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Background: In 2016, a new method was described to treat the painful impingement syndrome of the DRUJ: decompression corrective osteotomy of the distal radius. Clinical symptoms are based on a positive compression test; pain occurs with weight-bearing on the forearm. This phenomenon is seen in conjunction with a deformed sigmoid notch together with ulna minus-variance, which leads to increased tension in the distal oblique bundle of the interosseous membrane. The etiology of the condition can be either congenital, post-traumatic, or iatrogenic. Through the proposed osteotomy, decompression in the DRUJ is achieved. This study summarises the results of these surgical procedures performed in our hand centre exclusively in cases of congenital origin., Patients Und Methods: Remodelling of the DRUJ is achieved through the shortening of the distal radius together with closed wedge osteotomy. Relief of the interosseous membrane is accomplished by ulnar translation of the radial shaft. This study only included patients with congenital incongruency in the DRUJ. The results were evaluated using a visual analogue scale (VAS) and the Krimmer Wrist Score and by measuring the preoperative and postoperative range of motion as well as grip strength., Results: Within 11 years, 45 procedures were performed with our method on 38 patients, of which 17 were treated on the right side, 14 on the left side, and 7 bilaterally. In cases of bilateral incongruency, only the symptomatic side was treated. The statistical evaluation showed a significant reduction of pain on the VAS from 7.2 to 2 (p<0.001). No significant changes were seen in the range of motion (p=0.812). The Krimmer Wrist Score showed good to excellent results in almost 90% of cases., Conclusion: If the indication criteria are met, contraindications are avoided and the osteotomy is correctly performed, this technique leads to an improvement of patients' functionality and quality of life. From a preventive viewpoint, the influence on the progression of the degenerative changes is yet to be demonstrated in further studies. At any rate, this is a safe procedure, which leaves the path open for other possible options., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Fractures of the distal radius show a wide spectrum of different fracture patterns. Although standard X‑ray images are sufficient for extra-articular fractures, the exact analysis of intra-articular fractures requires the use of computed tomography (CT) with coronal, sagittal and axial sectional images. The classification is based on the Working Group for Osteosynthesis Questions (AO) criteria. The treatment strategy can be more precisely defined by a CT-based classification. Special attention must be paid to the presence of the key corners, as they have a high risk for primary or secondary dislocation if they not adequately stabilized., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The complex kinematics of the saddle joint has been a challenge in the development of trapeziometacarpal prostheses. The introduction of the dual-mobility design increases the range of motion and limits strains on the cup fixation. Therefore, rates of loosening and dislocation have been markedly reduced. Furthermore, several studies showed a similar relief of pain, range of movement and grip strength compared to the results of resection arthroplasty. The preservation of the length of the first ray as well as the more stable and functional joint can be favourable in younger and active patients. Further investigation is needed to determine whether or not those higher demands affect long-term survivorship. The high grade of patient satisfaction, the shorter recovery time and the safe surgical technique motivates considering the implantation of a total endoprosthesis with a dual-mobility cup as an attractive alternative to resection arthroplasty in the operative treatment for trapeziometacarpal osteoarthritis., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: The development and implementation of the "Interdisciplinary S3 Guideline for the Diagnosis, Treatment and Follow-up Care of Breast Cancer" (3) is intended to optimise national health services. This guideline already serves both as a basis for the certification of German breast centres and for the external comparative quality assurance based on guideline based quality indicators. Nevertheless, the effects of the implementation on relevant outcomes have not been examined so far., Methods: The retrospective cohort study analyses data of 3,976 female patients with primary breast cancer which were collected at the University of Ulm and co-operating certified breast centres between 2001 and 2005. Based on the S3 guideline, an analysis model was developed to allow for the examination of guideline-adherent therapy on the basis of the guideline recommendations, and the effects of guideline-adherent compared to not guideline-adherent therapy on overall (OAS) and recurrence-free survival (RFS) were examined subsequently., Results: In total, 2,063 (51.9%) of the 3,976 patients were treated in adherence the guideline. In 1,913 (48.1%) patients deviations from the guideline recommendations in at least one of the therapeutic options were found. The variable "guideline-adherent treatment" had significant influence on RFS [p < 0.001; HR=2.20; 95% CI (1.74 to 2.79)] and OAS (p < 0.001; HR=2.57; 95% CI (1.96 to 3.37)], each adjusted for age, tumour size, nodal status and grading. RFS decreases with the number of deviations from guideline recommendations [1 to 2 deviations: p < 0.001; HR=2.04; 95% CI (1.60 to 2.60); ≥ 3 deviations: p < 0.001; HR=3.64; 95% CI (2.43 to 5.45), also adjusted for age, tumour size, nodal status and grading]. Similar results were found for the OAS., Conclusion: Patients with breast cancer should be treated in adherence to guideline recommendations. Deviations and barrier factors will have to be evaluated in the future in order to further optimise both the guideline and guideline-adherent therapy., (Copyright © 2011. Published by Elsevier GmbH.)