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Nachkontrolle von transskaphoidalen perilunaren Luxationsfrakturen (TS-PLF) mittels MRT, um einerseits die Vorteile der MRT bezuglich Darstellung posttraumatisch degenerativer Veranderungen, der Beurteilung des Knorpelzustandes, der Bandintegritat und Blutversorgung der Handwurzelknochen zu nutzen, und andererseits diese Befunde in den Kontext der funk­tionellen Resultate und der subjektiven Patientenzufriedenheit (PRWE) zu stellen. In dieser retrospektiven Studie wurden 20 Patienten (1 Frau und 19 Manner) mit einem Durchschnittsalter von 30 (12–73) Jahren, die an unserer Klinik mit offener Reposition und innerer Fixation versorgt wurden, im Mittel 67 (25–145) Monate spater nachkontrolliert. Die funktionellen Ergebnisse wurden anhand der Handgelenksbeweglichkeit, der Faustschluss- und der Pinzettengriffkraft gemessen. Mit den erhobenen Daten wurde der „Mayo Wrist Score“ und der Handgelenksscore nach Krimmer berechnet. Der gesundheitsbezogene Gesamteindruck wurde mit dem SF-36 Fragebogen und die individuelle Handgelenksperzeption mit dem PRWE-Fragebogen ermittelt. Auf den Rontgenbildern in 2 Ebenen wurden die Knochenkonsolidierung uberpruft und die radiologischen Mase bestimmt (karpaler Hohenindex, SL-Abstand, SL- und RL-Winkel). Die MRT, ohne Kontrastmittel, diente zur Beurteilung der Gelenksflachen, der Vaskularisation der Karpalia und des SL-Bandes. Die Berechnung von statistischen Zusammenhangen erfolgte mittels SPSS. Handgelenksbeweglichkeit und Kraft waren im Vergleich zur nicht betroffenen Gegenseite um 10–20% verringert. Obwohl der groste Teil unseres Patientenkollektivs (85%) objektiv und subjektiv gute und sehr gute klinische Ergebnisse erzielte, zeigten die bildgebenden Untersuchungen bei 95% der Patienten eine Arthrose in mindestens 1/5 der evaluierten intrakarpalen Gelenke. Bei 5 Patienten fand sich in der MRT eine Komplettruptur des SL-Bandes, bei 2 eine Teilruptur. Diese Patienten wiesen in der MRT daruber hinaus die starksten degenerativen Veranderungen auf. Ein Zusammenhang zwischen Patientenzufriedenheit und den radiologischen Befunden fand sich nicht. MRT-Befunde korrelieren wie Rontgenbefunde nicht mit den subjektiven und objektiven klinischen Ergebnissen nach operativer Versorgung transskaphoidaler perilunarer Luxationsfrakturen. Es steht zu vermuten, dass die per MRT diagnostizierten SL-Bandlasionen eine wesentliche Bedeutung fur den Langzeitverlauf haben.

Treatment of fracture dislocations of the PIP joint represents a hand surgical challenge. In hemi-hamate arthroplasty, the palmar joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement.We performed hemi-hamate reconstructions in 10 patients (mean age 34.9 years), who sustained fractures of the base of the middle phalanx of ≥50% surface and dorsal PIP dislocations. Outcomes were assessed by clinical exam and X-ray. Evaluation criteria were range of motion of PIP and DIP joints, grip strength, joint alignment, complications and donor site morbidity. Mean follow-up was 8.6 months (range 3-14). Fractures mostly involved the 4th and 5th fingers, all patients were male. Indications were subluxation and comminuition in acute cases of6 weeks (5 patients) and chronic pain and morning stiffness in chronic cases (5 patients).Operative treatment was performed in average after 93 days (range 0-371 days) after injury. Average PIP motion was 71° (range 0-90); DIP motion was 54° (range 10-90) with a mean PIP flexion contracture of 6.5° (range 0-20). Grip strength averaged 95% of the opposite hand. 4 patients had revision surgery (2× arthrolysis PIP joint, 2× screw shortening, 1× neurolysis R. dorsalis N. ulnaris).Hemi-hamate autograft arthroplasty represents an effective procedure to address severe PIP joint fracture dislocations. It restores the comminuted articular surface in chronic injuries and in the acute injury it is a challenging but valuable alternative to extension block splinting. However, donor site morbidity and revision surgery have to be taken into account.

Weltweit ist etwa 1% der Bevolkerung von der rheumatoiden Arthritis betroffen. Die Lebensqualitat dieser Patienten ist durch die Schmerzen und die Funktionseinschrankung beeinflusst, die zu Beginn der Erkrankung meist an den Handen und Fusen beobachtet werden. Dank den Fortschritten der Pharmakologie stehen heute verschiedene Kombinationen von Medikamenten zur Verfugung, unter anderem Methotrexat und Biologika, die fruhzeitig und langfristig eingesetzt werden konnen. Die moderne Basistherapie hat in den letzten drei Dekaden die Rheumahandchirurgie in der Anzahl und Art der Eingriffe verandert. Invalidisierende Weichteil- und Gelenkschmerzen mit nachgewiesenen strukturellen Veranderungen stellen aber auch heute Indikationen fur einen operativen Eingriff dar. Durch die protektive antiinflammatorische Potenz der modernen Basistherapeutika haben reine Weichteileingriffe wie Synovektomien und Tenosynovektomien in Ihrer Haufigkeit deutlich abgenommen. Im Gegensatz hierzu hat die Anzahl der Kunstgelenkimplantationen im Bereich der Finger gegenuber den Arthrodesen eher zugenommen, wobei neben der Rezentrierung der Fehlstellung auch eine Restbeweglichkeit erhalten werden kann. Die Rheumahandchirurgie stellt deshalb nach wie vor eine therapeutische Option in der multidisziplinaren Behandlung von betroffenen Patienten auch im 21. Jahrhundert dar.

Background: Globally, tobacco can be attributed to more than 7 million deaths each year. To address this potentially avoidable mortality, The University of Texas MD Anderson Cancer Center has engaged its Global Academic Program´s (GAP) sister institutions (SI) by conducting an inaugural tobacco control assessment survey. A similar survey was done with our University of Texas academic and health science center affiliates that led to improved adoption of tobacco control policies as well as prevention and cessation services on all campuses. The baseline data collected will serve as a mechanism to develop a tobacco prevention and control strategy within a global cancer center network. Aim: To assess SI laws and policies regarding tobacco use, existing screening and cessation services. Strategy/Tactics: Qualtrics was used to administer a 27-item survey to our GAP SI from April-October 2017. Survey questions focused on key areas of tobacco prevention and control: policy, tobacco use screening, and cessation services. A survey link was emailed to 34 institutions in 23 countries. Program/Policy process: Survey GAP SI to determine current tobacco prevention and control measures being implemented. Convene GAP SI in May 2018 to share tobacco control best practices across the network and identify resources and supports to strengthen tobacco control efforts at each institution. Build collaborations aimed at progressive actions in tobacco control policies, educational programs and cessation services culturally appropriate to the needs and resources of the GAP network. Outcomes: Of the 34 GAP SI, 26 responded to the survey (76% response rate). Key findings among the 26 responding institutions: policy - 96% are located in cities with laws regulating the sale and/or use of tobacco products by minors and 77% of the cities have laws regulating the use of tobacco in the workplace; 42% of the campuses have designated smoking areas; tobacco use screening - 65% screen for and document patients´ tobacco status, however only 27% screen “all the time”; cessation services - 19% offer telephone counseling as a cessation service; 38% offer cessation services to the community; 46% offer cessation services to employees. What was learned: The baseline assessment identified areas of institutional needs: cessation services and campus policies. Further discussion with the SI will help engage them in further efforts to address gaps in tobacco control. Collectively, we aim to develop action steps to collaborate and enhance existing services by creating a global platform in which tobacco control best practices and resources can be shared.

Glomus tumours are solitary benign lesions most frequently located subungually on fingers and toes. In the rare case of a glomangiomatosis, the typical glomus cells are found on the altered vessel wall of the angiomatosis. Due to the rarity of this disease, no therapeutic golden standard has been mentioned in the literature, and a conservative treatment is usually adopted. The case of a 20-year-old craftsman with congenital, painful glomangiomatosis on his left dominant hand, progressively limiting the functionality of this limb, is reported. Two years after unsuccessful partial tumour resection, a surgical treatment based on radical tumour resection in terms of a finger amputation was performed. The 1-year follow-up showed no signs of pain for the patient.

Interfragmentary shear has been perceived as inhibitory to bone healing. We think this is because of inadequate balance between stimulatory and disruptive interfragmentary displacement magnitudes in the shear direction. We hypothesized that pure shear is not necessarily detrimental to bone healing. This was investigated by comparing bone healing under interfragmentary torsional shear, axial compression, and no applied motion. Applied motion was controlled carefully with similar interfragmentary principal strain magnitudes found to stimulate healing under axial compression. The observation period was 8 weeks. Torsional rotation stimulated intercortical mineralized callus formation with greater area than the group without applied motion, and led to a stiffness and rate of bony bridging similar to that of the no motion group. Axial compression stimulated less intercortical mineralized callus of a lower density than the no motion group, and there also was little bridging. These results support the hypothesis that interfragmentary shear does not necessarily inhibit bone healing.