Aims: Removal of metal implants after complete fracture healing is controversial. Potential negative aspects of indwelling implants such as stress shielding, metal release, allergies, limitations for later surgical procedures contrast with high cost. Furthermore, knowledge about indication, timing and complications remains very limited. Purpose of this study was to analyse published reports on indication, timing and complications of forearm plate removal. Methods: 14 studies (1984 to 2002), including 635 cases of forearm plate removal, were analysed for indication, timing and complications. Results: While 69.1% of the patients were asymptomatic, 30.9% complained of tenderness, barometric pain, implant prominence and bone infections. The average total frequency of complications was 24.0 (11.8–40)%: Iatrogenic nerve injuries occurred in 11.5 (2.0Ð29.1)%, followed by refractures in 7.7 (2.0–26.1)%, wound infections in 6.8 (4.8–11.5)% and hypertrophic scars in up to 9.1%. However, e.g. the increased forearm refracture rate turned out to be clearly associated with the use of 4.5mm DC plates, plate removal after less than 12 months, poor anatomic reduction and open fractures. Conclusions: Considering the identiþed risk factors, forearm plate removal can be performed with a low complication rate. Since the present analysis is based on a few heterogeneous retrospective studies, major prospective clinical studies are required to acquire representative data to þnally answer the question whether to remove the implant or not. However, leaving metal implants in young patients is necessarily associated with disadvantageous biomechanical properties, inevitable metal release and may interfere with later bone surgical procedures.

Aims: Severe necrotizing soft tissue infections (SNSTI) are characterised by rapid progression and high mortality. Purpose of this retrospective study is to review our experience with SNSTI emphasising clinical, diagnostic and treatment strategies, outcome and prognostic factors. Methods: 45 patients (26m/19f; mean age: 47.2 (14–82) years) with SNSTI involving skin, fascia and muscle, requiring critical care treatment, were included. Patientñs records were analysed for predisposing factors, clinical, diagnostic and treatment aspects and outcome. Results: Underlying diseases or injuries were arteriosclerosis (n=23) and diabetes (n=11). All cooperative patients reported on severe pain; swelling, erythema and necrosis generally occurred; the lower extremity was mostly affected (66.7%), followed by the abdomen (33.3%) and the upper extremity (6.6%). In 26.7% amputations were required; in all other cases repeated debridements were performed. Overall mortality rate was 17.8%. Increased mortality was associated with diabetes mellitus (38.5%), septic status (50%) and hemodynamic instability on admission (70.6%). Non-survivors showed higher age (p< 0.01), more often abdominal wall involvement (p< 0.001), increased lactate (p< 0.01), CK (p< 0.05) and decreased coagulation parameters (p< 0.02). Conclusions: A high index of suspicion, early clinical diagnosis, extensive adjusted surgical treatment, comprehensive critical care management and hyperbaric oxygen therapy are essential for successful management of frequently fatal SNSTI. Age, abdominal wall involvement and certain lab parameters (lactate, CK and coagulation status) turned out to be important prognostic markers.

Aims: Fracture repair with biodegradable implants (BDI) avoids implant removal, associated with improved patientñs beneþt and reduced health cost. However, foreign body reactions around the implants have been reported. Furthermore, data on in-vivo degradation of BDI remain limited on animal trials or human case reports. Therefore, the purposes of this prospective study were 1) to evaluate clinical and radiological results and side effects of biodegradable rods used to treat radial head fractures and 2) to assess the role of magnetic resonance imaging (MRI) to visualise BDI and their degradation. Methods: 31 displaced radial head fractures in 31 patients (median age of 30 (20–59) years) were þxed with PDLLA-rods. Clinical and radiological results were evaluated after a median follow-up of 18 (3–41) months (Broberg-Morrey score). MRI (1.5 Tesla) was applied in 14 patients. Results: The average Broberg-Morrey score was 90.5; 97% of the cases were classiþed as excellent or good, 3% as fair. Patientñs satisfaction was rated as excellent or good in 93%, as fair in 7%. No foreign body reaction was observed. In all 14 MRI cases localization, size and type of BDI were sufþciently depictable. Signiþcantly changed signal intensity, potentially representing material degradation, was not observed throughout a maximal follow-up interval of three years. Conclusions: More than 93% excellent or good subjective and objective results conþrm the advantageous use of PDLLA-rods for þxation of radial head fractures. MRI proved to be an appropriate non-invasive method to visualise type and size of BDI, whereas signs of implant degradation have not been seen after a median F/U of 18 months.