Matthias Pfau

A composite osteomusculocutaneous free flap from the medial femoral condyle for reconstruction of complex defects.

This combined anatomic and clinical study illustrates the first experiences of an osteomyocutaneous flap from the medial femoral condyle for reconstruction of composite tissue defects. We analyzed the anatomic consistency and the vascular distribution of this flap and showed that muscle tissue can easily be added as a composite flap. Twenty-one flaps were harvested from fresh adult cadavers with careful identification of the origin and the course of the three different branches of the descending genicular artery. The corresponding skin areas and muscle portion were identified. The clinical application of this flap was described for closure of complex calcaneal defects. The cadaveric study presented a constant pedicle length and diameter of the arteries, combined with a constant venous drainage. Furthermore, the medial condyle provided a corticocancellous segment and separate vascularity for skin and muscle portions. In the case reports, satisfying results of bone union and soft tissue contouring were achieved. The medial femur condyle region is a reliable donor site for composite flaps, providing a good corticocancellous bony structure and a separate skin paddle, as well as a muscle portion. Its vascular distribution shows anatomic consistency. Despite long-term atrophy of muscle transplants, we believe the additional muscle tissue improves the reconstruction results and provides better soft tissue contouring.

Fibulo-scapho-lunate arthrodesis after resection of the distal radius for giant-cell tumor of the bone

Giant‐cell tumors of the distal radius are rare. They have a high‐risk of local recurrence and a risk of pulmonary metastasis. Curettage alone or combined with adjunctive agents is often associated with local recurrence.

Palliative surgery for skeletal metastases from melanoma in the scaphoid – A critical case report appraisal

A 46-year-old woman with a history of metastatic malignant melanoma presented with what appeared to be a scaphoid nonunion. Biopsy and subsequent scaphoid excision confirmed the diagnosis of metastatic melanoma. Her quality of life was improved for her remaining 13 months by scaphoid excision. We assessed our results in relation to the literature.

Behandlungsalgorithmus der Kahnbeinpseudarthrose

INTRODUCTION We present a retrospective study on different treatment options for scaphoid nonunion. The results are compared to the literature and a treatment algorithm is proposed. MATERIALS AND METHODS Based on a retrospective case-control study, 208 patients suffering from scaphoid nonunion were treated between 2000 and 2006. The patients were grouped depending on the localization of the nonunion: proximal (n=10), middle (n=105), or distal (n=93) third. In the presence of a small avascular proximal fragment, a vascularized bone graft from the distal radius was added (n=53). The determination of scaphoid healing was achieved by conventional radiographs or CT scans. RESULTS Overall scaphoid healing occurred in 89.9% (n=187). For small proximal scaphoid fragments (n=93), we could show healing rates up to 83% (n=77). Using a vascularized bone graft from the distal radius, scaphoid consolidation was achieved in 81% for avascular proximal fragments and recurrent scaphoid nonunion (n=53). CONCLUSION Using sophisticated treatment options, the prognosis of scaphoid nonunions is very good.

[Treatment algorithm for scaphoid nonunion : retrospective case-control study of 208 patients].

INTRODUCTION We present a retrospective study on different treatment options for scaphoid nonunion. The results are compared to the literature and a treatment algorithm is proposed. MATERIALS AND METHODS Based on a retrospective case-control study, 208 patients suffering from scaphoid nonunion were treated between 2000 and 2006. The patients were grouped depending on the localization of the nonunion: proximal (n=10), middle (n=105), or distal (n=93) third. In the presence of a small avascular proximal fragment, a vascularized bone graft from the distal radius was added (n=53). The determination of scaphoid healing was achieved by conventional radiographs or CT scans. RESULTS Overall scaphoid healing occurred in 89.9% (n=187). For small proximal scaphoid fragments (n=93), we could show healing rates up to 83% (n=77). Using a vascularized bone graft from the distal radius, scaphoid consolidation was achieved in 81% for avascular proximal fragments and recurrent scaphoid nonunion (n=53). CONCLUSION Using sophisticated treatment options, the prognosis of scaphoid nonunions is very good.

Primary treatment of complicated flexor tendon injuries of the hand

Complicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III-V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.ZusammenfassungDie komplizierten Beugesehnenverletzungen können in Abrisse bzw. Ausrisse, Rupturen und Defektverletzungen eingeteilt werden. Sie stellen für den handchirurgisch tätigen Operateur oft eine besondere Herausforderung mit unzureichendem funktionellem Resultat dar. Abrisse bzw. Ausrisse werden üblicherweise durch Ausziehnähte oder Nahtanker versorgt. Bei den Rupturen sollte eine genaue Ursachenforschung betrieben werden. Therapeutisch kommen bei der rheumatoiden Arthritis vor allem Sehnenkopplungen, Transpositionen und die Tenodese bzw. Arthrodese in Frage. Die primäre Brückentransplantation hat eine seltene Indikation und empfiehlt sich bei sauberen Beugesehnendefekten in den Zonen III–V mit normaler Weichteilsituation. Die Nachbehandlung ist der postoperativen Beübung der einfachen Beugesehnenverletzungen praktisch gleichzusetzen.AbstractComplicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III–V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.

Pseudarthrosis after disruption of an incomplete luno-triquetral coalition: a case report

Whilst bony luno-triquetral coalitions are known to be asymptomatic, fibro-cartilage unions can cause ulnar-sided wrist pain. The purpose is to present the rare case of painful pseudarthrosis after traumatic disruption of an incomplete luno-triquetral coalition. Recommendations for proper diagnosis and treatment options will be discussed. The case of a 35-year-old male patient is reported, where disruption of a fibro-cartilaginous luno-triquetral coalition resulted in a painful pseudarthrosis. Luno-triquetral fusion with a corticocancellous wedge from the iliac crest and a Herbert screw was undertaken. Using this method pain was relieved but resulted in minor loss of range of motion. We recommend luno-triquetral fusion in the rare case of fracture or pseudarthrosis of a luno-triquetral coalition. The use of a corticocancellous wedge should be considered depending on gap formation after resection of the pseudarthrosis.

Primärversorgung komplizierter Beugesehnenverletzungen an der Hand

Complicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III-V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.ZusammenfassungDie komplizierten Beugesehnenverletzungen können in Abrisse bzw. Ausrisse, Rupturen und Defektverletzungen eingeteilt werden. Sie stellen für den handchirurgisch tätigen Operateur oft eine besondere Herausforderung mit unzureichendem funktionellem Resultat dar. Abrisse bzw. Ausrisse werden üblicherweise durch Ausziehnähte oder Nahtanker versorgt. Bei den Rupturen sollte eine genaue Ursachenforschung betrieben werden. Therapeutisch kommen bei der rheumatoiden Arthritis vor allem Sehnenkopplungen, Transpositionen und die Tenodese bzw. Arthrodese in Frage. Die primäre Brückentransplantation hat eine seltene Indikation und empfiehlt sich bei sauberen Beugesehnendefekten in den Zonen III–V mit normaler Weichteilsituation. Die Nachbehandlung ist der postoperativen Beübung der einfachen Beugesehnenverletzungen praktisch gleichzusetzen.AbstractComplicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III–V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.

100 Jahre nach Kienböck

Kienböcks disease (KD) leads to collapse of the lunate bone with severe consequences for the wrist function which for some patients may result in occupational invalidity. The many synonyms of KD (aseptic necrosis or avascular necrosis) insinuate that the true etiopathology remains poorly understood. This reviews aims at exploring the level of evidence which brought forward the different hypotheses on the origin of KD. The widespread theories about the origin were formed about 100 years ago but a specific therapy is still not within reach. Although the cause of the disease remains essentially unknown it is officially recognized as an occupational disease in Germany. Empirical attempts to explain the etiopathology are based on compression of the lunate, impaired vascularity through vibration exposition, fracture and dislocation of the lunate from the radiolunate fossa. The level of evidence urges a cautious interpretation of currently discussed hypotheses on the etiology of KD.

Reconstruction of the second metacarpal bone with a free vascularized scapular bone flap combined with nonvascularized free osteocartilagineous grafts from both second toes: a case report.

In this report, we present a case of a giant cell tumor of the second metacarpal bone. The tumor was treated by en bloc resection of the distal portion of the second metacarpal with adjacent interosseus muscle. Reconstruction was achieved using a free vascularized scapular bone flap with nonvascularized free osteocartilagineous grafts from both second toes. Structural integrity and metacarpophalangeal joint motion were preserved with good functional result. A brief review of literature is presented.