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We report the functional and radiographic results of 16 patients with fracture-dislocations of the ring and little finger carpometacarpal joints and 23 cases with fracture-dislocations of only the little finger carpometacarpal joint treated between 2006 and 2012. The above two cohort populations of patients were treated with either open reduction and pin fixation or closed reduction and pin fixation. These patients were followed for a mean of 13 months (range 9 to 48). The DASH scores for patients with fracture-dislocations of the ring and little finger carpometacarpal joints were 6.0 and of the little finger carpometacarpal joint 7.2. We found no functional differences in term of DASH scores after treatment between patients with fracture-dislocations of only the little finger carpometacarpal joint and both the ring and little finger carpometacarpal joints.Level of evidence: IV [ABSTRACT FROM PUBLISHER]

Background: The Surgical Safety Checklist (SSC) was introduced by the World Health Organization (WHO) in 2008 in order to analyse and reduce perioperative surgical morbidity. Preoperative estimation of the expected surgery time (EST) by the surgeon is an integral part of the SSC., Objective: The aim of the present study was to correlate EST and factual surgery time (FST), to identify factors influencing the correlation between the two parameters and to collect more information about planning surgical capacity., Material and Methods: A retrospective analysis researched the EST and FST for plate osteosynthesis in distal radius fractures, intramedullary femur nailing or the implantation of duo head prosthesis in proximal femur fractures in our department between 06/2012 and 12/2013., Results: 220 patients fulfilled the inclusion criteria and underwent further analysis (palmar plate osteosynthesis: n = 89, intramedullary femur nailing with joint involvement: n = 70, duo head prothesis: n = 61). Mean EST and FST exhibited no significant difference in any of the analysed surgical procedures. However, the correlation coefficients were comparatively low for individual surgical procedures (ρ = 0.60). The surgeon's experience had no influence on the correlation between EST and FST., Conclusions: In this study, the FST for palmar plate osteosynthesis, proximal intramedullary femur nailing and implantation of duo head prosthesis agreed well with the national average. Unexpected intraoperative complications may cause above average FST. In this case, the surgical team and coordinator must identify rapid individual solutions., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Bennett's fracture is a partial intra-articular fracture, with two main fragments of the first metacarpal bone. Treatment should aim to rebuild the articular surface and to achieve early mobilisation of the thumb saddle joint., Objective: To demonstrate the operation of direct screw osteosynthesis of a Bennet's fracture by a Gedda/Moberg radiopalmar incision in a video., Patient: During distortion of the thumb, a 31-year old patient suffered a Bennets's fracture, which was operated by direct screw osteosynthesis., Conclusion: Direct screw osteosynthesis is the method of choice to restore the articular surface and early mobilisation of the thumb saddle joint after Bennett's fracture., (Georg Thieme Verlag KG Stuttgart · New York.)

We report the functional and radiographic results of 16 patients with fracture-dislocations of the ring and little finger carpometacarpal joints and 23 cases with fracture-dislocations of only the little finger carpometacarpal joint treated between 2006 and 2012. The above two cohort populations of patients were treated with either open reduction and pin fixation or closed reduction and pin fixation. These patients were followed for a mean of 13 months (range 9 to 48). The DASH scores for patients with fracture-dislocations of the ring and little finger carpometacarpal joints were 6.0 and of the little finger carpometacarpal joint 7.2. We found no functional differences in term of DASH scores after treatment between patients with fracture-dislocations of only the little finger carpometacarpal joint and both the ring and little finger carpometacarpal joints., (© The Author(s) 2014.)

Secondary fracture displacement before osseous consolidation of distal radius fractures in children occasionally leads to restricted forearm rotation. So far, there is no consistent treatment recommendation to correct this complication. We report on 5 children with an age of 8-13 years (mean age 12.3 years, 4 boys, 1 girl) with secondary displaced distal radius fractures and high functional deficits in forearm rotation (mean ROM for pro-/supination 70-0-30°) after osseous consolidation. We performed corrective osteotomies of the distal radius using a palmar approach after a mean of 38 days. Stabilisation was achieved with a fixed-angle plate system. At the final follow-up examination (mean 9 months) the forearm rotation was normal. No complications were observed. We consider corrective osteotomies of the distal radius in children with deficits of forearm rotation to be a possible strategy. Early corrective osteotomies can lead to a predictable increase of function through reestablishing normal articulation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Carpometacarpal (CMC) fracture dislocations of the 2nd through 5th ray are rare injuries whose extent is regularly underestimated in the initial radiographic evaluation of the hand. Obtaining a computed tomography scan is imperative due to the radiographic underrepresentation of the full bone and joint injury. Restoration of bone and joint anatomy of the affected region is of paramount import to prevent joint deterioration and loss of hand durability and dexterity. Early surgical intervention can lead to good functional results. Different operative treatment strategies exist with a common approach being Kirschner wire, screw or plate fixation after closed or open fracture reduction and joint relocation.

Background: With a prevalence from 11.8 to 18% no fracture is as often associated with nerve damage as the humeral shaft fracture. Whether the radial nerve should be surgically explored in association with a palsy in humeral shaft fractures in order to exclude an interposition or discontinuity is being discussed controversially. The aim of this study was to assess the strategies for primary care of radial nerve palsies associated with humeral shaft fractures in Germany., Material and Methods: In a standardised survey 495 traumatological and 134 neurosurgical clinics were interviewed regarding the treatment of primary radial nerve palsies after humeral shaft fractures. The distribution of the survey included all level-one trauma centres. Statistics were based on the supply strategies, the number of observed contusions, discontinuities and inter-position of the N. radialis in the fracture gap. Moreover, the results were recorded after primary neurorrhaphy., Results: The evaluable response rate to the questionnaire was 56% (university hospitals 77%, level-one trauma centres 63%, level-two trauma centres 70%, level-three trauma centres 44%). 6097 humeral shaft fractures have been treated per year, the incidence of primary radial nerve palsy was 8.6%. Regarding the management strategies, 59% of the hospitals advocated exploration of the nerve, while 25% reported that the decision depends on the individual case. 16% reject the exploration in case of a primary nerve palsy. In the case of an exploration, contusions (74%) of the nerve were largely seen, followed by nerve interpositions in the fracture gap (19%) and discontinuity (7%). In the case of neurorrhaphy, a partial or complete remission was found in 87% of cases., Discussion: Although a primary expectant procedure is recommended in the literature due to the high spontaneous remission rate of 90%, an early exploration of the nerve is often preferred in clinical practice. In these cases, the use of an interlocking intramedullary nail as a minimally invasive treatment option does not appear useful due to the direct exposure of the fracture zone and the radial nerve. Interestingly, the feared discontinuity occurs rarely. The impact of nerve interposition in the fracture gap without surgical exploration remains unclear due to the lack of visibility., Conclusion: There is no consensus concerning the treatment of radial nerve palsies after humeral shaft fractures in Germany. Discontinuities are rare, the rate of spontaneous recoveries is high. Whether and when an exploration of the radial nerve is obligatory in primary radial palsy remains unclear and should be clarified by prospective randomised trials., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim: A degenerative tear of the anterior tibial tendon is a rare event compared to other tendons. The purpose of this study was to evaluate the functional results after surgical refixation., Method: In a retrospective study, we report the functional outcome of five consecutive operatively treated patients suffering from a tear close to the insertion site of the anterior tibial tendon. All patients were assessed postoperatively, the AOFAS and Richter scores were obtained and the range of motion in the ankle joint was evaluated., Results: Preoperatively all patients presented with a significant walking impairment due to a reduced active dorsiflexion, so the decision for surgical refixation was made. In all cases an MRI scan was performed preoperatively. Postoperative immobilisation without weight-bearing was done for six weeks. All patients returned to their former activity level, were satisfied with the postoperative result and had a normal gait in the follow-up examination. The range of motion was equal on both sides, the median AOFAS score was 86 and the median Richter score was 90 out of 100. There were no postoperative complications., Discussion: Untreated tears of the anterior tibial tendon lead to significant impairment of the ankle joint and deformities of the foot. There is no consensus about the treatment with recommendations for operative and non-operative treatment. Various surgical procedures have been described. The surgical reconstruction of the tendon leads to a restored function of the ankle joint and allows a normal gait and is therefore desirable. Due to the loss of function and the good results after surgical treatment in our study, the non-operative treatment is not advisable., Conclusion: Surgical repair of degenerative tears of the anterior tibial tendon leads to very good functional results and high patient satisfaction.

Delayed and non-union of isolated fractures of the capitate are rare injuries. Initial plain radiographs do not always show the fractures. Especially fractures through the neck of the capitate can lead to delayed union. We report on a patient with persistent localised pain over the capitate 5 months after a fall on the hand. The CT examination showed a delayed union of the capitate, which was treated with an iliac cancellous bone graft and screw osteosynthesis. Bone healing was verified 3 months after operation. Operative therapy is recommended in cases of delayed union or non-union of the capitate.