RESUMEN
PURPOSE: Juvenile hallux valgus deformity (JHVD) is rare but may be associated with symptoms or deformities that require surgical treatment. Literature recommends waiting to perform surgical treatment until maturity. However, if conservative treatment is not sufficient and the children's psychological or physical suffering is particularly severe, earlier surgical treatment should be considered. The aim of this study was to evaluate the safety and efficiency of temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal as a new treatment option for JHVD during growth age. METHODS: Between June 2011 and November 2017, 33 patients (24 girls, nine boys; 59 feet) with a JHVD were treated by temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal. At the time of surgery mean age was 11.1 years SD 1.4 (8 to 15). Patients were followed clinically and with standing, weight-bearing radiographs of the feet in two planes. RESULTS: In all, 22 patients (39 feet) were included into this study. Mean follow-up was 27.8 months SD 9.9 (12 to 58). The hallux valgus angle changed from 26.5° SD 6.6° preoperatively to 20.2° SD 6.2° (p < 0.001) at time of follow-up. The intermetatarsal angle changed from 14.1° SD 5.4° to 10.5° SD 2.9° during this time (p < 0.01). In two patients (three feet) the screws were removed before the JHVD was fully corrected due to local tenderness over the screw head. In two patients screw migration away from the growth plate was observed, resulting in no further deformity correction in one patient and increasing deformity in the other patient. No other complications were seen. CONCLUSION: Temporary screw epiphyseodesis of the lateral epiphyseal plate of the first ray metatarsal seems to be an effective, safe, technically easy and minimally invasive early treatment option to correct JHVD in children with particularly severe suffering. Due to the individual correction rate, frequent follow-up visits are recommended until skeletal maturity. LEVEL OF EVIDENCE: IV.
RESUMEN
BACKGROUND: The aim of this study was to evaluate the outcome at skeletal maturity of combined pelvic and femoral varus osteotomies in children with Legg-Calvé-Perthes (LCP) disease. METHODS: From January 1998 to December 2009, 69 patients with LCP disease underwent combined osteotomies at our institution. Fifty-two children (19 girls and 33 boys) met the inclusion criteria and were enrolled in the study. The LCP disease was classified and the cases of all patients were reviewed at skeletal maturity. The mean age (and standard deviation) at the time of diagnosis was 6.9 ± 2.4 years, and the mean age at the time of surgery was 7.9 ± 2.3 years. The mean time to follow-up was 10.8 ± 3.5 years. The final follow-up radiographs were assessed according to the Stulberg classification and the sphericity deviation score. RESULTS: The mean Harris hip score at the time of follow-up was 90 ± 13.2. According to the Harris hip score grading system, 37 patients (71%) had an excellent outcome; 8 patients (15%), a good result; 3 patients (6%), a fair result; and 4 patients (8%), a poor result. Seven patients (13%) were classified as having a Stulberg class-I hip; 20 (38%), a class-II hip; 15 (29%), a class-III hip; 6 (12%), a class-IV hip; and 4 (8%), a class-V hip. The mean sphericity deviation score was 24.4 ± 14.4 at skeletal maturity. There was a strong relationship between a younger age at diagnosis and better functional and radiographic outcomes. CONCLUSIONS: In the absence of a randomized study design, conclusions have to be drawn with caution. Combined pelvic and femoral osteotomies in these children with LCP disease did not result in better functional or radiographic outcomes compared with the historic results of Salter osteotomy or proximal femoral osteotomy alone. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fémur/cirugía , Enfermedad de Legg-Calve-Perthes/cirugía , Huesos Pélvicos/cirugía , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteotomía/métodos , Resultado del TratamientoRESUMEN
Growth of the pediatric spine occurs in phases. The first 5 years of life are characterized by rapid growth. The lower extremities and trunk contribute equally to the entire growth by 50 % each. In the following years, until the onset of puberty, a steady but reduced rate of growth is observed. During these years a T1-S1 growth of only 1 cm per year can be detected and the spine contributes only one third to the entire growth. Puberty consists of an acceleration phase lasting 2 years. In the first year of this phase the growth peak of the extremities and in the following year the growth peak of the spine can be noticed. The ensuing deceleration phase of puberty lasts for 3 years. During that period the development of the Risser sign, menarche, and fusion of the trochanter epiphysis are taking place. Clinical parameters such as sitting height, standing height, and arm span may be used to evaluate growth. Important radiological parameters include the Risser sign, the determination of skeletal age according to Greulich and Pyle, and the T1-T12 height. The use of the olecranon method during the ascending phase of puberty can be recommended. Problems of the developing spine may include malformations, developmental disruptions or deformations. According to their manifestations they have a different prognosis, which can be estimated by knowledge of residual growth and the typical course of spinal growth in childhood.
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Determinación de la Edad por el Esqueleto/métodos , Escoliosis/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Adolescente , Artrometría Articular , Niño , Preescolar , Diagnóstico Diferencial , Medicina Basada en la Evidencia , Femenino , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
Overweight and obesity in children and adolescents is a growing problem with an increasing number of patients presenting with comorbidities to pediatricians and orthopedic surgeons. This overview summarizes the most common orthopedic problems in overweight children and obesity and highlights the treatment options in addition to weight reduction and physiotherapy leaded activation. In early infancy a persitent genu varum may be seen as a sign of Blount disease. In the school ages flat feet or persistent knock-knees has a higher incidence in overweight children. The incidence for back pain and osteoporosis are related with overweight and obese. At puberty, the slipped capital epiphysis, which always needs a surgical management, is mostly related to overweight/obese. A symptomatic retroversion of the femur can cause discomfort and lead to a surgical therapy himself.
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Enfermedades Musculoesqueléticas/etiología , Sobrepeso/complicaciones , Obesidad Infantil/complicaciones , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Alemania , Humanos , Lactante , Masculino , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/terapia , Sobrepeso/epidemiología , Sobrepeso/terapia , Obesidad Infantil/epidemiología , Obesidad Infantil/terapiaRESUMEN
The primary goal of treatment in children with early onset scoliosis (EOS) is to control the deformity and to allow spinal and chest wall growth to continue and improve pulmonary function. In skeletally immature children spondylodesis leads to fusion of the instrumented segments with associated nonsymmetrical growth and pulmonary insufficiency. Non-fusion, techniques such as growing rods, vertical expandable prosthetic titanium rib® (VEPTR) and staples have evolved over the past years. Each technique has its different spectrum of indications which the surgeon has to follow accurately to prevent the patient from developing complications. A new trend started by using magnetically controlled growing rods to avoid the need for anesthesia and open surgery during adaptive growth. The intention of this article is to give the reader a synopsis about the three most important non-fusion techniques based on own experience and the current literature.
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Fijadores Internos , Procedimientos de Cirugía Plástica/instrumentación , Escoliosis/diagnóstico , Escoliosis/cirugía , Suturas , Niño , Preescolar , Femenino , Humanos , Masculino , Diseño de Prótesis , Procedimientos de Cirugía Plástica/métodos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Resultado del TratamientoRESUMEN
The typical asymmetry in infancy is recognized 2-4 weeks after birth and follows the development of a plagiocephaly. The unilateral flattening of the occiput leads to a permanent rotation of the head to one side, shortening of neck muscles and a triggering of the asymmetric tonic neck reflex (ATNR), also known as fencer response. Subsequently a muscle tone increase is forming on the side of the face while a decrease in tone is seen at the occiput side. Clinical signs like increasing neck stiffness, flexible positional scoliosis and pelvic obliquity may ultimately develop. Management includes early positioning, tummy time and physical therapy if asymmetry of posture or muscle tone are present.
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Anomalías Múltiples/diagnóstico , Anomalías Múltiples/terapia , Plagiocefalia no Sinostótica/diagnóstico , Plagiocefalia no Sinostótica/terapia , Diagnóstico Diferencial , Humanos , Lactante , Recién NacidoRESUMEN
Anterior vertebral body stapling is a new minimally invasive technique to correct scoliotic deformities without fusion. In the literature only preliminary reports with short follow-up periods are available. A total of six patients with a minimum follow-up of 2 years were available for examination. Of the six patients four demonstrated progression of scoliosis in spite of vertebral body stapling. All had curves of more than 35 degrees at the time of surgery, while two patients with less extensive curves below 35 degrees did not show signs of progression. Major complications were not observed. Vertebral body stapling for curves more than 35 degrees does not seem to be indicated and careful patient selection for stapling may be indicated for curves less than 35 degrees . A more general use of this technique is not recommended at this time.
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Dispositivos de Fijación Ortopédica , Escoliosis/diagnóstico , Escoliosis/cirugía , Columna Vertebral/cirugía , Suturas , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Most skeletal dysplasias are characterized by small stature. Less well known is the fact that most skeletal dysplasias are also associated with specific spinal problems or deformities. This article summarizes the various aspects of spinal problems in this patient population as well as the diagnostic strategies and current and new treatment options.
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Acondroplasia/complicaciones , Mucopolisacaridosis/complicaciones , Osteocondrodisplasias/complicaciones , Enfermedades de la Columna Vertebral/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Cifosis/diagnóstico , Cifosis/cirugía , Imagen por Resonancia Magnética , Masculino , Equipo Ortopédico , Radiografía , Escoliosis/diagnóstico , Escoliosis/etiología , Escoliosis/cirugía , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/cirugía , Fusión Vertebral , Estenosis Espinal/diagnóstico , Estenosis Espinal/etiología , Tracción/instrumentaciónRESUMEN
The introduction of the DRG system in Germany-optional since 1 January 2003 and mandatory for all hospitals as of 1 January 2004-has resulted in great uncertainty, particularly on the part of hospitals, since apprehension prevails that the diagnostic and therapeutic measures practiced in Germany will not be appropriately represented and remunerated by a DRG system. The G-DRG version 1.0 prepared within the framework of substitutive execution is largely identical to the Australian AR-DRG version 4.1. Adjustments that do justice to the realities of German treatment modalities were at most insignificant. It is therefore essential that stock be taken for each medical specialty to determine to what extent treatment procedures commonly followed in Germany are adequately reflected in this G-DRG system or whether adjustments are necessary to make allowances for German realities. To be able to provide qualified statements on the problems involved, scientific analysis of possible problems is necessary utilizing German data. Thus, we undertook an evaluation of how the special fields of orthopedics and accident surgery are represented in the G-DRG system. The resultant data form the basis for evidence of presumable deficits in the representation of orthopedic and accident surgery cases in the G-DRG system. The German Association for Trauma Surgery and the German Association for Orthopedics and Orthopedic Surgery have undertaken a DRG evaluation project together with the Organization of Directors for Accident Surgery (chairperson: Professor Dr. Mischkowsky, Kempten), the Organization of Directors for Orthopedics (chairperson: Professor Dr. Puhl, Ulm), the DRG Working Group of the German Association for Accident Surgery, and the Joint Commission of the Professional Association of German Surgeons and the German Association for Surgery in cooperation with the DRG Research Group of the University Clinic Muenster, the German Hospital Association, and the German Medical Association with the goal of examining the medical and economic homogeneity of the case groups. A total of 12,645 orthopedic and trauma surgery cases were collected from 23 clinics-11 university hospitals and 12 non-university hospitals-and assessed. On the basis of this database and when too few cases were evaluable also based on clinical considerations, 14 adjustment proposals were formulated and submitted on schedule on 31 March 2003 to the Institute for Hospital Remuneration. The results of the DRG evaluation project illustrated the problems involved in representing the exceedingly heterogeneous and complex activities of orthopedic and trauma surgery departments in a flat rate financing system that is not attuned to the realties of German treatment procedures. Version 1.0 of the G-DRG system is not sufficiently differentiated to represent the multifaceted diagnostic and therapeutic services provided by trauma surgery and orthopedic departments in Germany.
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Grupos Diagnósticos Relacionados , Cirugía General , Ortopedia , Traumatología , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/organización & administración , Alemania , HumanosRESUMEN
OBJECTIVE: The Implementation of a DRG-Variant in Germany - voluntarily since January 1 st, 2003 and obligatory from January 1 st, 2004 - has been leading to uncertainty, particularly in the hospitals, due to fears that currently practised German diagnostic and therapeutic measures will not be financed properly by a DRG-Variant. The G-DRG-Version 1.0 that was drawn up in connection with an executive order law is to a large degree identical to the Australian AR-DRG-Version 4.1. Adjustments to German requirements were made only marginally. Therefore it is necessary for every medical field to investigate by stock-taking to what extent currently practised German diagnostic and therapeutic measures are considered in the G-DRG-Version 1.0 and whether and where modifications and adaptations need to be made. In order to make qualified statements scientific evaluations of possible problems have to be made based German data. Therefore an evaluation was made of the mapping of the medical fields of orthopaedics and trauma surgery. The German Society of Trauma Surgery (DGU), the German Society of Orthopaedy and Orthopaedic Surgery (DGOOC) in cooperation with the DRG-Research-Group of the University Hospital Muenster, the German Hospital Federation (DKG) and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economical homogeneity of the case groups. METHOD: 12,645 orthopaedic and trauma surgery cases from 23 hospitals - 11 university hospitals and 12 non-university hospitals - were collected within an period of three months and were scientifically evaluated with regard to their performance homogeneity and length of stay homogeneity. RESULTS: The data formed the basis for the proof of suspected deficiencies of mapping of orthopaedic and trauma surgery cases within the G-DRG-Variant. Based on the data and additionally on conclusions of medical experts when the number of cases were small, 14 suggestions for adaptation were proposed and submitted by the deadline of March 31 st, 2003 to the InEK. CONCLUSION: The results of the DRG-Evaluation Project demonstrate the problems of mapping the very heterogenous and complex medical performances of orthopaedy and trauma surgery to a flat rate financing system that is not adapted properly to German conditions. The G-DRG-Variant Version 1.0 does not offer the sufficient possibilities of differentiation that are needed to map the various orthopaedical and trauma surgical measures in Germany.
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Grupos Diagnósticos Relacionados/estadística & datos numéricos , Grupos Diagnósticos Relacionados/normas , Reforma de la Atención de Salud/normas , Tiempo de Internación/estadística & datos numéricos , Ortopedia/estadística & datos numéricos , Ortopedia/normas , Traumatología/estadística & datos numéricos , Análisis Costo-Beneficio/economía , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Grupos Diagnósticos Relacionados/organización & administración , Grupos Diagnósticos Relacionados/tendencias , Alemania , Reforma de la Atención de Salud/tendencias , Implementación de Plan de Salud/economía , Implementación de Plan de Salud/organización & administración , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/normas , Reembolso de Seguro de Salud/estadística & datos numéricos , Reembolso de Seguro de Salud/tendencias , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Programas Nacionales de Salud , Ortopedia/economía , Ortopedia/legislación & jurisprudencia , Ortopedia/organización & administración , Centros de Rehabilitación/economía , Centros de Rehabilitación/organización & administración , Mecanismo de Reembolso , Traumatología/economía , Traumatología/organización & administración , Traumatología/normasRESUMEN
STUDY DESIGN: A report of three cases of pyogenic osteomyelitis of the occipitocervical junction. OBJECTIVE: To describe the conservative management of pyogenic osteomyelitis of the occipitocervical junction. SUMMARY OF BACKGROUND DATA: The therapeutic approach to inflammation of the upper cervical spine is controversial. METHODS: Pyogenic osteomyelitis of the occipitocervical junction is rare. In the orthopedic literature, only a few case reports with variable treatment methods are available. Three patients with pyogenic osteomyelitis of the occipitocervical junction were treated nonoperatively. Intravenous antibiotic therapy was begun after direct cultures or blood cultures were obtained. Early mobilization was accomplished by application of a halo vest. RESULTS: Two patients recovered by spontaneous fusion of the occipitocervical junction. Instability developed in the spine of one patient, but she refused further treatment. CONCLUSIONS: Diagnosis of osteomyelitis of the upper cervical spine is difficult. In cases with absence of neurologic symptoms or spinal abscess formation, treatment can be nonoperative.
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Antibacterianos , Vértebras Cervicales , Quimioterapia Combinada/uso terapéutico , Hueso Occipital , Osteomielitis/terapia , Restricción Física/métodos , Enfermedades de la Columna Vertebral/terapia , Adulto , Biopsia , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Diagnóstico Diferencial , Quimioterapia Combinada/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/patología , Osteomielitis/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Supuración/diagnóstico , Supuración/terapia , Tomografía Computarizada por Rayos XRESUMEN
The authors report their experiences with the percutaneous transforaminal approach to the epidural space. 85 patients were treated endoscopically for non-contained lumbar herniated discs. Very good and good results of 20 patients (learning curve) were obtained in 65%. However, reoperation rate was 25% versus 3% for the last 65 patients. The first 50 patients were treated under local anaesthesia, the last 35 patients under general anaesthesia. Operative technique is described in detail. Laser application in the epidural space is helpful for tissue ablation and to obtain hemostasis. No complications were observed. The main advantages of this new minimal invasive technique are, besides reduced morbidity, less epidural scarring and removal of the sequestered tissue under visual control while retaining disc tissue in the intervertebral space. Thus, the disadvantages of open nucleotomy with possible instability and abundant scarring may be avoided.
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Discectomía Percutánea/métodos , Endoscopía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Adulto , Anciano , Estudios de Cohortes , Contraindicaciones , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/patología , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
Therapeutic effect of botulinum toxin A was studied in a group of pediatric patients (n = 28) aged between 6 months and 18 years. The patients were diagnosed with cervical dystonia (n = 6), adductor spasm of the hip (n = 8), spastic drop foot (n = 7) and various other focal motor problems associated with spastic muscular hyperactivity (n = 7). The mean dose of botulinum toxin A (Dysport) used to inject into the affected muscle was 22 U/kg body weight. Reduced muscular hyperactivity with a significant increase in joint mobility was achieved for dystonic (p < 0.0001) as well as for spastic conditions in patients with adductor spasm (p < 0.0002). For these patients the improved joint mobility represented a significant benefit for both daily activities and nursing care. Local paresis and local hematoma were observed in 1/28 and 1/28 patients, respectively; 1/28 patients developed a secondary non-response. However, apart from these side effects, no other adverse reactions to botulinum toxin A treatment were recorded during the treatment and observation period (12-64 months). Our results suggest that botulinum toxin A represents an effective and safe therapeutic substance for the treatment of pediatric patients suffering of focal motor problems due to dystonic or spastic muscular hyperactivity.
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Toxinas Botulínicas Tipo A/uso terapéutico , Distonía/tratamiento farmacológico , Espasticidad Muscular/tratamiento farmacológico , Neurología , Fármacos Neuromusculares/uso terapéutico , Pediatría , Adolescente , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Distonía/diagnóstico , Electromiografía , Femenino , Humanos , Lactante , Masculino , Espasticidad Muscular/diagnóstico , Músculo Esquelético/inervación , Índice de Severidad de la EnfermedadRESUMEN
9 immature pigs (age: 8-12 weeks) underwent longitudinal traction with 10%, 30%, and 50% body weight followed by overhead traction with 10% and 30% body weight. Microcirculation of the femoral head was monitored by a laser-doppler flow probe and macrocirculation within the lateral circumflex artery by an ultrasonic perivascular transit time flow probe. Changes in blood flow during each traction period were compared to the preceding resting period and expressed in percentages. With any type of longitudinal and overhead traction a trend towards an improvement in micro-and macrocirculation of the hip joint was observed although no significant differences could be detected. Our results encourage the use of traction as a concept in management of developmental dislocation of the hip.
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Articulación de la Cadera/irrigación sanguínea , Tracción/efectos adversos , Animales , Cabeza Femoral/irrigación sanguínea , Luxación Congénita de la Cadera/fisiopatología , Luxación Congénita de la Cadera/terapia , Articulación de la Cadera/crecimiento & desarrollo , Flujometría por Láser-Doppler , Masculino , Microcirculación , Flujo Sanguíneo Regional , PorcinosRESUMEN
We report on a six-month-old child with severe intermittent dystonic posture of both legs associated to a thoraco-lumbar myelomeningocele. The patient presented with a combination of progressive hypertonic knee extension and hip flexion. While the mobility of the right leg improved sufficiently after physiotherapy and splinting, satisfactory improvement of the left leg could be achieved only after local injections of botulinum A toxin, allowing for adequate functional motor development.
Asunto(s)
Toxinas Botulínicas/uso terapéutico , Distonía/tratamiento farmacológico , Distonía/etiología , Meningomielocele/complicaciones , Toxinas Botulínicas/administración & dosificación , Terapia Combinada , Distonía/terapia , Humanos , Lactante , Masculino , Modalidades de FisioterapiaRESUMEN
The accuracy of technetium-99m human immunoglobulin (HIG) for the detection of chronic osteomyelitis (OM) was compared with white blood cell scintigraphy using 99mTc-labelled monoclonal mouse antibodies (MAB). Seventeen patients suspected of having OM in 20 lesions went through three-phase skeletal scintigraphy, HIG scintigraphy and MAB scintigraphy. The final diagnosis was established by open surgery, histology and bacteriology. Chronic OM was proved in 14/20 lesions. Six of these 14 infections were located in peripheral areas without active bone marrow and 8/14 in central areas with active bone marrow. In peripheral OM, 5/6 with HIG and 6/6 with MAB were true positives. In the central skeleton all 8/8 infections appeared as cold lesions in the MAB study, which were defined as being false negative due to their non-specificity. Using HIG, 5/8 central infections were determined to be truly positive by showing photon-rich lesions. These 5 lesions were located in the hip region and in the pelvis, whereas 3 lesions of the spine were missed. There were no false-positive results in either studies. In conclusion, MAB was superior to HIG in peripheral OM concerning sensitivity, anatomical landmarks and differentiation of soft tissue versus bone infection. In central OM MAB detected all lesions accurately, but no differential diagnosis was possible due to the non-specificity of photon-low areas. In this respect HIG seems to be more specific due to the increased accumulation even in central infection sites.
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Anticuerpos Monoclonales , Inmunoglobulinas , Osteomielitis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tecnecio , Tuberculosis/diagnóstico por imagen , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/epidemiología , Osteomielitis/inmunología , Estudios Prospectivos , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/inmunología , Tomografía Computarizada de Emisión de Fotón Único , Tuberculosis/epidemiología , Tuberculosis/inmunologíaRESUMEN
Besides wound infections we postoperatively are also facing the problems of other nosocomial infections, e.g. urinary tract infections, bronchopneumonia and sepsis caused by the use of intravenous devices. A preliminary survey was performed among 4008 patients in a multicentre study. After orthopaedic surgery we found the incidence of urinary tract infections to be 4.8%. Because of non satisfactory documentation the postoperatively acquired respiratory tract infections could not be evaluated properly. Sepsis due to the use of central or peripheral venous cannulas has been observed in 0.2%. Serious problems of nosocomial infections are discussed.