[Acute scaphoid fractures : Management under consideration of the new S3-level guideline]. / Die frische Skaphoidfraktur : Management unter Berücksichtigung der neuen S3-Leitlinie.

BACKGROUND: Scaphoid fractures represent the most common carpal fractures and are often problematic and frequently lead to nonunion with osteoarthritis and collapse of the wrist. The reasons for the nonunion are manifold. Therefore, the main goal of diagnosis and therapy of acute fractures is to achieve bony union and to restore the anatomic shape of the scaphoid. In the long run, only this can preserve the normal function of the wrist. METHODOLOGY: The given recommendations are based on the new S3-level guideline of the AWMF (Association of the Scientific Medical Societies). This guideline was established with involvement of all relevant medical societies based on a comprehensive and systematic review of the literature and after a process of formal consent. The focus of the guideline is recommendations regarding diagnosis and therapy of acute scaphoid fractures. MAIN STATEMENTS: After careful clinical examination consequent imaging must be performed, starting with X­rays in three standard projections. Computed tomography is indispensable for proof of a fracture and for therapy planning. The classification of Herbert and Krimmer is based on the CT under special consideration of instability and displacement of the fracture. Thus, indication for operative and non-operative treatment is mainly CT-dependent. Non-operative treatment may be indicated only for stable fractures (type A). However, operative treatment is strongly recommended for all unstable fractures (type B). For fixation, double-threaded headless screws are preferred. The operative technique depends on the fracture morphology. CONCLUSION: Diagnosis and therapy of acute scaphoid fractures are primarily aimed at the prevention of nonunion and arthritic carpal collapse with painful impairment of the wrist function. To achieve this, the S3-level guideline contains explicit recommendations.

[Clinical functional assessment of various surgical hand arthrodesis techniques]. / Klinisch-funktionelle Nachuntersuchung verschiedener handchirurgischer Versteifungsmethoden.

BACKGROUND: Total and partial arthrodesis of the wrist are currently sophisticated treatment options for many advanced pathological changes of the wrist. This retrospective study analyzed the subjective and objective outcome of different wrist arthrodesis techniques, e.g. total wrist arthrodesis, scaphotrapeziotrapezoid (STT) bone fusion and midcarpal arthrodesis. MATERIALS AND METHODS: Subjective physical and mental quality of life of 98 patients (total wrist arthrodesis n = 43, STT fusion n = 30 and midcarpal arthrodesis n = 25) was measured using the DASH questionnaire. The range of motion and grip strength were analyzed in 48 patients (total wrist arthrodesis n = 21, STT fusion n = 17 and midcarpal arthrodesis n = 10). RESULTS: Patients with partial wrist arthrodesis achieved a significantly better DASH score than patients with total wrist arthrodesis. Grip strength did not show any statistically significant differences between the two groups. Patients with STT fusion showed the best range of motion of the wrist. CONCLUSION: Partial arthrodesis seems to be superior to total wrist arthrodesis. Patients profit from a higher physical and mental quality of life.

[Does additive spongiosaplasty improve outcome after surgical therapy for solitary enchondroma in the hand?]. / Einfluss der Spongiosaplastik auf die Behandlungsergebnisse nach chirurgischer Therapie solitärer Enchondrome der Hand.

INTRODUCTION: The necessity of spongiosaplasty in the treatment of solitary enchondroma in the hand has been a subject of controversial discussions for several years. Over a period of 10 years the authors performed single curettage without spongiosaplasty. The aim of this study was to investigate our results and to compare these findings with those of other studies. PATIENTS AND METHOD: Over the last 10 years we have treated 106 patients with solitary enchondroma of the hand by single curettage without bone grafting. All patients underwent postoperative radiological examination. The mean follow-up was 34 months. The results of the X-ray investigation were examined retrospectively concerning the recurrence rates and the Hasselgren score. RESULTS: Two patients (1.9%) have experienced radiological changes according to Hasselgren score IV. One patient (0.8%) demonstrated radiological III° changes according to score of Hasselgren. Including the patient with the radiological changes according to Hasselgren score III, the overall recurrence rate was 2.8%. DISCUSSION: After comparing our results with those of other studies, we conclude that additional bone-grafting does not improve the recurrence rate of solitary enchondromas of the hand.

[Bacteria in the gallbladder wall and gallstones--indications for cholecystectomy]. / Bakterien in Gallenblasenwand und Gallensteinen--Indikation zur Cholecystektomie.

After cholecystectomy the bacterial content of the bile, gallbladder wall and gallstones was studied in 40 patients. Bacteria could be found in 9 cases in the gallbladder wall, in 8 cases in the gallstones and in 3 cases in the bile. In chronic inflammatory thickened gallbladder wall bacteria were positive in 8 of 14 cases whereas in normal gallbladders bacteria were found only in 3 of 26 cases (difference statistically significant, P = 0.01). It is concluded that in gallstone disease bacteria are not only present in bile but also in the gallbladder wall and within the gallstones. As bacteria are mostly present in a gallbladder wall with chronical inflammatory changes a thickened gallbladder should be removed even in asymptomatic or slightly symptomatic cases of gallstone disease in order to prevent relapsing cholecystitis.