Severe contracture of the proximal interphalangeal joint in Dupuytren's disease: does capsuloligamentous release improve outcome?

This prospective study assessed whether patients with severe proximal interphalangeal joint contracture (#10878;60 degrees ) due to Dupuytren's disease which persisted after fasciectomy alone benefited from an additional capsuloligamentous release. Forty-three patients with 43 severely contracted proximal interphalangeal joints underwent operative correction followed by a standardized postoperative rehabilitation programme. All were followed for 6 months. In 11 patients correction of the proximal interphalangeal joint to 20 degrees could not be achieved by fasciectomy alone, and an additional capsuloligamentous release was performed which effectively corrected all their residual flexion contractures. There were no statistically significant differences between the capsulotomy and the non-capsulotomy group with respect to the residual proximal interphalangeal joint contracture at the end of surgery, or at their last follow-up examination.

[Preoperative Intermittent Pneumatic Soft-Tissue Distraction in Patients with severe Dupuytren's Contracture]. / Die präoperative intermittierende pneumatische Dehnungsbehandlung bei ausgeprägter Dupuytrenscher Kontraktur.

PURPOSE: Evaluation of the outcome of preoperative intermittent pneumatic soft tissue distraction (IPD) in patients with severe contractures in Dupuytren's disease with special regards on recurrent deformities. METHOD: In a prospective study, nine patients with Dupuytren's contracture grade III and IV according to the classification of Tubiana were treated with a preoperative intermittent soft-tissue distraction using a pneumatic extension device followed by a standardized operative correction and follow-up program. Sixteen fingers were involved: grade I and II four fingers, grade III and IV twelve fingers. Nine fingers - grade III and IV seven fingers - in six patients had a recurrent deformity. RESULTS: The preoperative reduction of contracture simplifies the surgical treatment. Preoperatively using the IPD, the flexion contracture was reduced between 5 and 60 degrees. With an average of 29 (10 to 60) degrees, the improvement was greater in fingers with severe contracture (grade III and IV according to Tubiana) than in fingers with a minor contracture averaging 10 (5 to 25) degrees. In fingers with recurrent deformity, the reduction of the flexion contracture averaged 27 (5 to 60) degrees. There were no complications leading to break off of the distraction. CONCLUSION: The intermittent pneumatic distraction is a good alternative to the method introduced by Messina for preoperative soft-tissue distraction in patients with severe Dupuytren's contracture.

[Severe contracture of the proximal interphalangeal joint in Dupuytren's disease: does capsuloligamentous release improve outcome?]. / Die fortgeschrittene Dupuytrensche Kontraktur des Mittelgelenkes: Ist die Arthrolyse bei fortbestehender Fehlstellung nach Resektion des Kontrakturgewebes sinnvoll?1.

Purpose. Evaluation of effectiveness of capsuloligamentous release in severe PIP joint contractures in Dupuytren's disease. Method. Prospective study to compare the clinical outcome of eleven patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom an additional capsulotomy was performed to reduce a residual flexion contracture of the PIP joint of 20 degree and more after release and excision of all diseased fascia, with the outcome of 32 patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom the PIP joint contracture could be reduced by fasciectomy alone. Preoperatively all patients had a severe flexion contracture (60 degrees or greater) of one PIP joint. All patients underwent standardized operative treatment and postoperative extension splinting program for six months. Follow-up examinations included assessment of active range of motion at two, four, ten, 16 and 24 weeks after surgery. Results. In the noncapsulotomy group, preoperative contracture averaged 70.6 degrees and intraoperative residual contracture averaged 2 degrees. In the capsulotomy group, preoperative contracture averaged 78.6 degrees. Intraoperative residual contracture averaged 61.8 degrees before and 2 degrees after capsulotomy. At the final follow-up examination, PIP joint flexion contracture averaged 15 degrees in the noncapsulotomy group compared to 16 degrees in the capsulotomy group. Conclusion. Residual flexion contracture of a PIP joint after release and excision of all diseased fascia in Dupuytren's disease can be reduced by capsuloligamentous release. The data of this study showed no significant differences in the outcome at the final follow-up examination between patients with and without capsulotomy. Therefore, we recommend capsulotomy as treatment of residual flexion contracture of the PIP joint in Dupuytren's disease.

[Bone growth after finger replantation in childhood]. / Das Knochenwachstum nach Fingerreplantationen im Kindesalter.

Following replantation in childhood, growth disorders of the affected epiphysis can influence function and aesthetic appearance of the hand. In a retrospective study long-term results of replantation in the upper limb in childhood were analysed with respect to factors influencing further growth. 22 patients with 29 replanted fingers were reviewed clinically and radiologically after an average interval of ten years. An average bone growth of 93% compared to the contralateral non-injured side was found. With the epiphysis affected, bone growth was reduced to 86% of the contralateral side. Analysis of single phalanges showed a growth rate of 71 to 100% in phalanges distal to the amputation and also in phalanges initially severed. Potential factors influencing bone growth were assessed separately. Best results were achieved in straight injuries without epiphyseal affection. An influence of anoxia time or number of anastomosed vessels could not be found. Even though replantation in childhood affects growing bone, almost normal bone growth can be expected afterwards.

[Simultaneous management of multi-fragment distal radius fractures with palmar and dorsal approach]. / Die gleichzeitige Versorgung mehrfragmentärer distaler Radiusfrakturen von einem palmaren und dorsalen Zugang.

Reconstruction of the articular anatomy can be extremely difficult in distal radius fractures with severe comminution of both the dorsal and palmar cortices. In these cases, neither open reduction using an unilateral approach nor closed reduction with ligamentotaxis and fixateur externe will be successful. Reconstruction of both the dorsal and palmar cortical column is necessary. Sixteen of nineteen patients with unstable bicolumnar distal radius fractures treated by a combined plate osteosynthesis were studied retrospectively. Follow-up time averaged 32.5 months (8 to 74). At the time of re-examination the average grip strength and range of motion were reduced by 30% compared with the uninjured side. The average DASH-score was 11.2 points. Radiographic measurements revealed a satisfactory restoration of the radius concerning length and form. There were no signs of higher graded arthrosis.

[TFCC (Triangular Fibrocartilage Complex) lesions. Diagnosis and therapy]. / TFCC-Läsionen. Diagnostik und Therapie.

Lesions of the TFCC may have degenerative or post-traumatic causes. Distal radioulnar joint as well as the ulnocarpal joint can be affected. Patients present with ulnar-sided wrist pain especially in forearm rotation. Therapy depends on the degree of lesions and additional pathology. Wrist arthroscopy offers a certain diagnostic tool. In addition, adequate therapy can be realized. After failed arthroscopic therapy, ulnar shortening osteotomy reduces ulnar load significantly.

Severe Contractures of the Proximal Interphalangeal Joint in Dupuytren's Disease:Value of Capsuloligamentous Release.

A retrospective review of severe flexion contractures (60 degrees or more), involving 51 proximal interphalangeal joints in 40 patients with Dupuytren's disease, was performed. Thirty-two joints underwent aponeurectomy alone, 19 joints additional capsuloligamentous release. Mean follow-up was 12 months. No statistically significant difference was seen in the percentage of contracture correction in the capsulotomy group compared with the noncapsulotomy group.

TFCC lesions. Diagnosis and therapy.

Lesions of the TFCC may have degenerative or post-traumatic causes. Distal radioulnar joint as well as the ulnocarpal joint can be affected. Patients present with ulnar-sided wrist pain especially in forearm rotation. Therapy depends on the degree of lesions and additional pathology. Wrist arthroscopy offers a certain diagnostic tool. In addition, adequate therapy can be realized. After failed arthroscopic therapy, ulnar shortening osteotomy reduces ulnar load significantly.

[Radiological thorax monitoring in ventilated intensive-care patients]. / Radiologisches Thoraxmonitoring bei beatmeten Intensivpatienten.

PURPOSE: At many institutions chest x-rays (CXR) are routinely performed on mechanically ventilated patients on a daily basis. Among the aims of this study was the assessment of a) frequency of clinically relevant findings from routine CXR in surgical patients under mechanical ventilation, b) comparison of expectations of clinically important CXR findings with estimation of clinical relevance of findings once films were obtained, c) indications and clinical consequences of findings from CXR requested in addition to routine films. METHODS: Prospective study, 40 patients with 741 CXR. Standardised film reporting. Daily recording of clinical data by means of an evaluation score. Interview of intensive-care physicians for assessment of: what information was expected from any routine CXR? did CXR offer helpful information for further treatment planning? RESULTS: 26% of routine CXR had a considerable therapeutical impact. 43% of all routine CXR were expected to have an influence on patient management, 57% were not. 16% of those CXR that had been expected not to offer essential information, disclosed relevant findings. Of the additionally obtained CXR, 53% were performed to check position of endotracheal tube and catheters and 47% related to other indications. CONCLUSION: Critically ill surgical patients under mechanical ventilation should have daily CXR follow-up, as one-fourth of these films has an impact on the patient's management.

[Daily "routine chest x-ray" in ventilated surgical intensive care patients]. / Der tägliche "Routine-Röntgenthorax" beim beatmeten chirurgischen Intensivpatienten.

We investigated the relevance of daily routine chest x-ray in intensive care for therapeutical decision. A special emphasis was put on clinical laboratory parameters according to the APACHE-II-score. Within a prospective study we investigated 40 intubated patients of our surgical intensive care unit with a total of 609 x-ray films. 26% of all pictures gained influence on therapeutical procedure. Analysis of different patient subgroups showed only between those under 50 and those above 70 years of age an important discrepancy quote of relevant films (19 vs. 31%).

[Consequences of routine gastroscopy before cholecystectomy]. / Konsequenzen der routinemässigen Gastroskopie vor Cholezystektomie.

In a retrospective study of 610 patients the role of routine gastroscopy prior to cholecystectomy was investigated. The results demonstrated that only in a low incidence (11% of patients gastroscopied) relevant findings are present. However, most of these patients had a typical history. Therefore, despite risks, routine preoperative endoscopy prior to cholecystectomy should be performed only in patients with a history of upper abdominal pain or discomfort.

[Incidence of acetabular fractures before and after introduction of compulsory seatbelt fastening]. / Häufigkeit der Hüftpfannenfrakturen vor und nach Einführung der Gurtanschnallpflicht.

The most common causes of acetabular fractures of the hip joint are high speed car accidents, most often as a result of a direct trauma against the knee. With these causal relations in mind this study wanted to show the preventive character of the law for obligatory safety-belt-wearing in Germany introduced in August 1984. Therefore we analyzed the incidence and the severity of acetabular fractures of the hip joint five years before and five years after 1984 within the group of patients treated by the traumatology department of the university hospital of Mainz. We found 54 patients with acetabular fractures of the hip joint, within a period of five years after 1984 in contrast to 84 injuries within an equal five year period before 1984. Car accidents where the cause of injury in 63 cases within the period of five years before 1984, and in 23 cases in the same period after 1984. Also the severity and complexity of these injuries decreased significantly. Therefore we consider the introduction of obligatory safety-belt-wearing in Western Germany as a good preventive measurement to reduce the incidence of acetabular fractures of the hip joint as a result of car accidents.

Determination of biogenic amines in meat by combined ion-exchange and capillary gas chromatography.

A procedure is described for the determination of putrescine, cadaverine and histamine in meat. Crude perchloric acid extracts were pre-separated on a weakly acidic cation exchanger and the amines quantified by capillary gas chromatography. The diamines were analysed as trifluoroacetyl derivatives and histamine was converted into N alpha-trifluoroacetyl-N tau-ethoxycarbonylhistamine. The accuracy of the determination of diamines was examined by a precipitation pre-separation method and by mass fragmentometric quantification. The proposed procedure allows the sensitive, sufficiently precise and highly specific determination of putrescine and cadaverine in meat.