[Compartment syndrome of the forearm after intra-arterial self-injection : With a mixture of methadone, flunitrazepam, saliva and water]. / Kompartmentsyndrom des Unterarms nach intraarterieller Autoinjektion : Mit einem Gemisch aus Methadon, Flunitrazepam, Speichel und Wasser.

A drug-addicted patient injected himself intra-arterially with a mixture of methadone, flunitrazepam, saliva and water. The resulting compartment syndrome could be treated by fasciotomy and multiple debridement, with which a major amputation could be prevented. The course of the treatment and the resulting functional results are described, as well as a brief overview of the literature and a treatment proposal for similar cases.

Compression plate arthrodesis for osteoarthritis of the first carpometacarpal joint: A retrospective study of 77 cases.

Osteoarthritis of the first carpometacarpal joint (CMCJ1) is a common, painful condition with positive radiological findings in up to 32% of people over 50 years of age and up to 91% of people over 80 years of age. Currently, there is insufficient evidence to recommend one surgical treatment option over the others. We conducted a retrospective review of 77 patients treated for CMCJ1 osteoarthritis with plate arthrodesis between 1979 and 1996. The review included physical examination, including range of motion (ROM) of the thumb interphalangeal joint, metacarpophalangeal joint and CMCJ1, pinch grip, key grip and power grip strength, and a questionnaire on subjective outcomes (appearance, dexterity, load bearing, pain, strength, subjective overall result and if patients would choose the procedure again). The complication rate was 26%. However, the general patient satisfaction was high with 88% of patients saying they would choose to have the procedure done again. There was a significant decrease (side-to-side difference) in the ROM for palmar and radial abduction as well as opposition when compared to the opposite hand. Furthermore, there was a significant reduction (side-to-side difference) in pinch, key grip and power grip strength. ROM did not seem to have any influence on pain (and vice versa), load bearing, and the subjective overall result. No gender differences were noted. Despite the high complication rate, CMCJ1 arthrodesis remains a viable option for the treatment of CMCJ1 osteoarthritis in select patients requiring good thumb stability.

[Acute colonic pseudo-obstruction (Ogilvie's syndrome) - a rare complication after ablation mammae and direct reconstruction with a free TRAM flap]. / Die akute Pseudoobstruktion des Kolons (Ogilvie-Syndrom) - eine seltene Komplikation nach Ablatio mammae und Direktrekonstruktion durch freien TRAM-Flap.

We report a case of a 62 year old woman who presented with Ogilvie's syndrome as a complication of mastectomy with free TRAM flap reconstruction due to angiosarcoma of the right breast. In the acute postoperative period, the patient expired as a result of Ogilvie's syndrome related complications. Several assumptions regarding the causes of Ogilvie's Syndrome as well as current theories about aetiology, diagnosis and therapy are discussed in this case presentation.

[Impact of soft tissue injury on results after osteosynthesis of intraarticular fractures of the base of the middle phalanx of the finger]. / Einfluss von Weichteilverletzungen auf die Ergebnisse operativ versorgter intraartikulärer Mittelphalanx - Basisfrakturen.

BACKGROUND: The aim of this study was to investigate retrospectively if soft tissue injuries have an impact on the functional results of surgically treated intra-articular fractures of the base of the middle phalanx. PATIENTS AND METHODS: From 1/2007 to 4/2010 we operated on 27 patients with intra-articular fractures of the base of the middle phalanx with pins, screws or external fixation analogous to Suzuki. 5 patients were excluded. 13 patients had no significant soft tissue injury (kWTV group), 9 patients had significant soft tissue damage including open fractures, skin lesions or/and severe soft tissue swelling (WTV group). Postoperative function and complications were analysed based on total active range of motion (TAM) and range of motion of the proximal interphalangeal joint (PIP-ROM) with regard to the Larsen score and clinical data. RESULTS: Fractures with soft tissue injuries had a significantly worse TAM outcome (p=0.04) than fractures without soft tissue injury (kWTV group: TAM 197.1°; WTV group TAM 231.2°) even if the functional results regarding the Larsen classification were excellent or good in both groups (kWTV 100%, WTV 88.9%). There were no significant differences regarding PIP-ROM of both groups. CONCLUSION: Soft tissue injuries have a negative impact on the functional results of surgical treated intra-articular fractures of the base of the middle phalanx. The influence on PIP-ROM might be less. Other factors might play a considerable role for PIP-ROM. With an adequate operative treatment most intra-articular middle phalanx fractures show good to excellent functional -results.

[Results after osteosynthesis of extraarticular proximal phalangeal fractures]. / Ergebnisse osteosynthetisch versorgter Grundphalanxfrakturen der Finger.

The aim of the study was to retrospectively present and analyse the functional results of surgically treated extraarticular fractures of the proximal phalanx.From 1/2005-4/2008 we operated on 49 patients with 52 closed, extraarticular fractures of the proximal phalanx of the long fingers with either pins, screws or plates. 30 patients were male, 19 were female, the mean age was 35 years. Open fractures, fractures of the thumb and those with injuries to neurovascular structures or tendons were excluded. Postoperative physiotherapy was started on day 1 after surgery. Postoperative finger function and complications were analysed based on the total active motion (TAM) regarding the Belsky score and the classification of Page and Stern. In addition, patients were contacted by phone in 4/2009 to verify the subjective functional results at the end of the observation period.Three different operative procedures were employed: internal fixation by Kirschner wires (n=25), and open fixation by screws (n=8) or plates (n=19). The entire treatment period amounted to 12 (4-28) weeks, the observation time was 33 (11-50) months. Two patients, both after plate osteosynthesis, had to be reoperated because of functional deficits due to adhesions. In both a tenolysis and removal of the plate was performed. The functional result was excellent in 20 of 25 patients treated by Kirschner wires, in seven of the eight in the screw-fixation group and in 13 of the 19 patients treated by plate ostheosynthesis (TAM > 240°); the result was judged fair in 1 after plate osteosynthesis (TAM 215°). The remaining 11 patients showed a good outcome with a TAM between 220° and 239°. These favourable results remained subjectively stable at the end of the observation period, when all patients could be contacted by phone.Osteosynthesis by kirschner wires, screws and plates for closed extraarticular fractures of the proximal phalanx of the long fingers gives good to excellent results with few complications.

Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study.

Forty patients with a 30° to 70° palmar displacement of a little finger metacarpal neck fracture were treated either with closed reduction and intramedullary splinting, or conservatively without reduction. Functional mobilization was started after 1 week in both groups. A radiological and clinical assessment of flexion and extension of the small finger metacarpophalangeal joint was done at 2 and 6 weeks, and at 3, 6 and 12 months. In addition patient satisfaction and grip strength were recorded at 12 months. No statistically significant differences in range of motion and grip strength were found between the two groups. Patient satisfaction and the appearance were superior in the surgically treated group. We conclude that intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage.

[Factitious disorder and self-mutilation in hand and plastic surgery]. / Artifizielle Störungen und selbstverletzendes Verhalten in der Hand- und Plastischen Chirurgie.

Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented.

Photoablation of bone by excimer laser radiation.

BACKGROUND AND OBJECTIVES: The aim of the present study was to compare the usefulness of mechanical osteotomy tools and common laser systems with the ultraviolet (UV) laser in the field of the central nervous system and its bony capsule. STUDY DESIGN/MATERIALS AND METHODS: The cranial bones of 42 living rats were treated with UV laser radiation with wavelengths of 193 nm and 248 nm. The morphology and physical effects were evaluated by means of optical and scanning electron microscopy. RESULTS: This study shows the special characteristics of excimer versus infrared lasers or mechanical tools, such as high precision, no thermic damage, little depth effect, and no delay of healing processes. CONCLUSION: The excimer laser is an interesting instrument for microsurgery of bones in orthopaedics, neurosurgery, and otolaryngology.