Implantation of a denaturated cellulose adhesion barrier after plate osteosynthesis of finger proximal phalangeal fractures: results of a randomized controlled trial

Adhesions after osteosynthesis of finger proximal phalangeal fractures often cause stiffness. To minimize adhesions, the use of an adhesion barrier has been proposed. The results until now have not been convincing. The aim of this prospective randomized trial was to evaluate the use of an adhesion barrier. The trial included any isolated, closed proximal phalangeal fracture needing plate osteosynthesis. The patients were randomized into two groups: with or without application of the adhesion barrier. The outcomes we measured were finger ranges of motion and DASH score at 6 weeks and 6 months post-operatively. A total of 42 patients (42 fingers) entered the study; 37 completed the study. The key baseline characteristics were comparable. At 6 weeks there was a trend favouring the adhesion barrier that disappeared at 6 months. Overall the results do not support the use of this device.

[Nora's Lesion: A Rare Differential Diagnosis for Benign Peripheral Bone Tumours]

We report on a bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, in a 43-year-old female patient.

Complications following palmar plate fixation of distal radius fractures: a review of 665 cases

INTRODUCTION

Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series.

METHOD

Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures).

RESULTS

The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases.

CONCLUSION

Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.

[Resection, interposition and suspension arthroplasty for treatment of Basal joint arthritis of the thumb: a randomized and prospective comparison of techniques using the abductor pollicis longus- and the flexor carpi radialis tendon]

The operative treatment of thumb carpometacarpal joint arthritis may include resection-suspension-interposition-arthroplasty. Although quite a technically demanding procedure, a suspension arthroplasty using a strip of the flexor carpi radialis tendon is quite a popular technique. Other techniques, which use the abductor pollicis longus (APL) tendon, is also widely accepted.The aim of this randomized, prospective study was to compare the results of these 2 procedures 8 months postoperatively.From May 2005 to December 2006 a total of 55 operations in 53 patients with symptomatic Grade III or IV 1st CMC joint arthritis were identified and recruited into the study. They were then randomized to one of the 2 groups (APL vs. FCR). Patients were assessed preoperatively, and then immediately and 8 months postoperatively. Both, subjective parameters (Visual Analog Scale and DASH-Score) and functional parameters (maximum radial abduction, opposition and pinch- and key grip strength) where recorded. Additionally, the trapezial space was assessed radiographically postoperatively.After 8 months both groups had comparable subjective results (APL-group: VAS 2.3 points, DASH 24 points; FCR-group: VAS 1.9 points, DASH 20 points) as well as functional results (APL-group: radial abduction 55.3°, key-grip strength 8.1 kg, pinch-grip strength 5.5 kg; FCR-group: radial abduction 55.8°, key-grip strength 7.2 kg, pinch-grip strength 4.7 kg). Radiologically both groups showed an approximate 50% reduction in the height of the trapezial space.In resection-suspension-interposition-arthroplasty of the 1st CMC joint, similar results can be obtained using the technically less demanding APL-procedure when compared with the FCR-technique 8 months postoperatively.

Pathomorphological and histological analysis of the indirect revascularization method

OBJECTIVE

This experimental study was initiated to determine whether TMLR may prevent porcine myocardium from ischemia and necrosis after acute myocardial infarction. In addition, the influence of TMLR on healthy myocardium was analyzed.

METHODS

The short-term effectiveness of TMLR was evaluated in 38 open-chest anesthetized pigs with (n = 18) or without (n = 20) acute LAD occlusion (observation period 6 hours): Six pigs served as controls (thoracotomy only). An additional six pigs had LAD occlusion only (ischemic group). A subsequent 12 pigs were treated by TMLR (CO2) prior to LAD occlusion: Six pigs received one laser channel/cm2 (group 1) and in six pigs two channels/cm2 in the LAD territory (group 2) were performed. In addition, 14 pigs underwent TMLR without ischemia: Seven pigs received 1 channel/cm2 (group 3) and seven pigs 2 channels/cm2 (group 4). Pathomorphological assessment and histology were performed.

RESULTS

TMLR limits the expansion of the myocardial infarction zone: laser group 2 demonstrated a significantly smaller area of necrosis in the area at risk (ischemic group (32%) vs. laser group 1 (18%, p = ns) and 2 (8%, p = 0.0076); laser group 1 vs. 2, p = 0.0056). The amount of the area of necrosis of laser groups 3 (0.4%) and 4 (0.04%) compared to control (0%) did not differ significantly (p = ns). Furthermore, in the lased territories of laser groups 3 and 4 microscopic analysis revealed signs of ischemia in 10 +/- 30.9% of all examined histological samples (p = ns vs. control). During a short coronary occlusion the laser-induced tracks were partially filled with blue dye in 94.8 +/- 27.0/85.9 +/- 34.3/94.85 +/- 22.0%/70.21 +/- 47.0% (laser groups 1 - 4 respectively p = ns) The myocardial water content-measurements (MWC) of the ischemia and laser group 1 were not different at the end of the experiment (p = ns). In contrast, laser groups 2, 3 and 4 revealed significantly higher MWC values compared to control (p = 0.036, p < 0.001, p < 0.001; respectively).

CONCLUSIONS

This prolonged acute study demonstrates that preventive CO2-laser revascularization significantly reduces the amount of necrosis in the area at risk. Histological examination supported the idea that some pigment gained access to the ischemic tissue via patent channels. In healthy myocardium, TMLR significantly increases myocardial water content and induces non-significant small ischemic and very small necrotic areas surrounding open laser channels.

Analysis of the new indirect revascularization method by determining objective parameters of clinical chemistry, histo-chemistry and histology

OBJECTIVE

This experimental study was initiated to determine whether transmyocardial laser revascularization (TMLR) after acute myocardial ischemia may improve clinical chemistry and diminish the amount of necrosis. In addition, the influence of TMLR on healthy myocardium was analyzed.

METHODS

The prolonged short-term effectiveness of TMLR was evaluated in 44 open-chest anesthetized pigs with (n = 21) or without (n = 23) the setting of acute myocardial ischemia (observation period 6 h): seven pigs served as controls (thoracotomy only). An additional seven pigs had left anterior descending artery (LAD) occlusion only (ischemia group). A subsequent 14 pigs were treated by TMLR (CO2) prior to LAD occlusion: Seven pigs received one laser channel/cm2 (group 1) and in seven pigs two channels/cm2 in the LAD territory (group 2) were performed. In addition, 16 pigs underwent TMLR without ischemia: Eight pigs received one channel/cm2 (group 3) and eight pigs two channels/cm2 (group 4). Clinical chemistry, histo-chemical assessment and histology were performed.

RESULTS

TMLR limits the expansion of the myocardial infarction zone: laser group 2 indicated a significant smaller area of necrosis in the area at risk (ischemic group (31%) vs. laser group 1 (19%), P = ns; laser group 2 (7%) vs. ischemic group, P < 0.01; laser group 1 vs. 2, P < 0.01). The amount of the area of necrosis and ischemia of laser groups 3 and 4 compared with control did not differ significantly (P = ns). Preventive creation of microchannels before ischemia did not diminish ischemic parameters (P = ns). The myocardial water content-measurements (MWC) in the ischemia, laser 1 and 2 groups did not show any difference at the end of the experiment, except higher values of laser group 2 (P < 0.05). Laser groups 3 and 4 revealed significantly higher MWC values compared with control (P < 0.001).

CONCLUSIONS

This prolonged acute study demonstrates that CO2-TMLR significantly reduces the amount of necrosis in the area at risk, but does not reduce cardiac ischemic markers. In healthy myocardium, TMLR significantly increases myocardial water content and ischemic parameters and induces small ischemic and very small necrotic areas surrounding open laser channels. Generally, the elevated cardiac enzymes and proteins are mainly attributed to the expected rise caused by vaporization of myocardial tissue in all laser groups.