Acral melanoma of the heel mimicking a pressure sore.

Background: The clinical appearance of acral melanoma is diverse and can cause diagnostic difficulties in individual cases. Case description: We present a clinical case of an 83-year-old patient with a melanoma in the heel area that was initially interpreted as a pressure ulcer, resulting in delayed and more complicated treatment. Conclusions: Melanomas should be included in the differential diagnosis even in "typical" pressure ulcer areas. Against the background of increasingly poor healthcare in rural areas, an increase in such cases can be expected.

Results of a patient survey using an online questionnaire after implant removal for breast implant illness.

The use of silicone breast implants has a history of over 60 years. In recent years, specific health issues among implant wearers have repeatedly come into focus. The term "breast implant illness" has been circulating in scientific literature and on social media for several years. It describes a cluster of up to 60 different symptoms. The present results of an online survey conducted within a clinic's patient population of the last 8 years show, among other things, the evolution of 8 reported symptoms before and after breast implant removal. In the comparison before and after, there is a significant reduction in the intensity of symptoms after implant removal. A causal relationship with the removal of the implants is to be presumed.

Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes®): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation.

Long persisting scaphoid non-unions or scapholunate ligament ruptures can lead to carpal collapse. The resulting clinical symptoms are restrictions in the range of motion, pain, and loss of grip strength. The symptomatic treatment so far offers different options. In our study, the Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate) by Synthes® was used in 11 cases of advanced carpal collapse for a four-corner fusion of the wrist. The intra- and postoperative as well as follow-up results have been assessed and compared with those of current literature. The results of the Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M²-Dash) showed an average of 41.5 points (MD=44/SD=16.62/MIN=21/MAX=65). One of the re-evaluated patients complained about pain at rest. One patient stated pain after mild strain; 4 patients complained pain after heavy burden (e.g. boxing, weight lifting). Measuring the range of motion, the operated hand showed a maximum in dorsal extension of 78.31% and in flexion of 57.89% compared to the contralateral, non-operated hand. In performance testing the fist clenching sign as well as pinch grip were complete and void of pain in 100%, whereas opposition (dig. man. I to V) was complete in five patients (83.33%), with moderate pain in one patient (16.67%) and a persisting gap of 0.2 cm in n=1 (16.67%). In comparison with the current literature regarding healing rates, complications, and follow-up results, we recommend the Synthes® VA LCP ICF Plate as a good surgical option in patients suffering from advanced carpal collapse.

Long-term clinical results and quality of life in patients undergoing autologous fat transplantation for breast augmentation using the BEAULI™ protocol.

Introduction: Autologous fat transplantation for breast augmentation has become increasingly interesting for patients and surgeons but only a few standardized procedures are available. BEAULI™ (Berlin Autologous Lipotransfer) protocol provides a suitable method with a standardized protocol. The aim of the study was to trace the 5-year long-term results after breast enlargement using the BEAULI™ protocol and the determination of changes in quality of life in relation to the intervention. Patients and methods: The study included non-smoking, currently non-pregnant women from the first BEAULI™ study (2007-2010), who were operated only for aesthetic reasons. BMI values, the jugulum nipple distance (JND), the breast base, and the maximum breast circumference were determined. The patients answered also a questionnaire with 30 questions on the postoperative quality of life. Results: The results measured after 6 months remained constant over 5 years. There was an average increase of the JND by 1.8 cm or 9.5%, and a widening of the base by 1.2 cm or 8.8%, and of breast circumference by 4.4 cm or 24%. The patients' quality of life, especially self-confidence and acceptance of their own body, has improved significantly after the operation. Discussion: The satisfying 5-year long-term results and low complication rate are two big advantages of the BEAULI™ method. The option to use autologous fat transplantation for another purpose like for reconstruction of breasts after a mastectomy increases the attractiveness of this method. Conclusions: Fat transplantation for breast enlargement using BEAULI™ is a high-quality method with good results, and it is an alternative to silicone implants or other autologous tissue transplantations. Patients are satisfied with the BEAULI™ protocol, the complication rate is small, and natural results are achieved with moderate scars.

Hamate's coronal fracture: diagnostic and therapeutic approaches based on a long-term follow-up.

Hamate fractures are commonly divided into hook fractures and body fractures. The coronal fractures as a special form of hamate's body fracture are very rare injuries. Because of unspecific clinical findings and the mostly inconclusive x-ray imaging, these fractures are frequently overseen or misdiagnosed. This leads to further complications like secondary arthritis, persisting pain, and functional deficits in patient's wrist mobility. In our study, a collocation of coronal hamate fractures is analyzed and evaluated with respect to functional outcome after operative treatment and compared to the literature. Furthermore, we compare the strategies for diagnosis and treatment in our clinical center with those presented in the literature. Our standard in the initial diagnostic process is to obtain radiographs in an anterior-posterior, lateral, and 30° oblique view of the wrist. For further diagnosis and preoperative planning, a CT scan of the wrist is obligatory. Due to the high occurrence of comorbidities (especially CMC dislocations) all patients in our cohort obtained operative treatment. In long-term post-operative evaluation, we present the following results: The Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M2 DASH) imposed with an average of 26.22 points (MD=22/ SD=11.31/MIN=18/MAX=52). None of the re-evaluated patients sorrowed for severe pain in rest. Four patients stated pain (ranging from 3 to 5 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting). In exploring the range of motion of the operated hand the following results are obtained: dorsal extension: average 83.33° (MD=85°/SD=3.54°/MIN=75°/MAX=85°), flexion: average 77.78° (MD=80°/SD=4.41°/MIN=70°/MAX=80°). Additionally, a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 77.78%, opposition digitus manus I-V complete in 66.67%. The conservative treatment is not recommended (especially shown in the here presented "add" case with a misdiagnosed fracture). The open approach has its advantages compared to a closed operative procedure and should always be intraoperatively considered as an operative expansion.

Radiation Sensitivity of Adipose-Derived Stem Cells Isolated from Breast Tissue.

Within their niche, adipose-derived stem cells (ADSCs) are essential for homeostasis as well as for regeneration. Therefore, the interest of physicians is to use ADSCs as a tool for radiation oncology and regenerative medicine. To investigate related risks, this study analyses the radiation response of adult stem cells isolated from the adipose tissue of the female breast. To avoid donor-specific effects, ADSCs isolated from breast reduction mammoplasties of 10 donors were pooled and used for the radiobiological analysis. The clonogenic survival fraction assay was used to classify the radiation sensitivity in comparison to a more radiation-sensitive (ZR-75-1), moderately sensitive (MCF-7), and resistant (MCF10A) cell lines. Afterwards, cytotoxicity and genotoxicity of irradiation on ADSCs were investigated. On the basis of clonogenic cell survival rates of ADSCs after irradiation, we assign ADSCs an intermediate radiation sensitivity. Furthermore, a high repair capacity of double-strand breaks is related to an altered cell cycle arrest and increased expression of cyclin-dependent kinase (CDK) inhibitor p21. ADSCs isolated from breast tissue exhibit intermediate radiation sensitivity, caused by functional repair mechanisms. Therefore, we propose ADSCs to be a promising tool in radiation oncology.

Lymphocyte surface markers and cytokines are suitable for detection and potency assessment of skin-sensitizing chemicals in an in vitro model of allergic contact dermatitis: the LCSA-ly.

Allergic contact dermatitis is a widespread health disorder and occupational skin disease. Hence, screening for contact-sensitizing chemicals is highly relevant to toxicology, dermatology, and occupational medicine. The use of animal tests for this purpose is constrained by ethical considerations, need for high-throughput screening, and legislation (e.g., for cosmetics in the European Union). T cell activation is the final and most specific key event of the "adverse outcome pathway" for skin sensitization and therefore a promising target for the development of in vitro sensitization assays. We present a novel in vitro sensitization assay with a lymphocyte endpoint as an add-on to the loose-fit coculture-based sensitization assay (LCSA): the LCSA-ly. While the LCSA measures dendritic cell activation, the LCSA-ly offers the option for an additional lymphocyte endpoint which can be measured concurrently. We incorporated lymphocytes in our previously established coculture of primary human keratinocytes and monocyte-derived dendritic cells and tested nine substances: five sensitizers [2,4-dinitrochlorobenzene (DNCB) 1.25-15 µmol/l, p-phenylenediamine (PPD) 15.6-125 µmol/l, 2-mercaptobenzothiazole (MBT) 50-1000 µmol/l, coumarin, and resorcinol (both: 250-1500 µmol/l)] and four non-sensitizers (monochlorobenzene, caprylic acid, glycerol, and salicylic acid (all: 125-1000 µmol/l)]. DNCB and MBT increased a subset of IL-23 receptor+/IFN-γ receptor 1 (CD119)+ lymphocytes. DNCB, PPD, and MBT enhanced a subunit of the IL-4 receptor (CD124) and a memory marker (CD44) on lymphocytes. Remarkably, DNCB, PPD, and MBT raised IL-4 concentrations in coculture supernatants while IFN-γ levels decreased, which might point to Th2 activation in vitro. Coumarin, resorcinol, and non-sensitizers did not alter any of the tested surface markers or cytokines. IL-17 was not affected by any of the substances. Relative strength of sensitizers according to lymphocyte markers was DNCB > PPD > MBT, which corresponds to earlier results from the LCSA without lymphocyte endpoint, the murine local lymph node assay, and human data. This study is the first to prove the suitability of lymphocyte surface markers for sensitization testing and potency assessment.

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

A novel method to generate monocyte-derived dendritic cells during coculture with HaCaT facilitates detection of weak contact allergens in cosmetics.

The in vitro sensitization assay LCSA (Loose-fit Coculture-based Sensitization Assay) has proved reliable for the detection of contact sensitizers in the past. However, the coculture of human monocyte-derived dendritic cells (DCs) with primary human keratinocytes (KCs) in serum-free medium is relatively complex compared to other sensitization assays which use continuous cell lines. To facilitate high-throughput screening of chemicals, we replaced KCs with the HaCaT cell line under various culture conditions. Coculture of HaCaT with peripheral blood mononuclear cells in serum-supplemented medium leads to generation of CD1a+/CD1c+ DCs after addition of GM-CSF, IL-4, and TGF-ß1 (as opposed to CD1a-/CD1c- DCs which arise in the "classic" LCSA coculture). These cells resemble monocyte-derived DCs generated in monoculture, but, unlike those, they show a marked upregulation CD86 after treatment with contact allergens. All of the nine sensitizers in this study were correctly identified by CD1a+/CD1c+ DCs in coculture with HaCaT. Among the substances were weak contact allergens such as propylparaben (which is false negative in the local lymph node assay in mice) and resorcinol (which was not detected by CD1a-/CD1c- DCs in the "classic" LCSA). The level of CD86 upregulation on CD1a+/CD1c+ DCs was higher for most allergens compared to CD1a-/CD1c- DCs, thus improving the assay's discriminatory power. Three out of four non-sensitizers were also correctly assessed by the coculture assay. A false-positive reaction to caprylic (octanoic) acid confirms earlier results that some fatty acids are able to induce CD86 on DC in vitro. In conclusion, change of the LCSA protocol led to reduction of time and cost while even increasing the assay's sensitivity and discriminatory power.

Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction) treatment manual for temporary abdominal wall closure - results of 58 consecutive patients.

INTRODUCTION: The optimal treatment concept for temporary abdominal closure (TAC) in critically ill visceral surgery patients with open abdomen (OA) continues to be unclear. The VACM (vacuum-assisted closure and mesh-mediated fascial traction) therapy seems to permit higher delayed primary fascial closure rates (FCR) than other TAC procedures. MATERIAL AND METHODS: Patients of our clinic (n=58) who were treated by application of a VAC/VACM treatment manual in the period from 2005 to 2008 were retrospectively analysed. RESULTS: The overall FCR of all patients was 48.3% (95% confidence interval: 34.95-61.78). An FCR of 61.3% was achieved in patients who had a vicryl mesh implanted at the fascial level (VACM therapy) in the course of treatment. Mortality among patients treated with VACM therapy was 45.2% (95% CI: 27.32-63.97). CONCLUSIONS: The results of our own study confirm the results of previous studies which showed an acceptable FCR among non-trauma patients who were treated with VACM therapy. VACM therapy currently appears to be the treatment regime of choice for patients with OA requiring TAC.

Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life.

INTRODUCTION/BACKGROUND: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP). MATERIALS AND METHODS: In the present study 128 patients (130 fractures) that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes(®)) were retrospectively evaluated. Mean follow-up was 22.7 months (SD 10.6). The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance) pre-, postoperatively and at the last follow-up visit. Range of motion (ROM) was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH) and the Gartland-Werley score (GWS) were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey. RESULTS: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low. CONCLUSIONS: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present results.

Current concepts review: Fractures of the patella.

Fractures of the patella account for about 1% of all skeletal injuries and can lead to profound impairment due to its crucial function in the extensor mechanism of the knee. Diagnosis is based on the injury mechanism, physical examination and radiological findings. While the clinical diagnosis is often distinct, there are numerous treatment options available. The type of treatment as well as the optimum timing of surgical intervention depends on the underlying fracture type, the associated soft tissue damage, patient factors (i.e. age, bone quality, activity level and compliance) and the stability of the extensor mechanism. Regardless of the treatment method an early rehabilitation is recommended in order to avoid contractures of the knee joint capsule and cartilage degeneration. For non-displaced and dislocated non-comminuted transverse patellar fractures (2-part) modified anterior tension band wiring is the treatment of choice and can be combined - due to its biomechanical superiority - with cannulated screw fixation. In severe comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates for anatomic restoration of the retropatellar surface and extension mechanism results in best outcome. Additional circular cerclage wiring using either typical metal cerclage wires or resorbable PDS/non-resorbable FiberWires increases fixation stability and decreases risk for re-dislocation. Distal avulsion fractures should be fixed with small fragment screws and should be protected by a transtibial McLaughlin cerclage. Partial or complete patellectomy should be regarded only as a very rare salvage operation due to its severe functional impairment.

All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament.

BACKGROUND: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. METHODS: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. RESULTS: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18-24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0-7] mm. CONCLUSIONS: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware removal. Further clinical studies with larger patient cohorts and a control group are needed to further confirm these preliminary results.

Current diagnostics and treatment of the cubital tunnel syndrome in Austria.

According to the vote of the Austrian Society for Surgery of the Hand (ÖGH) an investigation to collect data on the current state of the treatment of cubital tunnel syndrome was initiated. Over one year a total of 875 patients with cubital tunnel syndrome were operated in Austria, this means an incidence of this nerve entrapment of 0.011%. Most of the operations were done by trauma surgeons (287; 33%). For diagnosis most of the centers rely on clinical symptoms, electroneurophysiology, and elbow X-ray. 40% of the institutions regard conservative therapy as useless and not indicated. If conservative treatment modalities are applied, physiotherapy (97%), non-steroidal anti-inflammatory medication (77%), and glucocorticoid injections (30%) are primarily used. In case of simple nerve entrapment most of the surgeons (72%) prefer simple nerve decompression. If there is additional pathology subcutaneous cubital nerve transposition is recommended (62%). Endoscopic techniques are only use by 3% of the surgeons. In the postoperative care, physiotherapy is favored in 51%, whereas 24% do not judge any postoperative care as beneficial. The three most often encountered complications were incomplete remission, scar contracture and hypertrophy, and postoperative bleeding.

Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors.

BACKGROUND: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu(®) Surgical Adhesive and ARTISS(®) fibrin sealant with a control population. MATERIAL AND METHODS: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. RESULTS: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000). CONCLUSION: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND. ( LEVEL OF EVIDENCE: level IV, retrospective case study).

Sinus pilonidalis in patients of German military hospitals: a review.

Pilonidal sinus disease (PSD) most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.

A new variant of scaphoid reconstruction: Treatment of scaphoid non-union with avascular bone interponate and high compression screw (Synthes(®)).

Scaphoid fractures as frequently overseen injuries often result in scaphoid non-unions, that need to be treated to prevent carpal collapse and secondary cartilage damage. Vital bone tissue and compression of fracture and bone graft ends seem to be crucial in for ossification and final bone healing. In the present study we compare our results using a high compression screw (HCS Synthes(®)) to results in the literature using different kinds of internal fixation including compression screws of various types. We present 22 patients with scaphoid non-unions treated with a bone graft and a HCS Synthes(®). We evaluated our post-operative results. The Manchester-Modified Disability of the Shoulder, Arm and Hand-Score (M-Dash) imposed with an average of 29.8 points (MD=29 / SD=9.46 / MIN=18 / MAX=48). None of the re-evaluated patients sorrowed for pain in rest. Five patients stated pain (ranging from 4 to 8 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting).In exploring the range of motion of the operated hand we deliver the following results: dorsal extension: average 72.73° (MD=80° / SD=17.23° / MIN=30° / MAX=85°), flexion: average 73.64° (MD=80° / SD=8.97° / MIN=60° / MAX=80°), ulnar deviation: average 39.09°, (MD=40° / SD=2.02° / MIN=35° / MAX=40°), radial deviation: average 29.09°, (MD=30° / SD=3.01° / MIN=20° / MAX=30°). Additionally a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 100%, moderate pain in n=1 (8.33%), opposition digitus manus I-V complete in 100%, moderate pain n=2 (16.67%). Three patients with persisting fracture gap had a scaphoid bone fractured in the proximal third; one patient even with a very small proximal fragment. One persisting non-union was localized in the middle third (period between injury and operation = 5 years). In conclusion, our patients showed better healing rates compared to results presented in the literature. Non-unions localized in the proximal third of the scaphoid did not seem to benefit using this technique.