Fracture sonography-review of literature and current recommendations.

Over a span of more than two years, a collaborative expert group consisting of 9 professional societies has meticulously crafted the S2e guideline on fracture sonography. This publication encapsulates the essential insights pertaining to specific indications. A thorough and systematic literature search, covering the period from 2000 to March 2021, was conducted across PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, complemented by an evaluation of bibliographies. Inclusion criteria encompassed randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews, while guidelines, conferences, reviews, case reports, and expert opinions were excluded. The SIGN grading system (1999-2012) was applied to assess evidence, and resultant SIGN tables were presented to the expert group. Specific recommendations for the application of fracture sonography were then derived through unanimous consensus after detailed discussions. Out of the initial pool of 520 literature sources, a meticulous screening and content assessment process yielded 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) for evaluation. The comprehensive analysis identified twenty-one indications that substantiate the judicious use of fracture sonography. Ultrasound emerges as a pragmatic and user-friendly diagnostic method, showcasing feasibility across a diverse range of indications.

Sonographic Diagnosis of Carpal Tunnel Syndrome.

Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.

[CME Sonography 90: Tumors and Nodules of the Hand]. / CME Sonografie 90: Tumoren und Knoten an der Hand.

CME Sonography 90: Tumors and Nodules of the Hand Abstract. In this CME, which focuses on ultrasound of the musculoskeletal system, we concentrate on tumors and nodules on the hand and fingers. Firstly, the main focus is on device adjustment and image quality optimization. Second, individual tumors and nodules are discussed clinically and sonographically. Here we divide the tumors and nodules according to their anatomical localization: skin and subcutaneous tissue, muscles and tendons, nerves, vessels, bones and joints.

Treatment Outcomes of 4-Corner Arthrodesis for Patients With Advanced Carpal Collapse: An Average of 4 Years' Follow-Up Comparing 2 Different Plate Types.

PURPOSE: The objective was to investigate the clinical and subjective outcomes of patients after 4-corner arthrodesis (FCA) for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) and to analyze complications. Furthermore, we compared the long-term results of a first-generation nonlocking plate (Spider) and a plate with a locking screw design (Flower plate). METHODS: In a retrospective cohort study, we included 39 patients with stage II or III SLAC or SNAC who underwent FCA. Twenty wrists were treated with a nonlocking plate and 19 with a locking plate. Patients completed the Patient-Rated Wrist Evaluation (PRWE) and the Michigan Hand Outcomes Questionnaire (MHQ). Active range of wrist motion, radiological signs such as impingement, and signs of implant loosening and nonunion, as well as postoperative complications, were assessed. RESULTS: After a median postoperative follow-up time of 4.1 years, the PRWE score was 18 and the total MHQ score 79. Patient-reported and clinical outcomes were similar for the 2 plate types. Wrists fixed with the nonlocking plate had more dorsal impingements and loosening than wrists fixed with a locking plate. One nonunion was noted in the nonlocking plate group, and a single case of implant failure was seen for each plate type. A total of 5 patients with a nonlocking plate incurred postoperative complications that required further medical treatment. CONCLUSIONS: FCA for patients with stage II or III SLAC or SNAC yields positive clinical and subjective outcomes. Based on the high complication rate following FCA with a nonlocking plate, we no longer use this implant and recommend fixation with a locking screw plate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Two cases of pisiform bone impingement syndrome after proximal row carpectomy.

Proximal row carpectomy (PRC) is an established surgical procedure used to treat post-traumatic osteoarthritis of the wrist with sparing of the midcarpal joint and advanced aseptic necrosis such as lunatomalacia. Proximalization of the distal carpal row following PRC may lead to secondary problems such as radiocarpal impingement. At follow-up, two of our patients complained about ulnar-sided wrist pain after proximal row carpectomy. Computed tomography (CT) scans were taken for both patients with an additional magnetic resonance imaging scan for one patient. The CT scan revealed clear osteolysis consistent with a pisiform bone impingement on the ulnar styloid process in both the cases, and also on the hamate in one patient. An impingement syndrome of this nature has not previously been described and should be kept in mind when patients report ulnocarpal symptoms after PRC.

The modified Clayton-Mannerfelt arthrodesis of the wrist in rheumatoid arthritis: operative technique and report on 93 cases.

Arthrodesis of a painful and destroyed wrist is one of the key operations in patients with rheumatoid arthritis. Clayton is given credit for the first description of an operative technique of wrist arthrodesis by means of an intramedullary Steinmann pin. Mannerfelt popularized this technique by using a Rush pin and additional fixation with staples. The aim of the present article is to give a detailed description of the operative technique used in our hospital. Over a period of 13 years, 104 modified Clayton-Mannerfelt arthrodeses were performed in 87 patients with rheumatoid arthritis. Ninety-three wrists were reviewed clinically and radiographically. The patients had high fusion rates and a reliable reduction in preoperative pain, with a low rate of complications. The pin technique is more versatile than standard wrist arthrodesis plates, and the wrist can be positioned according to the needs of the patient. This technique seems to be a good alternative to conventional wrist arthrodesis using an arthrodesis plate in wrists destroyed by rheumatoid arthritis, even in situations with difficult bone stock. In most cases, it is not necessary to remove the hardware.