Rupture Rate, Functional Outcome and Patient Satisfaction after Primary Flexor Tendon Repair with the Modified 4-Strand Core Suture Technique by Tsuge and Using the Arthrex FiberLoop® with Early Motion Rehabilitation.

PURPOSE: Our hypothesis was that the rupture rate after primary flexor tendon repair in the modified 4-strand core suture technique using the FiberLoop® (Arthrex, Munich, Germany) is lower than in other suture materials and functional outcome and patient satisfaction are superior compared to the current literature. PATIENTS AND METHODS: A 2-stage retrospective, randomized follow-up study of 143 patients treated with the Arthrex FiberLoop® after flexor tendon injury in zones 2 or 3 from May 2013 to May 2017 was performed. In the 1st stage, the rupture rate of all patients was assessed after a follow-up of at least one year by interview to exclude revision surgery. In the 2nd stage, 20% of the patients could be randomly clinically examined. Functional parameters, such as finger and wrist range of motion measured by goniometer, grip strength measured by Jamar dynamometer (Saehan, South Korea), patient satisfaction measured by school grades (1-6), pain levels measured by visual rating scales (0-10) and functional outcome according to the DASH-score were assessed. The Buck-Gramcko and Strickland scores were calculated. The length of sick leave was recorded. RESULTS: A rupture rate of 2.1% was recorded. 29 patients (20%) were followed up at a mean of 34 ± 7.5 months postoperatively. 10.3% of these patients had an incomplete fingertip palm distance. The mean postoperative grip strength was 24 ± 3.1 kg. 93% of the patients were very satisfied with the treatment. No patient complained of pain postoperatively. The mean postoperative DASH score was 6.7 ± 2.8 points. The mean Buck-Gramcko score was 14 ± 0.2 points. 93% of the patients had excellent and 7% good results according to the Strickland score. 67% of patients had a work accident and returned to work at a mean of 4 ± 0.2 months postoperatively. 31% of patients suffered a non-occupational injury and returned to work at a mean of 3 ± 0.4 months postoperatively. CONCLUSIONS: Primary flexor tendon repair in the modified 4-strand core suture technique using the Arthrex FiberLoop® has proven to be a viable treatment option in our series. The rupture rate was lower than in other suture materials. It leads to acceptable pain relief, grip strength and functional outcome. LEVEL OF EVIDENCE: IV; therapeutic.

Inter-Rater Reliability of Magnetic Resonance Imaging in Comparison to Computed Tomography and Wrist Arthroscopy in SLAC and SNAC Wrist.

The aim of the study was to assess the inter-rater reliability of magnetic resonance imaging (MRI) in comparison to computed tomography (CT) and wrist arthroscopy in patients with scapholunate (SLAC) or scaphoid non-union advanced collapse (SNAC) as well as to evaluate a grading score of cartilage lesions. A total of 42 patients (36 male, 6 female) at a mean age of 45 years (range: 19-65 years) with a SLAC or SNAC wrist who had a preoperative MRI and CT scan as well as underwent arthroscopy of the wrist between 2013 and 2018 were included in this study. Cartilage lesions, as assessed by MRI, CT and wrist arthroscopy, were classified by two hand surgeons in three stages. Inter-rater reliability was evaluated using the Kendall Tau-b test as well as the chi-square test to analyze for trend. The correlation between cartilage lesions, classified by arthroscopy and MRI, was low. A moderate correlation between CT and arthroscopy staging was shown. The highest inter-rater correlation was found between MRI and CT staging. An additionally performed logistic regression showed that progression of cartilage lesions as shown in MRI scans correlates with a restriction of range of motion (ROM). The level of cartilage lesion may be more severely classified in an MRI than during arthroscopy. Arthroscopy remains the gold standard in detecting cartilage lesions and thus in the decision-making process of the definitive treatment in carpal collapse.

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures.

A malunited distal radius fracture can lead to symptomatic ulnar impaction syndrome, which is a common cause for ulnar-sided wrist pain. If conservative treatment fails and symptoms persist after an arthroscopic ulnocarpal debridement, ulnar shortening osteotomy (USO) is the treatment of choice. Since the first USO described by Milch in 1941 after a malunited Colles fracture, many techniques have been described varying in surgical approach, type of osteotomy and osteosynthesis material used. Many studies demonstrated good to very good functional results after USO, reporting, however, a delayed union or non-union rate up to 18%. A modern, low profile, locking plate showed in our short-term study very good functional results and no implant-associated complications, in particular no non-union.

[Treatment of Metacarpal and Phalangeal Fractures]. / Behandlung der Mittelhand- und Phalangenfrakturen.

Metacarpal and phalangeal fractures are the second most frequent fractures of the upper extremity. Treatment goal is to restore the function of the injured hand. Due to better understanding of anatomy and biomechanics as well as the development of locking and low-profile implants for osteosynthesis of such fractures, there is a growing safety when choosing the operative treatment for the correct indication. Nevertheless, conservative treatment of these injuries still plays an important role.

The gel box - a testing device for the characterization of cryo- and radiofrequency lesions employed in interventional pain therapy.

BACKGROUND: Radiofrequency (RF) and cryolesioning are established methods for the therapeutic interruption of sensory nerve supply to facet joints and other painful musculoskeletal structures. The varying clinical success rates of these treatments have - among other technical issues - been attributed to the small size of these lesions combined with the limited precision in placing them. Since there are 2 different physical methods for lesioning and a wide range of probes and lesion generators available, it is likely that the lesions generated by them may be of different size. OBJECTIVES: We sought to devise an experimental setup that would allow for the reproducible and comparable evaluation of the size of cryo and RF lesions as they are being used in interventional pain therapy. METHODS: A wide range of potential media was evaluated for this purpose. Based on technical specifications, as well as on preliminary testing, a specific agar agar gel with a gel point of between 32 degrees C and 35 degrees C and a melting point of between 80 degrees C and 85 degrees C was selected for these experiments. Two different testing containers were constructed from transparent acrylic: one with a volume of 1,500 mL and the other with a volume of 12 mL. Each of them allows for the introduction of a cryo or a RF probe and 2 bundles of thermoelements into the gel volume. A water bath was used to maintain the gels at 37 degrees C and bundled, ultrafine NiCr-Ni thermoelements type K were used for measuring the isotherms. A series of RF and cryolesions were performed within these experimental setups to evaluate their suitability for the comparative testing of cryo and RF probes and generators. RESULTS: Both testing setups generated reproducible results and proved to be suitable for measuring RF as well as cryolesions. Visual observation of the lesions was better with the small testing container and rewarming / recooling after performing a cryo / RF lesion was more rapid with the smaller gel volume. LIMITATIONS: Our setup allows for the comparative measurement of RF and cryolesions, but it cannot simulate the realities within living tissue. While convection as a confounding factor was excluded by use of a gel, capillary perfusion and the specific characteristics of different tissues cannot be simulated. CONCLUSIONS: The testing setup described in this manuscript can serve for the comparative and reproducible study of RF and cryolesions that are commonly used in interventional pain therapy.