[Saw Injuries to the Hand - Epidemiological Aspects]. / Sägeverletzungen der Hand ­ epidemiologische Aspekte.

Background: No current studies regarding saw injuries have been published in German literature for quite some time. Despite awareness measures and safety instructions, saw accidents along with crush injuries are the most common causes of severe hand injuries. Approximately 12,000 circular saw injuries occur in Germany each year. Since professional providers have increased prices due to the rising energy costs and a wide range of different home appliance saws are available, increasing use has been made of portable circular saws in the do-it-yourself market sector. Patients and methods: At our hospital, we evaluated the data of 51 male patients with saw injuries. The present study investigated factors that may contribute to accidents involving saws. Results: 80 % of the accidents occurred at home, usually on weekends or after work. 51 % of the accidents happened while patients cut firewood. In 84 % of the cases, an electric table saw was used. The majority of severe hand injuries were sustained with lower priced saws. Injuries occurred most frequently between 11 a. m. and 2 p. m., primarily with injuries to bones, tendons, blood vessels and nerves. Replantable amputations or partial amputations occured rarely. In 37 % of the patients, anatomical reconstruction using osteosynthesis and/or microsurgical techniques was performed successfully. Conclusions: Saw injuries to the hand are sustained almost exclusively by men. Serious injuries from low-priced table saws and due to the lack of protective covering are predominant. Preventive measures and mandatory training could reduce the number of saw injuries in the years to come. The results obtained by us largely confirm the data from previous publications.

[Salvage procedure for painful proximalisation of the 1st metacarpal after trapeziectomy using the Mini TightRope®]. / Die Rettungsoperation mittels Mini TightRope® bei schmerzhafter Proximalisierung des 1. Mittelhandknochens nach Trapezektomie.

PURPOSE: This study analyses our results after revision surgery for failed trapezectomy and suspension arthroplasty with painful proximalisation of the 1(st) metacarpal using the Mini TightRope(®). PATIENTS AND METHODS: In a prospective observational study, 5 patients (4 women and 1 man) with an average age of 62 years were treated with the Mini TightRope(®) for revision of a failed Epping arthroplasty with painful proximalisation of the first ray. The mean time between initial surgery and revision was 23.1 (12.5-31.5) months; the mean follow-up was 25±7.7 (12-32) months. The pain level (visual analogue scale - VAS), pinch grip, and qDASH score were evaluated preoperatively and postoperatively. In addition, the Conolly score was used postoperatively. Directly after surgery and at the last follow-up exam, the degree of proximalisation of the first metacarpal was measured radiologically. RESULTS: At the last follow-up, there was significant mean pain relief during everyday stress, from 5.2 preoperatively to 1.6 (p<0.01) postoperatively, and a significant increase in pinch grip, from 0.5 kg to 3 kg (p<0.01). qDASH improved significantly, from 54 to 20 (p<0.001). The Conolly score showed 2 good and 3 fair results. Renewed proximalisation could not be entirely prevented, but was limited to an average of 2 mm. CONCLUSION: Mini TightRope(®) revision surgery after failed trapezectomy and suspension arthroplasty showes good results with significant pain reduction and gain of function. Renewed proximalisation of the first ray cannot be completely avoided.

[Pasteurella multocida as a rare cause of neonatal meningitis]. / Pasteurella multocida als seltener Erreger der neonatalen Meningitis.

Pasteurella multocida (P. multocida), a Gram-negative bacillus is a typical commensal in the oropharynx of animals such as dogs and cats. Human diseases caused by P. multocida are rare and include respiratory infections, sepsis and meningitis. P. multocida infections are described predominantly in patients with underlying chronic disorders, in elderly patients or in infants < or = 1 year. We describe the case of a 3-week-old boy with meningitis due to Pasteurella multocida. P. multocida was also identified in oral swab and stool cultures of the pet cat. A direct contact between baby and cat was negated by the parents. The patient recovered without any neurological sequelae.

[An update on thrombosis prophylaxis in orthopaedic and accident surgery]. / Update der Thromboseprophylaxe in Orthopädie und Unfallchirurgie.

The prevention of deep venous thrombosis has become a routine in orthopaedic surgery. While the necessity for prophylaxis is not questioned, its practice is still a matter of controversy. The development of new anticoagulants increases the variety of prophylactic methods but leads to a need for additional information. This review deals with the indications for thrombosis prophylaxis in relation to exposing and predisposing risk factors. The currently available modalities of prophylaxis, their pharmacological details and clinical significance are presented. Evidence based data, recommendations on the duration of prophylaxis derived from official guidelines, issues of the cost/effectiveness, and medico-judicial aspects are discussed.

[A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years]. / Die bipolare Radiuskopfprothese bei nicht rekonstruierbaren Radiusköpfchentrümmerfrakturen: Indikation, Behandlung und Ergebnisse nach 5 Jahren.

The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

Osteochondritis dissecans of the knee.

Osteochondritis dissecans (OCD) should be considered in young, active patients who have generalized or anterior knee pain. A careful physical exam includes a Wilson test, thigh girth measurements, diagnostic tunnel view radiographs, and other imaging studies as needed for grading and prognosis. Two case reports demonstrate the signs and symptoms of OCD. Treatment by primary care physicians with sports medicine training may be conservative if lesions are medial and in situ and if patients are not skeletally mature; otherwise, referral is advised. Prompt surgical treatment is generally successful.

Ergogenic drugs in sports.

This article provides the practicing physician with an account of the commonly used ergogenic substances. Specific agents discussed include the following: stimulants, narcotic analgesics, anabolic-androgenic steroids, beta-blockers, diuretics, growth hormone, other peptide hormones, blood doping, and erythropoietin.

[Results of elastic plate osteosynthesis of simple femoral shaft fractures in polytraumatized patients. An alternative procedure]. / Ergebnisse der elastischen plattenosteosynthese einfacher femurfrakturen beim polytrauma. Ein alternatives verfahren.

Primary medullary nailing of femoral fractures is burdened by the risk of central and pulmonary complications in patients with polytrauma, especially in conjunction with craniocerebral or thoracic trauma. This also applies to unreamed medullary nailing. Primary treatment with external fixation necessitates secondary surgery with an altered procedure, the timing of which is not predictable. Plate osteosynthesis with anatomical repositioning of the fragments and rigid fixation is a technically demanding procedure, but can lead to fragment necrosis due to fragment denudation. In a prospective study conducted from 1 September 1994 to 30 June 1996 on 17 polytraumatized patients (average ISS:30 points), simple femoral stem fractures (A-1 to B-3 of the AO-classification) were stabilized by elastic plate osteosynthesis using biological technique. While cautiously preserving the periosteal and muscle connections to the bone, a plate is inserted as a bridge without any interfragmentary compression. At least two to four holes are left free in the center of the plate. This allows micro-movements in the fracture gap without the risk of material fatigue. All of the fractures were immediately stabilized on the day of the accident. In four patients with severe craniocerebral trauma or manifest shock, the procedure was changed to plate osteosynthesis after application of primary external fixation. Secondary injuries (joint and pelvic fractures or craniocerebral trauma) delayed early loading in 12 cases. Four patients were mobilized postoperatively under partial loading. A fixation callus was radiologically detectable on average 6 weeks after surgery. This often allowed additional loading, depending on the secondary injuries. Full loading was possible after 14 weeks. Complications included one case of surgery-related malpositioning, one soft-tissue infection, one case of plate detachment after a fall and one case of periosseous calcification. There were no cases of bone infections or pseudoarthroses. Elastic plate osteosynthesis is thus a conservative osteosynthesis procedure with a low complication rate in polytraumatized patients, even in those with simple femoral fractures.

Hypothyroidism presenting as tendinitis.

Hypothyroidism usually presents insidiously with symptoms such as fatigue, cold intolerance, and weight gain. Less common findings include myalgia, arthralgia, and joint effusion. In the patient described here, a triathlete, interpretation of early signs and symptoms as typical tendinitis led to months of treatment failure. Considering hypothyroidism in the differential diagnosis for patients who have overuse syndromes can expedite treatment. Definitive diagnosis rests on testing of serum thyroid hormone levels. Treatment, which is usually quickly effective, consists of gradually adjusted thyroid hormone replacement.

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study]. / Determinanten der Lebensqualität nach offenem Unterschenkelbruch Typ III. Ergebnisse einer Multicenterstudie.

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test: P = 0.007): number of operations (adjusted beta: -0.21) and age (adjusted beta: -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals: good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.

[Arthrodesis of the wrist in arthritis]. / Arthrodese des Handgelenks bei Arthrosen.

The AO technique of wrist arthrodesis with an embedded iliac crest bone graft is a stable kind of fixation that allows early range of motion. Solid fusion with correction of the deformity and relief of pain can be achieved. A correct position in dorsal extension and ulnar abduction will improve hand function, but a decrease in grip strength must be expected.

Arthroscopic diagnosis of posttraumatic disorders of the wrist.

Arthroscopy of the wrist is a helpful diagnostic procedure in cases of painful problems that cannot be diagnosed by clinical and radiological examination. Arthroscopy of the wrist was done in 32 patients, who could not be diagnosed by clinical and radiological examination. During arthroscopy, lesions of the fibrocartilaginous disc and of the cartilage, synovitis of the joint capsule, scaphoid-lunate dissociations and a loose body were detected. As a result of arthroscopic findings, 10 operative procedures were necessary. Resection of a torn disc, local synovectomy, reconstruction of the torn scaphoid-lunate ligament and removal of a loose body were done by open arthrotomy (8 patients). In 2 patients shaving of chondral ulcers on the radial joint surface was performed, which obviated the need for an explorative arthrotomy. Arthroscopy is a simple method that enables new diagnostic possibilities in rare but difficult cases of posttraumatic pain of the wrist.

[Bridging plate osteosynthesis in simple femoral fractures--a minimally invasive method in polytrauma]. / Die überbrückende Plattenosteosynthese bei einfachen Femurfrakturen--eine minimal-invasive Methode beim Polytrauma.

Clinical studies and animal experiments have not yet reached a consensus on primary and unreamed medullary nailing in polytrauma, especially when craniocerebral and thoracic injuries are involved. Gaping plate osteosynthesis, a recognized technique for treating complex fractures, also represents, with our technique, an option in simple femoral stem fractures.

Osteochondritis dissecans of the knee.

Osteochondritis dissecans is a disorder in which a fragment of cartilage and subchondral bone separates from an articular surface. The etiology is uncertain, although trauma and ischemia have been implicated. The knee is most commonly affected, but the elbow and ankle may also be involved. Patients typically present during their adolescent or early adult years with nonspecific knee pain and swelling that worsens with activity. The diagnosis is confirmed by radiographic findings. Management decisions are based on the patient's age and the stability, location, and size of the lesion.

[Abductor digiti minimi-plasty: a local muscle flap for treatment of calcaneus fractures with limited soft tissue injuries]. / Die Abductor digiti minimi-Plastik: Ein lokaler Muskellappen zur Behandlung von Fersenbeinbrüchen mit begrenztem Weichteilschaden.

Wound healing complications and osteitis following calcaneus fractures are common problems due to compromised local soft-tissue perfusion. Transposition of the M. abductor digiti minimi was successfully performed in 12 cases. The problem of soft tissue coverage could be solved by this procedure. Up to now, no negative influence on the myo-osseous architecture of the feet could be observed.

[Functional healing of compartment syndrome of the tibia. An analysis of follow-up results]. / Funktionelle Ausheilung nach Compartmentsyndrom des Unterschenkels. Eine Analyse der Spätergebnisse.

In a retrospective review 78 compartmental syndromes, treated between 1980 and 1988, were analyzed. The mean follow-up was 42 months. 43 patients (53%) suffered an traffic accident. Direct trauma forces predominated (66 patients). The functional results after crush injuries had been worser than after contusion injuries or direct trauma forces. The functional results depended from the posttraumatic interval of decompression. The later the fasciotomy the worser the functional results had been. A wide fascial decompression is necessary. Two cases of rebound compartmental syndromes after unilateral fasciotomy reveal the skin as an important limiting factor in severe cases of compartmental syndrome.

[Muscle power and shoulder joint function after removal of the latissimus dorsi muscle]. / Muskelkraft und Schultergelenkfunktion nach Entnahme des M. latissimus dorsi.

Free transplantation of the latissimus dorsi muscle has become the treatment of choice in extensive soft-tissue defects of the lower leg after trauma. However, neither the ability of the remaining muscles of the shoulder to compensate for the lost function nor the long-term effects of latissimus dorsi removal on the function of the shoulder have been objectively measured. Therefore, the postoperative shoulder function in 23 patients was compared after removal of the latissimus dorsi muscle with 23 control subjects. The evaluation included a questionnaire, physical examination, and instrumented muscle-testing (cybex system). No significant statistical differences in the function of the shoulders of all the patients and control subjects could be verified, with the exception that 16 patients exhibited weakness during isokinetic torque during extension of the shoulder in a 55 to 65 degree flexion (4.2 +/- 1.2%). The latissimus dorsi free flap can therefore be recommended as a procedure for soft-tissue coverage of extensive wounds resulting only in negligible loss of function and a slightly altered appearance of the shoulder-girdle.

[Unreamed intramedullary nail or external fixator in complicated tibial fracture? A comparative analysis]. / Ungebohrter Marknagel oder Fixateur externe beim komplizierten Unterschenkelbruch? Eine vergleichende Analyse.

Sixty-seven fractures of the tibial shaft with concomitant soft tissue injury were managed at the "Bergmannsheil" Bochum, University Clinic between May 1, 1991 and March 31, 1993. 33 fractures underwent unreamed nailing whereas 34 fractures were stabilized with external skeletal fixation. There were 20 closed fractures with soft tissue compromise (13 types GII and 7 types GIII (Oestern/Tscherne classification)) and 25 compound fractures (8 grade I, 12 grade II and 27 grade III (Gustilo-Anderson classification)). The grade III open fractures were subdivided by the Gustilo-Mendoza-Williams classification (13 types IIIA, 10 types IIIB and 4 types IIIC). Sixty-five fractures have healed (1 amputation type IIIC, 1 patient died). The mean time to union was 28 weeks in the fixator group and 23.5 weeks in the unreamed nail group (statistically not significant, p < 0.095). Also the infection rate (1 case in each group), the fasciotomies due to compartment syndrome, the number of bone grafts, the number of device change and mesh grafts was not statistically significant in both groups. Only the number of performed flaps for wound coverage was statistically significant higher in the fixator group (p < 0.05). In the unreamed nailing population, breakage of the locking bolts occurred in 4 cases. In 3 cases secondary reamed nailing was necessary (2 delayed unions, 1 avulsion of distal bolts). Two fractures underwent dynamization by removal of the distal locking bolts 6 weeks post initial static nailing. The unreamed nail is a versatile implant for tibial shaft fractures with closed and open soft tissue compromise.(ABSTRACT TRUNCATED AT 250 WORDS)