Winkelstabile Implantate an der Hand

Currently there are various materials available for osteosynthesis in the region of the hand. The discussion in the literature about locking implants in the region of the hand is still continuing. Fractures of the bases of metacarpal bones and especially of the first metacarpals are good indications for locking plates but locking plates are not always advantageous. Most reconstructions of bones in the region of the hand can be achieved without using the thicker and more expensive implants. Non-locking implants, screws and Kirschner wires for osteosynthesis are mostly sufficient to achieve stable fixation but for phalangeal fractures plates should be avoided because of poor functional results. Only the hand surgeon can make the decision which of the various implants should be used.     

Nodular giant cell tumour of the tendon sheath of the hand: analysis of eighty-four cases—diagnostic decisions and outcome

Introduction

The giant cell tumour of the tendon sheath (GCTTS) of the hand is a benign tumour of unknown origin. The clinical diagnosis is supported by preoperative imaging. But the ideal imaging methods necessary for the diagnosis, preoperative planning and total tumour resection are still debated. Standard treatment is surgical resection with histological confirmation.

Methods

We followed up 84 patients who were operated upon for a histologically confirmed nodular type GCTTS for an average of 4.7 years (range four to eight). The preoperative symptoms and radiological findings of X-ray, ultrasound and MRI were reviewed and the surgeon asked for their impact on the surgical procedure.

Results

The average age at operation was 50.9 years, 65.5 % of the patients were female and 61.9 % of the lesions were located on the palmar aspect. Most tumours were found on the first three fingers. Two patients had tumours at two separate sites (2.4 %). After an average follow up of 31.5 months two recurrences were observed (2.4 %). In addition to X-ray and ultrasound, the preoperative findings of the MRI had no influence on the surgical procedure.

Conclusion

Our data on the nodular GCTTS are in accordance with published data concerning the age distribution, gender distribution, and localisation. No soft-tissue imaging method is superior for the diagnosis of nodular GCTTS or for the preoperative planning. A preoperative MRI may not be necessary as clinical and ultrasound examination are sufficient. To exclude bony erosions, a preoperative X-ray is necessary.     

Operative Rückzugsmöglichkeiten nach fehlgeschlagener Osteosynthese des distalen Radius

Background

Even in an era of clear improvements in implants and standardized treatment procedures, abortive osteosynthesis after distal radius fractures is not an uncommon complication.

Diagnostics

Although not every malunion of the radius leads to complaints, affected patients often suffer from limitations in movement, reduction in strength, pain and aesthetic deficits. Following thorough clinical and imaging diagnostics a selection from the possible treatment options must be made taking the results obtained from the diagnostics into consideration.

Therapy

Operative possibilities are available for reconstructing the anatomical features as accurately as possible, functional improvement without correction of the malunion, pain reduction alone and combined procedures.

Conclusion

Despite abortive osteosynthesis of distal radial fractures there are possibilities for anatomical reconstruction, retention of mobility and pain reduction. Taking the pathological deformities into consideration, the highest priority should be given to reconstructing the anatomical joint conditions as accurately as possible, even when the conservative treatment options were unsuccessful.     

Strategies for successful management of older patients with seizures

The incidence of seizures increases dramatically with age, making epilepsy in the older patient a common clinical presentation in the primary care practice. In the case of a single seizure or when the underlying cause can be corrected, antiepileptic drug (AED) therapy may not be warranted. For recurrent seizures, single AED therapy should be initiated at a low dose and gradually titrated upward. Control of seizure frequency is dependent on appropriate AED selection and compliance, drug-drug interactions, and minimization of side effects. Monitoring of AED serum levels is imperative for effective AED therapy. Conventional AEDs remain the standard initial anticonvulsants for epilepsy in older patients. The newer AEDs have demonstrated efficacy as adjunctive therapy and may offer reduced side-effect profiles and fewer drug-drug interactions.     

Adult-onset seizures: clinical solutions to a challenging patient work-up

The age-related increase in the incidence of seizures in older persons is directly related to the increase in prevalence of causative factors such as cardiovascular disease and stroke, primary and metastatic brain tumors, toxic-metabolic disturbances, and medications. Because the treatment plan depends on seizure etiology, comprehensive evaluation of each of these causes is imperative. Reliable history and thorough physical examination remain the most important steps for diagnosis and effective treatment. Nevertheless, assessment and treatment of new-onset paroxysmal events can be problematic, because numerous morbidities and syndromes--including transient ischemic attack, syncope, drug intoxication, amnesia, movement disorders, and psychiatric disorders--can present with similar symptomology.     

Ligamentäre Strecksehnenausrisse am Endgelenk

Management of soft tissue ruptures of extensor tendon lesions of zone I is both difficult and controversial. Because of their superficial position already minor injury can be sufficient for laceration. Furthermore many authors are convinced of an easy way of diagnosing and repairing extensor tendon ruptures in comparison to injuries of the flexor tendons. However, this injury can cause significant hand dysfunction and has to be treated with attention in order to provide the best possible outcome for the patient. Therefore we try to evaluate the common treatment procedures and to give guidelines for management of this injury.     

Atypical Rasmussen’s encephalitis treated with temporal lobectomy

Rasmussen’s encephalitis is characterized by seizures, progressive neurological deterioration and chronic inflammation of the brain. It typically presents in childhood and requires anatomic or functional hemispherectomy for seizure control. Here, we report an adult woman who presented with new onset, medically refractory seizures that were not progressive. The patient underwent a right anterior temporal lobectomy. The pathologic samples were consistent with Rasmussen’s encephalitis. The patient remained seizure free until her last follow-up at 2 years. This is an example of unique adult onset Rasmussen’s encephalitis, suggesting that this encephalitis represents a wide spectrum of presentations rather than a specific disease.     

Rekonstruktion der Handfunktion bei Querschnittlähmung

In more than a third of tetraplegic patients, besides the lower extremity, the function of hands and arms is also involved. This depends on the level of spinal cord injury. According to the loss of function the patients need a lot of help in daily life, and thus the wish is strong to achieve better function in grasping and holding. Combined operative treatments with tendon transfers, tenodesis, and arthrodesis make this possible in a lot of cases. After rehabilitation better function can be reached with the possibility for self-sufficiency for example in writing, eating, and washing.