Radiolunate fusion in the rheumatoid wrist with Shapiro staples: clinical and radiological results of 22 cases.

We performed a retrospective clinical and radiological case control study on 22 rheumatoid wrists following radiolunate fusion via Shapiro staples with a mean follow-up of 5 years. Radiographs showed one early loosening through dorsal staple migration and four nonunions. Six wrists fused in mild ulnopalmar dislocation of the lunate. Primary intra-articular positioning of a staple was found in nine wrists, secondary intra-articular staple dislocation was found in two wrists. Dorsal staple dislocation was found in four fused arthrodeses. Osteolysis around the staples was found in all but two wrists. In contrast to unsatisfactory radiological results the clinical results were good or excellent in 18 patients. Good and excellent clinical results in the majority of the patients following radiolunate fusion does not depend on the fixation device. Nevertheless staple fixation of the radiolunate joint in the rheumatoid wrist is associated with a high rate of radiological complications.

[Recurrence of solitary enchondroma at the hand after operative treatment]. / Rezidive operativ versorgter solitärer Enchondrome des Handskeletts.

PURPOSE: Solitary enchondroma is the most common bone tumour at the hand. Nevertheless there are only a few studies referring to a recurrence of this lesion after operative treatment. PATIENTS AND METHOD: 21 patients (17 women/4 men) were examined retrospectively 2 to 18 (mean: 9) years after operative treatment. Clinical and radiological examinations were performed. 3 to 4 years later 9 of these patients were re-examined. 1 patient was first seen at the time of the second examination. Recurrence was the endpoint of the study. RESULTS: At the first examination 11 patients had normal cancellous bone structure 4 to 18 (mean: 8) years after operative treatment. 7 patients had remaining bone defects and their follow-up was 2 to 15 (mean: 8) years. Recurrence was found in 3 patients 11 to 17 years postoperatively. Through the re-examination of 9 patients 2 further recurrences were found 4 to 6 or, respectively, 11 to 14 years postoperatively arising from remaining defects. Another remaining defect became normal cancellous bone structure 2 to 5 years postoperatively. Over all 6 recurrences were found in 22 patients. All patients were free of clinical symptoms. CONCLUSION: Recurrence may occur even more than 10 years postoperatively. Therefore we recommend periodical radiological re-examination for recurrence before weakness of bone can lead to a pathological fracture. Re-examination intervals of 2 to 5 years would probably be adequate.

[Rearthrodesis of the radiolunate joint]. / Die radiolunäre Rearthrodese.

Since 1983, radiolunate arthrodesis has been the gold standard for stabilising the rheumatic wrist. Rearthrodesis of the radiolunate joint has not yet been described. In a prospective study on five radiolunate rearthrodeses with a dorsal mini titanium plate and oblique screw, bone healing was achieved in four. Fatigue fracture of the plate occurred in one case of delayed bone healing. After another rearthrodesis using the same technique, bone healing was achieved. Complete fusion of the wrist can be avoided after failed radiolunate fusion using the described operative technique for rearthrodesis of the radiolunate joint. Preserving some wrist mobility is of high value for these multimorbid patients.

Solitary enchondroma at the hand. Long-term follow-up study after operative treatment.

Twenty-one patients (17 women and four men) who underwent operative treatment for a solitary enchondroma of the hand were examined at a follow-up of between 2 and 18 years (mean, 9 years). Radiographs showed normal cancellous bone at the site of surgery in 11 cases, three had recurrent enchondroma and seven had bone defects so that recurrence could not be excluded. Two of the three recurrences underwent reoperation. Previous studies have regarded persistent bony defects as evidence of complete excision without recurrence. However, in view of the slow asymptomatic growth of this tumour this opinion is incorrect. As shown in this study, recurrences may occur in these defects many years after excision surgery and go undetected until they cause widening or cortical erosion. We recommend periodical radiological re-examination for asymptomatic recurrences before weakness of bone leads to pathological fracture.

[Solitary tumorous muscular sarcoidosis (granulomatous myopathy) of the forearm extensors]. / Tumoröse solitäre Muskelsarkoidose (granulomatöse Myositis) der Handgelenk- und extrinsischen Fingerstrecker.

INTRODUCTION: Besides the lung and hilar lymph nodes, sarcoidosis may affect almost every other organ. Under the aspect of histology, non-caseating granulomas are normally found in sarcoidosis but also appear in connection with other diseases. Therefore some authors prefer the definition "granulomatous myopathy" in the case of solitary muscular affection as long as sarcoidosis is not found in at least two other organs. Others, however, speak of "solitary muscular sarcoidosis", if any other origin can be excluded. CASE REPORT: A 20-year old man mentioned a painless swelling in his left forearm. During a 6-year follow-up, intermittent growth with long intervals of inactivity could be ascertained. The diagnosis was supported by two biopsies within three years. Under oral therapy with prednisone the tumor decreased evidently. REVIEW OF LITERATURE: Out of 61 cases of tumorous sarcoid myopathy described in literature, only 9 lesions appeared in just one location. Three of these 9 showed no evidence of disease in other organs and referred to lower limbs of Japanese. As far as we know a unilocular solitary tumorous sarcoid myopathy of the upper limb has not yet been described. CONCLUSION: The tumorous sarcoid myopathy is mainly located between the muscle fibers. Therefore paralysis, atrophy and contracture is rarely discovered in this kind of sarcoid myopathy. It shows a slow "stop-and-go" progress and may spontaneously go in remission. The expected success of therapy is therefore to be carefully considered in every incidence in view of side-effects. Oral prednisone with an initial dose of 1mg per kg body weight per day seems to be the most effective therapy. A moderate dose reduction prevents recurrence.

[Bursitis tendinis calcanei in extensive calcaneus erosion]. / Bursitis tendinis calcanei mit ausgeprägter Kalkaneusarrosion.

INTRODUCTION: Mechanical and static stress as well as rheumatic diseases may cause retrocalcanear bursitis. Anatomic variants of the calcaneus predispose to this bursitis. CASE: A 51-year-old woman being afraid of operation waited 2 years before undergoing bursectomy al her right heel. For this reason the increase of calcanear bone loss and its stabilisation by sclerosis is well documented in X-rays and MR images. A secondary synovialitis of the peroneal tendons decided completely after bursectomy. No signs of rheumatic disease were found. CONCLUSION: The radiological, clinical and hisiological findings in long-persisting bursitis are often simular to those found in patients with rheumatic disease. Normal laboratory findings do not preclude an early stadium of rheumatic disease. For this reason, these patients had to be instructed to return if they develop further synovialitis to verify the diagnosis and to avoid delayed therapy.