Modern society is, to a great extent, characterised by a tremendous growth in transportation -- the freedom to travel is a central and fundamental human value. As mobility has increased so have health problems. The number of fatalities and serious injuries caused by road traffic is unacceptable, and, while a downward trend is visible in most countries, there still remains a lot to be done. This collection of contributions by scientists and administrators presents some of the latest findings in the area of mobility and its relation to medical treatment, rehabilitation, public health and prevention.

Ake Nygren Karolinska Institute, Sweden would like to welcome you on behalf of Karolinska Institute, I one of the organizers and initiators of this series of confer- ences on traffic safety. The conference we are opening today is the fourth in the series. Karolinska Institute is the largest medical university in Sweden. It is dedicated to improving health through research, educa- tion and dissemination of information and ideas. The series on traffic safety is one of the ways in which we are disseminating information and ideas on an international front. Karolinska Institute is 190 years old. The Medico Chirurgiska Institute was originally established in 1811 by royal decree after wars and cholera epidemics. In 1822, it became known by the name "Carolinska" . Amongst many other international endeavors, Karolinska Institute is perhaps best known for the nomination and appointments of Nobel Prize winners in medicine and physiology. Under the terms of Alfred Nobel's will, the prize winners are nominated and chosen by the Nobel Assembly of Karolinska Institute. During the hundred years that the prize has been in existence, several researchers from Karolinska Institute have become laureates. These are Hugo Theorell in 1955; Ragnar Granit in 1967; Ulf von Euler in 1970; and Sune Bergstrom and Bengt Samuelsson in 1982. In 1987, the medicine prize was awarded to Tonegawa from v Japan and in 1994 the literature prize was awarded to Oe Kenzaburo.

In bone surgery it is essential to compress fractures interfragmentarily in order to make them resistant to the tensile force of muscles and the force resulting from acceleration and deceleration. This can be best achieved by the use of cable tension bands as a traction mechanism. The cable tension band is - in terms of stability of fractures - far superior to the conventional rigid cerclage wire which has been widely used in osteosynthesis for over 100 years. The author explains the biomechanics of the tension band in detail. Theoretical findings are confirmed by clinical test results. All osteosynthetic techniques which can be carried out with cables are described giving details of operation instructions. Errors and risks are always pointed out. A reference book and operative manual at a time.

Paris October 10th, 1929 - Kyoto October 15th - 20th, 1978

Rodney E. Slater Secretary of Transportation, U. S. Department of Transportation know many of you have traveled great distances to be here. I To me, that shows not only your dedication to the cause, but demonstrates how very important transportation safety is becoming throughout the world. So I am very thankful to the main organizers of this third annual conference -- all of whom are from Sweden: Dr. Hans von Holst of the Royal Institute of Technology; Dr. Ake Nygren of the Karolinska Institute; Dr. Ake E. Andersson of the Institute for Futures Studies; and finally, Dr. Arne Witt16v and Lars Anell from AB Volvo. And let me give a special welcome to our friends from Africa. I will be visiting a number of African nations in January. And while my main mission is to promote trade and investment with the United States, we will be talking about safety, too. Airline safety, for example, is a big concern, as Africa grows and prospers and the demand for air travel expands. We discussed it during recent meetings of the International Civil Aviation Organization in Montreal several weeks ago. And we will do so again during my trip. plan to talk about how my department can help the Also, we many nations of Africa improve highway safety. Africa relies heavily on road transportation. But highway fatalities are very high. And the economic costs are very steep, especially for Africa's fragile, emerging v market economies.

Meniscal transplantation has become an attractive option in selected patients with incapacitating knee pain. This book discusses all aspects of meniscal transplantation, covering the use of both allografts and meniscal substitutes, including collagen and polyurethane implants. Acknowledged experts in the field review the basic science, explain indications, and describe surgical techniques and the results achieved to date. All the material is up to date, with information on new implants, new techniques, and new surgical approaches. Future trends in the treatment of meniscal lesions are also discussed as we move towards the application of regenerative strategies to restore meniscus function. "

Professor B.G. WEBER has once again and in a very timely fashion produced a superb book on an orthopaedic subject of great importance. "The Extemal Fixator" is the most comprehensive text on the subject in orthopaedic literature to date. Professor WEBER thoroughly discusses extemal fixation with c1arity, organization, profuse illustrations and roentgenograms. Professor WEBER acknowledges that the use of extemal fixation in orthopaedic surgery is not newand traces its history over the years. He points out c1early the fact that though at various times the "method" has experienced periods of disrepute, modem sophistication, improved technology and a better understanding of its philosophy have given the system a newand perhaps permanent place in the armamentarium of the orthopaedic surgeon. All methods of treatment have critics as well as supporters, and not infrequently the strongest criticisms are the result of poor understanding of the philosophy proposed and its proper implementation. Professor WEBER, in his carefully detailed and well illustrated book, has made it abundantly c1ear that the use of extemal fixators in the treatment of fractures must be c1early understood by the orthopaedic surgeon in order to obtain satisfactory clinical results. His discussion of its philosophy, pathomechanics and technology are most comprehensive and leave "no stone untumed" and because of this the book represents a most comprehensive text on the subject.

Trauma surgery has increasingly become a specialized field inspired by different principles and philosophy. A good trauma surgeon is a surgeon who knows how to perform abdominal vascular, thoracic, urologic, gynecologic, and orthopaedic procedures and is able to repair multiple traumatic injuries in the best sequence possible. In this first volume, practical, up-to-date guidance is provided on the optimal critical care and ICU management of trauma patients. In addition, individual chapters focus on specific injuries in orthopaedic trauma (and especially spinal trauma) and neurotrauma, with the aim of providing a fresh view of the surgical approach and practical suggestions for improving the skills of treating surgeons. Educational issues and the organization of a trauma center are also covered.

The volume will be a handy pocket guide for trainee surgeons and any surgeon, physician, or nurse who treats trauma patients. It will be particularly relevant for emergency department physicians, critical care and ICU doctors, orthopaedic surgeons, neurosurgeons, and professionals responsible for trauma care and decision making, programs of trauma education, or organization of a trauma center.

Also available: "Trauma Surgery" Vol. 2: Thoracic and Abdominal Trauma

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

The German edition of our book entitled "Operative Frakturen behandlung" by M. E. MUELLER, M. ALLGOEWER and H. WILLENEGGER (Springer, Berlin . Goettingen . Heidelberg, 1963) has been out of print now for more than three years. We are planning a new edition which will deal with the collective experience of 14,000 new cases, all treated by internal fixation, and will include the newest developments in the field of internal fixa tion. However, it will be some time before this new edition can be published. Increasing demands for a description of the AO technique of internal fixation has stimulated us to publish this manual. In it we shall describe in a comprehensive but somewhat apodictic mann er the principles and techniques of the AO methods of fracture treatment and reconstructive surgery, which in our hands, have stood the test of time. The book is written in a somewhat abbreviated style. It cor responds in subject matter to the teaching given at the AO courses in Davos, but deals with each subject more thoroughly. We have dispensed with pictures of the instruments, as these may be found in the Synthes Catalogue *. This manual should be regarded as the product of collective experiencc, containing new thoughts and new discoveries from basic research. In considering the risks of mistakes and dangers, we can only reiterate what we have already stated in "Technique of Internal Fixation of Fractures": "Open treatment of fractures is a valuable but difficult method which involves much responsibility.

This extensive and well-prepared manual is the work product of Klaus and Yvette Draenert, who are deeply interested in cemented total hip arthroplasty and in partic- ular, intensely involved in related research for the past 25 years. Their damage analysis is aimed at cement fixation with the purpose to rule out any risk for the patient. They introduce the theme with a wide review of the literature on the successes and failures of the various types of total hip components. Because of the lack of standardization of the various parameters used in these studies, they do not recommend anyone spe- cial type, and on the basis of this literature study they wonder why there is such a se- arch for new types and (fixation) methods of total hip arthroplasties. Instead of these long-term follow-up studies, the authors plead to carry out syste- matic histological research on retrieved human material as was firstly started and re- T. /. /. H. Slooff commended by the late Sir John Charnley. Their investigations demonstrate that po- lymethylmethacrylate behaves biologically as an inert material that can be integrated into the bone, without a fibrous membrane interface. This could also be assessed in their animal experiments when the appropriate biomechanical conditions are pro- vided. To achieve a connective tissue free bone-cement junction it is important to pre- vent deformation in the bone structures and micromotion between the bone-cement interface.

Pathological conditions affecting the hip and knee joints occupy a particular place amongst the important orthopaedic entities affect ing the extremities. On the one hand they are relatively frequent and on the other they mean for the patient limitation of his ability to walk, because of their considerable detrimental effects. A purposeful basic treatment of these joint diseases (and here osteoarthritis takes pride of place) is only possible if it stems from a reliable biomechanical analysis of the normal and pathological stressing of the joint in question. Whilst the situation in the hip can be considered to be fundamentally clarified, a comprehensive representation of the knee is still lacking, particularly when taking into account the latest knowledge of biomechanics. Recently our concepts of the kinematics of the knee have been completely changed, but the clinically important question of articular stressing remains unanswered. Dr. Maquet has carried out pioneer work in this field for some years in adapting, by analogy, to the knee joint principles already accepted for the hip joint. Since the knee is not a ball and socket joint, a complicated problem arises for which new thoughts are necessary. The results of the numerous operations carried out by Dr. Maquet according to the biomechanical considerations demon strate that his thinking is fundamentally correct. Above all, it is here again proven (as earlier in the case of the hip) that healing of osteoarthritis depends decisively on reducing and evenly dis tributing joint pressure.

Although the number of published papers on traumatic hip disloca tion in childhood is large, our actual current knowledge on this inju ry in this age group is still full of obscure points and unsolved prob lems. Luxation of the hip of traumatic origin in children is infrequent, and the small number of cases reported by authors and institutions, as well as the usually short follow-up in many cases, are responsible for the many doubts and questions, especially related to complications and outcome following the injury. Consequently the treatment, especially the postreduction management, has not been adequately defined. Dr. Antonio Barquet has made the great effort to analyze the ex perience gained from 38 cases in Uruguay and to review more than 500 references related to the subject, covering more than 1400 cases. He began to study this topic in 1976. It was the subject of his postgraduate monograph in 1979, which was followed by a statisti cal analysis of the major complication, i. e., avascular necrosis of the proximal femoral extremity, which was presented as his doctoral thesis in 1981. In addition, he has published numerous papers deal ing with several aspects of traumatic hip dislocation in children."

Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.

Lesions of the brain stem and related disorders of autonomous regulation systems have been the "Leitmotiv" of the scientific work in the Neurosurgical Department of the Giessen University under the leadership of the late Professor Hans Werner Pia. Some of the results have already been published in supplement volumes of Acta Neurochirurgica. The first one of these was Vol. 4 with the monograph written by H. W. Pia on "Die Schadigungen des Hirnstammes bei den raumfordernden Prozessen des Gehirns." Vol. 19 deals with central disorders of temperature regulation, written by G. Lausberg, followed by Vol. 20 with R. Lorenz's monograph on the effects of intracranial space-occupying lesions on blood pressure and heart rate. Shortly before his death Hans Werner Pia had asked me to combine and publish in this series of supplement volumes of Acta Neurochirurgica another five papers by his co-workers, also related to brain stem lesions and also to cerebral blood flow and CSF dynamics. The result is this volume which contains work dealing with the CT -findings of cerebral mass displacements and their clinical correlations (Sch6nmayr), with other lesions of the brain stem (Laun), with the blink reflex and acoustic evoked potentials in brain stem lesions (Klug and Csecsei), with blood flow in brain structures during increased ICP (Zierski) and with the description of a mathematical model for analysis and simulation of the haemodynamics of intracranial CSF (Hoffmann).

Fang Zhi-yang 1. 1 History of Traditional Treatment of Burns in China China is a country of ancient culture. The treatment of burn injury was documented more than 1500 years ago. As early as the Eastern Jin Dynasty, the Handbook of Prescriptions for Emergencies written by Ge Hong (281-341 A. D. ) and in the Southern Qi Dynasty (479-502 A. D. ) Liu J uan-Zi's Remedies Left Over by Ghosts, a book dealing mainly with diagnosis and treatment of traumatic wounds, are the earliest known monographs on "external diseases" in China. They record the treatment of burns with topical agents such as the preparation of a lard ointment of the liquid extract of Angelica anomalea Lallem, Gardenia jasminoides Ellis, Glycyrrhiza uralensis Fisch, Radia salviae miltiorrhizae, and the white cortex of willow. These herbs are found to be astringents and antibiotics. During the Sui Dynasty, a doctor of the Imperial Medical Academy (550- 630 A. D. ), Chao Yuan-fang, was authorized by imperial decree to compile the book General Treatise on the Etiology and Symptomatology of Diseases (610 A. D. ), the first book on etiology and symptomatology in China. This book with its valuable descriptions has been an authoritative and important reference for medical students for more than 1000 years.

Rapid developments in this successful diagnostic and operative technique have called for a new edition of "Arthroscopy of the Knee Joint." This second edition has been completely revised and retains very little material from the first edition. The diagnostic section has been considerably expanded and elucidated and the operative section adapted to modern technology. The first part of the book presents the external conditions and pre-requisites for diagnostic arthroscopy. The endoscopic anatomy and pathology of the knee joint are covered in detail. Particular emphasis is placed on practical hints for accurate arthroscopic procedures. The second part then discusses operative techniques. The reader discovers step-by-step how and which pathological findings should, in the author's opinion, be treated. Here, too, the problems and possible complications of arthroscopic surgery relevant to the individual techniques are dealt with in detail. Equipped with this book, the reader will be thoroughly informed on all current arthroscopic methods and possibilities.

Following a presentation of basic principles of fracture fixation and biomechanical principles the book turns to practical problemsolving areas, namely, the hand, wrist, elbow, shoulder, hip, knee, ankle and foot, and spine, and special problems in children. Internal fixation, including intramedullary nailing and the use of external fixation are described.
Compound fractures are everyday problems, and the principles of their management and practical solutions deserve separate discussion. The value of microsurgical techniques has been underestimated by orthopaedic experts and the indications, choices, and procedures need to be put into proper perspectives.

The need for greater international collaboration is becoming increas. ingly clear. Practically every nation or people has, in addition to its own characteristics and history, its own medical tradition. Methods and ways of thinking that are successfully established in one place may not be accepted in another for some time. The medical tradition and training in different countries can take quite different forms. What would our present knowledge be - Without the creative, spontaneous ideas and contributions from the romance countries? - Without the opportunity of research, as it is practised on a large scale in the USA, where so many young Europeans took their first steps in experimental science? - Without the conscientious clinical work done in Central Europe and the valuable experience gained there? - Without, finally, the sober and critical scientific approach, as fostered in the cool heads of Northern Europe for generations? None of these qualities is sufficient without the others, but together they are a source of strength. Ultimately, we hope, through sensible con centration of efforts (while maintaining variety), to overcome the lack of an integrated approach in experimental science and to prevent repetition of painful mistakes. In this regard, the first two ESKA congresses have brought us great advances."

Cervical Spine Research Society European Branch "The Cervical Spine Research Society is an organization of individuals interested in clinical and research problems of the cervical spine. Its purpose is for the exchange and development of ideas and philosophy regarding the diagnosis and treatment of cervical spine injury and disease. The com position of the membership should reflect the varying specialities and disciplines dealing with the cervical spine; biochemical, engineering, neurology, neurosurgery, radiology, orthopedic surgery and others," wrote J. William Fielding, New York City, one of the Society'S founding members. In 1984 the membership list contained 118 names. The overwhelming majority of members came from the United States, four from Canada and 9 Europeans, amongst them Mario Boni. He was the organizer, in con junction with the members of the Cervical Spine Research Society, of a splendid "International Meeting for the updating on pathology and surgery Preface VI of the cervical spine" held in Pavia (Italy) in May 1982. It was from this meeting that the idea of a European branch of the Society first originated, with the purpose of establishing multi-disciplinary meetings in Europe. The first meeting of the European branch was organized by A. Weidner in September 1984 in Osnabriick (Federal Republic of Germany). Mario Boni was elected president. He was not only the initiator but also the drivinglorce who tirelessly promoted the development of the European branch. Mario Boni's death in 1986 at the age of 64 was a great loss to us."

The past 25 years have seen a progressive improvement in external fixation techniques in terms of patient acceptability, ease of appli- cation and apparatus stability. The recent awareness in Europe of the method, application and excellent results of the technique pio- neered by G. A. I1izarov has caused a rapid increase here in the number of surgeons who have become "banderilleros". In particu- lar, external fixators can be used in the treatment of difficult clini- cal conditions, such as severe fractures and their sequelae, as well as for the correction of congenital deformities of the peripheral skeleton. As one of the first in France to use the lIizarov method, I became increasingly aware that we needed an updating of anatomical knowledge oriented towards this technique, which uses multiple fixation pins. Without this anatomical infonnation, there is real danger of damaging neuro-vascular structures or entering ajoint in the course of assembling the fixator. Traditional anatomical cross- sections are often inadequate or too schematic to serve as a safe guide for the surgeon using this particular technique. This is the reason why my colleagues Claude Faure and Philippe Merloz have produced and analysed a series of anatomical cross-sections of the limbs to serve this particular need.

The AOjASIF* dynamic hip screw (DRS) has been designed primarily to stabilize trochanteric fractures of the hip. Selected fractures of the femoral neck and some subtrochanteric fractures are further indications for the DRS [40, 46]. The dynam ic condylar screw (DCS) has been developed for fractures of the distal femur and is now being tested clinically. The DRS and DCS are carefully coordinated with the preexisting ASIF standard sets of equipment for internal fixation of fractures. The concept of a sliding screw for trochanteric fractures is not new. The first author describing such an implant was Schumpelick [44]; he gives credit to Pohl [22], who was primarily a manufacturer working for Gerhardt Kiinscher. Re described the possibility of impaction at the fracture site with a sliding device. In the United States Clawson [7, 8] introduced the hip screw and found it to be extremely beneficial in trochanteric fractures. At approximately the same time, Massie [31, 32] and Pugh [39] designed the sliding-type flange nails, which offer similar intramedullary splinting with the possibility of fracture impaction. The following chapters describe the concept and design features of the DRS, as well as the details of the surgical technique. The application of the DRS for different types of fractures is illustrated with clinical examples. The results of 268 cases of trochanteric fractures treated with the DRS are presented and compared with results using the angled blade plate and Ender's nails. Finally, some laboratory tests are described.

This supplement of Acta Neurochirurgica contains the proceedings of the Ninth Convention of the Academia Eurasiana Neurochirurgica held in Chateau St. Gerlach, Houthem, The Netherlands, 29 July - 1 August 1998. During this convention a three-day symposium on Neurosurgery and Medical Ethics was held. In this time of tremendous technical advancement in medicine in general and neurosurgery in particular, we are liable to lose sight of the sick patient as a human being, and the odds are that he will be the object rather than the subject of our action in the near future. It is a purpose and a task of the Academia Eurasiana Neurochirurgica to recognize this thread and to pay attention to tradition, morality and ethics in neurological surgery. The theme of this convention and the subject of the symposium met this purpose as no other. In the scientific sessions during the first day, the moral backgrounds of medical ethics in the most important cultures and religions in east and west were elucidated by invited experts in this field. A mutual respectful understanding of each other's conception of and belief in ethical principles is a growing necessity in our multicultural societies in both continents. On the second day, the ethical aspects of different fields of neurological surgery were discussed by members of the Academia. In this context, also the internationally much-discussed and much-criticized regulations on euthanasia in The Netherlands were explained.

La pathologie vasculaire a ete tres marquee par les progres biologiques de ces vingt demieres annees. Le systeme arteriel est main tenant considere comme un organe a part entiere. Modelee au cours de l'organogenese par les facteurs hemodynamiques, Ie paroi arterielle maintient une structure hautement organisee et des proprietes mecaniques qui dependent directement des conditions de pression et de debit. La monocouche endotheliale developpe 2 une surface de plusieurs centaines de m a l'interface sang-tissu; elle est a la fois un organe endocrine complexe synthetisant de nombreuses proteines qui participent a l'hemostase, une surface thromboresistante et hemocompatible, une barriere de permeabilite contr6lant les echanges sang-tissus. Les cellules musculaires lisses constituent un tissu multifonctionnel, contractile, assurant la synthese des composants structuraux responsables des proprietes mecaniques de la paroi arterielle, la transmission de la force contractile, et une etonnante activite reparatrice en reponse aux agressions. Tout ceci est soumis a un ensemble complexe de communications cellulaires qui font de l'endothelium un veritable systeme recepteur pour la paroi vasculaire. Parallelement, ou a la suite de ces progres, l'angeiologie s'est progressivement affirmee comme une specialite clinique. Debordant Ie cadre de la chirurgie vasculaire, elle integre les concepts physiopathologiques au diagnostic et au traitement des maladies arterielles. De cet effort d'integration est ne cet ouvrage, cherchant a concilier les connaissances fondamentales es plus recentes et la demarche clinique.

Sepsis and infection are the major enemies of the intensive care patient in whom immunological defenses are severely impaired. This major problem is thefocus of attention in this book, based on the presentation of the First International Congress on the Immune Consequences of Trauma, Shock, and Sepsis, which is one of the first attempts to exchange ideas on the state-of-the-art in this area of immunology. Both basic and clinical research, including new centres of attention, are described. The growing role of immunology in medicine opens new avenues to the under- standing of trauma and sepsis and will allow the design of novel therapeutic approaches.