Torsten Franz - Academia.edu (original) (raw)
Papers by Torsten Franz
Im Vergleich zu anderen Berufsgruppen leidet zahnmedizinisches Personal häufig unter Beschwerden ... more Im Vergleich zu anderen Berufsgruppen leidet zahnmedizinisches Personal häufig unter Beschwerden im Bereich der Hände und Handgelenke. Symptome entwickeln sich oft über einen längeren Zeitraum und manifestieren sich in Form von dumpfen Schmerzen, Taubheitsgefühlen und geschwollenen Fingern. Viele dieser Probleme sind durch eine gute Ergonomie vermeidbar. Im Folgenden werden einige der wichtigsten Krankheitsbilder im Bereich der Hände vorgestellt. Es werden präventive Ansätze wie ergonomische Arbeitsweisen und der Einfluss des Instrumentendesigns auf die Belastung der Finger aufgezeigt.
Osteoarthritis and Cartilage, 2001
Reduction of compressive stiffness of articular cartilage has been reported as one of the first s... more Reduction of compressive stiffness of articular cartilage has been reported as one of the first signs of cartilage degeneration. For the measurement of in situ compressive stiffness, a hand-held indentation probe has recently been developed and baseline data for macroscopically normal knee joint cartilage were provided. However, the histological stage of degeneration of the measured cartilage was not known. The purpose of this study was to investigate whether there is a relationship between the in situ measured compressive stiffness, the histological stage of degeneration, and the biochemical composition of articular cartilage. Instantaneous compressive stiffness was measured for the articular cartilage of 24 human cadaver knees. Additionally, biochemical composition (total proteoglycan and collagen content) and histological appearance (according to the Mankin score) were assessed for each measurement location. Despite visually normal surfaces, various histological signs of degeneration were present. A high correlation between Mankin score and cartilage stiffness was observed for the lateral patellar groove (R(2)=0.81), the medial (R(2)=0.83) and the lateral femoral condyle (R(2)=0.71), whereas a moderate correlation was found for the medial patellar groove (R(2)=0.44). No correlation was observed between biochemical composition and cartilage compressive stiffness. Our results are in agreement with others and show that the instantaneous compressive stiffness is primarily dependent on the integrity of the extracellular matrix, and not on the content of the major cartilage constituents. The high correlation between stiffness and Mankin score in mild osteoarthrosis suggests that the stage of cartilage degeneration can be assessed quantitatively with the hand-held indentation probe. Moderate and severe case of osteoarthrosis remains to be investigated.
Clinical Orthopaedics and Related Research, 2005
Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome are characterized by peculiar bo... more Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome are characterized by peculiar bone lesions that commonly involve the anterior chest wall. Osteitis typically is the most prominent skeletal lesion seen in synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. We present a patient with aseptic femoral osteitis and sternocostal hyperostosis. The classic clinical, radiographic, and histologic features of this syndrome are described. Diagnosis is difficult in patients with only one symptomatic bone. The lesion often is confused with suppurative osteomyelitis because of similar clinicopathologic findings. Although the optimal treatment is unclear, it is important to consider synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in the differential diagnosis of any lytic, sclerotic, or hyperostotic bone lesion to avoid unnecessary long-term antibiotic therapy.
Clinical Orthopaedics and Related Research, 2002
The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartila... more The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartilage defects is a well-accepted technique. Since 1995, the authors have used mosaicplasty to treat more than 110 patients with cartilage defects of the knee, hip, and ankle. The first 52 consecutive patients who had mosaicplasty of the knee and have an average followup of 37 months (range, 24-56 months) were examined. Indications for surgical treatment were osteochondritis dissecans, acute trauma, and posttraumatic lesions of the femorotibial joint, femoropatellar maltracking with recurrent episodes of patella dislocations, and distinct femoropatellar arthrosis. Preoperatively, cartilage defects were classified as International Cartilage Repair Society Grade III lesions in 23 patients and Grade IV lesions in 29 patients. Two years after surgery, an increased level of knee function was found in 86% of the patients. At the latest followup, improved knee function was observed in 92% of the patients. In four patients, reoperation was necessary because of graft failure. Complications and reoperation rate were related to large surface lesions. Autologous osteochondral transplantation is a valid option for the treatment of full-thickness osteochondral defects. However, the method is limited by the defect size and the number of plugs to be taken at the donor site.
Archives of orthopaedic and trauma surgery, 2015
Limited range of finger motion is a frequent complication after plate fixation of phalangeal frac... more Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems. From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS). No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total...
Neuro-Chirurgie, 2014
The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin sy... more The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.
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, 2010
A giant cell tumour of the distal radius or of the carpal bones, verified by incisional biopsies,... more A giant cell tumour of the distal radius or of the carpal bones, verified by incisional biopsies, should be approached as a low-grade malignancy. Lesions that arise in the bones of the hand or the wrist have a greater propensity to metastasise, and have a higher risk of local recurrence. In this case report we describe a 54-year-old women with a giant cell tumour of the distal radius (Campanacci grade III lesion), having a follow-up of five years without signs of local recurrence or metastatic disease. The general principles of and options for surgical treatment are discussed.
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, 2010
The purpose of our prospective study was to document the clinical and radiological results of con... more The purpose of our prospective study was to document the clinical and radiological results of conservative-functional treatment of extraarticular proximal phalangeal fractures without immobilisation of the wrist. The Lucerne Cast (LuCa) resembles a circular metacarpal brace leaving bare both flexion creases, the rascetta and the distal palmar flexion crease. Dorsally, the brace expands to beyond the proximal interphalangeal joints, fixing the metacarpo-phalangeal joints in an intrinsic plus position, thus causing the extensor aponeurosis to tighten and to move distally. Clinical and radiological results of 15 consecutive patients with a total of 20 fractured proximal phalanges were prospectively recorded through a minimum follow-up of 3 months. Fracture consolidation was achieved in all patients, with nine cases showing a dorsal angulation of 2 °-16°. A slight radial or ulnar deviation, respectively, was present in four cases (3 °-5°). Radiologically, a minor rotational deformity of...
Percutaneous Vertebroplasty and Kyphoplasty, 2006
Journal of Hand Surgery (European Volume), 2012
Journal of Hand Surgery (European Volume), 2012
Penetrating hand wounds are common and these are managed by thorough debridement. However, stab w... more Penetrating hand wounds are common and these are managed by thorough debridement. However, stab wounds without evidence of divided structures are often treated with irrigation using antiseptic substances, antibiotic therapy, and immobilization. Octenisept® (Schülke & Mayr Ltd) is a widely used antiseptic agent for disinfection of acute or chronic wounds. It has a broad spectrum of antiseptic efficacy and has become an antiseptic of first choice in many hospitals. Within a few months, four patients presented to us with chronic inflammation and severe tissue necrosis after irrigation of penetrating hand wounds with Octenisept®. Repeated surgery and debridement was required in all patients. Wound healing was prolonged and patients had persisting oedema. Penetrating hand wounds must not be irrigated with Octenisept®.
The Journal of Hand Surgery, 2012
For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, di... more For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast. Over a 2-year-period, a prospective, randomized, multicenter study was conducted at 4 hospitals in Switzerland. Clinical and radiological results of 66 consecutive patients having 75 extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Intra-articular and physeal fractures, pathological fractures, open fractures, concomitant injuries of the tendons or collateral ligaments, and accidents more than 7 days before presentation were excluded from the study. Radiographically, there were no statistically significant differences between the 2 groups in terms of palmar apex angulation and radial or ulnar angulation. There were no differences in total active range of finger motion. Wrist joint motion at the time of cast removal was statistically superior in patients treated with Lucerne cast. However, there were no significant differences in wrist joint motion at 12 weeks of follow-up. The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. Well-reduced, minimally angulated, or nonangulated fractures of the proximal phalanges of the fingers can be effectively treated using functional casts without immobilizing the wrist. Therapeutic II.
Journal of Clinical Ultrasound, 2014
Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. A rare ca... more Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. A rare case of carpal tunnel syndrome due to solitary osteochondroma arising from the metaphysis of the distal radius is presented. Preoperative diagnosis was suspected by physical examination and high-resolution sonography and confirmed by radiographs. Surgical treatment consisted of extended open carpal tunnel release and excision of the tumor.
European Spine Journal, 2004
European Journal of Pediatric Surgery, 2013
Fractures of the proximal phalanges of the fingers are common injuries in children and adolescent... more Fractures of the proximal phalanges of the fingers are common injuries in children and adolescents. The majority can be treated by closed reduction and splinting, and complications are rare. The purpose of the prospective study was to document the results of functional-conservative treatment of extra-articular physeal fractures using either a functional forearm cast or the Lucerne Cast (LuCa). Clinical and radiographic results of 13 pediatric patients having 13 extra-articular physeal fractures (e.g., juxta-epiphyseal fractures, Salter-Harris type I or II physeal fractures) of the proximal phalanges were recorded through a minimum follow-up of 6 months. Intra-articular physeal fractures (Salter-Harris type III or IV), fractures involving the proximal interphalangeal joint (PIPJ), pathological fractures, open fractures, and concomitant injuries of the tendons were excluded. Fracture consolidation was achieved in all cases within 4 weeks. No palmar apex angulations, no rotational deformities, and no PIPJ extension lags could be observed. All patients achieved full total active range of motion within 3 months. Well-reduced extra-articular physeal fractures of the proximal phalanges can be effectively treated using functional-conservative casts. Although children may need a functional forearm cast, a LuCa is adequate in compliant adolescents.Level of Evidence The level of evidence for the study is Level II (therapeutic studies).
Clinical Biomechanics, 2004
Objective. To determine the feasibility of polymethyl-methacrylate injection into the osteoporoti... more Objective. To determine the feasibility of polymethyl-methacrylate injection into the osteoporotic proximal femur and its effect on the mechanical properties.
British Journal of Sports Medicine, 2007
To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe s... more To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. Tertiary trauma centre in Bern, Switzerland. All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning hill etiquette.
Archives of Orthopaedic and Trauma Surgery, 2012
Micro- or macroreplantation is classified depending on the level of amputation, distal or proxima... more Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. Level IV.
Im Vergleich zu anderen Berufsgruppen leidet zahnmedizinisches Personal häufig unter Beschwerden ... more Im Vergleich zu anderen Berufsgruppen leidet zahnmedizinisches Personal häufig unter Beschwerden im Bereich der Hände und Handgelenke. Symptome entwickeln sich oft über einen längeren Zeitraum und manifestieren sich in Form von dumpfen Schmerzen, Taubheitsgefühlen und geschwollenen Fingern. Viele dieser Probleme sind durch eine gute Ergonomie vermeidbar. Im Folgenden werden einige der wichtigsten Krankheitsbilder im Bereich der Hände vorgestellt. Es werden präventive Ansätze wie ergonomische Arbeitsweisen und der Einfluss des Instrumentendesigns auf die Belastung der Finger aufgezeigt.
Osteoarthritis and Cartilage, 2001
Reduction of compressive stiffness of articular cartilage has been reported as one of the first s... more Reduction of compressive stiffness of articular cartilage has been reported as one of the first signs of cartilage degeneration. For the measurement of in situ compressive stiffness, a hand-held indentation probe has recently been developed and baseline data for macroscopically normal knee joint cartilage were provided. However, the histological stage of degeneration of the measured cartilage was not known. The purpose of this study was to investigate whether there is a relationship between the in situ measured compressive stiffness, the histological stage of degeneration, and the biochemical composition of articular cartilage. Instantaneous compressive stiffness was measured for the articular cartilage of 24 human cadaver knees. Additionally, biochemical composition (total proteoglycan and collagen content) and histological appearance (according to the Mankin score) were assessed for each measurement location. Despite visually normal surfaces, various histological signs of degeneration were present. A high correlation between Mankin score and cartilage stiffness was observed for the lateral patellar groove (R(2)=0.81), the medial (R(2)=0.83) and the lateral femoral condyle (R(2)=0.71), whereas a moderate correlation was found for the medial patellar groove (R(2)=0.44). No correlation was observed between biochemical composition and cartilage compressive stiffness. Our results are in agreement with others and show that the instantaneous compressive stiffness is primarily dependent on the integrity of the extracellular matrix, and not on the content of the major cartilage constituents. The high correlation between stiffness and Mankin score in mild osteoarthrosis suggests that the stage of cartilage degeneration can be assessed quantitatively with the hand-held indentation probe. Moderate and severe case of osteoarthrosis remains to be investigated.
Clinical Orthopaedics and Related Research, 2005
Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome are characterized by peculiar bo... more Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome are characterized by peculiar bone lesions that commonly involve the anterior chest wall. Osteitis typically is the most prominent skeletal lesion seen in synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. We present a patient with aseptic femoral osteitis and sternocostal hyperostosis. The classic clinical, radiographic, and histologic features of this syndrome are described. Diagnosis is difficult in patients with only one symptomatic bone. The lesion often is confused with suppurative osteomyelitis because of similar clinicopathologic findings. Although the optimal treatment is unclear, it is important to consider synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in the differential diagnosis of any lytic, sclerotic, or hyperostotic bone lesion to avoid unnecessary long-term antibiotic therapy.
Clinical Orthopaedics and Related Research, 2002
The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartila... more The use of multiple autologous osteochondral plugs (mosaicplasty) for repair of articular cartilage defects is a well-accepted technique. Since 1995, the authors have used mosaicplasty to treat more than 110 patients with cartilage defects of the knee, hip, and ankle. The first 52 consecutive patients who had mosaicplasty of the knee and have an average followup of 37 months (range, 24-56 months) were examined. Indications for surgical treatment were osteochondritis dissecans, acute trauma, and posttraumatic lesions of the femorotibial joint, femoropatellar maltracking with recurrent episodes of patella dislocations, and distinct femoropatellar arthrosis. Preoperatively, cartilage defects were classified as International Cartilage Repair Society Grade III lesions in 23 patients and Grade IV lesions in 29 patients. Two years after surgery, an increased level of knee function was found in 86% of the patients. At the latest followup, improved knee function was observed in 92% of the patients. In four patients, reoperation was necessary because of graft failure. Complications and reoperation rate were related to large surface lesions. Autologous osteochondral transplantation is a valid option for the treatment of full-thickness osteochondral defects. However, the method is limited by the defect size and the number of plugs to be taken at the donor site.
Archives of orthopaedic and trauma surgery, 2015
Limited range of finger motion is a frequent complication after plate fixation of phalangeal frac... more Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems. From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS). No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total...
Neuro-Chirurgie, 2014
The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin sy... more The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.
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, 2010
A giant cell tumour of the distal radius or of the carpal bones, verified by incisional biopsies,... more A giant cell tumour of the distal radius or of the carpal bones, verified by incisional biopsies, should be approached as a low-grade malignancy. Lesions that arise in the bones of the hand or the wrist have a greater propensity to metastasise, and have a higher risk of local recurrence. In this case report we describe a 54-year-old women with a giant cell tumour of the distal radius (Campanacci grade III lesion), having a follow-up of five years without signs of local recurrence or metastatic disease. The general principles of and options for surgical treatment are discussed.
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, 2010
The purpose of our prospective study was to document the clinical and radiological results of con... more The purpose of our prospective study was to document the clinical and radiological results of conservative-functional treatment of extraarticular proximal phalangeal fractures without immobilisation of the wrist. The Lucerne Cast (LuCa) resembles a circular metacarpal brace leaving bare both flexion creases, the rascetta and the distal palmar flexion crease. Dorsally, the brace expands to beyond the proximal interphalangeal joints, fixing the metacarpo-phalangeal joints in an intrinsic plus position, thus causing the extensor aponeurosis to tighten and to move distally. Clinical and radiological results of 15 consecutive patients with a total of 20 fractured proximal phalanges were prospectively recorded through a minimum follow-up of 3 months. Fracture consolidation was achieved in all patients, with nine cases showing a dorsal angulation of 2 °-16°. A slight radial or ulnar deviation, respectively, was present in four cases (3 °-5°). Radiologically, a minor rotational deformity of...
Percutaneous Vertebroplasty and Kyphoplasty, 2006
Journal of Hand Surgery (European Volume), 2012
Journal of Hand Surgery (European Volume), 2012
Penetrating hand wounds are common and these are managed by thorough debridement. However, stab w... more Penetrating hand wounds are common and these are managed by thorough debridement. However, stab wounds without evidence of divided structures are often treated with irrigation using antiseptic substances, antibiotic therapy, and immobilization. Octenisept® (Schülke &amp;amp; Mayr Ltd) is a widely used antiseptic agent for disinfection of acute or chronic wounds. It has a broad spectrum of antiseptic efficacy and has become an antiseptic of first choice in many hospitals. Within a few months, four patients presented to us with chronic inflammation and severe tissue necrosis after irrigation of penetrating hand wounds with Octenisept®. Repeated surgery and debridement was required in all patients. Wound healing was prolonged and patients had persisting oedema. Penetrating hand wounds must not be irrigated with Octenisept®.
The Journal of Hand Surgery, 2012
For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, di... more For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast. Over a 2-year-period, a prospective, randomized, multicenter study was conducted at 4 hospitals in Switzerland. Clinical and radiological results of 66 consecutive patients having 75 extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Intra-articular and physeal fractures, pathological fractures, open fractures, concomitant injuries of the tendons or collateral ligaments, and accidents more than 7 days before presentation were excluded from the study. Radiographically, there were no statistically significant differences between the 2 groups in terms of palmar apex angulation and radial or ulnar angulation. There were no differences in total active range of finger motion. Wrist joint motion at the time of cast removal was statistically superior in patients treated with Lucerne cast. However, there were no significant differences in wrist joint motion at 12 weeks of follow-up. The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. Well-reduced, minimally angulated, or nonangulated fractures of the proximal phalanges of the fingers can be effectively treated using functional casts without immobilizing the wrist. Therapeutic II.
Journal of Clinical Ultrasound, 2014
Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. A rare ca... more Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. A rare case of carpal tunnel syndrome due to solitary osteochondroma arising from the metaphysis of the distal radius is presented. Preoperative diagnosis was suspected by physical examination and high-resolution sonography and confirmed by radiographs. Surgical treatment consisted of extended open carpal tunnel release and excision of the tumor.
European Spine Journal, 2004
European Journal of Pediatric Surgery, 2013
Fractures of the proximal phalanges of the fingers are common injuries in children and adolescent... more Fractures of the proximal phalanges of the fingers are common injuries in children and adolescents. The majority can be treated by closed reduction and splinting, and complications are rare. The purpose of the prospective study was to document the results of functional-conservative treatment of extra-articular physeal fractures using either a functional forearm cast or the Lucerne Cast (LuCa). Clinical and radiographic results of 13 pediatric patients having 13 extra-articular physeal fractures (e.g., juxta-epiphyseal fractures, Salter-Harris type I or II physeal fractures) of the proximal phalanges were recorded through a minimum follow-up of 6 months. Intra-articular physeal fractures (Salter-Harris type III or IV), fractures involving the proximal interphalangeal joint (PIPJ), pathological fractures, open fractures, and concomitant injuries of the tendons were excluded. Fracture consolidation was achieved in all cases within 4 weeks. No palmar apex angulations, no rotational deformities, and no PIPJ extension lags could be observed. All patients achieved full total active range of motion within 3 months. Well-reduced extra-articular physeal fractures of the proximal phalanges can be effectively treated using functional-conservative casts. Although children may need a functional forearm cast, a LuCa is adequate in compliant adolescents.Level of Evidence The level of evidence for the study is Level II (therapeutic studies).
Clinical Biomechanics, 2004
Objective. To determine the feasibility of polymethyl-methacrylate injection into the osteoporoti... more Objective. To determine the feasibility of polymethyl-methacrylate injection into the osteoporotic proximal femur and its effect on the mechanical properties.
British Journal of Sports Medicine, 2007
To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe s... more To analyse the epidemiological data, injury pattern, clinical features and mechanisms of severe spinal injuries related to alpine skiing and snowboarding. A six-year review of all adult patients with severe spinal injuries sustained from alpine skiing or snowboarding. Tertiary trauma centre in Bern, Switzerland. All adult patients (over 16 years of age) admitted to a tertiary trauma centre from 1 July 2000, through 30 June 2006, were reviewed using a computerised database. From these records, a total of 728 patients injured from snow sports were identified. Severe spinal injuries (defined as spinal fractures, subluxations, dislocations or concomitant spinal cord injuries) were found in 73 patients (17 female, 56 male). The clinical features of these patients were reviewed with respect to epidemiological factors, mechanism of injury, fracture pattern, and neurological status. The majority of severe spinal injuries (n = 63) were related to skiing. Fatal central-nervous injuries and transient or persistent neurological symptoms occurred in 28 patients (23 skiers, 5 snowboarders). None of the snowboarders suffered from persistent neurological sequelae. Snowboarders with severe spinal injuries (n = 10) were all male (p<0.05), and were significantly younger than skiers (p<0.001). The most commonly affected site was the lumbar spine. However, 39 patients (53.4%) suffered from injury pattern at two or more levels. With advances in technology and slope maintenance, skiers and snowboarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in snow sports, but until recently very little attention has been given to spinal injury prevention on the slopes. Suggestions for injury prevention include the use of spine protectors, participation on appropriate runs for ability level, proper fit and adjustment of equipment, and taking lessons with the goal of increasing ability and learning hill etiquette.
Archives of Orthopaedic and Trauma Surgery, 2012
Micro- or macroreplantation is classified depending on the level of amputation, distal or proxima... more Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. Level IV.