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Introduction: Scaphoid nonunion after failed primary treatment remains challenging particularly when entailed by bone loss, avascular necrosis or deformity. We describe a scaphoid augmentation and fixation technique for cases of recalcitrant nonunion after screw placement by autologous press fit corticocancellous dowel. This study aims to provide reliable data on clinical and radiological outcomes and to contextualize in the face of other treatment options. Material and methods: The study included 16 patients with recalcitrant nonunion of the scaphoid. All patients received screw removal and scaphoid reconstruction by a dowel shaped non-vascularized corticocancellous bone graft from the iliac crest facilitating packing of the screw channel. Bone union, the scapholunate, radiolunate and intrascaphoidal angles were evaluated on X-ray and CT images, range of motion noted. Additionally grip strength, DASH and Green O'Brien scores were obtained from eight patients. Results: A union rate of 73% was noted after mean follow-up of 54 months. After revisional reconstruction of the scaphoid an extension–flexion rate of 84% of the healthy side was noted while pronation-supination reached 101%. DASH score averaged at 2.9, rest pain on a numeric rating scale was 0.43 with 99% peak grip force of the healthy side. Conclusion: In complex cases of revisional scaphoid nonunion after screw placement, the corticocancellous iliac crest pressfit dowel is an option for augmentation and stabilization of the scaphoid by preserving the articular surface. Level of evidence: IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Ziel der chirurgischen Versorgung von Beugesehnenverletzungen ist die frühzeitige Wiederherstellung der Kontinuität durch eine ausreichend stabile Naht, um eine frühfunktionelle passive oder aktive Behandlung zu erlauben und so Adhäsionen der Sehne - insbesondere im osteofibrösen Kanal der Finger - zu vermeiden. In den letzten Jahren wurde eine Vielzahl an Nahttechniken in den unterschiedlichsten Modifikationen beschrieben. Im Sinne „je mehr Nahtmaterial, desto stabiler“ wurde der Fokus auf die Erhöhung der Stranganzahl der Kernnaht gelegt, um frühzeitig aktive Nachbehandlungskonzepte zu erlauben. Trotz der höheren initialen biomechanischen Stabilität dieser Nahttechniken in experimentellen Studien konnte in klinischen Übersichtsarbeiten hinsichtlich der Rupturrate kein statistisch signifikanter Unterschied zwischen Zweistrang- und Mehrstrangnähten nachgewiesen werden. Auch bezüglich des funktionellen Ergebnisses war keine Überlegenheit der Mehrstrangtechniken gegenüber den Zweistrangtechniken nachzuweisen. Dementsprechend gibt es bis heute, abgesehen von einer stabilen Kernnaht und einer glättenden Feinadaptation, keinen Goldstandard hinsichtlich der idealen Nahttechnik oder des optimalen Nahtmaterials zur Versorgung von Beugesehnenverletzungen. [ABSTRACT FROM AUTHOR]

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article deals with rehabilitation after a deep transverse gash in the proximal palm with additional transection of all nine flexor tendons and of the median and ulnar nerves using the example of a 24-year-old female patient. The focus is set on the functional after-treatment according to Kleinert, on hardening techniques, on the examination of reinnervation and on sensitivity training. [ABSTRACT FROM AUTHOR]

Copyright of Grundwasser is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Zusammenfassung Die Indikation zur Anwendung des Fixateur externe am Handskelett hat sich im Lauf der letzten 25 Jahre über die Versorgung von höhergradigen Frakturen ausgedehnt und mittlerweile einen festen Stellenwert im Repertoire des versierten Handchirurgen erhalten. Durch die 3 Hauptwirkungen der externen Fixation wie Distraktion,Kompression und Immobilisation kann das handchirurgische Einsatzspektrum auch auf Infektsituationen, Fehlbildungen,Kallusdistraktionen u. a.ausgedehnt werden.Ein universelles Fixateursystem hat sich nicht herausgebildet. Aufgrund der Vielseitigkeit sind die Anforderungen an den Chirurgen gewachsen. Abstract In the last 25 years the indications for external fixation have been extended by a wide range of second- and third-degree fractures. The use of external fixation has now become an established element in the repertoire of any experienced hand surgeon.Owing to ist three main effects - distraction, compression and immobilisation - it can be applied in a wide spectrum of situations seen in hand surgery, such as infections, malformations and callus distractions.Even now,no one system of external fixation has become universally accepted for general use in the hand.The enormous range of different models and techniques means the demands such treatment makes on the skills of any modern hand surgeon are greater than ever and will certainly be important in the treatment of fractures of the hand in the future. [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)