[Percutaneous treatment of unstable fractures of the base of the middle phalanx : Technique according to Hintringer and Ender]

OBJECTIVE

Reconstruction of intra-articular impression fractures of the middle phalanx by percutaneous reduction over a small dorsal cortical window. Stabilization by lattice-like arranged K‑wires.

INDICATIONS

Impression fractures of the base of the middle phalanx with or without dislocation in the proximal interphalangeal joint.

CONTRAINDICATIONS

Fractures extending to the shaft of the middle phalanx.

SURGICAL TECHNIQUE

By a cortical window at the dorsum of the middle phalanx (through the tendon free triangle) the impression fracture is reduced from the medullary cavity. Reduction is secured and the articular surface is supported by lattice-like arranged K‑wires.

POSTOPERATIVE MANAGEMENT

Thermoplastic splint for the finger for 6 weeks, subsequently K‑wire removal, active range of motion exercises and hand occupational therapy.

RESULTS

In two case series already published, good clinical and radiological results were reported. No complications were detected in either series.

[Hands well - all's well : Prevention campaign of the Austrian General Accident Insurance Institution (AUVA) to reduce hand injuries]

Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. In comparison, leisure-time hand injuries show a significantly higher accident rate: 60% of hand injuries occur during leisure time. Far fewer safety measures are taken and a lack of adequate training and a disregard for safety recommendations are observed.This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%.These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.

[Radiological evaluation of k-wire osteosynthesis, in comparison to fixed-angle-plate osteosynthesis, in patients aged 80 years or more with distal radius fractures]

BACKGROUND

This study evaluates the short-term radiological outcome of K-wire osteosynthesis (KWO) in comparison to the fixed-angle-plate osteosynthesis (ORIF) on distal radius fractures in elderly patients (aged 80 years or more) with osteoporotic bones.

PATIENTS AND METHODS

This study retrospectivly compares the postoperative X-rays of distal radius fractures (obtained between the years of 1998-2009) of patients aged 80 years and above treated with KWO (228 fractures, mean age 85 years), with the results of patients who were treated with fixed-angle plate ORIF (120 fractures, mean age 84 years). Within the KWO results, we also further compared the radiological results of a static and a dynamic (Kapandji) KWO technique. Only patients with a postoperative, anatomic reduction, and those who were radiologically followed up in a period of 2 months and above were included. The radiological criteria included the palmar and radial inclination as well as the radial shortening.

RESULTS

With KWO performed in a static technique, 24% of the postoperative results showed no reduction loss. The use of the dynamic Kapandji technique KWO, improved the positive results to 63%. However, almost a third of the fractures (30%) treated with KWO, had shifted back to their preoperative positions, or worsened overall. The fixed angle plate (ORIF) was able to maintain 76% of all fractures in their postoperative positions. Merely 1.7% of the ORIF group sustained a complete reduction loss. The fixed-angle plate osteosynthesis shows a significant decrease of cases in which a complete repositioning loss is experienced.

CONCLUSION

Although the importance of anatomic reconstruction of distal radius fractures is often debated in cases involving elderly patients, it is our considered opinion that, should an operative solution be chosen, one should consider the fixed-angle-plate osteosynthesis as the preferred operation method to prevent loss of reduction.

Fourier transform infrared imaging analysis in discrimination studies of squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) of the oral cavity and oropharynx represents more than 95% of all malignant neoplasms in the oral cavity. Histomorphological evaluation of this cancer type is invasive and remains a time consuming and subjective technique. Therefore, novel approaches for histological recognition are necessary to identify malignancy at an early stage. Fourier transform infrared (FTIR) imaging has become an essential tool for the detection and characterization of the molecular components of biological processes, such as those responsible for the dynamic properties of tumor progression. FTIR imaging is a modern analytical technique enabling molecular imaging of a complex biological sample and is based on the absorption of IR radiation by vibrational transitions in covalent bonds. One major advantage of this technique is the acquisition of local molecular expression profiles, while maintaining the topographic integrity of the tissue and avoiding time-consuming extraction, purification, and separation steps. With this imaging technique, it is possible to obtain unique images of the spatial distribution of proteins, lipids, carbohydrates, cholesterols, nucleic acids, phospholipids, and small molecules with high spatial resolution. Analysis and visualization of FTIR imaging datasets are challenging and the use of chemometric tools is crucial in order to take advantage of the full measurement. Therefore, methodologies for this task based on the novel developed algorithm for multivariate image analysis (MIA) are often necessary. In the present study, FTIR imaging and data analysis methods were combined to optimize the tissue measurement mode after deparaffinization and subsequent data evaluation (univariate analysis and MIAs). We demonstrate that it is possible to collect excellent IR spectra from formalin-fixed paraffin-embedded (FFPE) tissue microarrays (TMAs) of OSCC tissue sections employing an optimised analytical protocol. The correlation of FTIR imaging to the morphological tissue features obtained by histological staining of the sections demonstrated that many histomorphological tissue patterns can be visualized in the colour images. The different algorithms used for MIAs of FTIR imaging data dramatically increased the information content of the IR images from squamous cell tissue sections. These findings indicate that intra-operative and surgical specimens of squamous cell carcinoma tissue can be characterized by FTIR imaging.

Near infrared spectroscopy patents for the physicochemical characterization of nanomaterials: the road from production to routine high-throughput quality control

The measurement of the physical and chemical ("physicochemical") properties of nanomaterials used in industry and science including chemistry, pharmacy, medicine, toxicology, etc., is time-consuming, expensive and requires a lot of experience of a well trained lab staff. Near-infrared spectroscopy (NIR; 4.000-12.000 cm(-1)), working in the wavelength region with the highest IR energy, allows obtaining multifactorial information of the material under investigation due to the occurrence of a high number of combination and overtone vibrations. Coupling of an optimized and well-designed measurement technique with multivariate data analysis (MVA) leads to a non-destructive, fast, reliable and robust novel NIR technique for the fast and non-invasive physicochemical characterization, which is suitable for high-throughput quality control due to the short analyses times of only a few seconds. In the following chapters, the patented basic NIR techniques full-filling these aims are introduced, described, summarized and critically discussed.

Infrared-spectroscopy: a non-invasive tool for medical diagnostics and drug analysis

Constant development enabled Infrared (IR) spectroscopy to become a widely used, non-invasive tool for fast sample analyses with less to no pre-preparation. Furthermore, computational data handling is no more a limiting factor and hence, IR measurements are predestined for clinical diagnostics and drug analysis. Within this review the focus was put on clinical topics of high interest. One example is Alzheimer's disease, where the exact metabolism is still not clarified, or blood glucose monitoring for high throughput screening of patients without taking any drop of blood. The second section of this manuscript was focused on the analysis of drugs. The detection of physico-chemical parameters in pharmaceutics and the improvement of industrial proceedings allowed a dramatic increase of quality of produced medicine. In pharmaceutical industries problems with the equable allocation of agents occurs especially in scaling up processes. IR-analyzing-techniques serve as fast and precise indicators for the detection of active components and their distribution in tablets. In combination with statistical factors and medical investigations pharmaceuticals can be improved from their development until their application, and every step can be easily controlled by IR spectroscopy.

[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. Important diagnostic steps include conventional X-rays, cinematography of the wrist, MRI, and arthroscopy. Different procedures such as wrist arthrography and CT are of secondary value. 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.

[Functional treatment of basal joint fractures of three-joint fingers]

Phalangeal fractures have up to now always been treated using a conservative static form of splint. Open reduction and stabilisation is preferred in the case of injuries with severe displacement, shortening, open fractures and joint involvement. In this study, we have shown the results of 86 proximal phalangeal fractures that were treated with "dynamic splinting". In the "intrinsic plus" position a dorsopalmar plaster splint is affixed in combination with a Bedford double finger stall, splinting the injured finger securely to its neighbour. Clinical and X-ray results were evaluated. Oblique, rotational and transverse fractures can be reduced and treated showing good results with dynamic splinting. Bending fractures cannot always be treated with this method. Especially basal fractures with dorsal comminution can be problematic. Comminuted fractures can only be treated with dynamic splinting if they have been primarily adequately reduced. Intraarticular condylar fractures have to be treated surgically. Our results have also shown that the fingers still are freely mobile even when the bone has not healed in an anatomical position.

[Intramedullary nailing of unstable proximal humeral fractures]

Unstable subcapital fractures and dislocation fractures of the humerus can usually be set by closed reduction. Stabilization of these fractures by intramedullary pins is a method which avoids damage to the soft tissues around the shoulder. Since 1985, elastic steel pins with special features have been in use. The last 20 mm of the tip of the pins is angulated at 15 degrees, and the distal end is curved in a special way for the last 20 mm. According to our experience, the results after using this method in the treatment of unstable fractures of the surgical neck (ASIF type A II/2) and dislocation fractures (ASIF type A III/2) are fair to very good. For unstable fractures (ASIF type C I/2) and other dislocation fractures (ASIF type C III/2), the method is only suitable if good reduction is possible. Between the end of February 1985 and the end of December 1990, 101 fractures of the proximal end of the humerus were treated by closed reduction and fixation with intramedullary pins. Following fractures in the anatomical neck, aseptic necrosis of the fragment of the head leads to unfavorable results. In two patients, pseudarthrosis with poor function developed. Disturbance of wound healing, postoperative hematoma, infection, myositis ossificans, or Sudeck's desease have not been observed.

Flexible intramedullary pins in the treatment of unstable proximal humeral fractures

A series of 35 proximal humeral fractures treated with flexible intramedullary pins between 1986 and 1988 are presented. Special design features of the pins include a proximal 15 degrees angulated 20 mm tip and a 20 mm curve distally. The method is suitable for fractures in the surgical neck with displacement of bone width (AO-type A2/2). In cases of fracture-dislocation or three- or four-part fractures it is only suitable when the fragments can be reduced satisfactorily. Complications are minimal with 95 per cent bone union.