[Arthroscopy of the proximal interphalangeal joint].

Objective: Pain reduction in the affected proximal interphalangeal joint (PIP joint) by synovectomy, loose body extraction, dorsal arthrolysis.

Indications: Therapy-resistant synovitis in rheumatoid arthritis (RA), early stage primary and secondary degenerative arthritis, loose bodies, capsular contracture.

Contraindications: Established biomechanic changes in RA (boutonniere and swanneck deformity).

[Arthroscopic Synovectomy of the Wrist in Chondrocalcinosis].

Background: Operative treatment of chondrocalcinosis (calcium pyrophosphate dihydrate deposition disease=CPPD disease) of the wrist is hardly ever mentioned in the literature. Since the chronic, recurrent type of this disease resembles rheumatoid arthritis (RA) as well as osteoarthritis, the author has performed arthroscopic synovectomy of the wrist, which achieves excellent results in RA und offers high patient comfort as an atraumatic procedure with low morbidity. This article presents the experience made with arthroscopic synovectomy in CPPD disease of the wrist.

Arthroscopic resection of occult dorsal wrist ganglia.

Introduction: Arthroscopic resection of dorsal wrist ganglia has become a well-accepted practice. However, there is a paucity of results on occult ganglia in the literature. The purpose of this study is to evaluate the subjective outcomes of occult dorsal wrist ganglion cysts resected arthroscopically, and to identify and examine intraarticular findings and relate them to pre-operative MRI findings and histologies.

[Arthroscopic resection of dorsal wrist ganglion cysts].

Objective: Pain relief and improvement of hand function by ganglion cyst resection and/or creation of a dorsal capsular window with partial synovectomy. In the case of visible ganglion cysts consideration of aesthetic aspects.

Indications: Visible and occult persisting dorsal wrist ganglion cysts, recurrent ganglion cyst after open or arthroscopic resection and intraosseous ganglion cyst with an extraosseous portion.

Wrist kinematics after radiolunate arthrodesis.

Introduction: Analysis of carpal kinematics after radiolunate and radioscapholunate arthrodesis shows good preservation of midcarpal joint congruity and motion. However, no biomechanical data exist on carpal kinematics after radiolunate arthrodesis in the wrist. Purpose of this study was to examine the individual motion of scaphoid, capitate and triquetrum after simulated radiolunate arthrodesis.

[Metacarpophalangeal joint arthroscopy].

Objective: Pain reduction in the affected metacarpophalangeal joint (MP joint) by synovectomy, loose body extraction and resection of intraarticular scars.

Indications: Synovitis in rheumatoid arthritis (RA) not responding to antirheumatic treatment, primary and secondary degenerative arthritis, osteochondral lesions, loose bodies, foreign bodies, capsular contracture, septic arthritis, posttraumatic arthralgia (old collateral ligament injury), intraarticular fractures.

Contraindications: Established biomechanical changes in RA such as ulnar deviation and palmar subluxation with extensor tendon luxation of the MP joint.

[Arthroscopy of the metacarpophalangeal joints].

With the advancements in arthroscopic technique, arthroscopy has become feasible in most human joints, even those as small as the finger joints. The metacarpophalangeal joints are very well suited for arthroscopy and arthroscopic therapy. Good results have been reported on arthroscopic synovectomy of the metacarpophalangeal joints in rheumatoid arthritis.

[Arthroscopic resection of dorsal wrist ganglia].

In arthroscopic wrist surgery, the resection of dorsal wrist ganglia has become a well accepted practice. As advantages for the minimally invasive procedure the low complication rate and low postoperative morbidity, less postoperative pain and faster recovery over open techniques are discussed. The possibility to assess accompanying joint pathology is considered as another advantage.

[Mid-term outcome after implantation of a pyrocarbon endoprosthesis in patients with degenerative arthritis].

Aim: The aim of this study was to make a mid-term evaluation of an unconstrained pyrocarbon prosthesis (Ascension®) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand.

Method: 13 implants (10 patients) were clinically and radiologically studied after a follow-up period of 71 months (range: 48-92 months).

Results: The average ROM was 52° (± 27°STD).

[Littler tenodesis for correction of swan neck deformity in rheumatoid arthritis].

Objective: Correction of swan neck deformity at the PIP and DIP joint by reconstruction of the oblique retinacular ligament through palmar transposition of one distally pedicled lateral band (oblique retinacular ligament reconstruction (ORL) = Littler II).

Indications: Rheumatoid swan neck deformity Nalebuff stages I-III (dynamic, partially contracted, contracted). The swan neck deformity should be of articular origin.

Treatment of malunion in ankle fractures.

Malunions are fractured bones that have healed in pathological positions. This leads to nonphysiological load transfer. Clinical symptoms at the ankle may include swelling, pain and impaired function.

[The sternoclavicular luxation].

Introduction: Injuries of the sternoclavicular joint are rare. Probably these injuries are frequently missed. Distorsion type lesions mostly heal uneventfully.

[Littler tenodesis for correction of swan neck deformity in rheumatoid arthritis].

Purpose: The aim of this study was to assess the results of operative treatment for rheumatoid swan neck deformity using Littler's technique consisting in the reconstruction of the oblique retinacular ligament.

Patients And Method: From 2004 to 2007 twenty rheumatoid patients with 30 PIP-joints affected by swan neck deformity underwent surgical correction. In all cases the tenodesis described by Littler was used.

[Mid-term results after scaphoid excision and four-corner wrist arthrodesis using K-wires for advanced carpal collapse].

Aim: Successful four-corner fusion after scaphoid excision provides pain relief und preserves an acceptable movability of the wrist. However, this treatment option for advanced carpal collapse is not without complications, such as malunion, hardware impingement or incomplete correction of lunate extension. K-wires, staples, Herbert screws or, recently, locking plates are all possible fixation techniques after scaphoid excision.

[Primary total elbow replacement for complex intra-articular distal humerus fractures].

Introduction: Open reduction and internal fixation of multifragmentary intra-articular fractures of the distal humerus often do not provide satisfactory results in elderly patients with osteoporosis.

Method: From December 2001 to January 2008 a total elbow arthroplasty (Coonrad-Morrey, Zimmer, USA) was performed on 12 patients (average age 81+/-9 ears) who presented with a type C distal humeral fracture. The mean time of follow-up with clinical and radiological assessment was 28+/-17 months.

[First results after implantation of a pyrocarbon-endoprosthesis in patients with degenerative arthritis].

Aim: Evaluation of an unconstrained pyrocarbon prosthesis (Ascension) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand.

Methods: In this study 10 patients (13 implants), that were treated with this type of prosthesis between February 2002 and January 2005 were clinically and radiologically studied.

Results: All but one patient were satisfied with the postoperative situation and would agree to another operation.

[CRPS type I psychological origin-case report].

The complex regional pain syndrome type I (CRPS I)-formerly named Sudeck's atrophy or reflex sympathetic dystrophy (RSD)-describes a complex of symptoms with chronic, poorly controllable pain, autonomic, sensomotor and trophic alterations. It is mainly caused by trauma or surgery. We describe the rare case of a spontaneous manifestation of a CRPS I in an adolescent patient with typical clinical and radiological findings and the recurrence of symptoms after a one-year symptom-free interval.

The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb.

We report the results of a new bone-tendon ligamentoplasty for the reconstruction of chronic injuries of the ulnar collateral ligament at the metacarpophalangeal joint of the thumb. The mean follow-up period was 36 months. Using the Glickel grading system, seven patients had excellent results and one patient had good results.