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This retrospective study compares the functional outcome after early active postoperative motion with the outcome after 6 weeks of immobilization by splinting in patients with proximal phalangeal fractures treated by percutaneous, antegrade pinning.46 out of 90 patients treated by closed reduction and percutaneous antegrade pinning of isolated fractures of the proximal phalanges were re-evaluated on average after 18.5 months. There were 17 women and 29 men with a mean age of 42.8 years. 28 patients underwent early active postoperative motion and 18 patients were immobilized by splinting for 6 weeks postoperatively. The two groups were statistically comparable with respect to age, gender, fracture localisation and morphology, mechanism of injury and operative time. Follow-up examination included measurement of active and passive range of motion (TAM; TPM) of the injured finger and the uninjured finger of the opposite side as well as grip strength of both hands. In addition, postoperative complications, the DASH-score and time interval between surgery and return to work were registered.There were no significant differences between the two groups regarding rate of complication, number or required revisions, finger motion and grip strenght. Patients with early active motion returned earlier back to work than patients treated by postoperative splinting (2.5 vs. 9.0 weeks; p = 0.035). With 1.7 the DASH-score in the group with early active motion was better than in the splinting group with 2.5 (p = .269).Patients with early active postoperative motion returned earlier back to work. There was no significant difference between both groups respecting global finger function.Compliant patients with a fracture of the proximal phalanx treated by closed reduction and percutaneous pinning can be treated with early active motion postoperatively.ZIEL: Diese retrospektive Studie vergleicht die klinischen Ergebnisse der frühfunktionellen Nachbehandlung mit den Ergebnissen mittels 6-wöchiger Schienenruhigstellung nachbehandelter Fingergrundgliedfrakturen nach perkutaner, antegrader K-Draht-Osteosynthese.Von insgesamt 90 Patienten, die zwischen 2010 und 2017 aufgrund einer isolierten Fingergrundgliedfraktur nach geschlossener Reposition mittels perkutaner, antegrader K-Draht-Osteosynthese operativ versorgt wurden, konnten 46 (17 Frauen und 29 Männer mit einem mittleren Alter von 42,8 Jahren) im Mittel nach 18,5 Monaten nachuntersucht werden. Bei 28 Patienten war eine frühfunktionelle, bei 18 eine statische Nachbehandlung erfolgt. Beide Gruppen unterschieden sich nicht statistisch signifikant bzgl. des Alters, der Geschlechtsverteilung, der Frakturlokalisation und -morphologie, des Unfallmechanismus und der Dauer der Operation. Bei der Nachuntersuchung wurde die aktive und passive Beweglichkeit des operierten Fingers (total active motion [TAM] und total passive motion [TPM], Fingerkuppen-Hohlhand-Abstand [FKHA], Nagelrand-verlängerter-Handrückenebenen-Abstand [NHREA]) und des korrespondierenden, unverletzten Fingers der Gegenseite gemessen und in Relation zueinander gesetzt (TAMrel, TPMrel). Des Weiteren wurde die Kraft bei verschiedenen Griffformen bestimmt und in Relation zur Kraft der unverletzten Gegenseite gesetzt. Intra- und postoperative Komplikationen, der DASH-Score und die Zeit bis zur Wiederaufnahme der Arbeitstätigkeit wurden erfasst.Keine signifikanten Unterschiede zwischen den beiden Gruppen konnten bzgl. der Häufigkeit von Komplikationen und notwendiger Revisionen, der Fingerbeweglichkeit und Kraft festgestellt werden. Patienten mit aktiver Nachbehandlung kehrten im Vergleich zu Patienten mit statischer Nachbehandlung jedoch signifikant früher an ihre Arbeitsplätze zurück (2,5 vs. 9,0 Wochen nach operativer Versorgung, p = 0,035). Der DASH-Score in der Gruppe mit aktiver Nachbehandlung war mit 1,7 Punkten etwas niedriger als in der Gruppe mit statischer Nachbehandlung mit 2,5 Punkten (p = 0,269).Patienten mit frühfunktioneller Nachbehandlung waren signifikant kürzer arbeitsunfähig. Zum Nachuntersuchungszeitpunkt fand sich kein Unterschied in der globalen Fingerbeweglichkeit beider Gruppen. Bei gegebener Compliance kann auf eine postoperative Ruhigstellung verzichtet werden.

Hand injuries are common and can result in a long time off work. To analyse and identify factors affecting time of work, a holistic view on patients is needed. World Health Organization's International Classification of Functioning, Disability and Health (ICF) with its bio-psycho-social perspective provides such a holistic view. The purpose of this study is to analyse time off work in patients with traumatic hand injuries and to identify factors affecting time off work from a bio-psycho-social perspective. We used factors derived from the ICF Core Set for Hand Conditions to predict time off work by applying Cox regression analyses and Kaplan-Meier method using data of a multicentre prospective study in nine German Level 1 hand trauma centres. In total, 231 study participants with a broad range of hand injuries were included. From these, 178 patients (77%) returned to work within 200 days. Impairments in mobility of joint functions and sensory functions related to temperature and other stimuli as well as higher hand strain at work led to extended time off work. Gender, fine hand use and employment status additionally influenced time off work in sub-models. Our results demonstrate that a bio-psycho-social perspective is recommended when investigating time off work.

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.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.After careful clinical examination consequent imaging must be performed, starting with X‑rays 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.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.

Background: Giant-cell tumors of the distal radius are rare. They have a high-risk of local recurrence and a risk of pulmonary metastasis. Curettage alone or combined with adjunctive agents is often associated with local recurrence. Methods: Three patients with giant-cell tumor of the distal radius are presented. All patients showed Campanacci grade 3 lesions. All patients underwent complete distal radius resection and reconstruction with a vascularized fibular graft distally fused with the scaphoid and the lunate, allowing midcarpal motion. Results: The follow-up period ranged from 6 to 60 months. For all three patients, emotional acceptance was excellent. The postoperative motion of the wrist was good, with a range of motion of 30-0-30°, 40-0-0°, and 30-0-10° (extension–flexion). There was neither tumor recurrence nor pulmonary metastasis. Conclusion: Fibulo-scapho-lunate fusion is an elegant method of distal radius reconstruction with good functional outcome and low risk of pulmonary metastasis. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

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.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).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.Partial arthrodesis seems to be superior to total wrist arthrodesis. Patients profit from a higher physical and mental quality of life.

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.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.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%.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.

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.