The Outcome of Distal Radius Fractures with Concomitant Injuries Is Similar to those of Isolated Distal Radius Fractures Provided that an Arthroscopically Supported Treatment Is Performed.

Background: Concomitant injuries of distal radius fractures (DRF) can have a fatal impact on the patients' outcome. However, wrist arthroscopy is a costly and complex procedure. It remains elusive whether patients benefit from an additional arthroscopy.

[Basal joint osteoarthritis of the thumb].

The basal joint of the thumb (articulatio carpometacarpalis pollicis) is the joint of the hand most frequently affected by arthritis. Arthritis of the basal joint of the thumb typically occurs in the second half of life and more frequently in women. The clinical symptoms are pain, joint swelling, reduced strength and limited hand function with a reduced hand span.

Patient satisfaction after hook plate treatment of bony avulsion fracture of the distal phalanges.

Background: Bony avulsion fractures of the distal phalanges can result in mallet finger deformity if not treated appropriately. Therefore, only minimally displaced fractures can be treated conservatively with a good outcome, as dislocation occurs very often. Several surgical treatment options have been developed during the past decades.

[Lundborg's resection arthroplasty vs. Pyrocarbon spacer (Pyrocardan®) for the treatment of trapeziometacarpal joint osteoarthritis: a two-centre study].

Various operative approaches exist for osteoarthritis of the trapeziometacarpal joint. The aim of this two-centre study was to compare the results of Lundsborg's resection arthroplasty with the implantation of the Pyrocardan spacer. We treated 20 patients with symptomatic osteoarthritis of the trapeziometacarpal joint in stage III / IV (Eaton-Littler classification).

[Strategies for complex injuries of the hand].

The quality of the reconstruction, follow-up treatment and care determine the treatment outcome of complex hand injuries. The initial estimation and therapy are decisive. Optimal results necessitate a structured approach with strategic planning, including thorough débridement, precise analysis of the resulting defect and loss of function and if possible unilateral reconstruction and well-founded planning of secondary interventions.

The Munich Wrist Questionnaire (MWQ) - development and validation of a new patient-reported outcome measurement tool for wrist disorders.

Background: Although self-assessment questionnaires for the wrist joint are numerous, most validation studies focus on a specific pathology and patient collectives. In addition the available questionnaires focus on subjective parameters such as pain, usual and specific activities but the range of motion (ROM) as an essential objective parameter in wrist disorders is rarely considered. Therefore the purpose of the presented study was to develop and validate a new universally applicable self-assessment score, the Munich Wrist Questionnaire (MWQ), which allows for the assessment of subjective as well as objective parameters of the wrist joint.

Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial.

Background: The purpose of the present study was to investigate the influence of the pronator quadratus (PQ) muscle repair following volar plate fixation of distal radius fractures with special regards to the forearm pronation strength. During the early recovery period of 3 months, an improvement of pronation strength and functional scorings was hypothesized for the PQ repair when compared to no repair.

Methods: The inclusion criteria were (1) men or women between 18 and 80 years, (2) isolated, closed fractures of the distal radius, (3) A2 to B2 types of fracture according to the AO fracture classification system, (4) primary volar locking plate osteosynthesis.

[Operation well performed but insufficiently documented and not indicated].

A 50-year-old patient presented with a lump in the main joint of the fourth finger of the left hand, which was suspected of being malignant, for an operation. Following surgery the lump was still present and, furthermore, the patient reported a wound resulting from surgery on the third finger accompanied by swelling, pain and a loss of mobility. The patient accused the physician of performing surgery without indications on the wrong finger together with failure to remove the lump.

[High-pressure injection injury of the hand. Underestimation of injury severity].

A 44-year-old man sustained a high-pressure injection injury of the left index finger with hot hydraulic oil in an occupational accident. On presentation to the occupational physician 4 h later the wound was irrigated and cleaned. At this time X-ray diagnostics, wound revision, administration of antibiotics and immobilization were not performed.

Significance of Traumatic Macroamputation in Severely Injured Patients: An Analysis of the Traumaregister DGU®.

Treatment of patients with traumatic macroamputations is challenging. The aim of this study is to analyze the significance of this type of injury in TraumaRegister DGU® (TR-DGU) and to depict the rate of formal surgical ablation of the traumatically induced amputation, epidemiologic data, as well as outcome in severely injured patients with amputations. We acquired data from the TR-DGU of the German Trauma Society (DGU).

[Arthroscopy-assisted management of wrist fractures].

Distal radius fractures are the most common fractures in humans and early surgical intervention with modern plating systems is becoming increasingly more established to avoid secondary dislocation. Even fractures with slight dislocations are adequately stabilized and the affinity for surgical intervention and plating procedures is applied to secure these simple fractures. In this aspect the surgical indications are significantly dependent on X-ray examination results.

[Alterations of cell phenotype in Dupuytren's disease--an in vitro analysis].

Introduction: Despite its potential complications, partial aponeurectomy still is the mainstay of treatment whenever it comes to significant contracture in Dupuytren's disease. With the goal in mind to identify new therapeutic strategies we isolated and characterised cells from healthy palmar aponeurosis (Kon) and compared them to cells isolated from palmar aponeurosis of patients with a primary manifestation of Dupuytren's disease (PrimDup) as well as from patients with recurrent Dupuytren's disease (RezDup). As cells from palmar aponeurosis from patients with Dupuytren's disease share characteristics with stem cells, such as the ability to differentiate into other cell types, we analysed the stemness, morphology and integrin receptor profiles of the cells.

Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularized fascia.

The surgical management of large defects of the Achilles tendon and overlying skin is very demanding and necessitates, as a rule, a free vascularized graft. The ideal characteristics of a thin layer of skin and a strong tendon component, combined with a reliable blood supply and minimal morbidity at the donor site, have only been partially met by all previous grafts used in this situation. The authors performed reconstructions in five patients with large defects of the Achilles tendon and overlying skin by using a perforator flap derived from the tensor fasciae latae flap.

[Implementation of a quality management system for the curriculum in emergency medicine education].

Medical teaching, training and education in basic and advanced life support were improved by basic quality management procedures. 3rd year medical students (n = 276) of two consequent semesters were questionnaired about their acute emergency medicine curriculum. While Group A (n = 134) received a standard course, the new course for group B (n = 142) was reorganised on the basis of the results of group A.

[The biological reaction in atrophic and hypertrophic pseudarthrosis of diaphysis of long bone. Causes and forms of appearance].

The grading of long-tubular-bone pseudarthrosis depends on the biological reaction or lack of reaction in pseudarthrosis or non-unions. Hypertrophic and oligotrophic pseudarthrosis belongs to biologically reacting non-unions, whereas non-reacting non-unions are necrotic pseudarthrosis and defective non-unions with partial decline or complete destruction of cortical substance. Pseudarthrosis is a serious disturbance or disorder within the regulation cycle in fracture healing, which consists of osteoregeneration, osteovascularization and stabilization.

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study].

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon.

Clinical experiences in tendon transfers for radial nerve palsy by a new method of Wiedemann.

Many modifications of tendon transfers have been described in the treatment of radial nerve palsy. Controversy persists over the muscles of choice to get the best results in motion of wrist and fingers. Patients with radial nerve palsy and treated by the methode of Merle d'Aubigne in neurophysiological tests showed that the pronator teres did not work very well for extending the wrist.

[Clinical experiences with a new Wiedemann method of radial replacement operation].

Many modifications of tendon transfers have been described in the treatment of radial nerve palsy. Controversy persists over the muscles of choice to get the best results in motion of wrist and fingers. Patients with radial nerve palsy and treated by the method of Merle d'Aubigne in neurophysiological tests showed that the pronator teres did not work very well for extending the wrist.

Arterial blood supply of the infrapatellar fat pad. Anatomy and clinical consequences.

The arterial blood supply to the infrapatellar fat pad (Hoffa's fat pad) was investigated in 12 knee joints of human cadavers. The infrapatellar fat pad is supplied by an anastomotic network which displays some striking topographic features. Its vascular blood supply protects it against necrosis, when either reconstructive operations are carried out or extensive surgical exposures of the knee are done.

[Plastic surgery in soft tissue reconstruction in large extremity defects].

Soft-tissue defects in the extremities vary greatly, depending on the trauma mechanism, localization and a number of factors related to the patient's physical condition. We offer an overview of the plastic surgery methods in reconstruction of different soft-tissue defects in the extremities, beginning with the diagnostic, clinical and radiological measures that make classification of soft-tissue defects possible, and then giving a concentrated view of the appropriate reconstruction methods. Collaboration between traumatology and plastic surgery seems to be especially important in lesions in the extremities.

Refractures: a consequence of impaired local bone viability.

Bone necrosis secondary to avascularity may not only delay or inhibit consolidation of a fracture, it may also be a cause of refracture. Both initial trauma und surgical insult will determine the extent of necrosis. Only the latter is under the surgeon's control; it can be reduced by gentle soft tissue handling and by minimizing periosteal stripping.