Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations.

INTRODUCTION: Dynamic external fixation systems are considered as optimal devices for treatment of fracture dislocations of the proximal interphalangeal joint (PiP). The pins and rubbers traction system (PRTS) is cheap, easy to assemble and comfortable and allows early mobilization of the affected digit. We investigated the influence of different wire positions and rubber strength and provided a follow-up of five consecutively treated patients. METHODS: Sixteen cadaver fingers (dig 2-5) were included into the biomechanical study. Forces for flexion of the PiP joint (30 degrees, 60 degrees, and 90 degrees) were measured by pulling the flexor digitorum profundus tendon; width of the PiP joint was assessed radiologically. Measurements were obtained prior and after assembly of PRTS and were repeated with three different types of rubbers and two different positions of the retention wire (distal and proximal). The clinical part of the study included five patients (21-72 years) who were treated using the PRTS. Mean follow-up was 272 days. RESULTS: The PRTS increased flexion force of the PiP joint. Proximal position of the retention wire increased forces for 30 degrees flexion. Different rubber strengths did neither increase PiP width nor influence flexion forces. In the clinical part of the study total range of motion was 74 degrees and DASH score was 10.1. Pinch grip of the affected digit was 72% of the unaffected side. DISCUSSION: The PRTS allows for efficient treatment of intraarticular fractures with PiP involvement. Although standardized positioning of the wires is important, proximal position of the retraction only increased forces for 30 degrees flexion.

Phlegmonous-infection in first degree Dupuytren's disease.

Dupuytren's disease belongs to the group of so called fibromatoses and is considered to be a non infectious disease. Since first degree Dupuytren's disease is generally not operated upon, we want to report the unexpected finding of phlegmonous-abscessing infection in nodules in Dupuytren's disease in a 61 year old patient, who was treated surgically because of complaining painful symptoms in first degree nodules in his palm without clinically visible signs of infection.

Malignant Natural-Killer cell neoplasm presenting as a mucous cyst on the distal interphalangeal joint of the finger.

This case report describes a very rare and highly malignant type of lymphoma, which presents as a mucous cyst on the finger. The cyst was excised and the specimen pathohistologically analyzed. The analysis revealed the presence of a Natural-Killer cell neoplasm. This case illustrates and stresses the importance of a pathohistological examination when doubts arise about the initial diagnosis of a benign tumorous lesion.

50 years experience with Dupuytren's contracture in the Erlangen University Hospital--a retrospective analysis of 2919 operated hands from 1956 to 2006.

BACKGROUND: Dupuytren's disease (DD) is a hand disorder mainly among the northern population. In contrast it is rare in the mediterranean population. Therefore typical habits and dietetic influences have been discussed as well as genetic predisposition. Still, since the first description by Dupuytren in 1834 only little is known about the etiology and pathogenesis of this disease. Some hints were found for a higher prevalence among people with diabetes, alcohol abuse or smoking. Also, intensive manual work or hand injuries have been discussed to have an influence on DD. To our knowledge this is the largest retrospectively evaluated series of symptomatic patients published to date. The study includes patients from the last 50 years. It was performed to show possible correlations between DD and typical risk factors such as diabetes, alcohol consumption, and smoking. METHODS: We retrospectively analysed all patient records with DD documented between 1956 and 2006 in the Surgical University Hospital in Erlangen. Data acquisition was conducted by reviewing the medical records from 1956 to 2006 including data from all patients who were surgically treated because of DD. RESULTS: We reviewed 2579 male and 340 female surgically treated patients with DD. More than 80% of the patients were between 40 and 70 years old. In 28.9% only the right hand was effected by DD, in 25.3% only the left hand and in 45.8% both hands. In 10.3% of all Patients suffered from Diabetes mellitus. Statistical analysis revealed no significant correlation between diabetes, alcoholism or smoking on the degree of DD in our patients. CONCLUSION: Most data are consistent with previously published results from smaller, comparable retrospective studies with regard to right- or left handedness. We could not confirm a statistically significant correlation of DD with diabetes mellitus, severe alcohol consumption, heavy smoking or epilepsy and the stage of the disease as described in other studies. However, in the whole cohort of our operated patients during the last 50 years the prevalence of the above mentioned risk factors is slightly higher than in the normal population.

Correlation between serum creatinine kinase levels and extent of muscle damage in electrical burns.

The relationship between clinical course and changes of laboratory findings in patients with high-voltage electrical burns with regard to creatinine kinase activity was analyzed in order to determine the value of this prognostic parameter with regard to patients survival and risk of limb amputation. In a retrospective study 42 patients with electrical burns were reviewed. CK serum levels were determined every day during the first 10 days following submission. Analysis of data revealed a relation between strongly elevated CK levels and patients risk of limb amputation and mortality. Although further research is necessary, there is strong evidence that the amount of burned body surface area does not directly correlate with the true extent of tissue damage caused by high tension injuries. Our data suggest that the degree of muscle tissue violation corresponds with the initial excess of creatinine kinase levels in blood serum. This may be an additional factor to support the decision for early surgical decompression of electrically burned extremities and aggressive surgical management of the high-voltage burn victim. Furthermore, it may provide a prognostic parameter for the clinical outcome of these patients.