[Combined convergent elbow dislocation with posterior luxation of the humeroulnar joint and radial head comminuted fracture in adults]. / Kombinierte konvergente Ellenbogenluxation mit posteriorer Luxation des Humeroulnargelenks und Radiuskopftrümmerfraktur beim Erwachsenen.

Transposition of the proximal radioulnar joint, so-called convergent elbow dislocation, is an extremely rare injury whereby the proximal radius crosses over the proximal ulnar and converges medially. This injury can occur in isolation or even less frequently in association with a posterior humeroulnar dislocation. Open reduction is almost always necessary. The diagnosis is frequently delayed as the injury is easily overlooked. In the literature, 13 cases in children and 2 in adults have so far been described. This is the first report of a combined elbow dislocation (posterior and convergent) with an initially diagnosed and definitively treated comminuted radial head fracture in adults.

[Perilunate injuries]. / Perilunäre Verletzungen.

Perilunate injuries are one of the most severe injuries of the hand. They occur relatively rarely but necessitate that diagnostic procedures should be carried out thoroughly and as soon as possible. The therapeutic strategy must consider the age, exact type and full extent of the injury. The key for successful treatment is exact anatomic reduction and stable fixation of all injured structures.

[Acute scaphoid fractures : Management under consideration of the new S3-level guideline]. / Die frische Skaphoidfraktur : Management unter Berücksichtigung der neuen S3-Leitlinie.

BACKGROUND: Scaphoid fractures represent the most common carpal fractures and are often problematic and frequently lead to nonunion with osteoarthritis and collapse of the wrist. The reasons for the nonunion are manifold. Therefore, the main goal of diagnosis and therapy of acute fractures is to achieve bony union and to restore the anatomic shape of the scaphoid. In the long run, only this can preserve the normal function of the wrist. METHODOLOGY: The given recommendations are based on the new S3-level guideline of the AWMF (Association of the Scientific Medical Societies). This guideline was established with involvement of all relevant medical societies based on a comprehensive and systematic review of the literature and after a process of formal consent. The focus of the guideline is recommendations regarding diagnosis and therapy of acute scaphoid fractures. MAIN STATEMENTS: After careful clinical examination consequent imaging must be performed, starting with X­rays in three standard projections. Computed tomography is indispensable for proof of a fracture and for therapy planning. The classification of Herbert and Krimmer is based on the CT under special consideration of instability and displacement of the fracture. Thus, indication for operative and non-operative treatment is mainly CT-dependent. Non-operative treatment may be indicated only for stable fractures (type A). However, operative treatment is strongly recommended for all unstable fractures (type B). For fixation, double-threaded headless screws are preferred. The operative technique depends on the fracture morphology. CONCLUSION: Diagnosis and therapy of acute scaphoid fractures are primarily aimed at the prevention of nonunion and arthritic carpal collapse with painful impairment of the wrist function. To achieve this, the S3-level guideline contains explicit recommendations.

[Hand injuries from combat sports]. / Verletzungen der Hand durch Kampfsport.

BACKGROUND: Each year 3.1% of German adults suffer from accidents related to sports and 75% of the injured athletes are male between 20 and 29 years old. The upper limbs are affected in more than 20% of cases and one third of these injuries involve the hands and fingers. OBJECTIVES: More than half a million athletes are organized in combat sport associations in Germany with an increasing trend. Combat sports are commonly said to have a high risk of injuries to the hand. The aim of this study was to test this hypothesis as well as to describe typical hand injuries associated with combat sports. MATERIAL AND METHODS: A systematic review of literature (up to January 2015) in PubMed/Medline and The Cochrane Library as well as a secondary search in the reference lists were carried out. CONCLUSION: Conclusive comparative studies on the incidence and severity of hand injuries directly related to combat sports action could not be found in the currently available literature. The overall risk of suffering from a sports injury seems to be relatively low in combat sports compared to other sports. Boxing, however, seems to be the most dangerous sport for injuries to the upper extremities and especially the hand. The injury pattern after punching (emergency patients and professional boxers) shows that more than half of these fractures affect the 5th metacarpal and 25% of these are the classical boxer's fracture. This differs significantly from the fracture distribution generally associated with sports, where fractures of the phalanges are the most common. Two rare conditions that may occur as a result of repeated punching are referred to as carpal bossing and boxer's knuckle and excellent results are described for both injury forms after surgical therapy.

[Angiomyolipoma of the kidney. Value of diagnosis in acute hemorrhage]. / Das Angiomyolipom der Niere. Stellenwert der Diagnostik bei der akuten Blutung.

We report about a severe retroperitoneal bleeding of a ruptured angiomyolipoma of kidney. Despite of maximal diagnostic effort including CT and angiography it was not possible to find the exact diagnosis preoperative. The extensive bleeding did not allow to resect only the tumor, nephrectomy was necessary.

[Waiting for the EuGH verdict to be put into practice or "Introduction of the four-day week on full pay"]. / Warten auf die Umsetzung des EuGH-Urteils oder "Einführung der Viertagewoche bei vollem Lohnausgleich"

The submitted model of working time transposes and interprets german industrial law. The result of this interpretation is a high level of acceptance of the employees, a fast education that is high qualified with costs that are still affordable. The advantage of this model compared with the shift-model that runs after the EuGH-decision is obvious if you look at the reality of our health care system. This is why it is important to have an efficient interpretation of the existing law. Of course it will be a necessity also in the future to create new models of working time and to adapt these models in a way that it fits into the structure of a hospital. It would be the wrong way to force a juridical and political decision, how it was done by the german government that gave a deadline to put the EuGH decision into operation, without the possibility of an interpretation that fulfils the demand of the hospital.

[Isolated transverse fracture of the os triquetrum. Case report of a rare injury]. / Isolierte Korpusquerfraktur des Os triquetrum. Fallbeschreibung einer seltenen Verletzung.

With the case of a 25 year old patient we will report of a rare injury, the isolated body fracture of a triquetrum bone. This kind of injury often happens in dorsalflected and ulnarducted hand position because of the anatomical position of the triquetral bone. The therapy of choice is conservative treatment with a volar splint for three to six weeks. Operation is only necessary in case of dislocation of a fragment [4]. Complications as an aseptic necrosis of a fragment is not reported. We found only one case of a pseudarthrosis [5]. Even in our case occurred a complete healing of the bone and a complete functional remission.

[Scapho-capitate fracture syndrome of both hands--first description of a bilateral occurrence of a rare carpal injury]. / "Scapho-capitate fracture syndrome" an beiden Händen. Erstbeschreibung des beidseitigen Auftretens einer seltenen Verletzung.

The scapho-capitate fracture syndrome is a rare but severe injury of the carpus. It is characterized by a rotation of the proximal fragment of the capitate bone of 90 or 180 degrees and a fracture of the navicular bone in the intermediate third. This injury is caused by a fall on the outstretched and dorsiflected hand. The scapho-capitate fracture syndrome was firstly described in 1956 by Fenton. There are 31 cases described in literature but none of these involves both hands. Here we describe the first case of scapho-capitate fracture syndrome in both hands, in a 21 year old woman who jumped out of a window with suicidal intentions. She was treated operatively by Herbert-screws and K-wires.

Applicability of the CALUX bioassay for screening of dioxin levels in human milk samples.

The CALUX (chemically activated luciferase expression) bioassay based on rat hepatoma (H4IIE) cells is a sensitive assay for the detection of Ah receptor agonists like 2,3,7,8-substituted chlorinated dibenzo-p-dioxins and dibenzofurans and related PCBs. In this paper, the assay was optimized and applied for monitoring levels of dioxins in human milk samples. Combination effects of dioxin-like compounds were evaluated by testing potential mechanisms of interaction between seven of the major dioxin-like compounds in human milk using the isobole method. Results showed that the compounds acted additively, indicating that the usual assumption of additivity in the risk assessment process is valid. In general the relative potencies (REPs) of the single agents were in accordance with their TEFs assigned by the World Health Organisation, except for the mono-ortho-substituted PCB118 that had a 40-fold lower REP in CALUX. The total dioxin-like activity was determined in 16 Danish human milk samples and was in the range 20.5-55.8 pg TEQ g(-1) fat. These values were compared with TEQs obtained from GC/MS analysis (range 14.8-43.6 pg TEQ-g(-1) fat) that overall were a little lower than CALUX TEQs. The results obtained with the bioassay when testing milk extracts fractionated into dioxins/furans, non-ortho PCB and mono/di-ortho PCB fractions indicated that the correlation between the bioassay and the chemical analyses depends primarily on the Ah receptor activity observed in the mono/di-ortho PCB fraction.