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Handchirurgie, Mikrochirurgie, plastische Chirurgie [journal]
- [Arthroscopy of the metacarpophalangeal joints]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):315-20.
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. Osteochondral lesions in degenerative arthritis, loose bodies and foreign bodies can well be treated. Arthroscopic arthrolysis for capsular contracture and treatment of post-traumatic lesions have been performed successfully. The arthroscopic assistance in the treatment of intraarticular fractures and the capsular shrinkage for instability have been described. However, metacarpophalangeal joint arthroscopy has not been popularised up to now and its role in clinical practice remains to be established. Existing indications will be discussed with respect to our own experience.
- (Dry) Arthroscopic Partial Wrist Arthrodesis: Tips and Tricks. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):300-306.
One of the options for performing a partial wrist arthrodesis is the arthroscopic technique. As a first advantage arthroscopy allows us to directly assess the state of the articular surface of the carpal bones and define the best surgical option during the salvage operation. Furthermore, it allows performance of the procedure with minimal ligament damage and minimal interference with the blood supply of the carpals. These will (presumably) entail less capsular scarring and more rapid healing. Lastly, there is cosmetic benefit by reducing the amount of external scarring. The procedure has a steep learning curve even for accomplished arthroscopists but can be performed in a competitive manner to the open procedure if the dry technique is used. The aim of this paper is to present the technical details, tricks and tips to make the procedure accessible to all hand specialists with an arthroscopic interest. As it is paramount that the surgeon is acquainted with the "dry" technique, some technical details about it will also be presented.
- Arthroscopy of the Distal Radioulnar Joint. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):295-299.
Wrist arthroscopy is now widely indicated for diagnosis and treatment of acute or chronic wrist pain, especially for triangular fibrocartilage complex (TFCC) lesions, as a gold standard. In most cases radiocarpal and midcarpal arthroscopy was performed, while DRUJ arthroscopy has been rarely performed because of its difficulties. Recent anatomic and biomechanical studies demonstrated that the radioulnar ligament (RUL), which is the proximal component of the TFCC facing to the DRUJ, is the primary stabilizer of the distal radioulnar joint (DRUJ). Rupture of the radioulnar ligament (RUL) at the fovea area, where it is the main attaching portion to the ulna and is the isometric point during forearm rotation as the rotation axis passes, is responsible for DRUJ instability. Although physical examination and imaging diagnosis may indicate a foveal detachment of the TFCC, DRUJ arthroscopy is potential for visualizing the RUL at the fovea. Role of DRUJ arthroscopy should be more important not only for diagnosis of rupture of the RUL but also for decision making of treatment option for RUL tear. DRUJ arthroscopy also demonstrates the joint surface of both the sigmoid notch and ulnar head, and the proximal surface of the TFCC.
- [Arthroscopic resection of dorsal wrist Ganglia]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):295-9.
In arthroscopic wrist surgery, the resection of dorsal wrist ganglia has become a well accepted practice. As advantages for the minimally inva-sive 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. The importance of identifying a so-called ganglion cyst stalk seems to have been overstated. Regarding the technique, the main discussion points are the size and localisation of the capsular window and the necessity of addi-tional midcarpal arthroscopy. The possibility and results of treatment of recurrent ganglion cysts are still controversial. Our own experience and that of some authors are positive. Hardly men-tioned in the literature is the treatment of occult dorsal wrist ganglia and its results, which is considered as very successful by the authors.
- [Arthroscopic Repair for Ulnar-sided Tears of the TFCC]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):286-94.
Accurately performed anatomic and biomechanical studies as well as clinical experience during the last years have widened our knowledge about function and pathology of the distal radioulnar joint (DRUJ) making a differentiated treatment possible. In cases of trauma a rupture of the ulnar part of the triangular fibrocartilaginous complex (TFCC) frequently occurs. An overview is given on the development of different arthroscopic techniques for repair and the state of the art is presented. The ulnar part of the TFCC is constituted of the superficial part which is less important for stability and the deep part which is anchored to the fovea of the ulnar head. This deep part is the most important stabiliser of the DRUJ. Each of these parts may rupture separately or both of them may rupture at the same time. Keystones for diagnosis are clinical examination and arthroscopy. On clinical examination instability of the DRUJ is to be evaluated by comparing it to the contralateral side. Furthermore, the degree of instability should be estimated. Extraarticular associated lesions must also be assessed clinically. On arthroscopy the TFCC may be evaluated from the radiocarpal joint as well as from its undersurface, from the DRUJ. In cases of avulsion from the fovea, an anatomic reconstruction with reinsertion of the deep part to the bone is indicated and may be performed successfully according to the published studies and our own experience. If a severe instability is found on clinical examination it is to be supposed that more stabilising structures - then only the radioulnar ligaments - are affected and reinsertion of the deep fibres to the fovea may not be sufficient.
- [Arthroscopic procedures at the wrist]. [Journal Article]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):278-85.
- Plate Presetting and Arthroscopic Reduction Technique (PART) for Treatment of Distal Radius Fractures. [JOURNAL ARTICLE]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):278-285.
Background: Arthroscopy has been reported to be an efficient adjunct for the surgical treatment for distal radius fractures (DRF). However, performing wrist arthroscopy during palmar locking plate fixation seems to be troublesome. We have developed a surgical technique involving presetting of a palmar locking plate and an arthroscopic reduction technique (PART) of the fracture that can facilitate the procedure. This study is aimed to investigate the effectiveness of our technique in the treatment of DRF. Patients and Methods: 249 fractures of the distal radius were treated by PART. 205 fractures in 200 patients were followed-up on average for 15 (12-60) months. There were 46 men and 154 women with an average age of 62 (16-85) years. According to the AO/ASIF fracture classification system there were 51 extra-articular fractures, and 154 intra-articular fractures. Scapholunate interosseous ligament injuries were classified according to Geissler and tears of the triangular fibrocartilage complex according to Abe. On arthroscopic inspection, residual intra-articular fragment dislocation after reduction under fluoroscopy was evaluated. Final evaluation included a radiological examination, measurements of wrist and forearm motion, grip strength, the Mayo modified wrist score (MMWS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: On arthroscopic inspection, intraarticular dislocations were found to be residual in 22.7%, even if reduction seemed to have been achieved when viewed by fluoroscopy. Scapholunate interosseous ligament tears were recognized in 29.8%, and triangular fibrocartilage complex tears in 62.4%. The mean palmar tilt was 5.7 (- 10 to 16)°, radial inclination 26.0 (18-31)°, and ulnar variance 0.1 (- 2 to 5) mm. The mean extension of the wrist was 71 (50-85)°, and the mean flexion was 62 (40-79)°. The mean pronation of the forearm was 87.5 (70-90)°, and the mean supination was 89.1 (75-95)°. The mean grip strength was 90.0% (31-133%) of the opposite side. According to the MMWS there were 156 excellent, 47 good, and 2 fair results. The mean DASH score was 3.9. Conclusions: The palmar locking plate in combination with arthroscopic reduction technique (PART) leads to good and excellent results. It can be recommended for all fractures of the distal radius needing operative treatment. Arthroscopic reduction of intra-articular fragments is superior to reduction under fluoroscopy. PART allows also the detection of intra-articular soft tissue lesions such as scapholunate ligament tears and injuries of the triangular fibrocartilage complex.
- [Arthroscopically assisted osteosynthesis of dorsally tilted intraarticular distal radius fractures - technique and results]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Oct; 46(5):271-7.
The present paper describes the indication and application of an arthroscopically assisted osteosynthesis for distal radius fractures. Visualisation of articular incongruency is emphasised with special regard to articular fracture fragment reduction. In addition to that, classification of soft tissue injuries and treatment options are discussed. The final clinical and radiological results of 17 patients are presented: DASH and PRWE averaged 4.9 and 6.0 respectively. Active range of motion measured 123° for flexion/extension, 51° for radial and ulnar deviation and 163° for pronosupination, which is 87%, 98% and 97%, respectively, compared with the opposite wrist. Radial inclination at final follow-up was 23°, palmar tilt measured 6° and ulnar variance averaged -1.2 mm. The scapholunate gap at follow-up was 1.6 mm, and the scapholunate angle measured 57°.
- [The interesting case: unilateral hypoplasia of the breast in becker nevus syndrome]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):266-7.
The Becker nevus syndrome is defined by the association of a Becker's nevus with ipsilateral breast hypoplasia and/or musculoskeletal disorders. There are only a few dozen case reports in the literature. We here present the case of a 20-year-old female patient who was treated in our clinic due to a breast asymmetry.
- [Acute Colonic Pseudo-Obstruction (Ogilvie's Syndrome) - A Rare Complication after Ablation Mammae and Direct Reconstruction with a Free TRAM Flap]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2014 Aug; 46(4):263-5.
We report a case of a 62 year old woman who presented with Ogilvie's syndrome as a complication of mastectomy with free TRAM flap reconstruction due to angiosarcoma of the right breast. In the acute postoperative period, the patient expired as a result of Ogilvie's syndrome related complications. Several assumptions regarding the causes of Ogilvie's Syndrome as well as current theories about aetiology, diagnosis and therapy are discussed in this case presentation.