[Treatment of acute injuries of the hand]. / Tipps und Tricks in der Behandlung offener Handverletzungen in der Notfallpraxis.

Treatment of acute injuries of the hand Abstract. Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. But first, we highlight the different methods of local anesthesia and discuss the use of a tourniquet or vasoconstriction with adrenalin - WALANT - instead.

Ranibizumab and Bevacizumab but Not Aflibercept Inhibit Proliferation of Primary Human Retinal Pigment Epithelium in vitro.

AIM: Treatment of exudative age-related macular degeneration by using vascular endothelial growth factor (VEGF) antagonists is the gold standard today. So far, several bioactive molecules have been approved for therapeutic use. In this study, we investigate the effects of ranibizumab (Lucentis®), bevacizumab (Avastin®), and aflibercept (Eylea®) on primary human retinal pigment epithelial (hRPE) cells in vitro. METHODS: hRPE cells were prepared from donor eyes and cultured under standard culture conditions. Scleral fibroblasts also prepared from donor tissue served as physiological controls. The impact of the anti-VEGF molecules on cell viability was investigated with the trypan blue exclusion assay, whereas proliferation was measured using the MTT assay. Biological activity of the molecules was quantified in a VEGF-enzyme-linked immunosorbent assay (ELISA). RESULTS: All tested substances were biologically active in vitro. They displayed no cytotoxicity on RPE cells or scleral fibroblasts. However, proliferation of RPE cells was significantly decreased after treatment with ranibizumab or bevacizumab but not with aflibercept. CONCLUSIONS: The humanized antibodies (fragments) interfered specifically with the RPE cells. The thereby measured inhibition of cell proliferation may indicate possible side effects on the physiology of RPE cells.

The first 100 patients treated with a new anatomical pre-contoured locking plate for clavicular midshaft fractures.

BACKGROUND: Pre-contoured locking plates were recently introduced in the management of clavicular midshaft fractures. These plates may offer advantages such as no necessity for intraoperative bending and reduced plate irritation. The purpose of this study was to review the clinical and radiographical outcome of the first 100 patients treated with a new anatomical pre-contoured locking plate. METHODS: In a retrospective single-center study, 100 consecutive patients (16 female, 84 male) with a median age of 40 years (range 15-82) who underwent surgery for clavicular midshaft fractures with a VariAx locking plate (Stryker Corporation Kalmazoo, MI, USA) between March 2012 and January 2016 were included. Postoperative follow-up was performed until union was clinically and radiographically achieved. Fracture type, surgical time, intraoperative need for contouring the plate, further surgery such as revision or hardware removal and complications were recorded. RESULTS: One-hundred patients with a dislocated midshaft clavicular fracture with a mean follow-up of 21.9 months (standard deviation 13.2) were included. Ninety-three patients reported normal shoulder function at latest follow-up. Median surgical time was 75.5 min (range, 35-179). In three patients, intraoperative bending of the plate was necessary. In two patients, plates designed for the other side were implanted. Five patients needed revision surgery: One patient with wound healing problems, one patient with a re-fracture after early (13 months) hardware removal and minor trauma, one patient with postoperative shoulder stiffness and two patients with failed osteosynthesis because of surgical implantation fault. One asymptomatic nonunion without further treatment was observed. In 30 patients, the plate was removed after a mean of 17.5 months (SD 4.2) because of subjective plate discomfort. CONCLUSIONS: With this new pre-contoured locking plate, good to excellent intraoperative fit to the anatomical shape of the clavicle can be achieved. The implant seems to be reliable regarding handling and complications. Clinical and radiological results are comparable to results reported in the literature. Hardware removal rate is comparable to other studies with a pre-contoured plate and lower compared to non-pre-contoured.

Bone-Preserving Arthroplasty With Abductor Pollicis Longus Tenodesis for Trapeziometacarpal Osteoarthritis.

Purpose: The objective of this study was to describe an original method of bone-preserving arthroplasty with abductor pollicis longus (APL) tenodesis and determine its safety and effectiveness as a treatment for early-stage osteoarthritis of the trapeziometacarpal joint. Methods: Eleven patients underwent a trapezium-preserving arthroplasty with APL tenodesis for stage 1 and 2 osteoarthritis were retrospectively reviewed. This arthroplasty consisted of a distally-based APL tendon being passed through the trapeziometacarpal joint. The proximal end of the tendon was then pulled and passed through a drill hole made at the neck of the second metacarpal and sutured to itself. Thus, distraction of the first metacarpal and interposition of the tendon were created. Postoperative radiologic and clinical follow-up visits were performed at 4, 8, and 12 weeks. Range of motion and strength were assessed after surgery. Patient satisfaction and outcome were assessed, and the disabilities of the arm, shoulder, and hand (DASH) score was used. Results: After a mean follow-up of 29.5 months (range, 16-43 months), the mean patient visual analog scale pain score improved from 7.1 to 2.3. The average DASH score of all patients at the follow-up examination was 18.3 ± 19.8. Patients' mean grip strength was 25.3 kg, which represented 102% of the value on the contralateral side. The key-pinch strength was 6.2 kg on the operated hand compared with 6.5 kg on the contralateral side. The mean thumb opposition Kapandji index was 9.4, which was similar to that of the contralateral side. Three patients were very satisfied with the postoperative outcome and 3 patients were satisfied. Two patients were lost to follow-up, 1 patient did not consent to share her data, and 2 patients had to undergo trapeziectomy. Conclusions: Although a larger study population and a longer follow-up period are needed to draw conclusions, bone-preserving arthroplasty with APL tenodesis showed satisfying results in patients presenting with early-stage osteoarthritis. This method is technically simple and time-efficient, does not reduce the range of motion, and leaves open all other surgical options. Type of study/level of evidence: Therapeutic IV, Case Series.