[Osteosynthesis of metacarpal fractures with 2.0 mm LCP system and functional postoperative treatment]. / Osteosynthese von Metakarpalefrakturen mit 2,0-mm-LCP und funktionelle postoperative Nachbehandlung.

BACKGROUND: Locking head systems are an additional option in the surgical treatment of metacarpal fractures. In this clinic 2.0 mm locking compression plates (LCP) are used, which provide the possibility of functional postoperative treatment even for complex and osteoporotic metacarpal fractures. For simple fractures and good bone quality the LCP system is used as a compression or neutralization plate. Depending on the type and localization of the fracture, different osteosynthesis techniques are used in order to achieve a functional postoperative treatment in as many patients as possible. MATERIAL AND METHODS: Between July 2009 and December 2010 a total of 49 patients were enrolled in a prospective trial. All patients underwent surgical treatment with a 2.0 mm LCP system. Postoperative functionality of the hand was restored without immobilization. Clinical and radiological examinations were performed after 6 and 12 weeks and after 6 and 12 months with documentation of the range of motion (ROM), grip strength, fingertip to palm distance and the disabilities of the arm, shoulder and hand (DASH) score. RESULTS: After 6 months a good functional result was achieved in all patients with no cases of malrotation. Radiographs showed a completely consolidated bone healing. CONCLUSION: After osteosynthesis with 2.0 mm LCPs all types of metacarpal fractures can be treated without immobilization.

Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis: long-term follow-up.

Radioscapholunate arthrodesis is the treatment of choice for symptomatic, degenerative radioscapholunate osteoarthritis. We report on three patients after radioscapholunate arthrodesis with a follow-up of 22-28 years. There were no short-term postoperative complications; range of motion and strength were stable. All three patients showed radiological evidence of progressive, but clinically asymptomatic midcarpal osteoarthritis. The conversion rate for radioscapholunate to panarthrodesis of the wrist is reported at 31% with follow-ups of more than five years, invariably due to either non-union, or progressive, symptomatic midcarpal osteoarthritis. Primary excision of the distal pole of the scaphoid during radioscapholunate arthrodesis probably plays an important role in avoiding these conditions in the long-term. This measure allows a residual range of motion more than previously believed; considering that the dart thrower's motion is the physiological axis of wrist motion.

[Clinical and radiological results after operative treatment of mallet fracture using Kirschner wire technique]. / Klinische und radiologische Ergebnisse nach operativ versorgten Frakturen dorsal an der Fingerendgliedbasismit Kirschnerdrähten.

BACKGROUND: In our clinic dorsal distal phalanx fractures involving more than 30% of the articulare line in the lateral view are treated operatively using the Kirschner wire technique. Recently conservative treatment of these fractures is more and more recommended. Therefore we investigated in a retrospective study our patients with special regards to complications. PURPOSE: The aim of this study was to evaluate the complications, as well as the clinical and radiological results of patients after operative treatment of dorsal distal phalanx fractures using the Kirschner wire technique. PATIENTS AND METHODS: 43 patients with dorsal intraarticular fractures of the distal phalanx involving at least one third of the articular surface of the distal interphalangeal (DIP) joint were treated between 02/05 and 08/09 using Kirschner wire technique. At a mean follow-up of 28 (8-60, median 24,5) months, 32 patients were evaluated clinically and radiologically as well as with ultrasound. RESULTS: 5 patients developed superficial wound infections and were treated with antibiotics. 2 of these patients needed an early removal of the Kirschner wires. 2 patients showed nail deformity and 2 had an ulnar deviation of the DIP joint. The mean extension lag was 10° (0-30°, median 10°), the mean flexion lag was 19° (0-60°, median 15°). 11 patients had a flexion lag of more than 20°. 4 patients had an extension lag of more than 20°. All of these patients showed tendon tears or large lesions by ultrasound. Degenerative changes were noted in radiographs of 15 patients. CONCLUSIONS: Because of unsatisfactory results in 63% (n=20), conservative treatment will be our treatment of choice in the future. Operative treatment will only be done in patients with subluxation of the distal phalanx.

[Long-term follow-up after surgery for thoracic outlet syndrome (TOS)]. / Langzeitresultate nach operativer Therapie bei Thoracic-outlet-Syndrom (TOS).

This is a long-term follow-up analysis of patients who have been operated on for Thoracic Outlet Syndrome (TOS) at our clinic in order to evaluate the quality of therapy and the criteria of indications for surgery. 39 patients with a total of 45 surgical procedures were examined after a median follow-up of 8.8 years. The results in this study are based exclusively on the subjective outcome assessment by the patients themselves. Assessment of the long-term result in the "vascular TOS" group (13 cases = 29 %) was good in ten cases (77 %), fair in two cases (15 %) and poor in one case (8 %). In agreement with the literature, we were able to achieve the best results in this group. In the "true neurological TOS" group (28 cases = 62 %), assessment of the long-term result was good in 19 cases (68 %), fair in six cases (21 %) and poor in three cases (11 %). A clear tendency to a poor prognosis could be seen in women with a combination of cervical rib and fibrous band and a long delay between onset of symptoms and surgery. Assessment of long-term result in the "disputed TOS" group (four cases = 9 %) showed good results in three cases and a fair result in one case. In the absence of objective pathologies, only few and carefully selected patients were operated upon. The presented long-term results confirm the use of individual therapeutic concepts with special consideration of anatomy and clinical picture.

[Radioscapholunate fusion: long-term results]. / Erfahrungen mit der radiokarpalen Teilarthrodese nach Gordon und King im Langzeitverlauf.

INTRODUCTION: A review of the literature on long-term results (> or = 10 years) following radiocarpal arthrodesis as recommended by Gordon and King shows a paucity of data. Regarding the suitability of this procedure for treating radiocarpal arthrosis, especially in younger patients, we collected and evaluated long-term results of this surgical procedure. MATERIALS AND METHODS: Five patients (four men, one woman), who were treated between 1978 and 1984 at our institution with a partial radiocarpal arthrodesis as described by Gordon and King were reexamined clinically and radiologically by the same examiner in the year 1990 and again in the year 2000. RESULTS: All five patients were very satisfied with the result of the operation. Two patients were completely free of pain, whereas the other three patients reported minor pain in the radiocarpal joint when applying strain. The active range of motion in the operated joint remained constant over the years (mean 60 degrees dorsopalmar, 30 degrees ulnoradial, 162 degrees pro-/supination). Conventional radiological imaging showed proper osseous consolidation in the areas of partial arthrodesis, and slight degenerative intercarpal alterations in the distal radioulnar joint were observed. Complete postprocedural reintegration into the workforce, including manually demanding work, was achieved. CONCLUSIONS: The results of the follow-up examinations of these five patients indicate that satisfying long-term results can be achieved after radiocarpal arthrodesis provided that the procedure is correctly indicated and the operation is conducted in a technically proper manner. This method of radiocarpal arthrodesis is likely also appropriate for young manual labourers suffering from painful radiocarpal arthrosis after distal intraarticular fracture of the radius, scaphoid non-union, scapholunar dissociation and Kienbock's disease.

[Wartenberg's Sign of Ulnar Nerve Lesion. A Contribution to Pathophysiology and to the Differential Diagnosis]. / Das Wartenberg-Zeichen des Nervus ulnaris. Ein Beitrag zur Pathophysiologie und Differenzialdiagnose1.

The abduction stance of the small finger is frequently, but not necessarily due to ulnar nerve paresis. Five cases suffering from bothersome permanent abduction of the small finger and referred under the diagnosis of ulnar nerve paresis are presented. Clinical, electrodiagnostic and imaging evaluation revealed different causes. While partial paresis with the function of the abductor digiti minimi muscle preserved usually results in a disturbing abduction stance, complete paresis of the ulnar nerve causes a less severe abduction posture of the small finger. Operative measures are indicated when the stance of the small finger is disturbing and when sufficient time has passed to make sure that spontaneous recovery cannot be presumed. Clinical, electrodiagnostic and imaging evaluation of three neurogenic cases disclosed a lesion of the ramus profundus distal to the branches innervating hypothenar muscles in one case, ulnar nerve injury with neuromuscular hyperactivity of the abductor digiti minimi muscle following split repair in another case and syringomyelia in the third case. Two patients revealed an abduction posture of the little finger of non-neurogenic origin. One of them showed closed ligament injuries. The other patient revealed necrosis, scarring and contracture of hypothenar muscles and atrophy of the third palmar interosseous muscle following compression in a tight cast.

[Mesenteric cyst as the etiology of abdominal pain--a case report]. / Mesenteriale Zyste als Ursache von Abdominalschmerzen--Eine Fallbeschreibung.

INTRODUCTION: Mesenteric cysts are part of the differential diagnosis of abdominal tumors. We want to remember this diagnosis with the following case report. CASE REPORT: A 35-year-old woman was admitted for abdominal pain that had begun two weeks previously. Sonographic examination and CT scan of the abdomen showed a 14 x 12 x 3 cm abdominal tumor without any relation to the uterus, adnexa or organs of the epigastrium. Laparotomy was performed and the cystic tumor removed. DISCUSSION: Mesenteric cysts are rare. The pathogenesis is not uniform and the clinical and radiologic diagnosis is difficult. The symptoms of this condition vary from acute abdominal signs to non-specific abdominal features or incidental findings. Mesenteric cysts can be located anywhere in the mesentery from the duodenum to the rectum. The treatment of choice is resection. CONCLUSIONS: Mesenteric cysts are rare abdominal conditions. The resection of the cyst and the verification of the diagnosis is the treatment of choice.

[Duodenal injuries in abdominal trauma]. / Duodenalverletzungen beim Bauchtrauma.

BACKGROUND: We retrospectively reviewed our patients between 1988 and 1996 with duodenal injuries to demonstrate the diagnostic and therapeutic management. MATERIAL AND METHODS: The charts of six patients treated in the Division of Traumatology of the University Hospital of Zurich between 1988 and 1996 have been retrospectively reviewed. The mean age was 25 years. In four patients a blunt trauma and in two patients a two gunshot caused the duodenal injury. The injury was classified with the "Duodenum Organ Injury Scale". RESULTS: The primary repair was successful in three patients, twice a Roux-en-Y duodenojejunostomy with repair of the biliary tract was performed and once a conservative treatment was chosen. No surgery related complications occurred. Two patients died postoperatively because of associated injuries. CONCLUSIONS: Duodenal injuries are rare and therefore correct diagnosis and treatment is difficult. In case of penetrating trauma or hemodynamic instable patients following blunt trauma the emergent laparotomy is mandatory. CT scan is recommended in cases of hemodynamic stable patients after blunt trauma. Primary repair is the treatment of choice in the majority of duodenal injuries.

Intussusception of the small bowel due to Peutz-Jeghers syndrome: a case report.

We report the case of a 45-year-old woman with an intussusception of the small bowel due to Peutz-Jeghers syndrome. Immediate laparotomy was performed, and approximately 5 cm of the small bowel had to be removed because of ischemic areas. Six other polyps were removed through buttonhole enterotomies. The Peutz-Jeghers syndrome is rare. Treatment is either surgery or a combination of surgery and intraoperative enteroscopy. Bowel resections must be kept to a minimum.

Influence of race on diagnosis in adolescent psychiatric inpatients.

OBJECTIVE: To examine racial differences in 352 psychiatric inpatients, aged 12 to 18 years, at a state hospital facility that accepted admissions from throughout South Carolina. These were all the adolescent admissions during an entire calendar year (1988). There were 101 African-American and 251 white subjects. METHOD: The data were abstracted from patients' hospital medical records and nursing incident reports. DSM-III-R discharge diagnoses were assigned to five non-mutually exclusive groupings (organic/psychotic, mood/anxiety, disruptive, personality, substance abuse). Racial differences were analyzed using chi 2, logistic regression, and T statistics. RESULTS: African-Americans were more likely to be involuntarily committed at the time of admission (p = .010). Organic/psychotic diagnoses were much more frequent in African-Americans (odds ratio = 3.15, p < .003). Whites (p = .0347) were almost two times more likely to receive mood/anxiety diagnoses even when controlling for gender, type of admission, and comorbid diagnoses. Substance abuse was more often diagnosed in whites (odds ratio = 5.46, p < .0001). CONCLUSIONS: This study identifies significant racial differences in the discharge diagnoses of psychiatrically hospitalized adolescents. African-Americans have fewer mood/anxiety and substance abuse diagnoses but significantly more organic/psychotic diagnoses. Some of these differences may reflect ethnocentric clinician bias in the diagnostic assessment of youth from differing cultural/racial backgrounds.

Experimental manipulation of cocaine craving by videotaped environmental cues.

Thirteen male patients consecutively admitted to an inpatient drug and alcohol rehabilitation hospital with the primary diagnosis of crack cocaine dependence were shown a 30-minute videotape that included salient environmental cues intended to elicit cocaine craving. The subjects were tested before and after the videotape by the use of a continuous 20-cm analogue visual instrument that asks them to rate their perceived degree of craving, mood, energy, and wellness. Only craving showed a statistically significant change from pretest to posttest. Correlations among the four separate ratings suggest that mood and craving are different dimensions that independently contribute to one's general sense of well-being. This study demonstrates that cocaine craving can be induced in a group setting by presenting certain visual and auditory cues on a video monitor. The procedure of obtaining self-ratings in response to videotaped environmental cues could be easily incorporated into research methods designed to assess pharmacologic efficacy in reducing the intense craving that reinforces addiction.