[Osteophyte-induced impingement reduces range of motion in humpback deformity of incorrectly healed scaphoid reconstruction]. / Osteophytenbedingtes Impingement verringert die Beweglichkeit bei in "Humpback"-Deformität fehlverheilter Skaphoidrekonstruktion.

BACKGROUND: The gold standard in the treatment of scaphoid pseudarthrosis is reduction, interposition of an iliac crest graft and stabilization with a headless bone (Herbert) screw, aiming to reduce the frequently observed humpback deformity. This study correlated the extent of humpback deformity after scaphoid reconstruction to clinical and radiological postoperative parameters. MATERIAL AND METHODS: Between 2008 and 2010 a total of 56 patients with scaphoid pseudarthrosis were surgically treated. Of the patients 34 could be included in this retrospective study. The average follow-up period was 7.3 months. The humpback deformity was evaluated by computed tomography (CT) scan performed along the long axis of the scaphoid. The disability of the arm, shoulder and hand (DASH) score, grip strength (Jamar), range of motion (RoM), Mayo wrist score (MWS) and other parameters were used to determine the clinical outcome. The patients were divided into two groups: 1) no or only slight humpback deformity (<25°), 2) severe humpback deformity (>45°). RESULTS: The RoM and DASH scores were slightly better for the first group. The second group had a significantly increased incidence of osteophyte formation (p < 0.05) and decreased RoM (-16°). CONCLUSION: It is postulated that the main disadvantage of an nonreduced humpback deformity is the increased occurrence of osteophyte formation in the dorsal aspect of the scaphoid. This can cause an impingement during extension and leads to a significant restriction of movement of the wrist. LEVEL OF EVIDENCE: III.

[Diagnostic accuracy of conventional X-ray imaging for assessment of trapeziometacarpal joint osteoarthritis]. / Genauigkeit der konventionellen Röntgendiagnostik bei der Beurteilung der Daumensattelgelenkarthrose.

BACKGROUND: Osteoarthritis of the trapeziometacarpal joint is a common and painful affliction that can be diagnosed using conventional X­ray imaging as well as arthroscopy and if necessary treated; however, the X­ray classification often does not sufficiently demonstrate the cartilage damage found in arthroscopy. OBJECTIVE: The aim of the study was to evaluate the diagnostic accuracy of conventional X­ray imaging compared to arthroscopy for osteoarthritis of the trapeziometacarpal joint. MATERIAL AND METHODS: The preoperative conventional X­ray images of 23 patients were presented to 10 experienced hand surgeons who were blinded to the arthroscopy results. Their ratings were compared to the results found with arthroscopy. RESULTS: Of the patients 11 were found to have grade 4 cartilage lesions according to the Outerbridge classification, 8 grade 3 lesions, 4 grade 2 lesions and no grade 1 lesions. Overall, 43% (95% confidence interval, CI 37-49%) of the cartilage lesions were diagnosed correctly using conventional X­rays. For grade 4 lesions 73% (95% CI 65-81%) of the surgeons made the correct diagnosis, in the case of grade 3 lesions 38% (95% CI 27-49%) and in grade 2 lesions 13% (95% CI 3-23%). CONCLUSION: This study presents an arthroscopy classification system that is specific for osteoarthritis of the trapeziometacarpal joint and provides an additional method of assessment if the X­ray grading of osteoarthritis according to Eaton and Littler is too unspecific. Arthroscopy can be used to safely differentiate the treatment-relevant stage and also includes treatment options.

Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease.

INTRODUCTION: The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS: Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS: The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS: PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.

[Diagnosis and treatment of degenerative disc lesions of the wrist]. / Diagnostik und Therapie der degenerativen Diskusläsion.

BACKGROUND: The triangular fibrocartilage complex (TFCC) widens the radiocarpal joint and takes part in load transmission from the carpus to the forearm. It is thereby prone to degenerative changes. The painful situation that can accompany degeneration is called ulnar impaction. DIAGNOSIS: Clinical examination helps differentiate between various causes of ulnar-sided wrist pain. Standard X­rays are needed to determine ulnar variance and stress radiographs can depict narrowing of the ulnocarpal joint space under load. MRI may prove degeneration of the TFCC itself or may indirectly confirm ulnar impaction in the presence of bone marrow edema in the ulnar head or at the proximal ulnar aspect of the lunate. TREATMENT: If conservative treatment fails to alleviate symptoms, arthroscopy may be indicated. On the one hand, this completes the diagnostic cascade, and, on the other hand, allows decompression of the ulnocarpal joint space by resection of the TFCC with partial resection of the ulnar head (wafer resection). In the case of ongoing pain, ulnar shortening sufficiently alleviates ulnar-sided wrist pain. Thereby, modern standardized operation techniques are safe enough to ensure bone healing at the osteotomy site. The aim of alleviating ulnar-sided wrist pain is mostly achieved if the correct treatment option is chosen.

Diagnosing central lesions of the triangular fibrocartilage as traumatic or degenerative: a review of clinical accuracy.

This study examined the reliability of surgeons' estimations as to whether central lesions of the triangular fibrocartilage complex were traumatic or degenerative. A total of 50 consecutive central triangular fibrocartilage complex lesions were independently rated by ten experienced wrist surgeons viewing high-quality arthroscopy videos. The videos were reassessed after intervals of 3 months; at the second assessment surgeons were given the patient's history, radiographs and both, each in a randomized order. Finally, the surgeons assessed the histories and radiographs without the videos. Kappa statistics revealed fair interrater agreement when the histories were added to the videos. The other four modalities demonstrated moderate agreement, with lower Kappa values for the assessment without videos. Intra-rater reliability showed fair agreement for three surgeons, moderate agreement for two surgeons and substantial agreement for five surgeons. It appears that classification of central triangular fibrocartilage complex lesions depends on the information provided upon viewing the triangular fibrocartilage complex at arthroscopy. LEVEL OF EVIDENCE: II.

[Overview and Introduction of a Treatment Concept for Postoperative Care and Mobilisation After Free Flap Transplantation in the Lower Extremity]. / Überblick und Vorstellung eines Behandlungskonzeptes zur postoperativen Therapie und Mobilisation nach freier Lappenplastik an der unteren Extremität.

Introduction: Free flap transplants for soft tissue reconstruction in the lower extremity are associated with a higher rate of complications compared with other areas. Mobilisation and the resulting hydrostatic pressure put strain on the flaps. In general, these effects are countered by slowly increasing hydrostatic pressure with the leg being compressed by elastic bandages. These postoperative regimes are also called dangling procedures or "flap training", but are not scientifically validated and therefore there is no consensus or guideline leading to a standard treatment regime. The goal of our study was to present an overview of currently performed regimes. Material and Methods: We conducted an email survey by sending a questionnaire to departments for plastic and reconstructive surgery in Germany, Austria and Switzerland, which perform free flap transplantations in the lower extremity. The questionnaire ascertained the starting point and the frequency of the dangling procedures, the introduction of weight-bearing on the operated extremity and the incidence of complications occurring during mobilisation. Results: We included 32 departments and compared them by the number of free flap transplantations performed per year. We found a wide variation between the postoperative treatment regimes. In most departments, flap training is started between the 3rd and 7th day after surgery and lasts between 5 and 15 min. The intervals with which flap training intensity is increased are inhomogeneous as well. The time until full weight-bearing is exerted on the operated extremity ranges from day 5 to week 3 postoperatively. Complications due to flap training were reported by one third of the participating departments. Conclusion: Elastic compression and patient mobilisation after free flap procedures in the lower extremity are considered to be very important in reducing complications and in protecting the flap from edema and volume overload. This article demonstrates that there is a wide variety in flap training regimes. It aims to help readers evaluate their own regimes and provides guidance for an individualised patient-oriented regime.

Postoperative negative pressure therapy significantly reduces flap complications in distally based peroneus brevis flaps: Experiences from 74 cases.

BACKGROUND: The distally based peroneus brevis muscle flap is a valuable therapeutic option for coverage of tissue defects around the ankle and the distal lower leg. However, the rate of postoperative flap complications requiring revisional surgery is high due to an impaired venous drainage and oedema formation. The purpose of this study was to evaluate if postoperative negative pressure therapy is able to reduce flap complications. METHODS: From April 2010 until March 2014, we treated 74 patients with distally based peroneus brevis muscle flaps for defect coverage at the lower leg. In four cases, an osteomuscular composite flap has been used to treat partly stability-relevant bone defects. In 43 cases, negative pressure therapy (75mmHg, continuous) with a circular dressing was initiated after the flap procedure for 7 days. In 31 cases no negative pressure therapy was initiated. We retrospectively analysed those two groups of patients. The primary endpoint was the incidence of flap complications with a need for revision surgery, which were classified in three grades. RESULTS: The group treated with negative pressure therapy had significantly less flap complications when compared to the control group (p<0.0001). Concerning the single grades of complication, the negative pressure therapy-group had a significantly smaller rate of skin graft necrosis (Grade 1; p=0.014) and partial flap loss (Grade 2; p=0.002) compared to the control group. There were no statistically significant differences concerning complete flap loss (Grade 3) between both groups. CONCLUSION: Postoperative negative pressure therapy for 7 days reduces flap complications in distally based peroneus brevis flaps.

Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis.

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. LEVEL OF EVIDENCE: IV.

[Four-Corner Fusion using Retrograde Headless Compression Screws]. / Die mediokarpale Teilarthrodese des Handgelenkes mit retrograden kopflosen Kompressionsschrauben.

This article describes our technique of 4-corner fusion using retrograde insertion of headless compression screws.

[Problems in complex hindfoot corrections]. / Probleme bei Komplexen Rückfusskorrekturen.

This article discusses the intraoperative and postoperative problems seen in the treatment of posterior tibial tendon dysfunction. Problems associated with tendon transposition procedures, osteotomy and arthrodesis are discussed. The preoperative, intraoperative and postoperative problems and complications and how to avoid or treat them will be addressed. The individual procedures are often part of other complex hindfoot reconstructions. For this reason the general and special aspects of treating posterior tibial dysfunction can often be transferred to avoiding and resolving problems in hindfoot surgery.

[Aseptic osteonecrosis of the head of the metacarpal (Mauclaire's disease)--case report and review of the literature]. / Die aseptische Osteonekrose des Metakarpalekopfes (Morbus Mauclaire)--Fallbericht und Literaturübersicht.

Aseptic osteonecrosis of the head of metacarpal is a rare disease with an unknown aetiology. It was first described by Mauclaire 1927. We now report on the treatment of 2 patients with Mauclaire's disease via transplantation of the calotte of the head of the 2nd metatarsal. At 26 and 30 months, respectively, after surgery both patients were free of complaints in activities of daily live and had free function of their fingers. There was no discomfort in the resection area at the 2nd metatarsal. Based on this experience, the method seems to be a recommendable option in young adults. A prerequisite is that the base of the proximal phalanx be intact.

[Migration and behavioral pecularities of nursery-school children in Basel]. / Migration und Verhaltensauffälligkeiten bei Basler Kindergartenkindern.

The Basle Kindergarten Study is looking at the effects of migration on health and development. Local, social and cultural relationships are broken up through migration. We call this break of relationship "up-rooting". Deviant behaviour can be understood as indicator of disturbed psychosocial development. Two hypotheses are examined: 1. Signs of up-rooting are concentrated in migrant-families. 2. The children in these families show more deviant behaviour. Both hypotheses are not supported by our preliminary data.

[Draft and course of a Basel Kindergarten study]. / Konzept und Ablauf der Basler Kindergartenstudie.

Programme and course of the Basle Kindergarten Study are presented. This study has to describe and analyse the somatic and psychosocial development of children of foreign workers, of people from other swiss cantons and of locals to get ideas referred to prevention.

[Personality, school-achievement and behavior disorders]. / Persönlichkeit, Schulleistungen und Verhaltensstörungen.

In the framework of the Basle Adolescence-Study, students with indications of behaviour disorders were the subject of a special analysis. The greater part of them belonged to the lower social class and frequented the intellectually less demanding branches of the school system. Even where this was not the case their personality profile showed the characteristics of the lower class populations. The theoretical base of the "labelling approach" could be verified. School and Counselling Service proved to be efficacious parts of the system of social control.

[Epidemiological factors and personality structure]. / Epidemiologische Faktoren und Persönlichkeitsstruktur.

The relation between sociodemographic characteristics and structure of personality (MMPI) was analyzed using the results of the "Basle Adolescence Study". Type of housing, family structure, employment of the mother and number of working hours of the father produced statistically significant differences, which, however, were small in respect to the general variability of the structure of personality.

[Evaluation of an educational program on smoking, alcohol and drug abuse]. / Evaluation eines Lernprogramms zum Thema "Rauchen, Alkohol und Medikamentenmissbrauch".

The learning program with the title "Consuming critically" has the objective to influence the learner so that he will completely abstain from smoking, drinking of alcoholic beverages and the abuse of medication or at least reduce the respective consumption. A reduction in consumption or a reduction in the predisposition to consume for those who were none-consumers was considered the criteria for a successful utilization of the program. The program was evaluated with a representative sample including all types of schools at the 8th grade in the Basle Schools. By a standardized questionnaire behaviour and attitudes were measured. Regarding the smoking of cigarettes changes in the desired direction could be shown in both behaviour and attitude. No effect could be proven as to the consumption of alcoholic beverages. A significant positive change in the attitude towards the proper use of medication could be demonstrated while the corresponding consumption pattern remained unchanged.

[Stability of answers to questions about eating habits]. / Stabilität der Antworten zu Fragen über Ernährungsgewohnheiten

Different indices are used to evaluate the stability of answers referring to eating habits, collected in an interval of 6 months. The stability is comparable to answers to questions referring to participation in various groups. Both are strongly dependent on the frequency of the characteristic measured.

[Personality and scholastic achievement]. / Persönlichkeit und Schulleistungen

Based on the data of the "Basle Adolescents Study" 7 scales of the MMPI and the IQ according to Raven were compared with the average of grades. Teachers confirmed socially desirable personality traits with good grades and gave lower grades to pupils with a less desirable personality.