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BACKGROUND: 10-15% of the population show allergic reactions against skin contact to metals as nickel, cobalt or chromium and have thus a risk of not tolerating implants containing those materials. The relationship between periimplantary hypersensivity reaction and given cutaneous contact allergy is currently unknown. A new developed multilayer coating system is supposed to prevent long-term allergic reactions that may result from uncoated implants. METHODS: Stability and function (concerning bonding durability, wear and ion release to the serum) of the multilayer coating system has been examined in a test series. RESULTS: The specific architecture of the multilayer coating system evidences a very good bonding durability. The results of the test in the simulator show a reduction of wear of approximately 60% compared to the uncoated implants. Ion concentrations within the serum of the wear tests were by magnitudes lower than those measured in reference tests on uncoated components. CONCLUSION: The results of the preclinical evaluation prove that the durability and function of the multilayer coating system are as intended.

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The osteosynthesis of the clavicle should be the exception and should only be indicated in the case of complicated fractures. The high rate of pseudoarthrosis given in medical literature, is due to errors in indication, selection of implants and in surgical techniques. Procedures like intramedullar wiring, axial screwing and single cerclage-wire suture are unsuited for osteosynthesis of the clavicle. After osteosynthesis of the clavicle we have found exceptional positive results, with respect to functional, radiological and after subjective evaluation, at a low rate of complication without any consequences occurring in the years to come. These results show, that mainly good or even excellent success can be achieved, at a limited indication, combined with careful surgery and a standardized surgery procedure of osteosynthesis of the clavicle.

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Cardinal symptom of the instability of thorax with paradoxical respiration is the irreversible respiratory insufficiency. The lethality is over 50%. For the treatment often besides the longterm respiration with the well known complications the operative stabilisation of the chest wall by osteosynthesis of the ribs by small plates. Thereby the mortality of this severe injury can be reduced significantly, if there is a good indication for osteosynthesis.

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It is useful to subdivide talus fractures in central and peripheric ones, as serious complications have to be expected only in the first group. Under 207 central talus fractures the feared talus necrosis has been found after operative treatment as well of collum as of corpus-trochlea fractures in about 21% of the cases, after conservative treatment in 11 respectively 19%, while posttraumatic arthrosis appears in over 50% (talus fractures with side injuries). The isolated central talus fracture has a better prognosis. The earlier the exact anatomical reposition is realized, the better are the results. Open talus fractures are threatened by infection. The so called central talus fractures--open or closed--are surgical emergency cases and so they have to be treated.

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The psychological attitude towards the seat belt of 70 injured motor car passengers could be examined. The belt fastening rate was changed after the experience of having had an accident. Almost 80% of the questioned persons now always fasten their seat belt, whereas this is done only by 43% of the total collective. Although the usefulness of seat belts is not doubted by the majority of the questioned persons, almost 80% of them are afraid of difficulties concerning the loosening of seat belts.

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Evaluation of more than 17,300 injuries caused by skiing in the Black Forest region between 1936 and 1980, shows that there has been a change in the pattern of injuries. However, the most frequent fracture occurring during skiing is, as it has always been, the fracture of the lower leg. Whereas ankle-joint fractures have receded, knee injuries have been increasing. This shows that the type of injuries to the leg have been undergoing a change as a result of modern skiing technique.

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A very rare case of simultaneous bilateral rupture of the achilles tendon is reported. The histology revealed severe degenerative lesions on both achilles-tendons in a healthy patient. This severe degeneration obviously caused the ruptures following an extreme initial stress.

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A case of a severe systemic anaphylactoid reaction is reported in a patient treated with dextran 60 to prevent venous thrombosis. Significant improvement of clinical symptoms occurred after the usual treatment of such incidents with corticosteroids, histamine H1 receptor antagonists, and plasma substitutes was supplemented with a histamine H2 receptor antagonist. We would therefore like to recommend that for such cases a histamine H2 receptor antagonist should be given in addition to the usual medication with corticosteroids and histamine H1 receptor antagonists. However, the value of complete histamine antagonism in these rather rare occurrences, can only be determined after furtherexperience has been gained.

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