[Moje prosthesis for the proximal interphalangeal joint]. / Moje-Prothese im proximalen Interphalangealgelenk.

PURPOSE/BACKGROUND: The purpose of this study was to find out if the Moje implant made of ceramic material can fulfil the clinical expectations that are expected in a replacement of the proximal interphalangeal finger joint (PIP joint). The performance was compared to the results achieved with hands that did not undergo surgery. PATIENTS/MATERIAL AND METHOD: From January 2001 to March 2005 15 patients suffering from primary arthrosis received a total of 21 Moje implants as PIP joint replacements. Computer-assisted data were collected including postoperative range of movement (in both hands), strength, pain reduction, patient satisfaction and number of complications. RESULTS: The average range of motion in PIP joints replaced by the Moje implant was 18.5 degrees (minimum 7 degrees lack of extension to 69 degrees flexion) which correlates to 26% of the ROM of the other hand side). The proportion of pinch strength "thumb opposition to index finger" of the hand that underwent surgery compared to the other side was 56%. Power achieved with the Jamar dynamometer was 94.2% of that, of the non-operated hand. 80% of the patients stated an improvement of their pain situation (more than 2 points on a VAS of 1-5). Most patients were well satisfied with the outcome of the surgery. There was a need for 13 re-operations in 9 fingers. The main problems were loosening of the proximal implant, with subluxation and fractures of the cortical bone. CONCLUSION: The Moje ceramic implant does not fulfil the published ideal attributes for a PIP joint replacement as shown in the clinical results. Even a modification of the prosthesis design in 2004 has not diminished the deficits in range of motion and stability. The implant in its present design shows neither the required performance, nor the ideal attributes needed for an adequate PIP joint replacement.

[Case reports of operative management of very large, benign phylloid tumors--is a safety margin necessary?]. / Fallberichte über operatives Management bei sehr grossen, benignen Phylloidtumoren--Ist ein Sicherheitssaum notwendig?

The phylloid tumor (PT, formerly called cystosarcoma phylloides) is a rare neoplasia of the female breast. Usually the PT is treated with breast-conserving surgery. In spite of progress in early diagnosis, PTs recur frequently--independently of tumor's degree of malignancy. Especially in cases of malignant PT, complete resection with tumor-free margins is seen as the only predictive marker for tumor recurrence or metastases. Benign PT is also often resected with wide tumor-free margins. Because of the tumor's occasionally enormous dimensions, this therapy concept makes breast-conserving surgery almost impossible. A simple enucleation of benign PT is an option to facilitate the preservation of breast tissue and a cosmetically satisfactory breast reconstruction. In the case of particularly large benign PT, enucleation even without wide margins prevents tumor recurrence.