Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen
-
Handchir Mikrochir Plast Chir · Jul 2001
Comparative Study[MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius?].
In a prospective study, 45 patients with fractures of the distal radius and radiologically suspected tears of the scapholunate interosseous ligament were examined. Magnetic resonance imaging was performed prior to wrist arthroscopy. The latter examination gave the definite diagnosis. ⋯ The use of intravenously applied contrast medium did not improve MRI accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament tears. Presumably, the results of MRI could be improved by a more sophisticated technique.
-
Handchir Mikrochir Plast Chir · Jul 2001
Review[Carpal injuries associated with distal radius fractures. Diagnosis and therapy].
The frequency of carpal injuries associated with distal radius fractures is often underestimated. Diagnosis of such lesions can be difficult. ⋯ An early diagnosis of ligament injuries and instabilities can be obtained through cinematographic examination, whereas injuries to the TFCC are mainly diagnosed by MRI. Arthroscopy provides exact diagnosis as well as therapy, including arthroscopically controlled reposition of centrally depressed fragments of the articular surface of the radius and even treatment of TFCC lesions.
-
Handchir Mikrochir Plast Chir · Jul 2001
[Treatment of Galeazzi's fracture - is the surgical revision of the distal radioulnar joint necessary?].
Fractures of the radial shaft associated with disruption of the distal radioulnar joint (DRUJ) are termed as Galeazzi-fractures. In Galeazzi's fracture, the aim of treatment is restoring the congruency of the joint and the stability of the DRUJ, thus preventing a loss of pronation or supination. ⋯ A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.
-
Handchir Mikrochir Plast Chir · Jul 2001
[Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius].
To investigate the occurrence of carpal ligamentous injuries in patients with fractures of the distal radius, the results of 122 wrist arthroscopies were analysed within a retrospective study. Indications for arthroscopy included suspected carpal instability according to radiographic findings and/or the necessity for internal fixation of the radius fracture. Arthroscopy revealed acute scapholunate ligament tears in 84 patients. ⋯ There was no association between ligamentous lesions and carpal angles or fracture dislocation. Scapholunate ligament tears were most frequent in sagittal articular fractures. In these cases, wrist arthroscopy should be performed during operative treatment of the radius fracture to allow direct visualization and subsequent repair of ligamentous tears.
-
Handchir Mikrochir Plast Chir · Jul 2001
[What are the indications for arthroscopic repair of ulnar tears of the TFCC?].
A clinical study was performed to assess the outcome after arthroscopic repair of ulnar tears of the TFCC of the wrist, and to determine which factors are of importance for the results. From 1994 until 1998, in 23 patients an ulnar tear of the TFCC of the wrist was found and treated by arthroscopic repair (average age 32 years, range 16 to 56, 11 female, 12 male). The articular disc was sutured by inside-outside-technique with 2/0 PDS to the floor of the sixth extensor compartment. 14 to 54 months (mean 27 months) after the operation, 21 patients were reexamined. ⋯ Ulnar tears of the TFCC of the wrist without marked instability of the whole DRUJ can be treated by arthroscopic suturing and satisfactory results can be expected. In case of clinical instability of the joint, it is to be assumed that the lesion extends to structures which cannot be seen and sutured arthroscopically. In these cases, open repair after arthroscopic examination must be considered.