In a prospective study, we used the nanocrystalline hydroxyapatite paste Ostim (Osartis, Obernburg, Germany) in combination with a palmar plate to treat comminuted radius fractures with a metaphyseal and articular component in order to examine the clinical use of Ostim as a bone substitute. Twenty-one patients with 22 radius fractures of AO types C2 and C3 were included in the study. The measurements, taken 10.2+/-1.3 months after the initial treatment, revealed a dorsopalmar tilt of 8.8+/-3.7 degrees , a radioulnar inclination of 18.8+/-2.8 degrees and an ulnar variance of 0.8+/-1.8mm. According to the Gartland and Werley evaluation, eight of the treated fractures attained an excellent, 11 a good and the remaining three a fair result. The study demonstrates that Ostim, in combination with angularly stable osteosynthesis, can be used as an acceptable bone substitute for the treatment of type C2 and C3 radial fractures.

In view of these differences in material properties, the clinical data from long-term use of the bone cements Refobacin Palacos R and Palacos R + G cannot be extrapolated to the newly developed PMMA cements Refobacin Bone Cement R and Smart GHV. Before broad clinical use of these cements, prospective clinical studies using RSA or DEXA and, as a second step, statistically powerful prospective comparative studies should be performed. Until these data are available, patients in whom Refobacin Bone Cement R and SmartSet GHV are used should be informed that the material employed deviates from the standard procedures for cemented joint replacement in the Scandinavian arthroplasty registers and that the long-term consequences cannot, in the final instance, be foreseen. This is essential in order to avoid later malpractice claims on the grounds of inadequate information.

A central venous catheter with a subcutaneous infusion port was implanted for chemotherapy into a 64-year-old woman with gastric lymphoma. Six weeks later, two weeks after a trivial trauma with hyperextension of the shoulder joint, it was found that the catheter had broken and its tip portion had embolized into the pulmonary artery: it was retrieved without difficulty via the femoral vein. This event suggests that pressure between clavicle and first rib can cause material fatigue in a silicon catheter. Such catheters should therefore not be implanted via the subclavian vein.

The antiseptic polyhexanide was investigated in a placebo-controlled, prospective, and randomized double-blind study on patients with bacteria-contaminated wound types 2 -4 comparing younger (< 65 years old, n=28) and elderly (≥ 65 years old, n=8) patients. The wound dressing with a 0.2 % polyhexanide/macrogolum solution was investigated in comparison to Ringer´s solution on days 0, 2, 4, 8, 11, and 15. Standardized swabs were taken on days 0, 2, 8 and 15 and investigated for microorganisms. An additive wound score for the condition of the wound base and the wound margin was determined. The use of polyhexanide led to a faster improvement of the wound score and a better reduction in microorganisms on the wound surfaces. This could also be observed in the subgroups of patients with different age. The findings suggest, that polyhexanide is also effective for the use in elderly patients.