Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures.

A wide range of different classifications exist for distal radius fractures (DRF). Most of them are based on plane X-rays and do not give us any information on how to treat these fractures. A biomechanical understanding of the mechanical forces underlying each fracture type is important to treat each injury specifically and ensure the optimal choice for stabilization. The main cause of DRFs are forces acting on the carpus and the radius as well as the position of the wrist in relation to the radius. Reconstructing the mechanism of the injury gives insight into which structures are involved, such as ruptured ligaments, bone fragments as well as the dislocated osteoligamentous units. This article attempts to define certain key fragments, which seem crucial to reduce and stabilize each type of DRF. Once the definition is established, an ideal implant can be selected to sufficiently maintain reduction of these key fragments. Additionally, the perfect approach is selected. By applying the following principles, the surgeon may be assisted in choosing the ideal form of treatment approach and implant selection.

[Arthrotenolysis of the proximal interphalangeal joint of the fingers. Operative technique and results]. / Arthrotenolyse der Fingermittelgelenke (PIP). Technik und Ergebnisse.

From 1994 to1999, 24 patients were subjected to tenoarthrolysis of the PIP joint by a single surgeon for various reasons. All cases were documented by the surgeon in photographs and the achieved extent of mobility was followed up to at least one year postoperatively. All results were documented in photographs or on video films. The patients did not have conventional arthrolysis following injury of the capsular ligaments of the PIP joint (with the exception of one case), but complex injuries of bone, flexor tendons, diseases, and conditions after infections, some of which had occurred up to seven years previously. Four patients had been subjected to tenoarthrolysis twice, one had undergone tenoarthrolysis even three times. Five joints were fully ankylotic before surgery and had 0 degrees of mobility. All cases were referred from external surgeons. It was not possible to find common denominators for these cases and to include them in a regular study. The sole criterion used for assessment, which has also been used in comparable studies, was preoperative mobility and the postoperative mobility achieved after one year. Preoperative mobility in the PIP joint was on average 27.5 degrees (range, 0 - 60) and could be increased to a mean of 70 degrees (range, 0 to 120) after one year. Thus, an improvement of 42.5 degrees was achieved. As the cases were very different, this study will probably be no more than a case presentation. Nevertheless, based on a careful assessment of video films and photographs and the results achieved in individual cases, conclusions may be drawn regarding technique, surgical planning and prognosis. The author believes that although the data does not suffice to make up a valid study, they still are worthy of presentation.

[Dorsal V-ligament reconstruction in scapholunate instability]. / Die dorsale V-Bandplastik zur Therapie der posttraumatischen skapholunären Instabilität.

In dynamic and static scapholunate instability after trauma, the repair of the scapholunate ligament is important to avoid scapholunate advanced collapse of the wrist. Direct suture even of fresh-torn ligaments can be technically demanding and occasionally unreliable, thus reconstruction may require additional tissue beside the ligament. Eighteen patients suffering from dynamic (n = 10) and static (n = 8) scapholunate instability were treated by a dorsal ligament reconstruction six months after trauma. A clinical wrist score according to Cooney showed an average of 86 points (maximum 100) within a follow-up of nineteen months after surgery. X-ray films documented no significant loss of scapholunate reduction. Using local tissue only, this method is always possible, very reliable and easy to perform.

[Case report of segmental neurofibromatosis of the 3rd finger ray]. / Fallbericht uber eine segmentale Neurofibromatose des dritten Fingerstrahls.

We report on a 36-year-old woman suffering from a segmental neurofibromatosis solely confined to the third finger. Microscopically, the tumor showed mesenchymal tissue containing myxoid material with features of the nerve sheath--myxoid neurofibroma. The tumor was characterized by the peculiar tendency to grow in a multifocal pattern involving the distribution of every nerve of one finger, by an extreme proneness to local recurrences as well as by a concomitant bone defect.

[Distorsions and dislocations of the finger joints]. / Distorsionen und Luxationen der Fingergelenke.

Injuries of the finger joints with damage to the capsule and ligaments are quite common. Nevertheless early diagnosis may be missed since patients look for relief only after a period of longstanding pain. A careful clinical and X-ray diagnosis is the prerequisite for appropriate treatment. Surgery is still indicated for most of the injuries of the ulnar ligament of the MP-joint of the thumb. Sprains or dislocations of the middle joint of fingers are quite usual. In most instances they may be treated by immobilisation or functional treatment. Persistent subluxation after reduction of the joint or large avulsion-fractures have to be treated by open surgery. Injuries of the MP-ligaments are frequently misinterpreted. Their treatment should be based on a very careful evaluation of the case.