Werterhellende Umstände im Bilanzrecht

Die Arbeit analysiert die Abgrenzung werterhellender von wertbeeinflussenden Umständen. Dabei werden die bestehenden Grundlagen in Judikatur und im Gesetz analysiert und die Bedeutung der Werterhellung herausgearbeitet. Als Abgrenzung werterhellender von wertbeeinflussenden Umständen dient das Stichtagsprinzip. Dabei ist der am Markt realisierbare Stichtagswert für die Beurteilung, ob ein werterhellender Umstand vorliegt, maßgebend

Self-inflicted partial epiphyseolysis of the distal femur—a case report

Introduction Injuries to the epiphyseal plate are of great concern as they can affect bone growth. Although epiphyseal fractures are common in adolescents, fractures of the distal femoral epiphyseal plate are rare. Case presentation We present a case of a Salter–Harris type 1 fracture of the distal epiphysis of the femur that was self-inflicted by a patient with paraplegia due to spina bifida. The patient was brought to the pediatrician's attention during a routine checkup with an apparent swelling of the right thigh. Upon presentation, we performed a radiograph and an additional MRI, which revealed a partial ventero-medial epiphyseolysis, consistent with a Salter–Harris type 1 fracture. Due to the dislocation, we indicated closed reduction with K-wires. Repositioning was performed using a modified Kapandji maneuver and was completed with additional K-wires. Conclusion Distal epiphyseolysis is a relatively rare injury that can lead to serious complications. Therefore, although rare, epiphyseal fractures should be considered in pediatric patients presenting with uncertain limb swelling

Double-level torsional osteotomy a treatment for the ‘inwardly pointing knee’ syndrome

Introduction A ‘inwardly pointing knee’ syndrome is a combined torsional deformity with increased femoral internal and tibial external torsion. After clinical and radiological verification of the torsional deformity and unsuccessful conservative therapy approach, a combined (double level) torsional osteotomy of femur and tibia might be the appropriate treatment. Here, we present the diagnostic algorithms, treatment, and outcome of combined torsional osteotomies of femur and tibia. The aim of the study is to show that patients treated with the procedure achieve patellofemoral stability and pain relief or reduction. Material and methods Twenty torsional osteotomies performed on 18 patients were included. Nine patients had experienced patellar dislocation in 11 joints before. All patients were suffering from anterior knee pain. All patients underwent a clinical and radiographical evaluation, including a torsion angle CT scan. Pre- and post-operatively multiple commonly approved scores (Lysholm Score, Tegner Activity score, Kujala Score, VAS and Japanese Knee Society score) were acquired. Results In 18 patients we performed 20 double-level torsional osteotomies. 9 patients suffered from patellar dislocations in 11 knee joints prior to surgery. All patients were suffering from anterior knee pain. Of these 7 patients achieved a stable joint after surgery without further patellar dislocations. All achieved more knee stability and experienced less patellar luxation then before surgery. The mean duration of follow-up was 59 months (range 9–173 months). The mean VAS was significantly reduced by 3.75 points (SD 2.09, p value 0.0002) from 5.50 points (SD 2.73, range 0–9) before surgery to 1.75 points (SD 1.67, range 0–5) after surgery. The Lysholm score increased significantly by mean of 27.6 (SD 17.55, p value 0.0001) from mean 62.45 (SD 22.71, range 22–100) before surgery to mean 90.05 (SD 10.18, range 66–100) after surgery. The Kujala Score did improve significantly in average by 25.20 points (SD 13.61, p value 0.00012) from mean 62.9 (SD 16.24, range 35–95) to mean 93.2 (SD 9.20, range 66–100). The Tegner activity score did increase significantly by 1.2 points (SD 1.47, p value 0.004) in average from mean 2.65 (SD 1.11, range 1–5) to mean 3.85 (SD 1.42, range 1–6). The Japanese knee score did increase significantly by 19.15 in average (SD 11.95, p value 0.0001) from mean 74.05 (SD 14.63, range 33–95) to mean 93.05 (SD 10.18, range 68–100). Conclusion This is the first publication reporting about simultaneous double-level torsional osteotomies in a comparatively high number of patients. In addition, this is the first publication assessing the patient collective afterwards with objectifying clinical outcome scores. The results show that double-level torsional osteotomy is an effective treatment for patients with patellar dislocation or subluxation associated to torsional deformities of femur and tibia. Furthermore, we introduce a diagnostic algorithm for ‘inwardly pointing knee’ syndrome. Level of evidence Level IV.Open Access funding enabled and organized by Projekt DEAL.Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Long-Term Outcomes Following Single-Stage Reamed Intramedullary Exchange Nailing in Apparently Aseptic Femoral Shaft Nonunion with Unsuspected Proof of Bacteria

Background: The aim of this study was to evaluate detection rates and risk factors for unsuspected proof of bacteria, as well as clinical and radiologic outcomes following femoral shaft nonunion without clinical signs of infection treated by a single-stage surgical revision procedure including reamed intramedullary exchange nailing. Methods: A retrospective cohort study was performed in a European level I trauma center between January 2015 and December 2022. Fifty-eight patients were included who underwent reamed intramedullary exchange nailing as a single-step procedure for surgical revision of posttraumatic diaphyseal femoral nonunion without any indications of infection in medical history and without clinical signs of local infection. Clinical details of the patients were analyzed and functional and radiologic long-term outcomes were determined. Results: In all patients, with and without proof of bacteria osseous, healing could be observed. The physical component summary of the SF-12 demonstrated significantly better results at least one year after the final surgical revision in case of a negative bacterial culture during exchange nailing. Conclusions: Clinical long-term outcomes demonstrated a trend towards better results following femoral shaft nonunion revision if there was no evidence for the presence of low-grade infected nonunion. In this case, a single-stage surgical procedure may be recommended

Suppression of the interleukin- 1ß-induced inflammatory response of human Chang liver cells by acute and subacute exposure to alcohol: an in vitro study

Aim To evaluate protective immunosuppressive dose and time-dependent effects of ethanol in an in vitro model of acute inflammation in human Chang liver cells. Method The study was performed in 2016 and 2017 in the research laboratory of the Department of Trauma, Hand and Reconstructive Surgery, the University Hospital of the Goethe-University Frankfurt. Chang liver cells were stimulated with either interleukin (IL)-1β or IL-6 and subsequently treated with low-dose ethanol (85 mmol/L) or high-dose ethanol (170 mmol/L) for one hour (acute exposure) or 72 hours (subacute exposure). IL-6 and IL-1β release were determined by enzyme-linked immunosorbent assay. Neutrophil adhesion to Chang liver monolayers, production of reactive oxygen species, and apoptosis or necrosis were analyzed. Results Contrary to high-dose ethanol, acute low-dose ethanol exposure significantly reduced IL-1β-induced IL-6 and IL-6-induced IL-1β release (P < 0.05). Subacute ethanol exposure did not change proinflammatory cytokine release. Acute low-dose ethanol exposure significantly decreased inflammation-induced formation of reactive oxygen species (P < 0.05) and significantly improved cell survival (P < 0.05). Neither acute nor subacute high-dose ethanol exposure significantly changed inflammationinduced changes in reactive oxygen species or survival. Acute and subacute ethanol exposure, independently of the dose, significantly decreased neutrophil adhesion to inflamed Chang liver cells (P < 0.05). Conclusion Acute treatment of inflamed Chang liver cells with ethanol showed its immunosuppressive potential. However, the observed effects were limited to low-dose setting, indicating the relevance of ethanol dose in the modulation of inflammatory cell response

Radial head and neck fractures in children and adolescents

BackgroundRadial head and neck fractures are a rare entity in pediatric patients. Due to specific characteristics of the blood supply and remodeling potential, the correct diagnosis and initiation of appropriate therapy are crucial for the outcome. Therefore, the aim of this retrospective observational study was to present the outcome of a series of pediatric patients with radial head and neck fractures.MethodsIn total, 67 pediatric and adolescent patients with a fracture of the proximal radius admitted to a Level I Trauma Center (Germany) between 2005 and 2017 were included in this retrospective observational study. Patients were stratified in accordance with the classification of Judet modified by Metaizeau and with the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).ResultsAO-PCCF fracture type of proximal radius was age-dependent. Epiphyseal axis angle and displacement angle correlated significantly. Fractures treated with a K-wire or embrochage centromedullaire elastique stable (ECMES) presented higher displacement angles. The duration of callus formation was dependent on both the reduction technique and fracture displacement. The range of motion after complete fracture consolidation was dependent on the Metaizeau type and reduction technique but independent of the duration of immobilization and physical therapy.Conclusion and clinical relevanceBoth the epiphyseal axis and displacement angle are suitable for measuring the initial fracture displacement in radiographs. Consolidation is dependent on the initial displacement and reduction technique. The mini-open approach leads to a worse reduction result, later callus formation, and a more restricted range of motion in terms of pronation. Furthermore, the range of motion at follow-up is independent of the duration of immobilization and physiotherapy

A New Experimental Polytrauma Model in Rats: Molecular Characterization of the Early Inflammatory Response

Background. The molecular mechanisms of the immune response after polytrauma are highly complex and far from fully understood. In this paper, we characterize a new standardized polytrauma model in rats based on the early molecular inflammatory and apoptotic response. Methods. Male Wistar rats (250 g, 6–10/group) were anesthetized and exposed to chest trauma (ChT), closed head injury (CHI), or Tib/Fib fracture including a soft tissue trauma (Fx + STT) or to the following combination of injuries: (1) ChT; (2) ChT + Fx + STT; (3) ChT + CHI; (4) CHI; (5) polytrauma (PT = ChT + CHI + Fx + STT). Sham-operated rats served as negative controls. The inflammatory response was quantified at 2 hours and 4 hours after trauma by analysis of “key” inflammatory mediators, including selected cytokines and complement components, in serum and bronchoalveolar (BAL) fluid samples. Results. Polytraumatized (PT) rats showed a significant systemic and intrapulmonary release of cytokines, chemokines, and complement anaphylatoxins, compared to rats with isolated injuries or selected combinations of injuries. Conclusion. This new rat model appears to closely mimic the early immunological response of polytrauma observed in humans and may provide a valid basis for evaluation of the complex pathophysiology and future therapeutic immune modulatory approaches in experimental polytrauma

The molecular fingerprint of lung inflammation after blunt chest trauma

Abstract Background After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown. Methods Therefore, inflammation in lung tissue following blunt chest trauma was characterized in a well-defined bilateral lung injury model. Using DNA microarrays representing 9240 genes, the temporal sequence of blunt chest trauma-induced gene-expression patterns in lung tissue was examined. Results The results suggest an activation of a highly complex transcriptional program in response to chest trauma. Chest trauma led to elevated expression levels of inflammatory and coagulatory proteins (such as TNFα receptor, IL-1α, IL-1β, C3, NF-κB and plasminogen activator). However, upregulation of proteins was found, usually incoherent of exerting effects in blunt thoracic trauma (pendrin, resistin, metallothionein and glucocorticoid-induced leucine zipper). Furthermore, significant downregulation was observed as early as 10 min after trauma for cytokines and complement factors (LCR-1, C4) as well as for intracellular signaling molecules (inhibitory protein phosphatase) and ion-channels (voltage-dependent Ca2+ channel). Conclusions Taken together, the provided global perspective of the inflammatory response following blunt chest trauma could provide a molecular framework for future research in trauma pathophysiology.http://deepblue.lib.umich.edu/bitstream/2027.42/113091/1/40001_2015_Article_164.pd

Comparing the outcome after double level osteotomies in severe valgus and varus knees

Introduction Osteotomies have played an important role in joint preservation surgery of the knee joint for many years. A double level osteotomy is performed for severe varus or valgus deformities. There are numerous publications on double level osteotomies for severe varus deformities, whereas there are no publications on valgus deformities. The hypothesis of this study was to compare the clinical outcome after varus DLO with that after valgus DLO. Material and methods In this retrospective study, 40 DLOs were followed up in 34 patients. In group one (13 cases, age 45.6 (16–61) years) a varization DLO was performed, in group two (24 cases, age 48.3 (20–61) years) a valgization DLO was performed. The pre- and postoperative clinical scores were recorded: Tegner Activity score, Japanese knee society Score and Lysholm Score. The leg axis and knee joint angles were recorded and compared pre- and postoperatively. Results The follow-up period was 24 (6–81) months. The follow-up rate was 73% (27/37). The preoperative leg axis in group one showed an average valgus of 15.9° (9–40°). Group two had an average varus of 12° (8–21°). Postoperatively, the leg axis was 3.4° varus in group one and 0.5° valgus in group two. The mLDFA changed in group one from 83.2° to 90.9°, the MPTA from 95.5° to 87.0°. In group two, the mLDFA changed from 91.9° to 85.9° and the MPTA from 83.3° to 88.3° on average. The JLCA changed in group one from − 3.2 (− 5°–0°) to − 0.5° (− 3–2°) postoperative and in group two from 3.3° (1–8°) to 3.0° (0–6°) postoperative. Tegner score, Lysholm score and Japanese knee Society score all improved significantly in both groups. Patients with a valgus axis have worse clinical scores before surgery than the varus group, but the varus group shows a higher potential for improvement postoperatively. Every patient stated that they would have the operation performed again. Complications were rare, two overcorrections required corrective surgery. Two hinge fractures were treated intraoperatively with additional contralateral plate osteosynthesis. Conclusions Patients show very good clinical results after DLO. The improvements in the valgus knees are greater, but starting from a lower preoperative level, probably due to improvements in both the lateral compartment and the patellofemoral compartment. An important finding was that JLCA is normalizing in valgization DLO but not in varization DLO. This needs to be considered in planning a DLO.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546

Traumatic fractures of the sternum – typical distribution and need for subgroups within AO and OTA classification system?

Introduction Objective of this study is the morphologic validation of the AO-classification of the sternal bone and particularly define subgroups. Methods Analyzed were all patients of a level I trauma center of a 7-year period with fractures of the sternal bone and the anterior rib cartilage. A total number of n  = 124 patients was included. The detailed evaluation of the CT-data recorded anatomical basic data of the rib cage and every fracture with its position, dislocation, fracture pattern (which was classified following the AO). Results 116 (93.5%) patients showed 134 single fractures of the sternal bone, 48 (35.8%) of the manubrium, 81 (60.4%) of the corpus sterni and 5 (3.7%) of the xyphoid. 16 patients had a dual fracture of manubrium and corpus. Fractures of the corpus were mostly type A-fractures, followed by type B-and C-fractures. Manubrial fractures had the same number of type A- and B-fractures. Subgroups were theoretically defined by the senior author of our group and validated. based on location, dislocation and course of the fracture. Discussion Sternal fractures are mostly shown at the corpus. Fractures of the xiphoid are very uncommon. Generally, corpus fractures are simple fractures, the rarer manubrium fractures show more complex fractures, which presumes a high trauma energy. The defined subgroups can help draw conclusion to the trauma mechanism and its potential concomitant injuries.Open Access funding enabled and organized by Projekt DEAL.Universitätsklinikum Erlangen (8546