Congenital or acquired absence of the spleen and functional hyposplenism are associated with abnormalities of host defence such as an increased susceptibility to infection with encapsulated bacteria. The effects of the lack of the spleen on cell‐mediated immunity are largely unknown. In the present study we have investigated peripheral blood lymphocyte subpopulations in healthy adults who had undergone splenectomy because of severe abdominal trauma > 4 years before the study. The results show a significant reduction in the percentage of CD4+ T cells due to a selective and long‐term decrease in the percentage of CD4+CD45RA+ lymphocytes, the CD4+ T‐cell subset mainly involved in primary immune responses to newly encountered antigens. Levels of the reciprocal CD45RO+CD4+ T‐cell subset were comparable between splenectomized and control individuals, as were lymphoproliferative responses and IFN‐gamma production to recall antigens. Decreased levels of CD4+CD45RA+ cells were accompanied by an impairment in primary immune responsiveness, as assessed by investigating T‐cell proliferation to stimulation with keyhole limpet haemocyanin and by measuring antibody responses following primary immunization with a clinically relevant T‐dependent antigen, hepatitis A vaccine, in vivo. These findings suggest a possible role of the spleen in the generation, maintenance and/or differentiation of naive, unprimed T cells or their precursors, which might have a possible functional relevance for primary immune responses following splenectomy.

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To obtain valid information on stress tolerance of pertrochanteric fractures, we exposed three different methods of osteosyntheses to dynamical stress and the results were compared. The methods of osteosyntheses were application of a 130 degrees angle plate, performing an adjoining osteosynthesis with bone cement or using cephalocondylar nails. The measurements in connection with photographical and roentgenological examinations of osteosyntheses under stress gave the following results: Compared with the other methods treatment with condylar nails gave equal results in static behaviour yet was clearly superior in its dynamic reaction.

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Basing on encouraging results with the fixation of pure articular cartilage with the fibrin sealant in animal experiments, pure cartilage fragments were replanted in human patients using fibrin sealant. From individual cases biopsies could be taken from macroscopically not well healed areas during arthroscopic examination. The histological results from these cases are presented together with overall clinical experiences. Six weeks after operation one side of the graft showed no union with the subchondral bone and was also separated from the cartilage bed. However, after three and six months, the grafted cartilage had fused with subchondral bone, but pannus-like tissue was covering the surface and filling the cleft at the border to the bed. After one and five years, complete fusion with the subchondral bone and the surrounding cartilage can be demonstrated. There is always covering pannus at the larger observation times. In the majority of the 48 cases treated so far excellent clinical results were obtained, enabling the patients to take up their sporting activities again.

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In continuation of our studies on dynamic tolerance after condylar nailing in pertrochanteric fractures, we have examined the femora of patients who died within the first 2 weeks after surgery and studied their stress tolerance. We appreciated the lack of the weight bearing medial cortical bone and the need for abduction at the fracture site by the behaviour under stress. The results under stress could be compared with an experimental fracture model. From these experiments conclusions have been made for the correct placement of condylar nails for their best static advantage.

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