Direct high-pressure Injury of the Palm after Injection of a Capsaicin-filled Gas Pistol. / Direkte Hochdruckinjektionsverletzung mit einer Capsaicin gefüllten Gaspistole in die Hohlhand.

High injection lesions of the hand are among the most serious injuries, with concomitant consequences. These lesions are often underestimated and may entail additional damages if that is the case. Not only the physical impact but also the chemical nature of the substance dictate the treatment.

The Reliability of Preoperative Total Knee Arthroplasty Planning -a Comparison of Two Calibration Markers. / Die Zuverlässigkeit der präoperativen Knietotalendoprothesenplanung - ein Vergleich zweier Kalibrierungsmarker.

BACKGROUND: Preoperative templating is the gold standard in planning elective total knee arthroplasty. This retrospective study analyses preoperative templating by using two different calibration devices. METHODS: Preoperative radiographic templating with TraumaCad using two different calibration devices was performed in 231 patients. RESULTS: Overall, 60.6% (n = 140) did not match and 39.4% (n = 91) matched for tibial as well as femoral size. Group I showed significantly more combined matches as well as for just the size of the femoral component. CONCLUSIONS: In this study, the KingMark calibration should be preferred to standardised ball markers.

Short-term radiological results after spheroid-based autologous chondrocyte implantation in the knee are independent of defect localisation.

BACKGROUND: Lesions of articular cartilage represent a crucial risk factor for the early development of osteoarthritis. Autologous chondrocyte implantation (ACI) is a well-established procedure in therapy of those lesions in the knee. The aim of the presented study is to detect differences in short-term radiological outcome depending on defect localization (femoral condyle vs. retropatellar) after spheroid-based ACI. OBJECTIVE: This study aimed to demonstrate that radiological outcome after spheroid-based ACI in the knee is independent of defect localization. METHODS: MRI-scans after retropatellar ACI and ACI of the medial/lateral femoral condyle, with a preoperative Outerbridge grade of III or IV were evaluated regarding MOCART 2.0. RESULTS: The mean defect-size was 5.0 ± 1.8 cm2, with a minimum size of 2 cm2 and a maximum size of 9 cm2. Scans were performed 7.7 months (± 3.1 months) postoperatively. The mean MOCART 2.0 score was 78.5 ± 15.6. No statistically significant influence neither of the localization (p= 0.159), the gender (p= 0.124) nor defect size (< 5 cm2 vs. ⩾ 5 cm2; p= 0.201) could be observed. CONCLUSIONS: The presented data demonstrate good to excellent radiological short-term results after spheroid-based ACI. Data indicates, that at least radiological results are independent of gender, defect-size and defect-localization.

The Proximal Femoral Bone Geometry in Plain Radiographs.

BACKGROUND: Osteoporosis represents the most common bone disease and has to be respected in planning total hip replacement, especially against the background of increasing uncemented total hip replacement. In this context, the radiographic geometry of the proximal femur got into focus and is controversially discussed.The aim of the presented study was to find any difference regarding known indices for proximal femur bone geometry between patients with high-grade osteoarthritis and patients suffering from a femoral neck fracture caused by low impact trauma. METHODS: Retrospective matched-paired analysis of 100 plane pelvic radiographs from 50 patients who suffered from high-grade hip osteoarthritis and 50 patients who suffered from femoral neck fracture was performed. Measurement of Canal-Bone Ratio (CBR), Canal-Calcar Ratio (CCR), Mineral Cortical Index (MCI) and Canal Flare Index (CFI) were performed. RESULTS: CBR was significantly higher in the fracture-group (0.45 +/- 0.06 vs. 0.41 +/- 0.08) (P-value= 0.008). Moreover, the femoral thickness 10 cm below the trochanter minor [F] was significantly higher in the osteoarthritis-group (34.68 +/- 4.14 vs 32.11 +/- 3.43) (P-value 0.001). CONCLUSION: In conclusion, patients with a femoral neck fracture demonstrated a higher CBR, which indicates a poorer bone quality. In case of planning a THA, the CBR is an index which can easily be measured and can be seen as one decision criterion in THA regarding fixation technique.

The Requirement for Closed Reduction of Dorsally Displaced Unstable Distal Radius Fractures Before Operative Treatment.

BACKGROUND: Dorsally displaced distal radius fractures are generally treated with closed reduction followed by casting. Current evidence suggests that fracture reduction is of no benefit before either conservative or surgical treatment. It has not been studied to date whether the degree of pain suffered by the patient during preoperative casting is any different if the fracture is reduced beforehand. METHODS: In a prospective, randomized trial, dorsally displaced unstable distal radius fractures were treated surgically, either with or without prior closed reduction (22 and 25 patients, respectively). The primary endpoint was the difference between the pain score (on the Visual Analog Scale) on day 1 after treatment and the initial pain score on presentation. The secondary endpoints included the clinical and radiological outcome and any damage to the median nerve. Moreover, the Krimmer score (strength, mobility, pain, and function of the wrist joint) an the DASH score (Disability of the Arm, Shoulder and Hand) were determined 3 and 12 months after treatment. This trial has been registered with the number DRKS00010570. RESULTS: With regard to the primary endpoint on day 1 after treatment, there was a statistically significant non-inferiority of the group without reduction, compared to the group with reduction. Sensory disturbances appeared at similar frequencies in the two groups four to six weeks after treatment (9.5% with reduction, 9.1% without). At 12 months, the Krimmer and DASH scores of patients whose fractures had not been reduced were no worse than those of patients whose fractures had been reduced (96 and 7 versus 96.5 and 4.5, respectively; p-values for non-inferiority, 0.004 and 0.008). CONCLUSION: This trial shows that dispensing with closed reduction before casting as a preliminary to planned surgery yields no disadvantage. Thus, in the authors' view, routine reduction is not warranted.

Correction to: Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint?

Unfortunately, the following reference was not included in the original publication of the article.

[Operative therapy of chronic palmar luxation of the distal ulna in florid CRPS - two cases]. / Operative Therapie einer persistierenden palmaren Luxation im distalen Radioulnargelenk bei floridem CRPS ­ 2 klinische Fälle.

We present two cases of chronic palmar luxation of the distal ulna which entails the development of complex regional pain syndrome (CRPS). Both cases have been finally treated with a hemiresection-interposition-arthroplasty of the distal radioulnar joint with perioperatively applied regional nerve block and i. v. administration of vitamin c. After surgical intervention function has improved and the CRPS symptomes subsided rapidly after few weeks.

The Treatment of Primary Arthritis of the Finger and Thumb Joint.

BACKGROUND: Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS: This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS: Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION: The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.

[Analysis of the accuracy of fit of five anatomically precontoured clavicle plate systems]. / Analyse der Passgenauigkeit fünf anatomisch vorgeformter Klavikulaplattensysteme.

BACKGROUND: A common method in surgical treatment of midshaft clavicular fractures is the clavicle plating system. In addition to traditional osteosynthetic devices, anatomically preformed plate systems also exist. Advantages are described in greater accuracy of fit and less irritation of surrounding soft tissues. The purpose of this study was to compare the anatomical fit of five different precontoured clavicle plating systems. MATERIAL AND METHODS: The anatomical fit of five different types of anatomical precontoured clavicle plates, 3 times VariaxSystem® (Stryker, Kalamazoo, MI), Meves® Plate (Ulrich medical Ulm, Germany) and LCP clavicle plate (Synthes, Bettlach, Switzerland) were investigated in 20 embalmed human cadaveric clavicles. An imprint of the space between the well-positioned plate and the clavicle was obtained using a silicone mass and the silicone imprint was digitally measured. Additionally, the anatomical fit was evaluated by three investigators following a standardized protocol (+2 to -2 points at lateral, midshaft and medial clavicle portions). RESULTS: The first three ranks went to the Stryker Variax-plates. They showed the least distance (Stryker 628027: 7­hole 1.44 mm, low curvature 0.93 mm-2.36 mm, 2. Stryker 628028: 8­hole low curvature 1.68 mm, 1.03 mm-2.4 mm and 3. Stryker 628128: 8­hole high curvature 1.87 mm, range 1.09 mm-3.1 mm) The evaluation of the anatomical fit by the investigators was in agreement with the measurement results. CONCLUSION: Although there was no complete congruency between the plates and the clavicle, all clavicle plates investigated in this study presented a reasonable anatomical shape. The 7­hole VariAx Stryker plate with slight curvature showed the best anatomical fit. A low profile and optimized anatomical precontouring can minimize irritation of the surrounding soft tissues and should be considered in plate design and implant choice.

Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint?

PURPOSE: The purpose of this study was to investigate whether there was a relationship between femoral neck antetorsion and the presence and pattern of osteoarthritis of the patellofemoral joint. It was hypothesized that an increased femoral neck antetorsion (1) correlates with osteoarthritic changes of the lateral facet of the patellofemoral joint and (2) correlates with an increased lateral trochlear height and a decreased sulcus angle. METHODS: Seventy-eight formalin-embedded cadaveric lower extremities from thirty-nine subjects with a median age of 74 years (range 60-88) were used. Surrounding soft tissues of the lower limb were removed. The femoral neck antetorsion was measured and referenced to the transepicondylar axis and the posterior condylar line. The height of the medial and lateral facet of the trochlea and the sulcus angle was measured. The location and the degree of patellofemoral cartilage degeneration were recorded. A Pearson's correlation analysis was performed to correlate the femoral neck antetorsion with the measured knee parameters. RESULTS: No significant correlation could be found between the femoral antetorsion and cartilage degeneration of the lateral patellofemoral joint (n.s.), the height of the lateral trochlea (n.s.) and the sulcus angle (n.s.). CONCLUSION: This study could not document that the femoral neck antetorsion and subsequent internal rotation of the distal femur correlated with the degree of degeneration of the lateral facet of the patellofemoral joint. Clinically, femoral internal rotation may play a minor role in the development of lateral patellofemoral joint degeneration.

Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint.

INTRODUCTION: The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period. MATERIALS AND METHODS: Eleven patients (range 21-50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46-114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)). RESULTS: A mean DASH score of 6.7 (range 0-22.5) and mean MMWS of 91.8 (range 75-100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases. CONCLUSIONS: Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.