), followed by secondary dislocation (7, 3 of them with re-trauma), secondary humeral head necrosis (6), implant failure (3), malposition (varus) (3), and infection (2). In 18 cases (12%) re-operation was necessary: removal of screws (7), re-osteosynthesis (6), hemiarthroplasty (5). The constant score (compared to uninjured side) was 6 months postoperatively 61 (71%) and after 12 months 73 (82%).

Conclusion: The problems of osteosynthesis of proximal humeral fractures using an internal fixator are shown by the complications. Especially rigid self locking head screws show a high risk to perforate the humeral articular surface. On the other hand results showed good primary and secondary stability in comparison with the literature.

Aims: The purpose of this study was to evaluate the clinical and radiological results of expandable titanium cages for vertebral body replacement in a prospective clinical trial. Methods: Since 04/1999 81 patients with thoracolumbar burst fractures underwent posterior stabilisation followed by vertebral body replacement using expandable titanium cages (VBR, Ulrich, Germany) þlled with cancellous bone graft. Postoperatively at 3, 6, 12 and 24 months clinical and radiological evaluation was performed including ßexion/extension views and quantitative CT-scans to assess stability and fusion. Results: Until 09/2002 40 patients had a one year, 12 a two year follow-up. Pain decreased from 62 to 25 on VAS, ROM increased and preoperative neurologic deþcit improved in 25% of patients. Average postoperative loss of lordosis was 5.5 degrees, subsidence of the cages was 4.5 mm. CT scans showed solid bony fusion in 25%, incomplete fusion in 35% and non-fusion in 40% after one year. One patient suffered of left side paralysis of diaphragm, 9 patients of post-thoracotomy-syndrome. Conclusion: With expandable cages a very exact adaptation to the height of the defect and a gradual press þt of the cage and endplates can be achieved. The clinical outcome after one and two years is similar to operative techniques using tricortical iliac crest bone graft or non-expandable cages. However, fusion could not be achieved in 40% of patients after one year.

Aims: Various studies could show that computer assisted pedicle screw insertion can reduce pedicle perforation rate. We conducted this study to verify if pedicle screw navigation can also avoid neurological complications. Methods: Within 20 months 112 patients were stabilised with 584 pedicle screws in the thoracolumbar spine (Th1-L5). 333 screws were inserted using a CT-based navigation system, 251 srews with conventional technique. Postoperatively, screw positons were assessed by an independent radiologist using CT-scans. Neurological complications and revision surgery were noted. Results: 47 (14.1%) of navigated screws perforated pedicle wall, 13 (28%) to medial side with 2 screws more than 4 mm. One screw (0.3%) had to be changed due to medial perforation of 6 mm in Th4. In the conventional group 60 (29.9%) screws perforated pedicle wall, 13 (22%) to medial side with 3 screws more than 4 mm. One patient had to be reoperated due to radicular deficit caused by a medial perforated screw in L1 (0.4%)Conclusion: CT-based navigation of pedicle screws decreased pedicle perforation rate significantly. However, considerable medial perforations up to 6 mm could not be avoided entirely. The rate of neurologic complicatons and revision surgery was the same in both computer assisted and conventional group.

From 1974 to 1989, we treated 50 patients with a simple dislocation of the hip: 38 were posterior dislocations and 12 were anterior. All dislocations primarily treated at our hospital were reduced by closed methods within three hours (mean 85 minutes (10 to 180)) and 43 were reviewed after an average follow-up of 8 years (2 to 17). It is widely held that isolated hip dislocation reduced within six hours gives an excellent outcome, but we found a significant number of complications. There were radiological signs of partial avascular necrosis in two, mild osteoarthritis in seven, and moderate degeneration in two. Heterotopic ossification was seen in four patients, but 29 of 33 MRI examinations were normal. Objective evaluation according to the Thompson and Epstein (1951) criteria showed fair and poor results in 3 of 12 anterior dislocations, but in 16 of 30 posterior dislocations. In six of the seven patients with no other severe injury, the hip had an excellent or good result; in only three of the eight patients with severe multiple injuries was this the case. The important factors in the long-term prognosis appear to be the direction of the dislocation and the overall severity of injuries.