Karl Josef Prommersberger

Statin-induced focal myositis of the upper extremity. A report of two cases

Statins are widely used to lower increased cholesterol levels with the aim to prevent major cardiovascular events. However, they bare the risk of myotoxic side effects. We report on two patients with focal weakness and pain in the upper extremities. In both patients, abnormal MRI signal heights in the muscle groups involved were indicative of the final diagnosis of focal myositis during statin therapy.

Load distribution of the hand during cylinder grip analyzed by Manugraphy

STUDY DESIGN Clinical measurement and basic research. INTRODUCTION Manugraphy allows assessing dynamically all forces applied perpendicular to a cylinder surface by the whole contact area of the hand with a high spatial resolution. PURPOSE OF THE STUDY To identify the physiological load distribution of the whole contact area of the hand during cylinder grip. METHODS A sample of 152 healthy volunteers performed grip force tests with 3 cylinder sizes of the Manugraphy system (novel, Munich, Germany) on 3 different days. The whole contact area of the hand was sectioned into 7 anatomic areas, and the percent contribution of each area in relation to the total load applied was calculated. The load distribution of the dominant and nondominant hands and with different cylinder sizes was compared. Furthermore, the load distribution between the finger phalanges of each finger was analyzed. RESULTS The results for the dominant and nondominant hands were in all 7 areas of the hand similar with the percent contribution differing within a range of 1%-4% (P > .138). Load distribution changed significantly with different cylinder sizes: all 7 areas differed between 1% and 7% with P < .001, most pronounced for the thumb. The load distribution of the phalanges showed that the contribution of the distal phalanges increased with ascending cylinder size, whereas the contribution of the proximal phalanges decreased. The interindividual variability of the load distribution pattern was noticeable. DISCUSSION For the clinical practice, Manugraphy might be a useful supplement to traditional grip force measurement for identifying the individual characteristics of a patients dysfunction and monitoring the progress of hand rehabilitation. CONCLUSIONS There is no universal or typical load distribution pattern of the hand but only an individual pattern. To evaluate a compromised hand, it is permissible to compare it with the healthy opposite hand as a reference. Several cylinder sizes should be used for load distribution testing. Using smaller handles in the daily life can help to compensate impairment of the thumb and fingertips. LEVEL OF EVIDENCE 2.

The Effect of Midcarpal Versus Total Wrist Fusion on the Hand's Load Distribution During Gripping

PURPOSE To analyze the total grip force and load distribution of the hand with midcarpal fusion (MCF) and total wrist fusion (TWF). METHODS Twelve patients with unilateral TWF and 12 patients with unilateral MCF were assessed at an average 64 months (range, 19-100 months) postoperatively. The total grip force and load distribution of both hands were measured by the Manugraphy system using 3 cylinder sizes. The load applied to 7 anatomical areas of the hand during cylinder grip was analyzed, comparing the operated and the nonsurgical hands. RESULTS For the 100 mm and 150 mm cylinders, a significantly lower total grip force was found in hands operated with either TWF or MCF. For the 200 mm cylinder, there was a significant difference between nonsurgical hands and those with MCF but not between nonsurgical hands and those with TWF. For the 100 mm cylinder, the difference between nonsurgical and operated hands was greater in hands with TWF than those with MCF. For the load distribution of the hand, no differences between the operated and the nonsurgical hand were found for either MCF or TWF. CONCLUSIONS MFC and TWF resulted in a reduced cylinder grip force. With respect to the load distribution, neither procedure influenced the relative contribution that each area of the hand produced during cylinder grip. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.

Parameters influencing hand grip strength measured with the manugraphy system

BackgroundThis study aimed to determine whether sex, hand length and the individual training status affect hand strength and whether these measurements differ if they are recorded using the Jamar dynamometer or a new cylindrical measuring system.MethodsFor this purpose, 152 healthy adults were examined using a new manugraphy measuring system (novel, Munich, Germany) comprising two measuring cylinders of different sizes and a Jamar electronic dynamometer with two grip positions corresponding approximately to the sizes of the cylinders. A descriptive analysis was performed as well as a correlation analysis using the Pearson correlation coefficient. To prepare predictive models, multiple linear regression analyses were carried out to determine factors that influence the force and p ≤ 0.05 was considered statistically significant.ResultsA significant difference in the maximum and mean strength was observed that is dependent on sex, with men stronger than women, in line with expectations, and hand length, with small hands able to exert less force than large hands. No consistent increase in strength could be attributed to repetitive manual loads applied either at work or in leisure activities.ConclusionsBoth measurement techniques yielded similar results, suggesting that manugraphy is well suited for clinical research purposes because it not only takes measurements that are just as reproducible and valid as the conventional measurement technique but in doing so measures not just the total strength of a hand but also enables more precise comparisons of isolated hand regions applying dynamic measurements.

Erratum to: 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures (Arch Orthop Trauma Surg, (2016), 136, (771-778), 10.1007/s00402-016-2438-4)

Wint, John M. Erickson, John McAuliffe, John T. Capo, John Taras, Jose A. Ortiz, Julie Adams, Karl-Josef Prommersberger, Kevin M. Rumball, Kyle D. Bickel, Lior Paz, Lisa Lattanza, Louis Catalano III, M. Jason Palmer, Marc J. Richard, Marco Rizzo, Maurizio Calcagni, Maximillian Soong, Megan M. Wood, Michael Baskies, Michael Behrman, Michael Darowish, Michael Nancollas, Michael W. Grafe, Michael W. Kessler, Miguel A. Pirela-Cruz, M. P. Bekerom, Naquira Escobar Luis Felipe, Nathan Hoekzema, Oleg M. Semenkin, Patrick W. Owens, Philip Blazar, Ralph M Costanzo, Ramon de Bedout, Renato M. Fricker, Richard L. Hutchison, Richard S. Gilbert, Rick Papandrea, Robert R. Slater, Robert R. L. Gray, Ryan Klinefelter, Ryan P. Calfee, Sander Spruijt, Sanjeev Kakar, Saul Kaplan, Seth Dodds, Stephen A. Kennedy, Steven Beldner, T. Apard, Taizoon Baxamusa, Thomas G. Stackhouse, Todd Siff, W. Arnnold Batson, Warren C. Hammert. Erratum to: Arch Orthop Trauma Surg (2016) 136:771–778 DOI 10.1007/s00402-016-2438-4

The Surgery of Neglected Distal Humerus Fractures in Children and Adults

The restoration of function after a neglected distal humerus fracture presents a formidable challenge to the surgeon because of both the complexity of the regional anatomy and the proximity of numerous neurovascular structures. Inadequate or unstable fixation, a failure to reposition the articular fragments anatomically, prolonged post-operative immobilization, or the development of soft-tissue complications will result in substantial disability for the patient. Complications after injuries affecting a child’s elbow are common due to understimating the severity of the injury on the native X-rays where the growth plates and cartilage structures can not be seen.