Rupture

Reposition und Retention von instabilen und/oder stark dislozierten Frakturen des oberen Schambeinastes mit Gefahr der Verletzung pelviner Organe mit transpubischer Schraubenosteosynthese. Wiederherstellung der Form und Funktion des Beckens. Indikationen Beckenringverletzungen mit dislozierten und/oder instabilen Frakturen des oberen Schambeinastes. Stabilisierung des vorderen Pfeilers des Azetabulums bei isolierten Frakturen des vorderen Pfeilers. Zusätzliche Osteosynthese im Rahmen der Behandlung von Azetabulumfrakturen mit Querkomponente in Kombination mit einer Stabilisierung des hinteren Pfeilers.

Instability of the glenohumeral joint can be associated with anteroinferior capsulolabral rupture. To understand its static stabilizing effect better, the collagen fiber orientation of the inferior glenohumeral ligament (IGHL), a component of the anteroinferior capsulolabrum, was studied with a small angle light scattering technique. Three rectangular samples (approximately 11 ϫ 6 mm) were excised from the axillary pouch, one from the anterior band (AB) of the IGHL and one control sample from the long head of the biceps tendon of 7 cadaveric shoulders. The small angle light scattering technique scans the tissue with a heliumneon laser beam and quantifies the fiber alignment based on the resultant scattering pattern. The fiber orientation was quantified by an orientation index, defined as the angle within which 50% of the fibers lie. The axillary pouch had a random orientation, whereas the AB-IGHL was random with some regions of localized alignment. The percentage of tissue with an orientation index range of 25°to 45°was 23.2% Ϯ 8.5% and 29.0% Ϯ 13.1% for the axillary pouch and the AB-IGHL, respectively, whereas that for the long head of the biceps tendon was 61.6% Ϯ 15.2%. This suggests that the collagen fibers in the IGHL are not highly aligned and the anteroinferior capsulolabrum can be modeled as a continuous sheet. Moreover, a biomechanical evaluation of the anteroinferior capsulolabrum that investigates the possibility that the mechanical properties may be directionally independent should be conducted. (J Shoulder Elbow Surg 2003; 12:247-52.) The glenohumeral joint is the most commonly dislocated diarthroidal joint in the body, and after the initial episode, 85% to 90% of young persons have subsequent dislocation. 12 Whereas surgical repair lowers recurrence, redislocation rates are as high as 12% and 23% after open and arthroscopic surgical procedures, respectively. 29 Acute dislocation in human beings was often found to result in a Bankart lesion, 3,4,21 which includes rupture of the anteroinferior capsulolabrum. This is now known to include a lesion of the glenoid insertion site of the inferior glenohumeral ligament (IGHL), 14,18,25 the primary static restraint to anterior translation of the humeral head on the glenoid. Given that surgical repairs have focused on restoration of the anteroinferior capsulolabrum, 1,24 its anatomy has been meticulously studied. The collagen cross-links, collagen fibril diameter and density, amino acid composition, and elastic fibers have also been examined. 23 When compared with the capsule from unstable shoulders, the normal capsule consists of a greater number of cross-links and smaller fibril diameters. Further research has demonstrated that the anterior capsule is composed of areolar (loose connective) tissue. The anterior band (AB), axillary pouch, and posterior band (PB) of the IGHL have been identified, 20 and the ability of each component to resist forces along its long axes in the medial-tolateral direction was studied. 5,6,30 The AB-IGHL exhibits an increased thickness and superior mechanical properties compared with the other components of the capsule. 5 Recent research also demonstrated the importance of the capsular tissue between the AB-IGHL and PB-IGHL, the axillary pouch. 8,17 Significant forces were transmitted in the direction perpendicular to the long axis of the AB-IGHL. In an effort to understand the role of the anteroinferior capsulolabrum in resisting dislocation better, the orientation of the collagen fibers within each of the three regions of the IGHL has been qualitatively examined with polarized light microscopy. 10,20 O'Brien et al 20 found the axillary pouch to be less organized than either the AB-IGHL or the PB-IGHL and demonstrated a great deal of intermingling of the fibers. This finding indicated that the axillary pouch could resist forces other than those in the medial-to-

Injuries of the abdominal visceral vessels are uncommon but devastating entities resulting in extremely high rates of mortality. The most common cause of abdominal vascular injuries is penetrating trauma, accounting for 90% to 95% of these injuries. In contrast, blunt trauma accounts for 5% to 10% of all abdominal vascular lesions. Although traumatic injury to the celiac artery is among the rarest of all vascular injuries, mortality can be as high as 75%. We report a 66-year-old patient who sustained multiple injuries in a motor vehicle crash. The initial whole-body computed tomography (CT) scan revealed a combination of severe brain injury and bilateral thoracic lesions. On day 6 after the accident, the patient's clinical situation deteriorated rapidly. At this time, the abdominal arterial CT scan showed a dissection of the celiac artery. Therapeutic anticoagulation was not feasible because of the intracranial hemorrhage. Also the patient's clinical situation worsened so rapidly that interventional therapy, including surgical and endovascular treatment, could not be performed. Finally, the patient died of fulminant hepatic failure, therefore not surviving a potentially treatable injury. The diagnosis of celiac artery dissection in this patient was significantly delayed because the initial trauma CT protocol did not include an arterial phase of the abdominal vessels. ( J Vasc Surg 2007;46:576-80.)

Arterial grafts and experimental soft tissues are commonly preserved using refrigeration and freezing. The present study was designed to investigate effects of common storage protocols on arterial mechanics. Porcine aortas were axially distracted to failure implementing fresh, refrigerated, and frozen storage conditions. Fresh tissues were tested within 24 h of sacrifice; refrigerated tissues were stored at ؉4°C for 24 or 48 h prior to testing, and frozen tissues were stored at ؊20 or ؊80°C for 3 months prior to testing. Blunt arterial injury experimentally occurred in distraction with intimal subfailure before ultimate failure in 82% of specimens. Subfailure stress decreased in refrigerated (0.59 ؎ 0.19 MPa) compared to fresh (0.83 ؎ 0.39 MPa) and frozen (0.99 ؎ 0.41 MPa) specimens. Ultimate stress was also significantly decreased in refrigerated (0.83 ؎ 0.19 MPa) compared to fresh (1.15 ؎ 0.39 MPa) and frozen (1.32 ؎ 0.31 MPa) specimens. Subfailure and ultimate strain were not significantly dependent upon storage technique. Young's modulus significantly decreased in refrigerated (1.89 ؎ 0.63 MPa) compared to fresh (2.98 ؎ 1.45 MPa) and frozen (3.49 ؎ 1.32 MPa) specimens. Physiological, subfailure, and ultimate failure mechanics between fresh and frozen specimens were not significantly different. Clinically relevant intimal failures can be reproduced and injury mechanics determined while adhering to experimental protocols of freezing specimens before testing. However, short-term tissue refrigeration may affect mechanics.

To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. Structural anomalies could alter the mechanical prope...

Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. This review will focus on short-and medium-term mechanical complications of catheter placement; infectious complications will be discussed in a separate article. The most important risk factors are patient characteristics (morbidity, underlying disease and local anatomy), the expertise of the doctor performing the procedure, and nursing care. Placement aids, such as ultrasoundguided catheter insertion, are also discussed.

Pain thresholds and levels of distress before and in the early postoperative period after anterior cruciate ligament surgery were measured in professional and amateur male soccer players and compared. Between June 2005 and March 2007, 30 soccer players (10 amateur, 20 professional) with acute or chronic tears of the anterior cruciate ligament who were scheduled for a bone-tendon-bone ACL reconstruction procedure were enrolled in the study. Measures of pain intensity, depression and anxiety were assessed 1 day pre-operation and 1 week and 3 weeks post-operation (T1 T2 and T3). Pain was assessed using a visual analog scale (VAS), depression with the Beck Depression Inventory (BDI), and anxiety with both the state and trait forms of the State-Trait Anxiety Inventory (STAI). Scores on the VAS, BDI, and STAI in both groups were analyzed. The mean VAS scores at T1 and T2 in professional players were not significantly higher than those in amateur players (P N 0.05). Professionals had significantly higher BDI scores at T1 and T2 (P b 0.05), but this difference was not significant at T3 (P = 0.12). High depression scores did not correlate with high pain scores.

Knowledge of the three-dimensional balance of loads at the knee joint is required to adequately assess the treatment and Ž . rehabilitation of the malfunctioning knee. This report focuses upon the moment arms for the knee in internalrexternal IE rotation motion. It augments prior work that defined flexionrextension moment arms. Muscle excursions and angular motion of the lower leg during IE rotation were measured in 17 fresh-frozen hemi-pelvis specimens. Moment arms were calculated as the derivatives of excursion with respect to the angle. Rotational motion was performed for the normal and anterior cruciate Ž . ligament ACL -deficient knee. Of the 13 muscles measured at the knee, seven were significant contributors to IE rotation: the biceps femoris long and short head externally rotate opposite the gracilis, sartorious, semimembranosis, semitendonosus and popliteus, functioning as internal rotators. Moment arm magnitudes were greatest with the knee in a flexed position Ž w x w x . internal external rotators peaked at 70Њ 90Њ flexion . At 30Њ flexion, the IE rotation moment arm minima and maxima were 10.1᎐11.6, 6.8᎐9.0, 6.0᎐15.7, 8.2᎐14.1 and 0.0᎐10.4 mm for the semimembranosis, semitendonosus, gracilis, sartorius and popliteus, and 14.7᎐27.9 and 18.5᎐31.5 mm for the biceps femoris short and long, respectively. Moment arms for the ACL-deficient condition were significantly changed only at extremes of flexion᎐extension. ᮊ

This is a longitudinal study of the identity process through times of dramatic social change. Using a narrative psychological approach this research follows the life stories of five Egyptian bloggers as they write their stories on online blogs over the course of the three years following the 2011 revolution, at which time Egypt has witnessed major social and political changes. The aim is to understand the identity process of individuals as they develop and adapt through changing social contexts and how they create alternative social relations as they engage in prefigurative politics. The findings shed light on how ruptures trigger a process of reflexivity, adaptive learning, and sense-making that facilitates coping and the reconstruction of a positive identity after ruptures. It also suggests that the narration of the experience of rupture through storytelling creates a heightened sense of agency in individuals' ability to create new meanings of their world in spite of the socio-cultural and political constraints. This study presents narratives as an informing methodological resource that connects identity process with social representations and emphasizes the value of storytelling as an integral part of the adaptation process.

Tears of the peroneal tendons are not uncommon but remain an underappreciated source of chronic lateral ankle pain. The purpose of this study was to identify the typical patient profile and nature of the injury, to analyze the course of treatment, and to determine the prevalence of complications seen with surgical repair. Forty patients with chronic pain over the peroneal tendons from the Foot and Ankle Institute at the Western Pennsylvania Hospital underwent peroneal tendon repair. During a 3-year period, a retrospective review was performed by evaluating medical records, surgical reports, and radiographs. The average patient age was 42 years (range, 13 to 64 years). The most common cause was an ankle sprain or other traumatic injury (58%). Peroneus brevis tears (35 patients; 88%), peroneus longus tears (5 patients; 13%), combined peroneus brevis and longus tears (15 patients; 37%), low-lying peroneus muscle belly (13 patients; 33%), lateral ankle ligamentous disruptions (13 patients; 33%), and peroneal subluxation (8 patients; 20%) were identified during surgery. The average follow-up was 13 months (range, 9 to 40 months). Ninety-eight percent of the patients were able to return to full activities without pain at final follow-up. The minor complication rate (transient symptoms) was 20%. Clinically significant (major) complications (continued symptoms or revisionary surgery) occurred in 10% of patients. This study indicates that lateral ankle ligamentous incompetence, combined peroneal brevis and longus tears, and low-lying peroneus muscle belly commonly coexist in patients with peroneal tendon injuries. Appropriate surgical intervention of peroneal tendon tears and their coexisting pathology yields successful and predictable results with few clinically significant complications.

The purpose of our study was to clarify the events that take place during anterior cruciate ligament (ACL) failure, focusing on the behavior of the ACL as a composition of multiple fibers, during uniaxial tension along the ligament.Ten fresh-frozen human cadaveric knee specimens were fixed in an Instron machine (Instron, Norwood, MA), and load was applied parallel to the ACL axis. Two cameras were used to detect the failure mode of the ACL and its different groups of fibers. The distinct bundles of fibers were marked in each specimen before testing. The macroscopic findings during the experiment were used for comparison with the biomechanical results.The ACL showed a non-monotonic response during testing. The load-elongation curve showed a plateau or a second peak after the initial drop in load. Macroscopically, some fibers were failing initially, whereas the intact fibers had a remaining load potential. In our setting, 3 different failure patterns were recognized, specifically, a midsubstance tear of the anteromedial or the posterolateral bundle with a subsequent failure of the intact bundle or an initial avulsion of the anteromedial attachment. Analysis of the video frames showed a direct connection between the failure patterns in the load-elongation curves and the macroscopic sequence of events during ACL failure.The ACL ligament acts as a multifiber construction. In our setting, rupture follows 3 specific patterns where a complete or partial tear of the fiber bundles occurs first and the remaining intact fiber bundles have a potential load resistance.Our study allows a better understanding of the mechanical properties of the ACL. An update on the biomechanics of ACL failure during uniaxial tension after the “double-bundle revolution” could provide data helpful for ACL reconstruction.

Background and Purpose. Little evidence supports the prescription of preoperative rehabilitation in the treatment of chronic anterior cruciate ligament-defi cient (ACLD) subjects. The aim of the present study was to assess the effectiveness of a specifi c six-week pre-operative exercise programme on ACLD knees. Method. A single, masked, controlled study was designed. This comprised two matched groups of 12 chronically ACLD patients awaiting reconstruction and a group of 12 matched uninjured control subjects. Only one ACLD group received a home-based exercise and educational programme. Assessment before and after the exercise intervention included: knee joint stability (clinical and KT1000 evaluation); muscle strength (Cybex II); standing balance and functional performance (agility, hop and subjective tests). Results. At the time of initial assessment there were no statistically signifi cant differences in any measures for the two ACLD groups but both ACLD groups were signifi cantly different from the uninjured control group as regards quadriceps strength and function. Measures taken after six weeks showed no signifi cant improvement in the untreated ACLD group or in the uninjured control group The treated ACLD group showed signifi cant improvement in the following measures: quadriceps strength measured at 60˚ and 120˚ per second (p < 0.001); single leg standing balance with eyes closed (p < 0.001); instrumented passive stability at 20 lb (89N) force (p = 0.003); agility and subjective performance (p < 0.001). The incidence of unstable episodes had decreased in the treated ACLD group, reducing further damage to the joint. Conclusion. This study leaves little doubt that pre-operative physiotherapy had a positive effect on motor function in ACLD subjects and should be prescribed routinely to maximize muscle stabilizing potential prior to reconstruction. Patients report improved stability and, in certain cases, may Chronic ACLD: effectiveness of home-based physiotherapy FIGURE 1: The sway meter, as used to assess single-leg balance with eyes open, eyes closed and on a foam surface.

Wrist arthroscopy is a valuable diagnostic and therapeutic tool. Thermal ablation can be used concomitantly to treat partial ligamentous tears, triangular fibrocartilage cartilage complex tears, and to perform partial synovectomy. We reviewed 47 consecutive patients who underwent wrist arthroscopy with concomitant thermal ablation between 1997 and 2001. Three patients sustained serious complications. The serious complications included, in all three patients, tendon ruptures and in one case, a 5 ϫ 10-mm full-thickness skin burn. Thermal treatment of collagenous tissues has recently gained popularity in the orthopedic literature, but there is little information on the potential complications. The arthroscopist of large and small joints must be aware of the risks involved when using thermal ablation.

Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with four-strand gracilis and semitendinosus tendon (N = 37) or with patellar tendon-bone (N = 35) from the ipsilateral side. The groups were similar in terms of age, sex, level of activity, degree of laxity, meniscal lesions found surgically, and rehabilitation program. The follow-up was performed at another hospital by independent observers after 6, 12, and 24 months. Sixty-one patients (32 with hamstring tendon grafts and 29 with patellar tendon grafts) complied with the follow-up routine for the full 24 months. No differences were found between the groups with respect to Cincinnati functional score, KT-1000 arthrometer measurements, or stairs hopple test results. The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months, but no differences were found after 24 months. The hamst...

The purpose of the study was to examine reproductbllity of knee laxity measurements obtained using the Dynamic Cructate Tester (OCT) from day-to-day, set-to-set. and trlal-to-trlal. In Part I. peak anterior Ubtal translation (Am was assessed for 1 anterior eructate Jtgament (ACL) defictent and 16 control subjects during two sets of three active trlals (maximal Isometric quadr1ceps cont.racttons) and three passive trlals (240 N load) conducted over four consecutive days. In Part Il, peak ATI was recorded for 12 chronic ACL deficient subjects during one set of five active and five passive trlals within one day. Results wereanalysed using mixed repeated measures ANOVA designs with tntraclass reliability coeffictents (ICC) calculated from the ANOVA results. There were no stgntftcant differences In the mean peak ATI results among the four tests days or between the two test sets conducted within a day. with ICC ranging from R 1 =0.939 to 0.980. It was concluded peak ATI measurements obtained using the OCT were reproducible from day-to-day and set-to-set. A stgntftcant main effectoftrtal was found on both active (F12,321 = 13.93: p < 0.001) and passive (F12.321 = 57.21: p < 0.001) peak ATI results. It was therefore recommended a full pretrial should be conducted before knee laxity assessment ustng the OCT to ensure reproducible results.

Background: Tendon transfers are commonly used for correction of pathology or deformity of the foot and ankle. Bioabsorbable implants have been developed as an alternative to metal interference screws. The purpose of this study was to document complications following tendon transfers of the foot and ankle using bioabsorbable poly-L-lactide interference screws. Methods: A retrospective chart review was used to identify patients in whom either of the 2 senior authors had performed a tendon transfer of the foot and ankle using a bioabsorbable interference screw between 1999 and 2005. A minimum of 6 months of follow-up was required for inclusion in the study. In all, 31 patients were identified who met the inclusion criteria with an average follow-up of 75 weeks. All screws were made of poly-L-lactide (PLLA). Results: Complications were identified in 12 (39%) of patients. All of the complications reported were known complications of the tendon transfer procedure itself, and were not directly related to the bioabsorbable screw. Conclusions: Based on these early results, PLLA implants appear safe and effective for tendon transfers of the foot and ankle. However, until long-term outcomes are available, judicious use of these implants is recommended. Level of Evidence: Level IV, retrospective case series.

a dorsal interosseous muscle is documented poorly in the literature and to our knowledge only has been described by Ishizuki.l A systematic search probably would reveal a higher rate of these associated lesions. In the present series they did not influence the final result.

John Barth‟s “Lost in the Funhouse ” is a prime example of a postmodernist short fiction. The poetics of the work is mainly concerned with questions of ontology and frequently seeks to foreground this notion in different ways so much so that the reader gets lost in a funhouse of reading. Accordingly, the story has been divided into separate worlds, each trying to call into attention its own ontological existence and significance. Barth‟s story self-consciously implements certain techniques at different levels of his work to foreground world formation and draw the reader‟s attention towards the worlds of the text. His story foregrounds different planes, each of which stands independently as an ontological world: the world of language and text, the metafictional level, the projected world level, and the external world of the author. However, the resultant ontological ruptures, which are intentionally induced, cause various complications in the narrative. Ontologies are presented as un...

Purpose Surgery involving arthroscopic reconstruction of the injured ligament is the gold standard treatment for torn anterior cruciate ligament (ACL). Recent studies support the hypothesis of biological self-healing of ruptured ACL. The aim of the study is to evaluate, in an animal model, the efficacy of a new technique, dynamic intraligamentary stabilization that utilizes biological self-healing for repair of acute ACL ruptures. Methods The ACL in 11 adult female white alpine sheep was transected and in 8 sheep reconstructed by dynamic intraligamentary stabilization. To enhance the healing potential, microfracturing and collagen were used in all animals. The contralateral, non-operated knees served as controls. At 3 months postkilling, all animals were submitted to magnetic resonance imaging and biomechanical and histological evaluation. Results No surgery-related complications were observed. Postoperatively, all animals regularly used the operated leg with full weight bearing and no lameness. At the time of killing, all animals exhibited radiological and histological healing of the transacted ACL. Biomechanical tests confirmed successful restoration of anteroposterior translation in the dynamic intraligamentary stabilization knees. Histological examination revealed dense scar tissue at the ends of the transected ligaments exhibiting hypercellularity and hypervascularization. Conclusion The dynamic intraligamentary stabilization technique successfully induced self-healing of ruptured ACL in a sheep model. Knee joints remained stable during the healing period allowing free range of motion and full weight bearing, and no signs of osteoarthritis or other intraarticular damage in the follow up were observed.

Our aim with this systematic review was to assess the effectiveness of various functional treatments for acute ruptures of the lateral ankle ligament in adults. We performed an electronic database search using MEDLINE, EMBASE, COCHRANE CONTROLLED TRIAL REGISTER and CURRENT CONTENTS.

The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. Methods: A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Results: Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Conclusions: Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level of Evidence: Level IV, therapeutic case series.

Objective: The purpose of this study was to evaluate the effect of an 830-nm GaAlAs diode laser operating at output powers of 40, 60, 80, and 100 mW and energy density of 30 J/cm 2 on the repair of partial calcaneal tendon ruptures in rats. Methods: A partial tendon rupture was induced in all animals, which were treated with laser irradiation for 5 consecutive days. Six days after injury, the injured tendons were removed and examined by polarized light microscopy. Collagen fiber organization was evaluated by birefringence measurements, and collagen content was determined by Picrosirius Red staining. Results: It was observed that the higher the output power (60-100 mW) the greater the amount of type III collagen ( p < 0.01). The amount of type I collagen was significantly greater ( p = 0.05) in the 80 mW group than in the control group (sham stimulation). A nonstatistically significant improvement in the realignment of collagen fibers was observed in the irradiated groups. Conclusions: Low-level laser therapy resulted in significantly greater amounts of type III collagen (output powers of 60 mW or more) and type I collagen (output power of 80 mW), however, no significant differences between groups were found in the realignment of collagen fibers.

This case report describes complete musculotendinous junction rupture of the left extensor digitorum communis tendon at the site of an extraosseous ulnar component of a revision elbow replacement, mimicking the more frequent problem of rheumatoid extensor tendon rupture at the wristFIGURE 1: A Ulna, B migration of cement restrictor, and C palpable lump on the dorsoradial aspect of the left proximal forearm.

Purpose The purpose of this study was to determine the difference in the concentrations of testosterone, 17-b estradiol and progesterone between female patients with and without ACL rupture and the possible effect of these hormones on generalised joint laxity. Methods Female subjects with non-contact knee joint injury were included in this study. They were divided into two groups: the examined group, consisting of female subjects with ACL rupture, and the control group, consisting of female patients without ACL rupture. In the next step, the patients from these two groups were paired off on the basis of three factors: the level of professional sports involvement (including the type of sports activity), the side of the body where the injury had occurred (left or right) and the age of the subjects. In the end, there were 12 pairs (24 subjects). The concentrations of sex hormones were established from saliva specimens with the aid of the Salimetrics enzyme immunoassay. Generalised joint laxity was tested with the aid of the ''laxity score'' according to Beighton, Solomon and Soskolne. Results Female subjects with ACL rupture had significantly lower concentrations of testosterone (p \ 0.01), significantly lower concentrations of 17-b estradiol (p \ 0.05) and significantly lower concentrations of progesterone (p \ 0.01) than female subjects with intact ACL. Conclusions Decreased concentrations of testosterone, 17-b estradiol or progesterone may be a risk factor leading to ACL rupture. The concentrations of these hormones do not affect generalised joint laxity. Additional research on a larger group of patients is necessary to further determine the effects of these hormones on generalised joint laxity and ACL ruptures. Young female athletes with lower concentrations of sex hormones are more prone to anterior

the in-situ forces in the MCL and PLS, respectively, were approximately two and five times as large as those in the intact knee (P Ͻ 0.05). The results of this study demonstrate that, although both the MCL and PLS play only a minor role in resisting anterior tibial loads in the intact knee, they become significant after ACL injury.

Objective To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). Methods In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. Results Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). Conclusions MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.

OBJECTIVE: In Norway, we have experienced a gradual increase in the incidence of obstetric anal sphincter injuries from under 1% in the late 1960s to 4.3% in 2004. This study was aimed to assess whether an interventional program causes a decrease in the frequency of anal sphincter tears.

Verletzungen des Skelettmuskels gehören mit 10-55% zu den häufigsten Sportverletzungen überhaupt [7, 22, 32]. Sie können aufgrund von außen einwirkender Gewalt (Traumen) oder durch verschiedene innere Ursachen (Stoffwechsel, Vorschädigung etc.) hervorgerufen werden. Dabei kommt es zu einem Missverhältnis zwischen Belastung und Belastbarkeit, was posttraumatisch innerhalb eines bestimmten Regenerationszeitraums (Stunden bis Wochen) zu einer Funktionseinschränkung der Muskulatur führt.

Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large. ( Surv Ophthalmol 45 :473-488, 2001. © 2001 by Elsevier Science Inc. All rights reserved.) Key words. cataract surgery • complications of phacoemulsification • posterior capsule defect • posterior capsule rent • posterior capsule tear • posterior polar cataract • primary posterior capsulorhexis • trauma Surv Ophthalmol 45

Injury to the anterior cruciate ligament (ACL) is common and affects young individuals, particularly girls, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors have been identified, which include anatomic variations, neuromuscular deficits, biomechanical abnormalities, playing environment, and hormonal status. Multicomponent prevention programs have been shown to be effective in reducing the incidence of this injury in both girls and boys. Programs should include a combination of strengthening, stretching, aerobic conditioning, plyometrics, proprioceptive and balance training, as well as education and feedback regarding body mechanics and proper landing pattern. Preventive programs should be implemented at least 6 wk prior to competition, followed by a maintenance program during the season.

Background The use of venous thromboembolism prophylaxis after an Achilles rupture is controversial. The rates of reported deep vein thrombosis (DVT) range from 6.3% to 34%. There is no agreement regarding prophylactic therapy after an Achilles tendon rupture. Questions/purposes We determined the overall risk of DVT and pulmonary embolism (PE) after an Achilles tendon rupture and identified potential risk factors including surgery. Patients and Methods We retrospectively reviewed a large healthcare management organization database and identified 1172 patients who had Achilles tendon ruptures.

The risk factors for the development of osteoarthritis (OA) in patients who have had an anterior cruciate ligament (ACL) rupture are reviewed. Although the principle arthrogenic factor is the increased anterior tibial displacement that is associated with the rupture, other direct and indirect factors contribute. Meniscal and chondral injuries can be present before, during, and develop after the index injury, making assessment of the relative importance of each difficult. Most studies concentrate on the radiological changes following ACL rupture and reconstruction. However the rate of significant symptomatic OA needing major surgical intervention is lower. This needs to be considered when advising patients on the management of their ruptured ACL. The long-term outcome in patients who are symptomatically stable following an ACL rupture is uncertain, although in a small cohort of elite athletes all had degenerative changes by 35 years and eight out of 19 (42%) had undergone total knee replacement. At 20 years follow-up the reported risk of developing osteoarthritis is lower after ACL reconstruction (14%-26% with a normal medial meniscus, 37% with meniscectomy) to untreated ruptures (60%-100%).