Author Correction: Nanofocusing of hard X-ray free electron laser pulses using diamond based Fresnel zone plates.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

[Dorsal plate arthrodesis of the thumb metacarpophalangeal joint]. / Die Arthrodese des Daumengrundgelenks durch Plattenosteosynthese.

OBJECTIVE: Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. INDICATIONS: Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. CONTRAINDICATIONS: Local infection of the thumb metacarpophalangeal joint area. SURGICAL TECHNIQUE: Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K­wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. POSTOPERATIVE MANAGEMENT: Splint for 3 weeks. Full load after 6-8 weeks. RESULTS: The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.

Compression plate arthrodesis for osteoarthritis of the first carpometacarpal joint: A retrospective study of 77 cases.

Osteoarthritis of the first carpometacarpal joint (CMCJ1) is a common, painful condition with positive radiological findings in up to 32% of people over 50 years of age and up to 91% of people over 80 years of age. Currently, there is insufficient evidence to recommend one surgical treatment option over the others. We conducted a retrospective review of 77 patients treated for CMCJ1 osteoarthritis with plate arthrodesis between 1979 and 1996. The review included physical examination, including range of motion (ROM) of the thumb interphalangeal joint, metacarpophalangeal joint and CMCJ1, pinch grip, key grip and power grip strength, and a questionnaire on subjective outcomes (appearance, dexterity, load bearing, pain, strength, subjective overall result and if patients would choose the procedure again). The complication rate was 26%. However, the general patient satisfaction was high with 88% of patients saying they would choose to have the procedure done again. There was a significant decrease (side-to-side difference) in the ROM for palmar and radial abduction as well as opposition when compared to the opposite hand. Furthermore, there was a significant reduction (side-to-side difference) in pinch, key grip and power grip strength. ROM did not seem to have any influence on pain (and vice versa), load bearing, and the subjective overall result. No gender differences were noted. Despite the high complication rate, CMCJ1 arthrodesis remains a viable option for the treatment of CMCJ1 osteoarthritis in select patients requiring good thumb stability.

[The fibrous skeleton of the hand : Changes with Dupuytren's contracture]. / Das fibröse Skelett der Hand : Veränderungen bei der Dupuytren-Kontraktur.

The exact knowledge of the anatomy of the fibrous skeleton of the hand is an absolute prerequisite for any treatment of Dupuytren's disease. The fibrous skeleton does not only include the palmar aponeurosis, but also numerous retinacula cutis, which are not found in current anatomy books. Here, eponyms facilitate the otherwise difficult and over-pronounced names of the fiber systems. Skoog, Legueu and Juvara, Gosset, Grapow, Grayson, Cleland, Thomine, and Barton are the most important. This systematic review of the fibers and strands is designed to help reduce iatrogenic complications.

Implantation of a denaturated cellulose adhesion barrier after plate osteosynthesis of finger proximal phalangeal fractures: results of a randomized controlled trial.

Adhesions after osteosynthesis of finger proximal phalangeal fractures often cause stiffness. To minimize adhesions, the use of an adhesion barrier has been proposed. The results until now have not been convincing. The aim of this prospective randomized trial was to evaluate the use of an adhesion barrier. The trial included any isolated, closed proximal phalangeal fracture needing plate osteosynthesis. The patients were randomized into two groups: with or without application of the adhesion barrier. The outcomes we measured were finger ranges of motion and DASH score at 6 weeks and 6 months post-operatively. A total of 42 patients (42 fingers) entered the study; 37 completed the study. The key baseline characteristics were comparable. At 6 weeks there was a trend favouring the adhesion barrier that disappeared at 6 months. Overall the results do not support the use of this device.

[Ten Cases of Cryptotia Corrected using Ono's Technique]. / Zehn Fälle von Kryptotie, korrigiert mit der Ono Technik.

Cryptotia is a very rare condition of ear deformity found in Europe which is more common in Asian populations. The upper ear portion is hidden and fixed in a pocket of skin of the mastoid. Conservatively, this deformity can be treated by molding of the posterior sulcus starting early after birth. Various surgical procedures are described in the literature. We successfully operated on a total of 10 ears of 9 patients with the technique described by Ichiro Ono in 1995. Here, a triangular flap is raised above the ear to reconstruct the posterior sulcus together with a rhomboid-shaped flap in the anterior part of the ear in order to elongate the helix. Among all patients, regular contours and a stable and successful outcome was observed.

Features and limitations of mobile tablet devices for viewing radiological images.

PURPOSE: Mobile radiological image display systems are becoming increasingly common, necessitating a comparison of the features of these systems, specifically the operating system employed, connection to stationary PACS, data security and rang of image display and image analysis functions. MATERIAL AND METHODS: In the fall of 2013, a total of 17 PACS suppliers were surveyed regarding the technical features of 18 mobile radiological image display systems using a standardized questionnaire. The study also examined to what extent the technical specifications of the mobile image display systems satisfy the provisions of the Germany Medical Devices Act as well as the provisions of the German X-ray ordinance (RöV). RESULTS: There are clear differences in terms of how the mobile systems connected to the stationary PACS. Web-based solutions allow the mobile image display systems to function independently of their operating systems. The examined systems differed very little in terms of image display and image analysis functions. CONCLUSION: Mobile image display systems complement stationary PACS and can be used to view images. The impacts of the new quality assurance guidelines (QS-RL) as well as the upcoming new standard DIN 6868 - 157 on the acceptance testing of mobile image display units for the purpose of image evaluation are discussed.

[Osteoconductive behaviour of beta-tricalcium phosphate ceramics in osteoporotic, metaphyseal bone defects of the distal radius]. / Osteokonduktive Eigenschaften von Beta-Trikalzium-phosphat in osteoporotischen, metaphysären Radiusdefekten.

BACKGROUND: Surgical treatment of osteoporotic distal radius fractures with locking plates does not completely prevent loss of reduction. Additional bone deficit stabilisation with the use of bone substitute materials is receiving increased attention. Most knowledge on the in vivo behavior of bone substitutes originates from a small number of animal models after its implantation in young, good vascularized bone. PURPOSE: This paper investigates the osteoconductivity, resorption and biocompatibility of beta-tricalcium phosphate as a temporary bone replacement in osteoporotic type distal radius fractures. PATIENTS AND METHODS: 15 bone samples taken from the augmented area of the distal radius of elderly people during metal removal were examined. RESULTS: The material was found to be osteoconductive, good degradable, and biocompatible. Degrading process and remodelling to woven bone seem to require more time than in available comparative bioassays. CONCLUSIONS: The material is suitable for temporary replacement of lost, distal radius bone from the histological point of view.

[Ganglia of the hand and wrist--a retrospective study on the origination of recurrences]. / Ganglien der Hand und Handgelenkes--eine retrospektive Studie zur Rezidiventstehung.

This study examines retrospectively the impact of operative and perioperative factors on the recurrence rate of finger and wrist cysts.Out of a total of 237 recorded cyst operations in 201 patients, 46% were carried out for dorsal wrist ganglia, 38% for finger ganglia, and 16% for palmar wrist cysts. 133 (56%) patients answered on a mailed questionnaire. At an average of 2 years 79 of these 133 patients could be re-examined. Data concerning history, size of the cyst, location of the cyst, the hand surgical experience of the performing surgeon were taken from the charts. Statistical analysis were performed.There were 48 (36.1%; n=133) recurrences. Most (79.2%) occurred within the first year. A higher recurrence rate was observed in patients with a longer history, larger ganglia, and when patients were operated by less experienced surgeons. Recurrence rates did neither correlate with the ganglion location, the patient's age, and gender.

What benefits does ultrasound-guided axillary block for brachial plexus anaesthesia offer over the conventional blind approach in hand surgery?

Axillary block for brachial plexus anaesthesia is a popular anaesthetic technique for hand surgery with different approaches. We investigated the efficacy of the blind and ultrasound-guided approaches administered by a hand surgeon. A total of 141 patients were prospectively randomized to Group A without and Group B with ultrasound guidance. The principal variables evaluated were number of failures, duration of surgery, time to onset of anaesthesia, volume of anaesthetic injected, and complications. The success rate and the mean time to onset of anaesthesia were significantly better under ultrasound guidance. The duration of surgery and the rate of complications did not differ. Ultrasound-guided plexus anaesthesia is markedly more effective than the blind technique when performed by a hand surgeon.

[Propeller flaps: the reliability of preoperative, unidirectional Doppler sonography]. / Propeller-Lappenplastiken: die Reliabilität der präoperativen, unidirektionalen Dopplersonografie.

BACKGROUND: Propeller flaps represent an elegant and reliable method for soft-tissue reconstruction of the extremities and trunk, obviating the need for free tissue transfer. Preoperative localisation of perforators adjacent to the defect is important regarding the pivot point and length of the flap. Most commonly unidirectional Doppler sonography is used. The reliability of this method regarding propellerflaps has not thoroughly been evaluated. The aim of this study is to assess the positive predictive value of this method for planning propeller flaps. PATIENTS AND METHOD: In a total of 68 patients, soft-tissue reconstruction using propeller flaps was planned with unidirectional Doppler sonography. Defects were located on the lower extremity in 48 cases, the buttock area in 15 cases and the trunk in 5 cases. RESULTS: In 12 cases no adequate perforators were located intraoperatively despite a positive Doppler signal. In the lower extremity Doppler produced a false-positive result in 21% of the cases, whereas in the buttock region only 13% false positives result were found. The positive predictive value overall was 82%. When no perforator was located, flap coverage was achieved using the reverse sural artery flap in 6 cases, the free peroneal artery perforator flap in 3 cases, local advancement flaps in 2 cases and skin grafting in 1 case. DISCUSSION: The reliability of unidirectional Doppler sonography is inadequate for localisation and selection of the dominant perforator when planning propeller flaps. A high rate of false-positive results needs to be anticipated especially distally in the extremities. In 18% of cases an alternative surgical plan was required to achieve soft tissue coverage. We recommend using colour duplex sonography for a more reliable preoperative localisation of perforators.

Nanofocusing of hard X-ray free electron laser pulses using diamond based Fresnel zone plates.

A growing number of X-ray sources based on the free-electron laser (XFEL) principle are presently under construction or have recently started operation. The intense, ultrashort pulses of these sources will enable new insights in many different fields of science. A key problem is to provide x-ray optical elements capable of collecting the largest possible fraction of the radiation and to focus into the smallest possible focus. As a key step towards this goal, we demonstrate here the first nanofocusing of hard XFEL pulses. We developed diamond based Fresnel zone plates capable of withstanding the full beam of the world's most powerful x-ray laser. Using an imprint technique, we measured the focal spot size, which was limited to 320 nm FWHM by the spectral band width of the source. A peak power density in the focal spot of 4×10(17)W/cm(2) was obtained at 70 fs pulse length.

[An analysis of the value of bowel preparation for preventing postoperative complications in endoscopic surgery]. / Análisis de la utilidad de la preparación intestinal en la prevención de complicaciones postoperatorias en cirugía endoscópica.

OBJECTIVES: To assess the relationship between mechanical preparation of the bowel before endourological surgery and the occurrence of postoperative complications. MATERIALS AND METHODS: A prospective, randomized study was conducted in 162 patients undergoing TUR of the bladder, TURP, and lase adenomectomy from October 2008 to February 2009. No patient was excluded. An enema was administered before surgery to 66 patients, but not to the remaining patients. Variables analyzed included occurrence of urinary tract infection (UTI), fever, acute urinary retention (AUR), postoperative need for enemas or laxatives, surgical field contamination, and mean hospital stay. A descriptive analysis, a means comparison (t test), and a Chi-square test were performed. RESULTS: Mean patient age was 70.5 years (SD+/-10.62), and mean hospital stay 4.8 days (SD+/-3.9). UTI occurred in 6.2% of patients, fever in 3.1%, and AUR in 1.2%, and 15.4% of patients required enemas or laxatives. Fecal contamination of the surgical field was found in one patient (0.6%). There were no statistically significant differences between the study groups in the variables analyzed. CONCLUSIONS: In our series, bowel preparation using enema has shown no value for decreasing postoperative complications of endourological surgery.

[Factitious disorder and self-mutilation in hand and plastic surgery]. / Artifizielle Störungen und selbstverletzendes Verhalten in der Hand- und Plastischen Chirurgie.

Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented.

Análisis de la utilidad de la preparación intestinal en la prevención de complicaciones postoperatorias en cirugía endoscópica / An analysis of the value of bowel preparation for preventing postoperative complications in endoscopic surgery

Objetivos: Determinar la relación entre la preparación mecánica intestinal previa a la cirugía endourológica y la existencia de complicaciones postoperatorias. Material y métodos: Diseñamos un estudio prospectivo y aleatorizado con 162 pacientes intervenidos mediante RTU vesical, RTU prostática y adenomectomía láser entre octubre de 2008 y febrero de 2009, sin excluir a ningún paciente. A 66 pacientes se les administró un enema previo a la cirugía y a los restantes no. Analizamos la incidencia de infección urinaria (ITU), fiebre, retención aguda de orina, necesidad de enemas o laxantes durante el postoperatorio, contaminación del campo quirúrgico y la estancia media. Realizamos un análisis descriptivo, comparación de medias (t test) y chi cuadrado. Resultados: La edad media fue de 70,5 años (DS±10,62) y la estancia media fue de 4,8 días (DS±3,9). Un 6,2% de los pacientes tuvo ITU, un 3,1% tuvo fiebre, un 1,2% presentó retención aguda de orina y el 15,4% necesitó enemas o laxantes. Se recogió un caso de contaminación con heces del campo quirúrgico (0,6%). No se encontraron diferencias estadísticamente significativas para las variables analizadas entre ambos grupos de estudio. Conclusiones: En nuestra serie, la preparación intestinal mediante el empleo de enemas no ha demostrado utilidad para disminuir complicaciones durante el postoperatorio de cirugía endourológica (AU)

Objectives: To assess the relationship between mechanical preparation of the bowel before endourological surgery and the occurrence of postoperative complications. Materials and methods: A prospective, randomized study was conducted in 162 patients undergoing TUR of the bladder, TURP, and lase adenomectomy from October 2008 to February 2009. No patient was excluded. An enema was administered before surgery to 66 patients, but not to the remaining patients. Variables analyzed included occurrence of urinary tract infection (UTI), fever, acute urinary retention (AUR), postoperative need for enemas or laxatives, surgical field contamination, and mean hospital stay. A descriptive analysis, a means comparison (t test), and a Chi-square test were performed. Results: Mean patient age was 70.5 years (SD+/−10.62), and mean hospital stay 4.8 days (SD+/−3.9). UTI occurred in 6.2% of patients, fever in 3.1%, and AUR in 1.2%, and 15.4% of patients required enemas or laxatives. Fecal contamination of the surgical field was found in one patient (0.6%). There were no statistically significant differences between the study groups in the variables analyzed. Conclusions: In our series, bowel preparation using enema has shown no value for decreasing postoperative complications of endourological surgery (AU)

[The interdisciplinary treatment of Merkel cell carcinoma: a retrospective case analysis and review of the current literature]. / Interdisziplinäre Behandlung des Merkelzellkarzinoms: Eine retrospektive Fallanalyse und aktuelle Literaturübersicht.

BACKGROUND: Merkel cell carcinoma is a rare, -aggressive, neuroendocrine malignancy of the skin. Over the period from June 2005 to January 2007 (18 months) 7 Merkel cell carcinomas in different tumour stages and localisations were treated in our department for hand, plastic and reconstructive surgery. Given an incidence rate of approximately 0.1-0.4 per 100 000 inhabitants, this accumulation of cases is considerably higher than would be statistically expected. This led us to analyse our cases retrospectively and provided the opportunity to discuss the treatment modalities on the basis of the current literature. PATIENTS AND METHODS: All patients were referred to our clinic after incomplete tumour excision and histopathological diagnosis elsewhere, for further surgical treatment. Two female and 5 male patients, aged 63 to 83 years, were treated. The patients' data were collected and analysed retrospectively. RESULTS: In all cases an R0 resection could be achieved, with safety resection margins between 1.5 cm and 4.5 cm. The reconstruction of the resulting defects was achieved by skin transplants in six cases and a primary suture in one case. All patients received adjuvant radiotherapy. Furthermore, three patients received adjuvant chemotherapy due to metastases of the progressed Merkel cell carcinoma. Three patients remained free of recurrence and in two patients a progression of the tumour disease could be impeded, whilst two patients succumbed to their disease. CONCLUSIONS: In the case of an early diagnosis, an R0 resection can usually be achieved. A safety resection margin of a minimum of 1.5 cm in the face and 3 cm for localisation on the extremities should be obtained. To reduce the local recurrence rate, adjuvant radiotherapy should be conducted. The benefit from chemotherapy still remains unclear.