Osteomyelitis is one of the most severe complications that can arise following operative treatment of bone. It requires a long-term treatment. The patient can never be sure that it heals completely. The pathophysiology depends on: (1) the extent of soft tissue damage and impairment of blood supply; (2) inoculation of bacterial flora; (3) the instability of the fracture area; and (4) the general defensive condition of the organism. The symptoms of acute osteomyelitis are those of acute inflammation. They appear 1 week to 3 months after operation. The diagnosis can only be made on clinical examination by an experienced surgeon. X-Ray findings are lacking. The treatment of acute osteomyelitis involves debridement of soft tissue and bone sequesters, refixation of the fragments, most often by means of an external fixator, and suction drainage or wet dressing. The reconstruction of the bone is done in a second step. The cancellous bone grafting is performed from a medial approach. Closure of the soft tissue follows. In the case of chronic osteomyelitis scarring, fistulas and muddy secretion are present. The function of the bone is disturbed. X-Ray examination shows loosening of the metal and failing structure of the bone. In this case too, the first step is the debridement of soft tissue and bone. All the metal inside is removed. Stabilization is achieved by means of an external fixator. Once the fracture area has been cleaned, cancellous bone grafting is done once, twice, or even more frequently. For wound closure it is necessary to rotate muscle groups, to cover the bone with dermatomic skin, or to use microvascular flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Eighty-two patients suffering from a severe deformity of the distal radius were operated on in the course of the past 7 years. The corrective osteotomy was done by implanting a corticocancellous bone graft to restore the correct angle of the joint surface and the correct length of the radius. In addition to this, a buttress T-plate was used, which could be removed 6 months later. In 80% of the cases the results with regard to the function of the patients' hands were good. The operative technique is standardized. It is possible to perform this kind of operation on patients of any age, and the procedure can check Sudeck's atrophy. When the obvious disability of the forearm is corrected the mobility of the wrist joint is simultaneously improved.

The starting point for the investigation of calcium phosphate ceramics is given by the bone regeneration, including osteo-conduction, osteo-stimulation and osteo-induction. The amount of the autogenous bone, which can be used for transplantation to induce the organo typical regeneration, is a small one. Based on animal experiments we created a standardized model for investigation of bone regeneration, using the human iliac crest. The empty iliac crest was filled by hydroxylapatite, tricalcium phosphate, Kiel bone or it remained empty as a control group. Clinical examination, X-ray control, blood chemistry and documentation were done with 104 patients divided in these four groups. Radiography, histological examination and morphometry were done with biopsies of 40 patients. The results show a bony ingrown into the ceramic material. The pores were filled by lamellar bone with new grown osteons. The ceramic granules are complete integrated. The ceramic blocks are only fixed at the edges and at the surface by bone trabeculae. The Kiel bone is surrounded by fibrous tissues without any contact to new built bone. It doesn't act as a bone substitute. The bone regeneration in the not fulfilled iliac crest was fast and of a hard quality of lamellar bone and of big amount. Both ceramics show remarkable degradation. The tricalcium phosphate brakes into pieces and shows dissolution. The hydroxylapatite in smaller particles. The degradation stopped, if the particles were surrounded by new bone. These ceramics can be used as augmentation material in combination with autogenous bone. They act as bone substitutes. The integration and bonding to new bone is complete and can be loaded by mechanical strength.

The starting point for the investigation of calcium phosphate ceramics is given by the bone regeneration, including osteoconduction, osteostimulation and osteoinduction. The amount of the autogeneic bone, which can be used for transplantation to induce the organo typical regeneration, is a small one. Calcium phosphate ceramics are used as bone substitute. The basic knowledge of clinical employment is summarized. A new model for investigation of bone regeneration is introduced. In part II the results will be discussed.

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