Subtalar instability: a biomechanical cadaver study.

HYPOTHESIS: Subtalar instability is thought to be one of the possible causes for chronic functional instability of the foot and ankle. The purpose of this study was to determine the extent of ligament injury that is followed by subtalar instability and to depict consecutive pathologic joint motion. METHODS: Twelve fresh human cadaver lower legs were investigated with respect to pathologic motion and mobility of the subtalar joint in a modified spinal column simulator after arthrodesis of the talocrural articulation and selective sectioning of the lateral ligaments of the subtalar joint. In order to simulate several injury mechanisms, ligaments were dissected starting anteriorly in group one (n = 6) and posteriorly in group two (n = 6). RESULTS: Dissection of the bifurcate ligament in group one resulted in a significant increase in plantar- and dorsiflexion, dissection of the inferior extensor retinaculum resulted in a significant increase in eversion and inversion. Additional dissection of the lateral talocalcaneal ligament resulted in a significant increase in internal and external rotation. Dissection of the calcaneofibular ligament in group two was followed by significant kinematic changes regarding all degrees of motion in the subtalar joint. CONCLUSIONS: The calcaneofibular ligament plays a key role in lateral stabilisation of the subtalar joint. Therefore, ligaments of the subtalar joint should be included in surgical repair.

[The interdisciplinary treatment of Merkel cell carcinoma: a retrospective case analysis and review of the current literature]. / Interdisziplinäre Behandlung des Merkelzellkarzinoms: Eine retrospektive Fallanalyse und aktuelle Literaturübersicht.

BACKGROUND: Merkel cell carcinoma is a rare, -aggressive, neuroendocrine malignancy of the skin. Over the period from June 2005 to January 2007 (18 months) 7 Merkel cell carcinomas in different tumour stages and localisations were treated in our department for hand, plastic and reconstructive surgery. Given an incidence rate of approximately 0.1-0.4 per 100 000 inhabitants, this accumulation of cases is considerably higher than would be statistically expected. This led us to analyse our cases retrospectively and provided the opportunity to discuss the treatment modalities on the basis of the current literature. PATIENTS AND METHODS: All patients were referred to our clinic after incomplete tumour excision and histopathological diagnosis elsewhere, for further surgical treatment. Two female and 5 male patients, aged 63 to 83 years, were treated. The patients' data were collected and analysed retrospectively. RESULTS: In all cases an R0 resection could be achieved, with safety resection margins between 1.5 cm and 4.5 cm. The reconstruction of the resulting defects was achieved by skin transplants in six cases and a primary suture in one case. All patients received adjuvant radiotherapy. Furthermore, three patients received adjuvant chemotherapy due to metastases of the progressed Merkel cell carcinoma. Three patients remained free of recurrence and in two patients a progression of the tumour disease could be impeded, whilst two patients succumbed to their disease. CONCLUSIONS: In the case of an early diagnosis, an R0 resection can usually be achieved. A safety resection margin of a minimum of 1.5 cm in the face and 3 cm for localisation on the extremities should be obtained. To reduce the local recurrence rate, adjuvant radiotherapy should be conducted. The benefit from chemotherapy still remains unclear.

The blood supply of the scaphoid bone.

Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible.

[Peroneal nerve palsy caused by a recurrent proximal tibiofibular joint ganglion--a case report and review of the literature]. / Peronäusläsion, hervorgerufen durch ein rezidivierendes Ganglion des proximalen Tibiofibulargelenkes--Eine Falldarstellung und Literaturübersicht.

PURPOSE/BACKGROUND: Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete. MATERIAL AND METHODS: We report a case of a 60-year-old man with peroneal nerve palsy caused by recurrent proximal tibiofibular joint ganglion. RESULTS: Within the context of the current literature, clinical symptoms, diagnostics, differential diagnosis with regard to imaging methods, neurology, pathology and the broader spectrum of operative and non-operative treatment are discussed. The cyst was completely resected, but a recurrent cyst developed eight years later. At reoperation, a communication of the cyst with the tibiofibular joint was demonstrated. Despite complete resection of the cyst and ligation of the ganglion stem, a routine postoperative MRI disclosed a second recurrence of the cyst nine months later. On the last clinical examination, twelve years after onset of the symptoms, a complete paresis of the peroneal nerve was seen. CONCLUSION: This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.