[Experiences with the STT (scapho-trapezio-trapezoid) arthrodesis. A retrospective evaluation]. / Erfahrungen mit der STT-Arthrodese. Eine retrospektive Auswertung.

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

[Is mini-screw osteosynthesis a suitable procedure in surgical treatment of intra-articular distal phalanx fractures?]. / Ist die Minischraubenosteosynthese ein geeignetes Verfahren in der operativen Behandlung bei intraartikulären Endgliedfrakturen?

In a retrospective clinical study, the results of operative treatment of intraarticular fractures of the distal phalanx were studied. From February 1992 to December 1998, 75 patients were treated operatively, 47 were examined. 14 patients were treated with Lengemann wire and temporary transfixation of the DIP joint, 25 patients were treated with screw fixation and in eight patients another procedure (wire suture, Kirschner wire, "Hakendraht", combination of screw and wire) was used. All patients had little or no pain. All patients had no or only little limitation in activities of daily living. Two patients after screw fixation had serious limitations. Four patients after Lengemann wire fixation had an extension lag in the DIP joint of up to 10 degrees, four patients between 11 and 20 degrees and one patient 25 degrees. 19 patients after screw fixation had an extension lag of the DIP joint of up to 10 degrees, five patients between 11 and 20 degrees and one patient of 25 degrees. Arthrosis of the DIP joint was seen in five patients after Lengemann wire fixation and in two patients after screw fixation. Screw fixation in the treatment of intraarticular fractures of the distal phalanx is a good, but demanding procedure with the potential for exact reconstruction of the joint surface, since implant removal is not necessary.

[Radiologic diagnosis of lunate necrosis]. / Radiologische Diagnostik der Lunatumnekrose.

In the literature little is to be found concerning diagnosis and differential diagnosis of Kienböck's disease. Because of technical development in radiological imaging, we now possess very detailed pictures. However, there are many radiological findings within the lunate bone, which can be misinterpreted as Kienböck's disease. Pathological findings of the lunate bone are demonstrated, which are not Kienböck's disease. These findings were compared to different stages of Kienböck's disease and identified. The early stages of Kienböck's disease show changes especially in the MRI, which are very similar to acute bone bruise, ulnar impaction syndrome, synovialitis or gout. Vessel tubes or an intraosseous ganglion can be mistaken for Kienböck's disease. In the late stages of Kienböck's disease, it can be difficult to differentiate this from pseudarthrosis of the lunate bone. The differentiation between Kienböck's disease and other pathological findings is at times very difficult--even with MRI. However, sometimes diagnosis can only be verified by MRI. We therefore suggest that Kienböck's disease must be correctly diagnosed with help of the MRI before commencing with any therapeutic steps.

[Treatment of difficult scaphoid pseudarthroses by bone transplantation and additional implantation of the second dorsal metacarpal artery using the Fernandez and Eggli technique--report of experiences]. / Behandlung schwieriger Skaphoidpseudarthrosen durch Knochentransplantation und zusätzliche Implantation der zweiten dorsalen Metakarpalarterie in der Technik nach Fernandez und Eggli--Erfahrungsbericht.

One of the procedures for the treatment of scaphoid-nonunion with loss of blood supply to the proximal fragment involves the technique described by Fernandez and Eggli (1995). After resection of the necrotic bone and inserting a corticocancellous bone graft from the iliac crest, the second dorsal intermetacarpal artery is implanted into the proximal fragment of the scaphoid. In our hospital, six patients underwent this procedure from May 1998 to June 2000 because of necrosis of the proximal pole or an unsuccessful previous operation. Union was achieved in five patients. In one case, nonunion persisted and the cystic area increased. The described technique is suitable for improvement of bone healing of the scaphoid in complicated cases. The advantages of this technique lie in the predictable anatomy of the second intermetacarpal artery and the straightforward dissection.

[Fractures near the base of the first metacarpal bone--clinical outcome of 21 patients]. / Basisnahe Frakturen des ersten Mittelhandknochens--Untersuchungsergebnisse von 21 Patienten.

Fractures of the base of the first metacarpal are particularly common. The present examination was carried out in order to find out a correlation between the clinical outcome and the type of the fracture, the quality of reduction, the surgical procedure, and the extent of osteoarthrosis. From February 1992 to August 1997, 24 patients with Bennett fracture-dislocation, Rolando fracture und extraarticular fracture--eight patients in each group--were treated operatively. After a median interval of 33 months, 21 patients were reviewed. The evaluation was done using a new score with subjective (pain and utility) and objective (strength and range of motion) parameters. The "DASH score" was also used. Excellent results were found in the intra- and the extraarticular fractures. The extent of palmar abduction was 98% and 86% of the contralateral side in Bennett and Rolando fractures, 90% in extraarticular fractures. Key pinch was 93%, 77%, and 90% of the contralateral side (Bennett, Rolando and extraarticular fractures). This means 97, 85, and 87 points in the new score and 100, 93, and 85 points in the DASH score. The results after intraarticular fractures did not correlate with the type of treatment. Osteoarthrosis was found to correlate with the quality of reduction of the fracture, but remained asymptomatic. Intraarticular fractures have no worse prognosis. Nevertheless, exact reduction, either by the open or closed method, should be the aim of treatment.

[Graner operation in therapy of semilunar bone necrosis. Review of the literature and personal results]. / Operation nach Graner zur Therapie der Lunatumnekrose. Literaturübersicht und eigene Ergebnisse.

Intercarpal arthrodesis with interposition of the capitate osteotomized in Graner's technique is performed in the treatment of stage III Kienböck's disease. Although clinical results are satisfactory, there are complications such as necrosis of the capitate, pseudarthrosis of the capitate, and arthrosis of the radiocarpal joint. From 1992 to 1995, twenty patients were treated for Kienböck's disease by Graner's technique in the Clinic of Hand Surgery II in Bad Neustadt/Saale. Seventeen patients were submitted to follow-up studies. The range of motion (extension/flexion) of the wrist was 55 degree. The grip strength was 67% of the other hand. Four patients continued to complain of pain. Necrosis of the capitate was found in four cases, pseudarthrosis in two cases, and arthrosis of the radiocarpal joint in five cases. Based on the poor X-ray results found in this review, the authors feels there is no indication for Graner's technique. They favor STT arthrodesis in stage III of Kienböck's disease.

[Causes for reoperations after osteosyntheses of finger and mid-hand fractures]. / Ursachen von Nachoperationen nach Osteosynthesen von Finger- und Mittelhandfrakturen.

31 patients reoperated after osteosynthesis of a metacarpal or a phalangeal fracture were reviewed over a period of three years. The cause of injury was in 18 cases a crush, in six cases a fall, in five cases a saw injury, and in two cases axial trauma. A postoperative plaster splint immobilisation over a period of at least three weeks was carried out in 29 cases. Reoperation was necessary in most of the cases because of a loss of range of motion and a nonunion. The complication rate was independent of the method of fixation, but did depend on the type of injury. Fractures associated with soft tissue injury were more likely to develop complications.