Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the dist... more Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the distal radio-ulnar joint, and the interosseous membrane. This can lead to osteoarthritis, impaction syndrome, or instability. If all three structures are injured and lead to instability, the situation is almost unmanageable and many times ends in a one-bone forearm. In this article, we demonstrate a new way to reconstruct the proximal and distal radio-ulnar joint with two patient-specific coupled prostheses. These have been developed with the biomechanical conditions of the forearm in mind, where there are very large forces between the bones. As a result, we are able to present a patient previously severely restricted in the use of his hand and arm via a splint that compressed the forearm, who is now able to perform everyday activities and even light sports, such as badminton, without pain.
Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Oku... more Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Okutsu double- or triple-loop technique after iatrogenic or traumatic rupture of at least two adjacent flexor tendon pulleys in the finger and distal palm; mean age of injury was 4.77 years. The mean follow-up was 4.66 years after reconstruction of mostly A2 pulleys in a single surgeon setting. Outcome measures included ROM, NRS pain, satisfaction, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Krimmer score, Buck–Gramcko score, Jamar grip strength, pinch grip, and vigorimetry compared to the uninjured side. The median patient satisfaction score was 6.6/10. Hand function using the DASH score was 9.5. Grip strength on the Jamar Dynamometer showed only a slight reduction of 13% compared to the uninjured side. The resultant force of the operated fingers on the vigorimeter is almost 60% of that of the contralateral side, and the finger-palm distance of the operated finger was r...
In patients suffering from epidermolysis bullosa dystrophica (DEB), the most severe form of epide... more In patients suffering from epidermolysis bullosa dystrophica (DEB), the most severe form of epidermolysis bullosa, trauma or friction cause separation of the skin from underlying tissue with consecutive painful blisters, scarifications, contractures, and pseudosyndactyly. To retain functionality of the hands surgical procedures are necessary. Anesthesia is challenging as difficult airways make general anesthesia risky. Regional anesthesia is considered controversial in patients with EB as accidental subcutaneous injections can cause severe blisters. As ultrasound-guided procedures became standard of care this might have changed however. In this case series, we describe feasibility, efficacy, and safety of ultrasound-guided plexus axillaris block in DEB patients undergoing hand surgery. We performed a retrospective analysis of the charts of all children with DEB undergoing hand surgery under plexus axillaris block and sedation between 2009 and 2013 in our institution. Nineteen proced...
Das fibröse Skelett der Hand Veränderungen bei der Dupuytren-Kontraktur Die detaillierte Kenntnis... more Das fibröse Skelett der Hand Veränderungen bei der Dupuytren-Kontraktur Die detaillierte Kenntnis der normalen Anatomie des subkutanen Fasersystems der Hand sowie der veränderten Anatomie durch Knoten und verdickte Stränge ist essenziell sowohl für die Diagnostik als auch insbesondere für die Therapie der Dupuytren-Kontraktur. Nur wenn die speziellen Eigenheiten dieses Fasersystems und der daraus resultierende natürliche Verlauf der Dupuytren-Kontraktur bekannt sind, können richtige Diagnosen und wichtige Differenzialdiagnosen zur Dupuytren-Kontraktur gestellt und somit Eingriffe mit fatalen Auswirkungen vermieden werden.
Das bindegewebige Skelett der Hand ist ein hochkomplexes, mehrschichtiges System, das die gängige... more Das bindegewebige Skelett der Hand ist ein hochkomplexes, mehrschichtiges System, das die gängige Literatur nur unzureichend im Zusammenhang darstellt. Die Kenntnis dieser aufeinander abgestimmten und ineinandergreifenden Systeme ist die Basis zum Verständnis der Entwicklung der Dupuytren’schen Kontraktur. Der Artikel stellt sowohl die gesunde Anatomie als auch deren Veränderungen bei Dupuytren dar und geht auf die Bedeutung der einzelnen Systeme in der Therapie ein.
Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of... more Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears and the comparison with short- and mid-term results. The study included nineteen patients (mean 49.2 years of age) with a mean follow-up time of 13.6 years (13.1–14.3 years). Examination parameters included disabilities of arm, shoulder, and hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), Krimmer Score, determination of range of motion in comparison to the contralateral extremity. Grip and pinch grip strength measurement and pain level assessment was performed, as well. The mean MMWS after at least 13.1 years was 95.8 (85–100, SD 5.6). Mean DASH Score was 10.2 (0–55.8, SD 13.6). Mean Krimmer Score was 97.2 (85–100, SD 4.8). Grip strength reached 101% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison to the healthy contralateral extremity. None of the patients suffered from major complications. Fourteen of nineteen patients regarded pain level reduction as excellent. Five patients reported a relevant pain level reduction. Sixteen of nineteen patients regarded functional outcome as excellent, the other three patients reported on a pleasing improvement of the functional outcome. Arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears may be an efficacious and safe surgical technique for ulnar-sided TFCC tears in the long term.
ZusammenfassungInfektionen der Endglieder sind unter allen Handinfektionen am häufigsten. Untersc... more ZusammenfassungInfektionen der Endglieder sind unter allen Handinfektionen am häufigsten. Unterschieden werden die dorsalen Infektionen, die sich im Bereich des Nagelwalls entwickeln und Paronychien genannt werden, und die palmaren Infektionen, die die Fingerbeere oder Fingerkuppe betreffen. Die akuten Paronychien müssen je nach Infektionsort gezielt eröffnet werden. Dazu sind genaue anatomische Kenntnisse des Nagelaufbaus erforderlich. Chronische Paronychien haben meist andere Ursachen, und die Therapie ist deutlich schwieriger. Fingerbeereninfektionen sind häufig stark schmerzhaft, da die Infektion im kompliziert aufgebauten Druckkammersystem stattfindet und eine Schwellung durch die fibrösen Septen begrenzt ist. Eine spätere Ausbreitung, wenn die Septen zerstört sind, in den Knochen oder die Beugesehnenscheide ist aber möglich.
Background: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impinge... more Background: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. Purpose: To determine the maximum amount of the coracoid that can be resected during arthroscopic coracoplasty without leading to coracoid fracture or avulsion of the conjoint tendon during simulated activities of daily living (ADLs). Study Design: Controlled laboratory study. Methods: A biomechanical cadaveric study was performed with 24 shoulders (15 male, 9 female; mean age, 81 ± 7.9 years). Specimens were randomized into 3 treatment groups: group A (native coracoid), group B (3-mm coracoplasty), and group C (5-mm coracoplasty). Coracoid anatomic measurements were documented before and after coracoplasty. The scapula was potted, and a traction force was applied through the conjoint tendon. The stiffness and load to failure (LTF) were determined...
Die Rhizarthrose führt zu einer wesentlichen Einschränkung der Handfunktion, da das Daumensattelg... more Die Rhizarthrose führt zu einer wesentlichen Einschränkung der Handfunktion, da das Daumensattelgelenk die für die Greiffunktion entscheidende Oppositionsfähigkeit des Daumens ermöglicht. Im Anfangsstadium der Erkrankung stehen zunächst wirksame konservative Therapieoptionen und später gelenkerhaltende Eingriffe zur Verfügung. Im fortgeschrittenen Erkrankungsstadium, nach Ausschöpfen der konservativen Therapie und bei entsprechendem Leidensdruck hat sich die Resektionsarthroplastik des Daumensattelgelenks mit ihren Varianten als maßgeblicher Standardeingriff bewährt, da sie zuverlässig und langfristig mit einer niedrigen Komplikationsrate zu einer deutlichen Schmerzlinderung, einer sehr hohen Patientenzufriedenheit und einer guten Wiederherstellung der Handfunktion führt. Daneben stehen für besondere Indikationen weitere gelenkresezierende Eingriffe wie etwa der endoprothetische Ersatz oder die Arthrodese des Daumensattelgelenks zur Verfügung.
Die Infektionen des Fingerendglieds sind nicht zu unterschätzen, da es zahlreiche Differenzialdia... more Die Infektionen des Fingerendglieds sind nicht zu unterschätzen, da es zahlreiche Differenzialdiagnosen zu beachten gibt, die besser nicht (sofort) operiert werden sollten, sondern erst eine spezielle und häufig interdisziplinäre Diagnostik (dermatologisch – histologisch – radiologisch – internistisch) benötigen. Darüber hinaus finden sich immer wieder nicht fachgerechte Schnittführungen, die zu teilweise katastrophalen Ergebnissen führen. An Bildbeispielen werden Differenzialdiagnosen und die Folgen ungünstiger Schnittführungen stichpunktartig dargestellt.
OBJECTIVE Reliable wound coverage of the fingertip and palmar aspect of the middle finger with a ... more OBJECTIVE Reliable wound coverage of the fingertip and palmar aspect of the middle finger with a sensate flap in order to restore early function. INDICATIONS Palmar, oblique pulp defects or amputations at the distal finger phalange with uncovered bone, tendons, and/or neurovascular structures. CONTRAINDICATIONS Peripheral perfusion deficiency, size of defect exceeding flap capacity, obliteration of the flap artery, i.e. contralateral finger artery. SURGICAL TECHNIQUE Harvesting of adipocutane, midlateral triangle based on proper digital vessel flap; distal flap transposition and primary closure of the harvesting defect, flap dimension 4-5 mm larger than defect. POSTOPERATIVE MANAGEMENT Finger splint for 2 weeks, followed by exercises with flap conditioning. RESULTS Very reliable defect coverage with 9% minor and temporary complications, all of which healed without consequences.
Purpose The goal of this study was the assessment of long-term outcome of dorsal capsular imbrica... more Purpose The goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability. Methods The study included ten patients (mean 38.7 years of age) with a mean follow-up time of 11.2 years (9.3 years to 14.3 years). Examination parameters included Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), determination of range of motion in comparison with the healthy extremity, pre-and post-operative pain level assessment, and examination of DRUJ stability. Results Eight of ten DRUJs proved to be stable after the above-mentioned follow-up. Mean MMWS was 92.5 (65-100; SD: 11.1). Mean DASH Score was 8.8 (0-60; SD: 18.4). Grip strength reached 93.5% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison with the healthy contralateral extremity. Nine of ten patients regarded pain level reduction as excellent. Eight of ten patients regarded DRUJ stability as excellent after surgery. Conclusion Dorsal capsular imbrication of the DRUJ is an efficacious surgical technique for post-traumatic dorsal instability in the long-term.
Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be ... more Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. Nevertheless, various malformations, such as malrotation, spur development, bone shortening, deviation of the axis and combinations of these individual deformities may appear in the course of time. Corrective osteotomy can correct these deformities with clinically impaired function and improve/optimize hand function. Prerequisites for corrective osteotomy are a precise analysis of the deformity, precise osteotomy, exercise stable osteosynthesis and intensive follow-up treatment of the hand. Complications, such as implant failure, postoperative tendon and joint adhesions, joint contracture and nonunion are however possible.
After reading this article, the participant should be able to: 1. Appreciate the variation and ev... more After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration. 3. Understand the biology of repairing flexor tendon lacerations. 4. Appreciate the technical challenges in flexor tendon repair relating to different zones. 5. Understand the rationale of postoperative hand therapy. 6. Have an overview of the types of secondary tendon surgery. Flexor tendon injury constitutes a considerable trauma workload for hand surgeons, and a vast amount of research is dedicated toward improving outcomes in tendon repair. This Continuing Medical Education article aims to provide an up-to-date evidence-based outline of flexor tendon surgery in the hand. The authors reviewed the literature on flexor tendon repairs to include a balanced overview of the experimental and clinical research. For each section, the best levels of evidence were assessed in the ...
ZusammenfassungKahnbeinbrüche sind die häufigsten knöchernen Läsionen des Karpus. Da sie nicht se... more ZusammenfassungKahnbeinbrüche sind die häufigsten knöchernen Läsionen des Karpus. Da sie nicht selten wenig klinische Symptome hervorrufen, werden diese Frakturen bei unzureichender Diagnostik häufig übersehen und mangelhaft therapiert. Deshalb ist bei klinischem Verdacht ein Frakturausschluss mittels Schichtbildgebung obligat. Anhand der CT kann der Bruch des Kahnbeins nach Krimmer und Herbert klassifiziert und davon abhängig die Therapie festgelegt werden. Da auch die Durchblutung des Kahnbeins recht fragil ist, kommt es in bis zu 37% der konservativen Therapien mittels Ruhigstellung bei „stabilen“ Typ A Verletzungen zur Ausbildung einer Pseudarthrose. Selbst operativ stabilisierte Typ B Verletzungen haben ein Pseudarthroserisiko von bis zu 10%. Es werden straffe Pseudarthrosen von instabilen Pseudarthrosen unterschieden. Erstere lassen sich oft minimalinvasiv mit perkutaner Schraubenosteosynthese therapieren, letztere müssen meist offen mit Interposition eines Spongiosatransplant...
Online teilnehmen unter: www.springermedizin.de/cme Für diese Fortbildungseinheit werden 3 Punkte... more Online teilnehmen unter: www.springermedizin.de/cme Für diese Fortbildungseinheit werden 3 Punkte vergeben.
Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the dist... more Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the distal radio-ulnar joint, and the interosseous membrane. This can lead to osteoarthritis, impaction syndrome, or instability. If all three structures are injured and lead to instability, the situation is almost unmanageable and many times ends in a one-bone forearm. In this article, we demonstrate a new way to reconstruct the proximal and distal radio-ulnar joint with two patient-specific coupled prostheses. These have been developed with the biomechanical conditions of the forearm in mind, where there are very large forces between the bones. As a result, we are able to present a patient previously severely restricted in the use of his hand and arm via a splint that compressed the forearm, who is now able to perform everyday activities and even light sports, such as badminton, without pain.
Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Oku... more Twenty-three patients with a mean age of 52.7 years underwent pulley reconstruction using the Okutsu double- or triple-loop technique after iatrogenic or traumatic rupture of at least two adjacent flexor tendon pulleys in the finger and distal palm; mean age of injury was 4.77 years. The mean follow-up was 4.66 years after reconstruction of mostly A2 pulleys in a single surgeon setting. Outcome measures included ROM, NRS pain, satisfaction, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and Krimmer score, Buck–Gramcko score, Jamar grip strength, pinch grip, and vigorimetry compared to the uninjured side. The median patient satisfaction score was 6.6/10. Hand function using the DASH score was 9.5. Grip strength on the Jamar Dynamometer showed only a slight reduction of 13% compared to the uninjured side. The resultant force of the operated fingers on the vigorimeter is almost 60% of that of the contralateral side, and the finger-palm distance of the operated finger was r...
In patients suffering from epidermolysis bullosa dystrophica (DEB), the most severe form of epide... more In patients suffering from epidermolysis bullosa dystrophica (DEB), the most severe form of epidermolysis bullosa, trauma or friction cause separation of the skin from underlying tissue with consecutive painful blisters, scarifications, contractures, and pseudosyndactyly. To retain functionality of the hands surgical procedures are necessary. Anesthesia is challenging as difficult airways make general anesthesia risky. Regional anesthesia is considered controversial in patients with EB as accidental subcutaneous injections can cause severe blisters. As ultrasound-guided procedures became standard of care this might have changed however. In this case series, we describe feasibility, efficacy, and safety of ultrasound-guided plexus axillaris block in DEB patients undergoing hand surgery. We performed a retrospective analysis of the charts of all children with DEB undergoing hand surgery under plexus axillaris block and sedation between 2009 and 2013 in our institution. Nineteen proced...
Das fibröse Skelett der Hand Veränderungen bei der Dupuytren-Kontraktur Die detaillierte Kenntnis... more Das fibröse Skelett der Hand Veränderungen bei der Dupuytren-Kontraktur Die detaillierte Kenntnis der normalen Anatomie des subkutanen Fasersystems der Hand sowie der veränderten Anatomie durch Knoten und verdickte Stränge ist essenziell sowohl für die Diagnostik als auch insbesondere für die Therapie der Dupuytren-Kontraktur. Nur wenn die speziellen Eigenheiten dieses Fasersystems und der daraus resultierende natürliche Verlauf der Dupuytren-Kontraktur bekannt sind, können richtige Diagnosen und wichtige Differenzialdiagnosen zur Dupuytren-Kontraktur gestellt und somit Eingriffe mit fatalen Auswirkungen vermieden werden.
Das bindegewebige Skelett der Hand ist ein hochkomplexes, mehrschichtiges System, das die gängige... more Das bindegewebige Skelett der Hand ist ein hochkomplexes, mehrschichtiges System, das die gängige Literatur nur unzureichend im Zusammenhang darstellt. Die Kenntnis dieser aufeinander abgestimmten und ineinandergreifenden Systeme ist die Basis zum Verständnis der Entwicklung der Dupuytren’schen Kontraktur. Der Artikel stellt sowohl die gesunde Anatomie als auch deren Veränderungen bei Dupuytren dar und geht auf die Bedeutung der einzelnen Systeme in der Therapie ein.
Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of... more Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears and the comparison with short- and mid-term results. The study included nineteen patients (mean 49.2 years of age) with a mean follow-up time of 13.6 years (13.1–14.3 years). Examination parameters included disabilities of arm, shoulder, and hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), Krimmer Score, determination of range of motion in comparison to the contralateral extremity. Grip and pinch grip strength measurement and pain level assessment was performed, as well. The mean MMWS after at least 13.1 years was 95.8 (85–100, SD 5.6). Mean DASH Score was 10.2 (0–55.8, SD 13.6). Mean Krimmer Score was 97.2 (85–100, SD 4.8). Grip strength reached 101% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison to the healthy contralateral extremity. None of the patients suffered from major complications. Fourteen of nineteen patients regarded pain level reduction as excellent. Five patients reported a relevant pain level reduction. Sixteen of nineteen patients regarded functional outcome as excellent, the other three patients reported on a pleasing improvement of the functional outcome. Arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears may be an efficacious and safe surgical technique for ulnar-sided TFCC tears in the long term.
ZusammenfassungInfektionen der Endglieder sind unter allen Handinfektionen am häufigsten. Untersc... more ZusammenfassungInfektionen der Endglieder sind unter allen Handinfektionen am häufigsten. Unterschieden werden die dorsalen Infektionen, die sich im Bereich des Nagelwalls entwickeln und Paronychien genannt werden, und die palmaren Infektionen, die die Fingerbeere oder Fingerkuppe betreffen. Die akuten Paronychien müssen je nach Infektionsort gezielt eröffnet werden. Dazu sind genaue anatomische Kenntnisse des Nagelaufbaus erforderlich. Chronische Paronychien haben meist andere Ursachen, und die Therapie ist deutlich schwieriger. Fingerbeereninfektionen sind häufig stark schmerzhaft, da die Infektion im kompliziert aufgebauten Druckkammersystem stattfindet und eine Schwellung durch die fibrösen Septen begrenzt ist. Eine spätere Ausbreitung, wenn die Septen zerstört sind, in den Knochen oder die Beugesehnenscheide ist aber möglich.
Background: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impinge... more Background: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. Purpose: To determine the maximum amount of the coracoid that can be resected during arthroscopic coracoplasty without leading to coracoid fracture or avulsion of the conjoint tendon during simulated activities of daily living (ADLs). Study Design: Controlled laboratory study. Methods: A biomechanical cadaveric study was performed with 24 shoulders (15 male, 9 female; mean age, 81 ± 7.9 years). Specimens were randomized into 3 treatment groups: group A (native coracoid), group B (3-mm coracoplasty), and group C (5-mm coracoplasty). Coracoid anatomic measurements were documented before and after coracoplasty. The scapula was potted, and a traction force was applied through the conjoint tendon. The stiffness and load to failure (LTF) were determined...
Die Rhizarthrose führt zu einer wesentlichen Einschränkung der Handfunktion, da das Daumensattelg... more Die Rhizarthrose führt zu einer wesentlichen Einschränkung der Handfunktion, da das Daumensattelgelenk die für die Greiffunktion entscheidende Oppositionsfähigkeit des Daumens ermöglicht. Im Anfangsstadium der Erkrankung stehen zunächst wirksame konservative Therapieoptionen und später gelenkerhaltende Eingriffe zur Verfügung. Im fortgeschrittenen Erkrankungsstadium, nach Ausschöpfen der konservativen Therapie und bei entsprechendem Leidensdruck hat sich die Resektionsarthroplastik des Daumensattelgelenks mit ihren Varianten als maßgeblicher Standardeingriff bewährt, da sie zuverlässig und langfristig mit einer niedrigen Komplikationsrate zu einer deutlichen Schmerzlinderung, einer sehr hohen Patientenzufriedenheit und einer guten Wiederherstellung der Handfunktion führt. Daneben stehen für besondere Indikationen weitere gelenkresezierende Eingriffe wie etwa der endoprothetische Ersatz oder die Arthrodese des Daumensattelgelenks zur Verfügung.
Die Infektionen des Fingerendglieds sind nicht zu unterschätzen, da es zahlreiche Differenzialdia... more Die Infektionen des Fingerendglieds sind nicht zu unterschätzen, da es zahlreiche Differenzialdiagnosen zu beachten gibt, die besser nicht (sofort) operiert werden sollten, sondern erst eine spezielle und häufig interdisziplinäre Diagnostik (dermatologisch – histologisch – radiologisch – internistisch) benötigen. Darüber hinaus finden sich immer wieder nicht fachgerechte Schnittführungen, die zu teilweise katastrophalen Ergebnissen führen. An Bildbeispielen werden Differenzialdiagnosen und die Folgen ungünstiger Schnittführungen stichpunktartig dargestellt.
OBJECTIVE Reliable wound coverage of the fingertip and palmar aspect of the middle finger with a ... more OBJECTIVE Reliable wound coverage of the fingertip and palmar aspect of the middle finger with a sensate flap in order to restore early function. INDICATIONS Palmar, oblique pulp defects or amputations at the distal finger phalange with uncovered bone, tendons, and/or neurovascular structures. CONTRAINDICATIONS Peripheral perfusion deficiency, size of defect exceeding flap capacity, obliteration of the flap artery, i.e. contralateral finger artery. SURGICAL TECHNIQUE Harvesting of adipocutane, midlateral triangle based on proper digital vessel flap; distal flap transposition and primary closure of the harvesting defect, flap dimension 4-5 mm larger than defect. POSTOPERATIVE MANAGEMENT Finger splint for 2 weeks, followed by exercises with flap conditioning. RESULTS Very reliable defect coverage with 9% minor and temporary complications, all of which healed without consequences.
Purpose The goal of this study was the assessment of long-term outcome of dorsal capsular imbrica... more Purpose The goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability. Methods The study included ten patients (mean 38.7 years of age) with a mean follow-up time of 11.2 years (9.3 years to 14.3 years). Examination parameters included Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), determination of range of motion in comparison with the healthy extremity, pre-and post-operative pain level assessment, and examination of DRUJ stability. Results Eight of ten DRUJs proved to be stable after the above-mentioned follow-up. Mean MMWS was 92.5 (65-100; SD: 11.1). Mean DASH Score was 8.8 (0-60; SD: 18.4). Grip strength reached 93.5% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison with the healthy contralateral extremity. Nine of ten patients regarded pain level reduction as excellent. Eight of ten patients regarded DRUJ stability as excellent after surgery. Conclusion Dorsal capsular imbrication of the DRUJ is an efficacious surgical technique for post-traumatic dorsal instability in the long-term.
Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be ... more Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. Nevertheless, various malformations, such as malrotation, spur development, bone shortening, deviation of the axis and combinations of these individual deformities may appear in the course of time. Corrective osteotomy can correct these deformities with clinically impaired function and improve/optimize hand function. Prerequisites for corrective osteotomy are a precise analysis of the deformity, precise osteotomy, exercise stable osteosynthesis and intensive follow-up treatment of the hand. Complications, such as implant failure, postoperative tendon and joint adhesions, joint contracture and nonunion are however possible.
After reading this article, the participant should be able to: 1. Appreciate the variation and ev... more After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration. 3. Understand the biology of repairing flexor tendon lacerations. 4. Appreciate the technical challenges in flexor tendon repair relating to different zones. 5. Understand the rationale of postoperative hand therapy. 6. Have an overview of the types of secondary tendon surgery. Flexor tendon injury constitutes a considerable trauma workload for hand surgeons, and a vast amount of research is dedicated toward improving outcomes in tendon repair. This Continuing Medical Education article aims to provide an up-to-date evidence-based outline of flexor tendon surgery in the hand. The authors reviewed the literature on flexor tendon repairs to include a balanced overview of the experimental and clinical research. For each section, the best levels of evidence were assessed in the ...
ZusammenfassungKahnbeinbrüche sind die häufigsten knöchernen Läsionen des Karpus. Da sie nicht se... more ZusammenfassungKahnbeinbrüche sind die häufigsten knöchernen Läsionen des Karpus. Da sie nicht selten wenig klinische Symptome hervorrufen, werden diese Frakturen bei unzureichender Diagnostik häufig übersehen und mangelhaft therapiert. Deshalb ist bei klinischem Verdacht ein Frakturausschluss mittels Schichtbildgebung obligat. Anhand der CT kann der Bruch des Kahnbeins nach Krimmer und Herbert klassifiziert und davon abhängig die Therapie festgelegt werden. Da auch die Durchblutung des Kahnbeins recht fragil ist, kommt es in bis zu 37% der konservativen Therapien mittels Ruhigstellung bei „stabilen“ Typ A Verletzungen zur Ausbildung einer Pseudarthrose. Selbst operativ stabilisierte Typ B Verletzungen haben ein Pseudarthroserisiko von bis zu 10%. Es werden straffe Pseudarthrosen von instabilen Pseudarthrosen unterschieden. Erstere lassen sich oft minimalinvasiv mit perkutaner Schraubenosteosynthese therapieren, letztere müssen meist offen mit Interposition eines Spongiosatransplant...
Online teilnehmen unter: www.springermedizin.de/cme Für diese Fortbildungseinheit werden 3 Punkte... more Online teilnehmen unter: www.springermedizin.de/cme Für diese Fortbildungseinheit werden 3 Punkte vergeben.
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