[Rare case of palmar disc dislocation after wrist distorsion]. / Seltener Fall einer palmaren Diskusluxation nach Handgelenkdistorsion.

OBJECTIVE: The aim of this study was the elaboration of clinical symptoms and image findings in injuries of the wrist and ulnar-sided pain with accompanying damage to the articular disc and the triangular fibrocartilage complex (TFCC). MATERIAL AND METHODS: This article reports about a 26-year-old male patient who presented to the department of surgery of this hospital after repeated falls onto the right wrist. Following the latest fall there was persistent wrist pain and limited movement, especially in supination. The physical examination showed pressure pain above the ulnocarpal complex; however, under forced pronation and supination no pain in the ulnocarpal complex could be triggered. RESULTS: Due to the symptoms damage to the TFCC was suspected and a magnetic resonance imaging (MRI) examination of the wrist was carried out. A TFCC damage reaching as far as the dorsal radioulnar ligament involving the dorsal suspension was demarcated with dislocation and displacement of the disc. For further differentiation of the damaged structures arthrography was performed and contrast medium containing gadolinium was injected into the joint gap. The imaging showed avulsion of the dorsal triangular disc from the dorsal suspension with volar dislocation. Treatment was continued with an arthrotomy by the formation of an ulnar pedicled capsular flap, the luxated TFCC was repositioned, central frayed and torn parts were resected and smoothed. Finally, the TFCC was refixed with two 3/0 PDS U­sutures. CONCLUSION: Ulnar-sided wrist pain can be caused by a variety of clinical pathologies, so that often no diagnosis can be made based on clinical symptoms alone and an imaging method is required; however, for a clear assessment of the ligament or joint injuries an MRI is necessary. Particularly for the evaluation of the TFCC injuries MRI is a sensitive diagnostic method. In the decision making, especially when atypical injury patterns are present, an arthrography should be performed in addition to MRI to obtain the best possible information on the anatomical circumstances. KEY POINTS: In cases of injuries of the wrist and ulnar-sided pain collateral damage to the articular disc and the TFCC should always be considered and excluded when appropriate. A dislocation of the disc at the wrist is a rare consequence of trauma but should be considered in the differential diagnosis. In cases of unclear MRI results and complex injuries of the wrist or unclear symptoms, MR arthrography can be helpful.

Analysis of Operative Techniques of Fractures of the First Metacarpal Base.

INTRODUCTION: Over time, the operative treatment of extra-articular and intra-articular fractures of the first metacarpal base has gained significant importance, and at present, there are many operative strategies available because of the different osteosynthesis procedures in practice today. PURPOSE: In this retrospective cohort study, we analyze the possible differences between 2 distinguished operative osteosynthesis techniques, in terms of patient outcome, operation time, duration of radiation exposure, and postoperative radiographic results. METHODS: Fifty-two patients operated on for first metacarpal extra-articular or intra-articular base fracture were investigated retrospectively by means of records. After reduction, osteosynthesis was performed on 34 patients with K-wires (group I), and on 18 patients with plates and/or screws (group II). Of the 52 patients, 19 were available for a prospective follow-up examination. RESULTS: After analyzing the operation time, a significant difference between the 2 operative techniques for epibasal and Bennett fractures (P = 0.0089 and P = 0.02) was recorded. Furthermore, for the time of radiation exposure, no significant difference could be detected. Also, no statistical difference was found between the 2 analyzed groups in terms of patient outcomes and postoperative radiographic results. CONCLUSIONS: The determined data of the operated extra-articular and intra-articular first metacarpal base fractures revealed approximately equal results for patient outcome, postoperative x-ray results, and time of radiation exposure during the operation. After analyzing the operation time of epibasal and Bennett fractures, we can recommend that the K-wire fixation is superior to the plate and/or screw osteosynthesis as a treatment, because of the associated benefits of keeping costs low without harming the patient in the long term.

[Dentogene Focus as a Rare Cause of Necrotizing Fasciitis]. / Dentogener Fokus als Ursache für eine nekrotisierende Fasziitis.

History and clinical findings We elaborate the case of a 72-year-old patient who presented with a painful swelling of the lower jaw in the emergency unit. Investigations and diagnosis In the clinical examination and the CT scan, a widespread cervical emphysema was found which raised suspicion for the presence of a necrotizing fasciitis of the head and neck due to aerogenic infection. Close spatial vicinity to the teeth of the left upper and lower jaw was present, so that the necrotizing fasciitis was assumed to be odontogenic. Treatment and course Based on the clinical presentation and the imaging findings the diagnosis of necrotizing fasciitis in the sense of a possible infection with gas building bacteria accompanying with an infection of the mediastinum was made. Immediately performed therapy included sternotomy and extended surgical debridement of necrosis. Conclusion The presented case emphasizes that necrotizing fasciitis due to gas-producing infections should be considered as a differential diagnosis for cervical soft tissue emphysema for which an odontogenic focus is the most common cause. Rapid diagnosis is essential for successful treatment consisting of immediate surgical debridement and intravenous antibiotics.

Refinement of Tissue-Engineering Chamber Implantation in the Rat.

PURPOSE: Rodent in vivo models that successfully generate new adipose, muscle, or vascular tissue in a tissue-engineering chamber (TEC) has advanced in the last decade. In this article, technical refinements in these operative foreign body implantations have been described to improve the execution of animal models in a way so that they can reduce wastage of time and resources. MATERIALS & METHODS: Male Sprague-Dawley rats were studied and randomly divided into two equal sized groups. In each group, a different operative procedure was used for implanting the TEC. Twenty animals were operated with diagonal incisions in the groin region, followed by staples for wound closure after TEC implantation. The remaining 20 animals received longitudinal incisions in the abdominal region followed by wound closure with ongoing intradermal nonresorbable sutures and skin glue. The outcome of both procedures with regard to complications, animal growth, and experimental failure was compared. Statistical analysis was performed using the nonparametric chi-squared (χ2) test. RESULTS: Significant difference in wound dehiscence was recorded in Group I as compared to Group II (p = 0.0001). Consequently, 55% of the experiments had to be aborted in Group I and the animals were removed from the experiment. On the contrary, in Group II, all the animals could be kept. CONCLUSION: Median longitudinal incisions and thorough wound closure with ongoing intradermal nonresorbable sutures, followed by application of skin glue, are strongly recommended to prevent surgical site complications, such as wound dehiscence, animal harm, and failure of the individual experiment.

Poly-guanosine strings improve cellular uptake and stimulatory activity of phosphodiester CpG oligonucleotides in human leukocytes.

CpG-oligonucleotides (CpG-ODN) have been shown to exert strong immuno-stimulatory effects through activation of Toll-like receptor 9 (TLR-9). However, TLR-9 triggering takes place in endosomal compartments and thus CpG-ODN have to be taken up prior to signal transduction. We here report that 3'-poly-guanosine strings can improve cellular internalisation of phosphodiester but not of phosphorothioate CpG-ODN. Improved cellular uptake correlated with enhanced IL-6 secretion and proliferation of PBMC. Also, TLR-9 transfected HEK293 cells were activated more efficiently by poly-guanosine modified CpG-ODN. The results indicate that the synthesis of stimulatory CpG-ODN based on a phosphodiester backbone is feasible via such poly-guanosine substitutions. In addition we observed that phosphorothioate ODN were able to exert immunostimulatory effects independent of the presence of CpG motifs.