[Finger injuries in ball sports]. / Fingerverletzungen beim Ballsport.

Ball sports are the most frequent cause of sport injuries and 60% of all hand injuries involve the fingers. The most common injury is closed rupture of the extensor tendon of the distal interphalangeal joint (mallet finger). Rupture of the deep flexor tendon (jersey finger) occurs particularly in contact ball sports, such as rugby. Injuries of the proximal interphalangeal and metacarpophalangeal joints are of high functional relevance. These injuries frequently represent complex lesions which are demanding both in diagnostics and therapy. Errors in diagnosis or insufficient treatment can lead to misalignment and functional impairment of the hand. This article provides an overview of the current treatment strategies and includes recommendations for the treatment of professional athletes.

[Carpometacarpal fractures and fracture dislocations of rays 2-5]. / Karpometakarpale Frakturen und Luxationsverletzungen des 2. bis 5. Strahls.

BACKGROUND: Fractures and fracture dislocations of carpometacarpal joints 2-5 may be easily overlooked. This can be explained by often subtle clinical and radiographic signs. In case of clinical suspicion with apparently normal standard x-rays, a computed tomography with thin slices should be promptly performed. Therapy is predominantly operative and aims at anatomic reduction and reconstruction of joint congruity. TREATMENT: To facilitate treatment decisions, especially concerning closed or open fixation, we have defined 3 pathomorphological patterns (types I-III). Decision criteria are sagittal or coronal plane of fracture, degree of destruction of the articular surface, and radial or ulnar location of the injury. Following operative therapy, early mobilization of all finger joints should be performed.

Percutaneous antegrade scaphoid screw placement: a feasibility and accuracy analysis of a novel electromagnetic navigation technique versus a standard fluoroscopic method.

BACKGROUND: Central screw positioning in the scaphoid provides biomechanical advantages. METHODS: A prospective randomized study of six fluoroscopically guided and six electromagnetically navigated screw (ENS) placements was performed on human cadavers. Accuracy of screw position was determined. Intraoperative fluoroscopy exposure times, readjustments of drilling directions, complete restarts and complications were documented. RESULTS: The ENS method provided a mean time benefit of 7.34 min compared with the standard method and the mean screw length ratio (SLR coronar: ENS 0.96 ± 0.04 mm, SFF: 0.92 ± 0.04 mm, P = 0.065; SLR sagittal: ENS 0.98 ± 0.02 mm, SFF: 0.91 ± 0.04 mm, P = 0.009) and the screw axis deviation angle (AD coronar: ENS 3.33 ± 2.34°, SFF: 10.33 ± 2.58°, P = 0.002; AD sagittal: ENS 2.83 ± 0.98°, SFF: 11.00 ± 6.16°, P = 0.002) were lower. Using the electromagnetic navigation procedure no drilling readjustments or restarts were required, no cortical breach occurred. CONCLUSIONS: Compared with the standard fluoroscopic technique, the ENS method used in this study showed higher accuracy, less complications, required less operation and radiation exposure time.

[Severely displaced radial neck fractures after minimally invasive joystick reduction and Prévot nailing: long-term course in childhood]. / Stark dislozierte Radiushalsfrakturen nach minimal-invasiver Joystick-Reposition und Prévot-Nagelung: Langzeitverlauf im Kindesalter.

Significantly displaced radial neck fractures in children are at risk for functional problems due to malaligned healing or growth disturbances at the proximal growth plate. Anatomic reduction is needed, especially in older children (aged 10+ years). Elastic stable intramedullary nailing (ESIN) (1993 Metaizeau) is the preferred method. When closed reduction is not possible, we use a joystick technique to fully reduce the radial head. The aim of this study was to challenge the hypothesis that this manipulation leads to secondary complications by affecting blood flow. Also, we asked the question to which extent an additional injury to the growth plate leads to functional problems concerning range of motion in the elbow joint. We undertook a retrospective analysis of children with severely displaced radial head fractures that occurred as isolated incidents or in combination with complex elbow fractures who had been treated by us with this technique between 1998 and 2004. We collected data on the clinical and radiological healing process.