[Wrist joint arthroplasty: results after 41 prostheses]. / Handgelenksendoprothetik: Erfahrungen nach Implantation von 41 Prothesen.

PURPOSE: The advantage of wrist arthroplasty remains controversial, primarily due to the high complication rate. For this reason it seems sensible to monitor the results of different types of prostheses even with small numbers of cases. We were particularly interested to see if wrist joint arthroplasty is a useful alternative for patients with rheumatoid arthritis, and which of the types we used shows the best results. PATIENTS AND METHODS: In our hospital, 41 wrist joint prostheses (15 Meuli, 16 BIAX and 10 Universal 2) were implanted in 36 patients from 1992 until 2005 (follow-up 1 to 14 years, mean 5.3 years). 33 patients had rheumatic destruction of the wrist, two had osteoarthritis following fracture of the scaphoid, and one pseudarthrosis after failed arthroplasty and arthrodesis for Kienböck's disease. Mean age was 54 years, ranging from 34 to 73 years. 14 patients had had surgery on this wrist before. The patients were sent a questionnaire including the DASH score, and a clinical evaluation and X-rays were performed. RESULTS: 33 patients with 38 wrist arthroplasties answered the questionnaire, 34 wrist joint prosthesis of 29 patients could be evaluated. DISCUSSION: 6 prostheses had to be removed because of complications (3 arthrodeses were performed after removal, 3 prostheses were exchanged). There were 4 dislocations (3 times with the Meuli type, once with the BIAX type). There was one case of CRPS type I. But subjectively, in answering our questionnaire, 31 of 38 patients claimed to be very satisfied or satisfied with the result of the operation, only 6 were less satisfied or not satisfied at all. An improvement of pain was found by all but one patient. An increase in strength or range of movement was found more rarely. The mean postoperative DASH score was 61 points. Mean wrist joint mobility was 50 degrees for extension/flexion, and 20 degrees for radial- and ulnar abduction. CONCLUSION: The result of total wrist joint arthroplasty depends very much on a careful patient selection. A preoperative bony malposition of the wrist and a tendon dysfunction seem to be responsible for a bad result. High expectations with regard to range of movement and strength should be avoided. A good reduction of pain can be achieved but the risk of complication is still higher than in arthrodesis.

[Epiphysiolysis of the proximal tibia in high jumping]. / Eine proximale Tibiaepiphysenlösung beim Hochsprung.

Damage to the proximal epiphysis of the tibia is a most unusual injury. The case in point happened without a trauma. The mechanism of the injury is discussed. The different types and the frequency of the injury are presented on the basis of the literature. Treatment of this typical AITKEN-I fracture rarely offers problems.

[Knee arthroplasty - another late result 34 years later]. / Kniearthroplastik - Ein weiteres Spätergebnis nach 34 Jahren.

This description of a 34-year course of a knee-joint arthroplasty after fibrous ankylosing of the knee joint due to shell-splinter injury and lower-leg amputation contralaterally is intended to draw attention once again to this method of treatment. In particular, the great importance of co-operation by the patient in this method of treatment is underlined. Even today, allo-arthroplasty is in such cases no alternative offering a more favourable prognosis when compared with the long-term result obtained by means of the method described.

[Epicondylitis humeri lateralis, operative technique and results (author's transl)]. / Epicondylitis humeri lateralis Operationstechnik und Ergebnisse.

Epicondylitis humeri lateralis is caused by excessive strain on the extensors of the forearm. Chronic inflammation of the epicondylus humeri lateralis and irritation of sensitive fibres of the radial nerve result. The pain can be eliminated by Hohmann's operation on the epicondylus humeri lateralis, with complete separation of the forearm extensor roots. Additional denervation of the epicondylus humeri lateralis (A. Wilhelm's method) eliminates the pain sensations due to the disease by interrupting the sensitive nerve fibres of the N. radialis. These two operations are complementary and a combination of both increases the success rate to 90%.