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Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- Modified Proximal Interphalangeal Joint Palmar Plate Arthroplasty after Fracture Dislocation: A Case Report. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Jun; 46(3):192-195.
We present the results of treatment of a neglected fracture of the base of the middle phalanx of the ring finger, with dorsal proximal interphalangeal joint dislocation. A modified palmar plate arthroplasty technique was used with the removal of bony remnants and non-anatomic palmar plate insertion to the fracture site. At one-year follow-up the patient showed excellent recovery with an active range of motion of the ring finger of 290° (93% of the other side), strong total grip (48 kg) and a quick DASH score of 11. X-ray images showed perfect re-building of the palmar lip of the base of the middle phalanx with no signs of arthritis. Other options for the treatment of acute and chronic PIP joint fracture dislocations are discussed.
- [Operative Treatment of Rhizarthrosis with Trapezectomy and Suspension of the First Metacarpal with a Mini TightRope®] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Jun; 46(3):179-185.
Purpose: The aim of this work was to examine the utility of the Mini TightRope(®) after trapezectomy and suspension of the first metacarpal in cases of clinically manifest rhizarthrosis. Patients and Method: 31 Patients (26 female, 5 male, mean age 57.9 years) with primary rhizarthrosis were treated with a trapezectomy and suspension of the first metacarpal with a Mini TightRope(®) (cost 225 Euro). In the course of a retrospective study, all patients underwent a clinical and radiological re-examination at an average of 13.5 (6-22) months. To assess the therapy, a clinical and radiological examination as well as the score of Buck-Gramcko were used. Results: 74.2% of the patients obtained good and very good results, 12.9% achieved satisfactory or poor outcomes. In 2 patients the Mini Tight-Rope(®) had to be removed due to a proximalisa-tion of the first metacarpal and strong pain in rest and motion after 6-7 months. Whereas the distance between the distal scaphoid pole and the base of the first metacarpal postoperatively averaged 11.1 (8-14) mm, it averaged 5.3 (0-10.2) mm in the follow-up examination. Conclusion: With the presented procedure it is possible to achieve in the majority of the treated patients good and very good results. 2 early removals of the implants, a documented proximalisation in spite of the implant and the price of the Mini TightRope(®) of currently 225 Euro need to be discussed critically.
- [Commentary on: Strobel U, Tami I, Andreisek G, et al. Comparison of Functional Results with MRI Findings after Surgical Treatment of Transscaphoid Perilunate Fracture Dislocations of the Wrist: The Role of Scapholunate Ligament Lesions.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Jun; 46(3):177-178.
- [Median Nerve Neuropathy after Perilunate Dislocation Injuries.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Jun; 46(3):163-168.
Purpose: The purpose of this retrospective study was to investigate the frequency and appearance of median nerve neuropathy following perilunate dislocation injuries with respect to the preceding surgical decompression and the clinical outcome. Patients and Methods: 32 patients were followed for a mean of 65 months after surgery for perilunate dislocation, including carpal tunnel release in 13 patients. 10 of 11 patients with clinical symptoms of median nerve affection at follow-up had additionally an electrophysiological examination. Median neuropathy was assumed if 2 or more parameters were pathologic. Patients with and without median neuropathy were compared. The DASH score, pain, wrist motion, grip strength and the Mayo wrist score were used to rate the outcome. Results: In 6 patients, neuropathy of the median nerve persisted since injury in spite of carpal tunnel release in 5 of them. 3 patients showed secondary, delayed median nerve affection. Patients with median neuropathy had a worse result with regard to pain at rest, grip force, the DASH score, and the Mayo wrist score. The difference was statistically significant for pain with activities. Conclusion: Median neuropathy following perilunar dislocation injuries is frequent. It appears rather like a chronic neural lesion than a typical compression syndrome. A primary carpal tunnel release cannot always prevent persistent neural disorders.
- [Limits to Arthroscopic Treatment of Degenerative Triangular Fibrocartilage Complex Lesions Depending on the Ulnar Variance.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Jun; 46(3):151-162.
Purpose: The present prospective study investigated the influence of the static ulnar variance on the success of arthroscopic debridement of degenerative TFCC lesions. Patients and Methods: 10 patients with an ulnar positive variance ("Ulna+") and 12 patients with ulnar neutral or ulnar negative variance ("Ulna-/0") were examined preoperatively (U0), as well as at 2 (U2) and 6 (U6) months after arthroscopic debridement of degenerative TFCC le-sions and compared with each other. After the U2 investigation due to persistent complaints in 9 of 10 patients with an ulnar positive variance there was a need for further surgery, consisting of ulnar shortening osteotomy (USO). The following parameters were recorded in each case: pain at rest and with load, the summed wrist range of motion - consisting of extension and flexion, radial and ulnar deviation, pronation and supina-tion - compared to the contralateral side, the strength of the affected hand compared to the contralateral side, the Mayo modified wrist score (MMWS), the Krimmer score and the DASH score. Preoperatively there were no significant differences between the 2 cohorts "Ulna+" and "Ulna-/0" except for the characteristic "pain at rest". Results: At 2 months postoperatively (U2), the results in the cohort "Ulna+" remained at a significantly or tendentially poorer level compared to the cohort "Ulna-/0". The subsequent surgical treatment of the subgroup "Ulna+" with USO led to almost complete approximation of the results at 6 months postoperatively (U6). In addition to this, with time (U6) within each subgroup there were tendential or significant improvements of all characteristics compared to the preoperative situation (U0). At U6 four of 22 patients were -unable to work. Conclusion: Degenerative lesions of the TFCC can be treated successfully by arthroscopic debridement in cases of ulnar negative and ulnar neutral variance. Patients with ulnar positive variance and persistent complaints after debridement of the TFCC can be treated successfully with a secondary ulnar shortening osteotomy.
- [Text Mining, a Method for Computer-Assisted Analysis of Scientific Texts, Demonstrated by an Analysis of Author Networks.] [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 May 8.
Searching for relevant publications is becoming more difficult with the increasing number of scientific articles. Text mining as a specific form of computer-based data analysis may be help-ful in this context. Highlighting relations between authors and finding relevant publications concerning a specific subject using text analysis programs are illustrated graphically by 2 performed -examples.
- [Young Forum of the German Society for Handsurgery (DGH)]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Apr; 46(2):135.
- [Report of the DGH Retreat in Düsseldorf]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Apr; 46(2):134.
- [FESSH Travel Award: Hand Trauma Centres in Europe]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Apr; 46(2):132-3.
- [Advertising rights for doctors - the legal borders]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Apr; 46(2):125-31.
The increasing liberalisation of the advertising rights for physicians.Which new advertising forms present themselves for doctors and where are the limits of the advertising right.Evaluation of case law and consulting practice.Only advertisement which is contrarious to professional standards is inadmissible. As long as the preferred advertising is in the range of the Musterberufsordnung, Berufsordnungen der Länder, HWG and UWG it is permitted.The advertisement for physicians will find out new ways and possibilities in the future. The individual chambers and courts, how-ever, have not yet developed uniform line, so that in case of doubt professional help is advised.