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Scapholunate dissociation in stages 2 and 3 may lead to posttraumatic damage if left untreated. Different types of treatment have been described, including capsulodesis, tenodesis, and others. The purpose of all procedures is to avoid palmar shift of the distal scaphoid resulting in secondary arthritis (SLAC wrist). This study aimed to evaluate a modified dorsal ligamentoplasty in second- and third-degree scapholunate dissociation in a prospective study design. Furthermore, the study aimed to find out if there is a correlation between radiological and clinical parameters at follow-up and whether or not a SLAC wrist can be avoided. From 2007 to 2011 we performed 29 dorsal ligamentoplasties in our hospital in patients with second- and third-degree scapholunate dissociation. In a prospective study design, 25 patients were followed up after an average period of 18 months. Parameters recorded preoperatively included ROM, the radiological parameters SL diastasis, SL diastasis in power grip and SL angle, the DASH score, and the VAS score. The postoperative evaluation additionally included power grip, the Mayo wrist score, and patients' subjective satisfaction. The average subjective satisfaction after surgery was good. The average postoperative ROM was 83.8 % of the ROM of the healthy wrist and decreased by 11 % compared with the preoperative level. The average postoperative grip strength was 85.7 % of the strength of the healthy hand. The VAS score was 2.7 with a significant reduction from 6.7 preoperatively. The average DASH score decreased significantly from 60 preoperatively to 22.5 postoperatively. The average Mayo wrist score after surgery was 73. All radiological parameters at follow-up were significantly better than preoperatively, although they remained in a pathological range. The Pearson correlation analysis showed no relevant correlation between clinical and radiological scores. Three cases (12 %) required revision surgery. The described modified dorsal ligamentoplasty at the carpus can be recommended in second- and third-degree scapholunate dissociation. Clinical results are comparable to other techniques, but there is only a single approach required and the complication rate is very low. The short average follow-up of 18 months must be viewed critically as the rate of SLAC wrists might be higher during longer follow-up periods., Competing Interests: Interessenskonflikte: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated., Materials and Methods: A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti-Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score., Results: The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen., Conclusions: The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone healing in this study, for patients at risk gadolinium-enhanced MRI scan could be helpful to estimate vascularisation preoperatively. In cases of poor vitality, vascularised bone grafting should be considered.

Diffuse hemangiomatosis of the spleen is a very rare benign tumor in which the whole spleen is permeated by neoplastic blood vessels. It is occasionally accompanied by severe disturbances of blood coagulation. The histogenesis of this tumor remains obscure. No systematic investigations of the immunophenotype of the neoplastic endothelium have been published. We describe a case of isolated benign diffuse hemangiomatosis of the spleen in which the enzyme-histochemical and immunohistochemical findings suggested an origin in the splenic sinus endothelial cells. Some of the tumor endothelial cells reacted with UEA-1, BMA 120, antibodies against the von Willebrand factor, CD34, and CD8, an antigen which, in man, is expressed only by suppressor/cytotoxic T cells and the endothelial cells of the splenic sinuses. Enzyme-histochemical investigations revealed reactivity for nonspecific esterase and lack of reactivity for alkaline phosphatase--a pattern typical of the sinus endothelial cells. The tumor could be distinguished from other tumors/tumor-like lesions of the spleen that exhibit endothelium with characteristics typical of the splenic sinuses (peliosis, splenoma, littoral cell angioma) on the basis of its histological features. The lack of expression of histiocytic antigens by the tumor endothelium is also evidence against a diagnosis of littoral cell angioma, which also derives from the sinus endothelium. Thus, this tumor could not be identified as any of the recognized tumors/tumor-like lesions of the spleen and it is therefore proposed that it should be designated diffuse sinusoidal hemangiomatosis.