[Kapandji-Sauvé procedure with distal radioulnar fusion and segmental resection of the ulna]. / Die Arthrodese des distalen Radioulnargelenks mit gleichzeitiger Ellensegmentresektion nach Kapandji-Sauvé.

OBJECTIVE: The Kapandji-Sauvé procedure aims at improvement of rotation in the distal radioulnar joint and reduction of pain. Cases of ulnar impaction syndrome can also be corrected during the same procedure. INDICATIONS: The most important indication is painful und restricted forearm rotation after fracture of the distal radius combined with obsolete dislocation or destruction of the distal radioulnar joint. CONTRAINDICATIONS: It is a salvage procedure and is contraindicated when reconstruction of the radioulnar joint or shortening of the ulna is possible. Further contraindications are rheumatic arthritis and osteoporosis. SURGICAL TECHNIQUE: The Kapandji-Sauvé procedure creates a new distal rotatory joint due to distal radioulnar fusion and segmental resection of the distal ulna. POSTOPERATIVE MANAGEMENT: Forearm cast including the wrist for 3-4 weeks. Phyisiotherapy and intensive exercises of the fingers on postoperative day 1. After removing the cast, careful rotation exercises are possible. RESULTS: In 75 patients, the Kapandji-Sauvé procedure was performed between 1990 and 2003. Failure was observed in one patient with a bony regeneration between the resected ulnar segment. In 3 cases, a nonunion of the radioulnar joint was found. After revision with bone grafting, bony consolidation of the joint was identified in all cases. In 2 cases, there were problems with the proximal ulnar stump, whereby this was corrected in one case by resection of a ball-type callus. In the other case, painful ulna-snapping was reduced by shortening of the ulna. In earlier follow-up with 45 patients and later long-turn follow-up, ranging from 3-12 years, not only were significant improvement of forearm rotation and reduction of pain observed, but also good patient satisfaction was found.

In vivo corrosion of four magnesium alloys and the associated bone response.

Degrading metal alloys are a new class of implant materials suitable for bone surgery. The aim of this study was to investigate the degradation mechanism at the bone-implant interface of different degrading magnesium alloys in bone and to determine their effect on the surrounding bone. Sample rods of four different magnesium alloys and a degradable polymer as a control were implanted intramedullary into the femora of guinea pigs. After 6 and 18 weeks, uncalcified sections were generated for histomorphologic analysis. The bone-implant interface was characterized in uncalcified sections by scanning electron microscopy (SEM), element mapping and X-ray diffraction. Results showed that metallic implants made of magnesium alloys degrade in vivo depending on the composition of the alloying elements. While the corrosion layer of all magnesium alloys accumulated with biological calcium phosphates, the corrosion layer was in direct contact with the surrounding bone. The results further showed high mineral apposition rates and an increased bone mass around the magnesium rods, while no bone was induced in the surrounding soft tissue. From the results of this study, there is a strong rationale that in this research model, high magnesium ion concentration could lead to bone cell activation.

[Results of Kapandji-Sauvé procedure with distal radio-ulnar fusion and segmental resection of the ulna]. / Ergebnisse nach radioulnarer Arthrodese mit distaler Ellenteilresektion nach Kapandji-Sauvé

The Kapandji-Sauvé procedure was performed in 75 patients between 1990 and 2003. The most important indication was painful and restricted forearm rotation after fracture of the distal radius combined with dislocation or destruction of the distal radioulnar joint. 25 patients were followed up using a modified Martini score. We found a significant improvement of forearm rotation, reduction of pain and a good patient satisfaction in a long-term follow-up ranging from three to 12 years.

[Circumscribed median nerve compression caused by a leiomyoma. Preoperative localization with spiral CT]. / Punktuelle Läsion des Nervus medianus bei Einschnürung durch ein Leiomyom. Präoperative Lokalisation mittels Spiral-CT.

Dysfunction of the median nerve is quite common and mostly observed related to carpal tunnel and pronator syndromes. We report a rare case of median nerve compression caused by a leiomyoma in the distal forearm. Spiral CT with MPR (multiplanar reconstruction) clearly located the lesion preoperatively.

[Ulnar nerve compression in the area of the wrist]. / Ulnariskompression im Bereich der Handwurzel.

Clinical investigation precisely determines the localization of ulnar nerve entrapment in Guyon's canal. The cause of compression can be due to internal (tumor, distal fibrous arch or proximal ligament arcade, nerve or muscle anomalies) or external influences (ulnar neuropathy of cyclists, thrombosis of ulnar artery by hypothenar hammer syndrome, fractures of pisiform or hook of hamate). Treatment involves splitting the roof of Guyon's canal, the ligaments or muscle anomalies, and excision of a tumor.

[A small distal osseous avulsion of the fibrocartilago palmaris of the middle finger interphalangeal joints. Results of conservative therapy]. / Der kleine distale knöcherne Ausriss der Fibrocartilago palmaris der Langfingermittelgelenke. Ergebnisse der konservativen Behandlung.

Chip avulsions of the palmar plate are divided into four degrees (Hintringer). Conservative treatment is preferred for degree I and II and in some cases in degree III. Only a short immobilization for six or seven days is necessary, then the patient will begin with active movement of the fingers. It is important to avoid hyperextension of the joint. Analysis of results in 69 cases with only conservative treatment showed very good results in 72%, good results in 20.4%, and satisfactory results in 4.5%. The results in one case (Hintringer III) was poor.

[Wrist para-articular radioulnar arthrodesis with distal Kapandji ulnar resection]. / Die handgelenknahe radioulnare Arthrodese mit distaler Ellenteilresektion nach Kapandji.

In 19 patients, the Sauvé-Kapandji procedure was performed between 1990 and 1993. The most important indication was the painful and restricted forearm rotation after fracture of the distal radius combined with dislocated or destroyed radio-ulnar joint. 18 patients were followed up. The only failure was found in a patient with bony regeneration across the resected ulnar segment and non-union of the distal radio-ulnar joint fusion. In all other cases, we found reduction of pain, an improved forearm rotation and grip strength.