Study Design. Case-control study.Objective. We designed a case-control study to analyze the risk factors associated with the development of heterotopic ossification (HO) in patients with traumatic spinal cord injury.Summary of Background Data. Patients with spinal cord injury have a high risk of developing HO, although the exact etiopathogenesis is still unknown. Several factors are known to be potential risk factors. However, we are not aware of any large clinical studies evaluating the risk factors for HO.Methods. Patients who were treated for a traumatic spinal cord injury in our hospital, and who subsequently developed HO, were identified by querying the electronic database at our hospital from 2002 to 2010. One hundred thirty-two patients and 132 controls were included. Our primary outcome measures were the risk of developing HO according to whether the patient had experienced a complete spinal cord lesion according to American Spinal Injury Association Impairment Scale; tetraplegia or paraplegia; cervical, thoracic, or lumbar injury; severe chest trauma; and the time interval between injury and surgery. Secondary risk factors explored were patient age; sex; presence and number of comorbidities; length of hospital and intensive care unit stay; associated traumatic injuries; presence of spasticity, pressure ulcers, deep venous thrombosis, and urinary tract infection; and pulmonary complications, such as pneumonia and necessity of tracheostomy.Results. Patients with associated spasticity and thoracic trauma, complete lesion, pneumonia, presence of tracheostomy, and urinary tract infection had a higher risk of developing HO.Conclusion. Adequate management of potential risk factors could help reduce the overall incidence of HO and outcome in patients with traumatic spinal cord injury.

PURPOSE:Loss of joint mobility, resulting loss of function peripheral nerve entrapment and pressure sores are the known complications of heterotopic ossification.METHODS:We reported about a 32-year-old male patient, referred to our clinic presenting with incomplete tetraplegia after a motorcycle accident. The patient developed a HO in both hips 19 days after injury. Single-dose radiation therapy with 7 Gy with an electrode voltage of 15 MeV was performed.RESULTS:One month after radiation therapy, the patient developed a fever of 104ºF and blood tests showed increased C-reactive protein (CRP), creatinine kinase (CK), serum myoglobin and dark-colored urine due to myoglobinuria. Further diagnostic measures showed only massive recurrent HO. With the suspicion of a possible case of rhabdomyolysis due to the severe muscular distension caused by the recurrent HO, the patient was transferred to our intermediate care unit for further treatment. Forced diureses were applied to reduce the high levels of CK in blood. However, laboratory monitoring showed a further increase in CRP, CK (15,000 U/l) and myoglobin. A repeated radiation therapy was undertaken in a time interval of 14 days. After radiation therapy, a control MRI was performed and no signs of florid HO were visualized, CRP, CK, myoglobin, as well as body temperature and urine colour, had returned to normal and the patient was feeling well.CONCLUSIONS:We report the case of our patient to increase awareness among physicians and training staff working with patients with a spinal cord injury to expedite the diagnosis of rhabdomyolysis in the setting of HO and SCI.

Intramedullary spinal cord metastases (ISCM) are rare spinal cord neoplasms associated with severe neurological deterioration and poor life expectancy. However, their incidence is expected to increase as a result of advances in diagnostic techniques and longer survival of patients with cancer due to improvements in cancer therapy. Reports on ISCM from primary urothelial carcinoma are virtually non existent. We report a 74-year-old male patient with a significant history of a high-grade urothelial carcinoma who presented with progressive back pain and concomitant weakness, grade 3-4/5 proximally and 0-1/5 distally, and distal hyperesthesia and hyperalgesia, particularly of the left lower limb. MRI revealed a contrast-enhancing intramedullary lesion at Th11/Th12. Laminectomies of Th11/Th12 and lesion resection were performed. Postoperative histopathological examinations confirmed the metastatic nature of the lesion. Subsequently the patient developed multiple brain metastases. Radiation therapy was refused by the patient. We conclude that ISCM are devastating complications of systemic cancer. Early and thorough diagnosis, as well as carefully considered and prompt therapy, is important for minimizing the patient's functional deficit, thus improving quality of life.

Purpose Several fixation techniques exist to repair the distal biceps brachii tendon. We aimed to evaluate the clinical and functional outcomes after distal biceps tendon repair using three different fixation techniques.Methods A total of 54 patients were included in the study and were available for follow-up (mean, 30.7 months; SD 18.6). Surgery was performed using a single-incision approach with Corkscrews or Mitek suture anchors or with a two-incision exposure using transosseous sutures. The patients were evaluated with range of motion (ROM) measurements for flection/extension and pronation/supination as well as Disabilities of Arm Shoulder and Hand (DASH) scores. Furthermore, the duration of surgery and the length of hospital stay as well as the complication rate were analyzed.Results Fifty-four out of 73 patients were available after a mean follow-up time of 30.7 months (SD 18.6) for clinical evaluation. There was no statistical significant difference between the three groups comparing the mean DASH score, the length of hospital stay, the duration of surgery, or the ROM. The most common complication was neurapraxia, with 6 cases. All 3 reruptures were registered in the Mitek anchors group. Two patients in the Mitek anchors group required an open arthrolysis due to stiffness of the elbow.Conclusions In summary, we achieved good clinical and functional results after surgical repair of the distal biceps tendon using Corkscrews, Mitek anchors, or transosseous sutures. The results conferred by Corkscrews were comparable to the other techniques, justifying their use.Level of evidence III.

The authors conducted a retrospective study on 183 cases of spondylodiscitis, treated conservatively (44%) or surgically (56%) between November 1991 and June 2006. The male/female ratio was 99/84, and the mean age 62.6 years. The mean follow-up period was 12 years (range 4-19). Interesting from a clinical viewpoint: temperature, white blood cell count, and CRP were sometimes normal, while pain varied from slight to unbearable. The commonest risk factor was diabetes mellitus, and the most frequent pathogen was Staphylococcus aureus. Methicillin resistant Staphylococcus aureus (MRSA) was found in 6 patients, and 3 or 50% of these died, in sharp contrast with the overall mortality rate of 8.7%. A neurological deficit was seen in 43.7% of the patients; complete recovery occurred in 71% of the patients with a Frankel D stage, but in only 15.4 to 222% of those with a stage A, B or C.

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old woman was admitted with a bimaleollar right ankle fracture. The patient underwent an emergency operation with open reduction and internal fixation. Six weeks after the surgery, the syndesmotic screw was removed without complication. The patient presented 4 weeks after removal of the screw complaining of persistent swelling and tenderness of the right ankle without a history of trauma. Radiographs showed a non-displaced distal tibial fracture around the site at which the syndesmotic screw was inserted. The distal tibial fracture was treated conservatively with a toe-to-knee cast for 6 weeks. In summary, the authors present a rare case of distal tibial fracture. Surgeons should bear this additional complication in mind.

The VAC-therapy is a safe, easy, and effective therapy for the management of chronic wounds. Known advantages of the VAC technique are the quicker wound healing by stimulating the blood flow, the formation of granulation tissue, angiogenesis, and cell proliferation. The use of negative pressure treatment can decrease the number of dressing changes and length of hospital stay. However, some related complications after and during VAC therapy have been described. We here describe a rare complication during the treatment of severe os ischium sore with VAC therapy, which has not been reported in the literature yet. We report about a 43-year-old paraplegic patient, referred to our clinic from a regional hospital where he had been admitted 2 months earlier, presenting with a necrotizing fasciitis after VAC therapy during the treatment of fourth grade os ischium sore. After operative debridement and long-term antibiotics with Ciprofloxacin soft tissue closure was performed using a myocutaneous tensor fascia lata flap. Temporary stabilization was achieved by a triangle external fixateur attached to the right femur and the pelvis. After 1 week the tapping point of the muscle flap could be covered with local skin mesh-graft from the right calf as a donor site. The patient was mobilized in a wheelchair and was discharged home 3 months after admission. The VAC technique is a safe, easy, and effective means in chronic wound care management. However, the described rare complication should be kept in mind. The clinical management of VAC therapy requires a distinct indication and close clinical monitoring by experienced medical professionals. The use of VAC therapy in fourth grade sores may have deleterious consequences for the patient.

Carcinoid tumors with a primary site in the central nervous system have not been reported in literature yet. We report here about a 41-year-old patient with recurrent and progressive low back pain and bilateral S1 radiculopathy on admission. The patient underwent hemi-laminectomies of the vertebral bodies L5 and S1 and an en bloc resection of the tumor. Postoperative histopathological examination resulted in a well-differentiated intrathecal neuroendocrine tumor (carcinoid) of the terminal filum. Postoperative staging showed no pathological abnormalities and no tumor recurrence after 6 months. Even though rare, carcinoids should be considered as differential diagnosis of tumors occurring in the CNS.

Einleitung: Material und Methoden: Ergebnisse: Schlussfolgerung: Introduction: Material and Methods: Results: Conclusions: