Divergent descriptions of the anatomic location and biomechanical function of the iliotibial tract (IT) can be found in the literature. This study attempted to obtain exact data regarding the anatomic course and material characteristics including the biomechanical properties of this structure. The following were its aims: (1) anatomical investigations of the IT; (2) mechanical properties of the IT; (3) femoral head centralizing force of the IT and subligamentous forces in the height of the greater trochanter in different joint positions by using a custom-made measuring prosthesis and a subligamentous positioned sensor; (4) construction of a finite element model of the proximal femur including the IT and measuring the femoral neck angle under variation. The hip joints and IT in a total of 18 unfixed corpses were evaluated. We studied the anatomic relationship to surrounding structures, as well as the material properties with the help of tensile strength testing utilizing an uniaxial apparatus. During the test, a load-displacement curve was registered, documenting the maximum load and deformation of the IT. To measure the subligamentous pressure at the height of the greater trochanter, a custom-made sensor with a power-recording instrument was constructed. Furthermore, an altered hip prosthesis with a pressure gauge at the height of the femoral neck was used to measure the forces which are directed at the acetabulum. The investigations were done in neutral-0 position and ab/adduction of the hip joint of the unfixed corpse. In addition, we varied the femoral neck angle between 115 degrees and 155 degrees in 5 degrees steps. To confirm the subligamentous forces, we did the same measurements intraoperatively at the height of the greater trochanter before and after hip joint replacement in 12 patients. We constructed a finite element model of the proximal femur and considering the IT. The acquisition of the data was done at physiological (128 degrees), varus (115 degrees), and valgus (155 degrees) femoral neck angles. The influencing forces of the IT at the height of the greater trochanter and the forces at the femoral head or the acetabulum could be measured. Our anatomical investigations revealed a splitting of the IT into a superficial and a deep portion, which covers the tensor fasciae latae. The tensor fasciae latae has an insertion on the IT. The IT continues down the femur, passing over the greater trochanter without developing an actual fixation to the bone. Part of the insertion of the gluteus maximus radiates into the IT. The IT passes over the vastus lateralis and inserts at the infracondylar tubercle of the tibia or Gerdy's tubercle, at the head of the fibula, as well as at the lateral intermuscular septum. Portions also insert on the transverse and longitudinal retinaculum of the patella. Concerning the material properties of the IT, we found a structural stiffness of 17 N/mm extension on average (D = 17 N/mm). The subligamentous measurements at the height of the greater trochanter in the unfixed corpse an...

Presently, extracorporeal shock-wave therapy (ESWT) is not yet a standard therapeutic technique in orthopaedics. The mechanism for the analgesic effect or the effect of shock waves on osseous defects are still unknown. With the help of a review of the literature, indications and success rates for ESWT in the treatment of non-unions are outlined, while adequate impulse and energy rates are defined according to the present state of knowledge. Non-union is defined as an absent healing process after a duration of 6 months. The aim of this study is to rate the published data. A total of 52 papers referring to ESWT of the locomotor system are reviewed, with a focus on the 635 patients from 10 publications who underwent ESWT to treat non-unions. Validation was performed for each paper dealing with this topic according to the internationally accepted system of the American Association of Spine Surgery as types A-E. Conclusions regarding possible applications in therapy were taken only from high-quality publications of types A and B. This advice can be regarded as scientifically as well as economically sound. The investigations concerning non-union hardly live up to scientific standards. No serious complications were observed. Because of the complication rate in operative treatment of non-unions, ESWT seems to be justifiable. The techniques of ESWT, energy density levels and impulse rates will be described. Atrophic non-unions seem to represent a poorer starting point in comparison with hypertrophic non-unions. Most investigations showed a consolidation of the non-union during a period of 3 months following ESWT, so that in case of treatment failure, operative treatment in the form of a re-osteosynthesis would only be delayed for this period of time. The advantages of ESWT are its non-invasiveness and low rate of complications. The primary aim of further research should be the evaluation of adequate energy density levels and impulse rates for various indications in accordance with evidence-based medicine. Long-term results need to become available before ESWT can be compared with established methods.

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Of these patients, 122 were available for follow-up examinations, on average 5.9 years (range 2.2-12.3 years) after the original injury. The operative procedure was carried out as described by Kirchmayr in 19176 utilizing non-resorbable suture material in all instances. This group consisted of 15 women and 107 men with an average age of 41.1 years (range 22.0-74.0 years).Postoperatively, the affected extremity was immobilized for 2 weeks in an long-leg cast in 300 of plantar flexion in the ankle, which was then reduced to 150 for the second two week period. For the final 2 weeks of a 6 week immobilization period a short-leg walking cast in neutral position was applied. For the following 3 months a heel elevation of 1.5 cm was prescribed. A programme of physical therapy was only necessary in isolated instances.Of the 122 patients available for follow-up examinations, 50 also completed a questionnaire concerning the subjective results. An ultrasound examination using the Siemens Sonolinee model with a 5.0 Mhz linear transducer was carried out on 71 patients (9 women, 62 men; average age 44 years). The examination was performed with the ankle in a neutral position. The classification of the internal structure of the Achilles tendon was carried out using a modification of the Thermann model3 and the 121

Thanks to the significantly increased accuracy, fluoroscopic navigation offers a high degree of safety and efficacy for this minimally invasive procedure. The operation can easily be performed successfully causing only minimal collateral damage to the bone, preserving the joint surface. The inherent risks of the retrograde drilling of osteochondritic lesions are lower with navigation, while the radiation exposure of the patient and the staff is significantly reduced.

In summary, there are many parameters affecting the outcome in the treatment of fragility and hip fractures. Technical features as well as surgeon characteristics play an important role and the ultimate solution has yet to be developed. Even though fracture morphology may indicate a specific treatment option, patient characteristics play an important role in decision-making. The development of centers of fragility fracture care in Germany could help to lower the complication rate and increase quality of life in hip fracture patients in the future.

As part of a retrospective study, 76 patients with acute tears of the anterior cruciate ligament who underwent reinsertion and augmentation with the semitendinosus tendon were examined. The follow-up took place on average 4.5 years (range 3-7 years) after surgery. A decreased range of motion upon comparison with the uninjured opposite side was seen in 43 patients. The Lachman test revealed a grade 1 instability in 42 patients, grade 2 in 17 and grade 3 in 2, while 15 patients had a negative test result. The average Lysholm score was 92 points and the Tegner activity score had an average of 7.1 points. KT-1000 measurements showed an identical degree of anterior translation for both knees at 89 N in 25 individuals. The analysis revealed a difference of 2 mm in 15 patients, 4 mm in 19,6 mm in 15 and greater than 6 mm in 2. The radiographic follow-up examination revealed a deterioration of the degenerative change of 1 deg in 17 patients and 2 deg in 4 patients. Isometric testing showed no loss in flexion strength of the operated knee joints compared to the healthy opposite side. The ratio between flexion and extension strength was also identical for both knees. The reinsertion and augmentation with a single strand of semi-tendinosus tendon is not, as this study demonstrates, the appropriate reconstructive technique for the majority of ACL tears.

With the newly developed epiDRB computer-assisted navigation becomes easier and safer to handle even in punctures and other percutaneous procedures at the spine as much as at the extremities without an unproportionate amount of additional trauma. Due to the special design referencing of more than one vertebral body is possible at one time, thus decreasing radiation exposure and increasing efficiency.