[Does Epping resection arthroplasty lead to loss of hand strength? A prospective study]. / Führt die Resektionsarthroplastik nach Epping zur Kraftminderung der Hand? Eine prospektive Studie.

FCR-sling resectional arthroplasty does not definitely prevent a proximalisation of the first metacarpal bone. Since power transmission of the thenar muscles requires a particular length of the thumb, does proximalisation lead to a reduction of grip strength of the hand? In a prospective study, hand-, key- and pinch-grip strength was compared to preoperative data. Pain intensity and thumb mobility were also examined. In comparison to preoperative data, the pain-free pinch grip improved 60% after three months and 100% after 12 months (p < 0.01). The maximum pinch grip improved 11% after three and 34% after 12 months (p < 0.01). The pain-free key grip improved 22% after three months and 50% after 12 months (p < 0.01). The maximum key grip showed a fair reduction after three months, but after 12 months the key pinch strength came up to preoperative level. The hand grip strength showed a statistically significant improvement of 9% after three months and 34% after 12 months (p < 0.01). After one year, 80% of the patients were completely painfree. There was no clinically relevant disturbance of thumb movement following surgery. Owing to proximalisation of the first metacarpal, a scapho-metacarpal distance of 5.3 (2-9) mm was measured. Despite proximalisation of the first metacarpal, a significant improvement of the grip strength was observed, which was rooted in simultaneous pain reduction.

[Osteosynthesis with resorbable hemi-cerclage in metacarpal fractures]. / Osteosynthesen mit resorbierbaren Hemizerklagen bei Metakarpalfrakturen.

The use and results of biodegradable hemicerclages for metacarpal fracture fixation were reviewed retrospectively. A total of 92 metacarpal fractures in 78 patients were treated with polyglycolic or polydioxanon sutures. Study parameters included time for bony union, duration of immobilisation, total active range of motion, and complications. The hemicerclage achieved rigid fracture fixation and permitted early mobilisation exercises without jeopardizing bony union. Immobilization of metacarpals was performed for a median of 3.4 (1.5 to 6) weeks. There were no complications of wound healing. Adequate bony union was achieved after a median of 4.5 weeks (3.5 to 7 weeks). In one case, premature loading of the fracture led to displacement and delayed union. At the end of treatment (6.1 [4 to 7.5] weeks), total active range of motion was 98 (85 to 100)%. Ideal indications are oblique or torsion fractures of the metacarpals. In these cases, immobilisation up to wound healing is sufficient.

Fixation of metacarpal fractures using absorbable hemi-cerclage sutures.

We retrospectively reviewed the use of biodegradable hemi-cerclage sutures in the treatment of 79 metacarpal fractures in 66 patients. The polyglycolic acid hemi-cerclages achieved sufficient fracture fixation to permit early motion exercises, but fractures were also immobilized for a mean of 3.7 (range, 1.5-6) weeks postoperatively, during which time physiotherapy was given. Adequate bony stability was achieved after a mean of 4.5 (range, 3.5-7) weeks and fracture redisplacement occurred in only one case.

Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography.

In many cases the complexities of skin-flap microcirculation are difficult to assess despite all the subjective and objective examination techniques available today. Adequate microcirculation is essential for tissue viability, so any method employed for studying microcirculation should provide as accurate an assessment of the prevailing conditions as possible. Of all the clinical methods, the fluorescence technique using the dye sodium fluorescein has so far provided the most reliable results. However, the pharmacokinetic properties of this tracer have prevented the technique from becoming established in clinical practice. The fluorescent dye indocyanine green (Cardio Green), on the other hand, has far more favorable pharmacokinetics. In an experimental animal model, the fluorescence technique using indocyanine green (indocyanine green angiography, ICGA) was used to study postoperative changes in the microcirculation of a skin flap. On the day of operation, indocyanine green angiography revealed a state of hemodynamic imbalance for which the organism was able to compensate in the postoperative phase with the aid of humoral, physical, and metabolic factors. With indocyanine green angiography it was possible to quantify objectively the new hemodynamic equilibrium. Basically, microcirculation may be quantified in temporal and spatial terms. The significant objectivity of indocyanine green angiography and short intervals between each examination favor its possible and meaningful use in clinical practice and give cause for continuing studies.

[Objective evaluation of the microcirculation in the skin with indocyanine green angiography (ICGA). A method for the clinic?]. / Objektive Beurteilung der Mikrozirkulation an der Haut mit der Indozyanin-Grün-Angiographie (ICGA). Eine Methode für die Klinik?

In some cases, assessment of the microcirculation of tissues can be very difficult. Various methods have been proposed for evaluating microcirculation, none of which has so far established itself for clinical use. Indocyanine Green Angiography (ICGA) is a suitable and objective method for quantifying microcirculation and due to the pharmacocinetic properties of this dye the prospects for clinical application of this fluorescence technique are rather promising. In an experimental animal study, postoperative changes of microcirculation were examined in a skin flap. The day of operation, ICGA showed pathophysiologic changes of the microcirculation which was corrected during the postoperative phase. This new state of haemodynamic equilibrium was objectively quantified by ICGA. The objectivity and repeatability within short time intervals speak for clinical application after adequate development and experience. The indication has to be clarified in each case. Rare incidence of negative reactions should be kept in mind.

Infrared videoangiofluorography of the skin with indocyanine green--rat random cutaneous flap model and results in man.

We report a new technique for visualizing and measuring skin perfusion on a macroscopic scale using low doses of indocyanine green (0.3 mg/kg body weight). The method was first evaluated in the rat random cutaneous flap model and subsequently applied to determine skin perfusion in a patient with peripheral arterial occlusive disease (PAOD), a patient with forefoot necrosis due to diabetic microangiopathy, and a healthy volunteer. The observed kinetics of fluorescence appearance could only be explained by transition of the dye to a third compartment different from the blood plasma and having a greater affinity for indocyanine green. In PAOD reduced skin perfusion in the tissue surrounding the arterial ulcer could be clearly demonstrated, whereas skin perfusion in diabetic microangiopathy seems to be unaffected. Other potential clinical applications for the technique in dermatology and vascular and reconstructive surgery are briefly discussed.

Responsiveness of leg alignment changes associated with articular pressure testing to spinal manipulation: the use of a randomized clinical trial design to evaluate a diagnostic test with a dichotomous outcome.

OBJECTIVE: A study was undertaken to assess the stability of leg alignment reaction to a pressure challenge and its responsiveness to an adjustive intervention. DESIGN: Prospective, double-blind clinical trial of a diagnostic test. SETTING: Laboratory: Center for Technique Research. PARTICIPANTS: Forty-two chiropractic college students, faculty and staff. INTERVENTIONS: A high-velocity, low-amplitude, short lever adjustment of a single vertebra from among C1 and T3-T7; or a sham adjustment similar to a manual diagnostic pressure test at C1, T3-T7 or T9-T10. MAIN OUTCOME MEASURES: Leg alignment reactivity: An increase in leg alignment discrepancy (yes or no) following a metered pressure challenge to a vertebra. RESULTS: On average, stability was poor at T3-T7 (Kappa = 0.04), moderate at C1 (K = 0.47), and fair for sham pressure tests (K = 0.30). Responsiveness: The proportion of positive baseline leg alignment reactions that responded (became negative) to sham adjustment was 95% at T3-T7 and 55% at C1. Further analysis was untenable since too few vertebrae were implicated for an adjustment. CONCLUSIONS: For the population investigated, the majority of the responsiveness of the leg alignment diagnostic test to a rotatory adjustment appears to be a diagnostic illusion (i.e., background noise unrelated to a treatment intervention). Further research with different subject populations, regions of investigation, leg alignment measurement techniques and vertebral challenge techniques are indicated.

Reactivity of leg alignment to articular pressure testing: evaluation of a diagnostic test using a randomized crossover clinical trial approach.

OBJECTIVE: A study was undertaken to assess the reliability of detecting leg alignment changes (reactivity) and to determine if the observed leg alignment reactivity can be attributed to a rotatory articular pressure challenge. DESIGN: Prospective double-blind crossover trial of a diagnostic test. SETTING: Laboratory: Center for Technique Research. PARTICIPANTS: Forty-two chiropractic college students, faculty and staff. INTERVENTIONS: A standardized force of 2 or 3 kg was applied with a 1 cm2 rubber-tipped pressure algometer on the lateral aspect of the T3-T7 spinous processes and the posterior aspect of the lateral masses of C1. MAIN OUTCOME MEASURES: Leg alignment reactivity: an increase in leg alignment discrepancy (yes or no) following a diagnostic intervention. RESULTS: The reliability for detecting leg alignment reactivity was poor: on average, Kappa = 0.05 in the thoracics and 0.06 at C1. On average, the attributable risk of leg alignment reactivity (pressure test risk--sham test risk) was less than 4%. In many cases, the sham rate was greater than the pressure test rate. CONCLUSIONS: For the population investigated, leg alignment reactivity to rotatory pressure testing can, in the majority of cases, be attributable to background noise. This procedure was not found to be viable for identifying vertebrae for adjustment. Further research with different subject populations, regions of investigation, leg alignment measurement techniques and vertebral challenge techniques are indicated.