Background: Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight -bearing capacity and had the largest increase in application of the wrist brace (WristWidget). Purpose: In this prospective study, we wanted to test if the weight -bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight -bearing capacity and (2) show a higher increase of weight -bearing capacity after application of a wrist brace compared to all other types of injury. Study Design: This was a prospective cohort study. Methods: Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight -bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t -test for normally distributed values, MannWhitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. Results: Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight -bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight -bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) Conclusions: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Jeden Tag beraten wir Patienten mit fortgeschrittener Rhizarthrose in unserer Sprechstunde. Bis vor gut 5 Jahren hätte man zur Schmerzlinderung schwerpunktmäßig Trapezium-resezierende Verfahren angeboten. Auf Basis deutlich positiverer Studienergebnisse moderner Prothesenmodelle erfreut sich der endoprothetische Ersatz des Daumensattelgelenkes nun auch hierzulande zunehmender Beliebtheit. Dieser Beitrag gibt einen Überblick über die Entwicklung der Sattelgelenk-Endoprothetik, Indikationen, OP-Technik, Komplikationsmanagement und Nachbehandlung.

Background: This study assesses the variability of the palmar radiocarpal artery (PRCA), dorsal carpal branch of the ulnar artery (DCBUA), and anterior interosseous artery (AIA) in superselective catheter angiographies of the wrist (SCAW). Methods: Secondary analysis of consecutive SCAW (2009–2011). Measurements of the distances of the PRCA to the midface of the radiocarpal joint, the DCBUA to the styloid process of the ulnar, and maximum diameters of PRCA, DCBUA, and AIA. Results: Seven female and ten male patients (mean 35 years) received SCAW. All patients suffered from Kienbock’s disease. The mean distance from the PRCA to the radiocarpal joint was 7.9 ± 2.3 mm and the distance from the DCBUA to the styloid process of the ulna was 29.6 ± 13.6 mm. The mean maximum diameter of the PRCA was 0.6 ± 0.2 mm, that of the DCBUA was 1.1 ± 0.4 mm, and that of the AIA 1.2 ± 0.3 mm. In six cases (35%), all three arteries contributed to the PRCA; in eight cases (47%), the radial and AIA; in two cases (12%), the radial and ulnar artery; and in one case (6%), only the radial artery contributed. Conclusions: SCAW are feasible to assist in preoperative planning. Os pisiforme transfer with DCBUA might be the best choice for a vascular bone graft in Kienbock’s disease.

BACKGROUND:Osteoarthritis of the proximal interphalangeal (PIP) joint of the finger often leads to global hand-function detriment. Different techniques for the arthrodesis of the proximal interphalangeal joint have been described that all lead to union in a reasonable percentage of patients and period of time. This biomechanical study aims to analyze and compare the primary stability of different techniques of arthrodesis to render postoperative immobilization unnecessary.METHODS:Arthrodeses of 40° of composite cylinders were tested with different techniques in four-point bending for stability in extension as well as flexion.RESULTS:In extension, the compression screw and the compression wires showed the highest stability-whereas in flexion, plate fusion was superior. Tension band, cerclage or compression screw fusion showed the best compromise in flexion/extension stability.CONCLUSIONS:Fusion techniques that apply compression to the fusion show superior stability. Cerclage, tension band and compression screws might be able to provide enough stability to withstand the forces exerted during unencumbered activities of daily living. Arthrodesis with plates should be limited to patients with special indications and require immobilization during consolidation.

Abstract Introduction: Fireworks carry a high risk for hand injuries. Methods: The study presents data of 146 patients hospitalized with hand injuries caused by fireworks during the turn of the years 2005 to 2023. Statistical data presented include number, age and sex, injury patterns and concomitant injuries. Results: The number of injured increased over the years with a significant increase in 2016 and incision during the COVID pandemic. Those affected were predominantly male. The age group between 19 and 36 years was the most represented, followed by elders between 37 and 65 years. Children and adolescents under 18 were affected in one-third of cases. Injury patterns included combinations of soft tissue lesions, open fractures and finger amputations. Concomitant injuries predominantly involved the head. One quarter of the patients showed post-traumatic stress disorder. Discussion: Hand injuries from fireworks often result in permanent physical integrity disorders. Posttraumatic stress disorder is often. The increasing number of cases may be due to structural changes in the rescue service and the level of awareness of a specialized facility, in addition to a fundamental increase in injuries. Most striking was the decline in numbers during the COVID pandemic. The immediate rebound after the end of the restrictions supports the consideration of a permanent ban.

Background Timely treatment of scapholunate instability depends on early identification, but current imaging methods are either intricate or fail to demonstrate the dynamic stages. Purpose To calculate the diagnostic accuracy of four-dimensional (4D) CT for diagnosing instable scapholunate ligament (SLL) tears. Materials and Methods This prospective study enrolled consecutive participants with clinically suspected SLL tears who underwent 4D CT from July 2020 to May 2022. A historical study sample diagnosed at cineradiography served as a comparison, and wrist arthroscopy was the reference standard. Scapholunate joints greater than 3 mm were interpreted as instable at index 4D CT and cineradiography. Diagnostic accuracy was expressed as sensitivity and specificity. Areas under the receiver operating characteristic curve and cutoff values for both index tests were calculated. Intraclass correlation coefficients (ICCs) were computed to compare interrater reliability. Effective radiation doses at 4D CT were measured with thermoluminescent dosimeters. Results The study included 40 participants (mean age, 43 years ± 14 [SD]; 24 male) evaluated at 4D CT and 78 patients (mean age, 45 years ± 11; 50 male) historically evaluated at cineradiography. Four-dimensional CT helped detect instable tears in 26 of 35 participants (sensitivity, 74.3% [95% CI: 56.7, 87.5]. Cineradiography revealed instable tears in 52 of 63 patients (sensitivity, 82.5% [95% CI: 70.9, 91]). Four of five participants with stable scapholunate joints were identified at 4D CT (specificity, 80.0% [95% CI: 28.4, 99.5]), and 12 of 15 patients with stable SLLs were identified at cineradiography (specificity, 80.0% [95% CI: 51.9, 95.7]). Interrater agreement of radiologic measurements on 4D CT scans was good to excellent (ICC range, 0.89-0.96). The effective radiation dose ranged from 67 to 72 mSv at the wrist and was less than 1 mSv at the head. Conclusion Four-dimensional CT results are highly reproducible. Instable scapholunate joints greater than 3 mm were detected with a sensitivity of 74.3% and a specificity of 80% in an exploratory trial. Further evidence from larger randomized trials is warranted. German Register for Clinical Trials no. DRKS00021110 (Universal Trial Number U1111-1249-7884) Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.

The fracture of the fifth metacarpal neck (also called a boxer's fracture) is the most common fracture of the hand1,3. Displaced fractures often result in volar angulation of the metacarpal head, shortening, and residual malrotation4-7. The present video article demonstrates the steps of performing intramedullary single-Kirschner-wire fixation of the fifth metacarpal neck1, with the aim of the procedure being to achieve a closed reduction and internal stabilization of such a fracture. Although many fractures can be treated with a splint only, surgery should be performed in patients with excessive volar angulation, relevant shortening, or rotational deformity5-7. Description:For this procedure, the injured arm of the patient is placed on an arm table. The incision is made 1 to 2 cm longitudinally over the ulnar base of the fifth metacarpal bone. The cortical bone is opened with an awl, and a bent 1.6-mm Kirschner wire is inserted into the medullary canal. After reaching the fracture region, the fracture is anatomically reduced. The Kirschner wire is then advanced into the head of the fifth metacarpal, securing the reduction. Malrotation can be addressed in this stage by rotating the wire under fluoroscopic control. After ensuring anatomical reduction clinically and by fluoroscopy, the wire is shortened under the skin, followed by closure of the incision. We utilize a mid-hand brace for splinting. Alternatives:Nonoperative treatment is common for fifth metacarpal neck fractures in the absence of malrotation, excessive angulation, and shortening. Other surgical techniques include a similar procedure that involves the use of multiple Kirschner wires, plate fixation, transverse Kirschner wire pinning, and, less commonly, retrograde headless screw fixation2,7-9. Rationale:The main advantage of this technique is the preservation of the metacarpophalangeal joint and the minimal soft-tissue damage. Additionally, the use of a single Kirschner wire provides stability at low cost. With some experience, this surgery can be performed within 20 minutes1,9. Expected Outcomes:This procedure provides good fracture reduction and stabilization8. The outcome is usually satisfactory, with very low Disabilities of the Arm, Shoulder, and Hand scores1. Malrotation, angulation, and shortening are sufficiently addressed, and the technique shows the same results as fixation performed with use of 2 intramedullary wires. Important Tips:Bending the Kirschner wire to ensure easy gliding in the medullary canal provides the opportunity to reduce the metacarpal neck once the wire is safely in the head.Aim distally as you open the cortical bone with the awl in order to facilitate the insertion of the Kirschner wire.The primary reduction should be made manually, not by the wire. Subacute fractures and substantially displaced fractures require direct force for a satisfactory reduction, which cannot be achieved by rotation of the wire only.The cortical bone on the metacarpal head is very thin. Take care not to drive the Kirschner wire through the cortical bone and into the joint.Shorten the wire under the skin approximately 1 cm above the bone surface; this ensures easy removal and prevents skin irritation. Acronyms and Abbreviations:K-wire = Kirschner wire.

Study design: Retrospective cross-sectional case series.Background: Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.Purpose: In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Methods: Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoper-ative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and eti-ology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.Results: The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p < 0.001). The relative load of the affected hand compared to the unaf-fected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29) with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).Conclusion: The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.(c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning this disease. This includes careful consideration of the prevalence, pathogenesis, microbiology, diagnostic methods and the conservative, medical and surgical treatment. The emergence of the disease can subdivided in post-traumatic, postoperative, spread from contiguous infections and hematogenous. The individual patient-specific risk must be considered. Early diagnosis and correct management are essential to preserve bony structures and the articular function of the hand. A two-step surgical procedure is usually necessary, but uncertainties about the optimal treatment are still existing. Satisfactory control rates of the infection and successful bone reconstructions can be achieved. But complications, a limited range of motion and amputations of finger parts can still not be avoided in all cases.

ZusammenfassungDiese Arbeit gibt einen Überblick über Epidemiologie, Ätiologie, Klinik, Diagnostik und Therapie von Infektionen an Hand und Handgelenk.

Zusammenfassung Die Osteomyelitiden im Bereich von Handgelenk und Hand sind weniger häufig als die Knocheninfektionen der langen Röhrenknochen, aber nicht selten. Viele Fragen zur Klassifikation, Pathogenese, Diagnostik, zum Therapiemanagement sowie den erreichbaren Behandlungsergebnissen sind bisher nur wenig ausreichend wissenschaftlich kontrolliert. Die Pathogenese der Erkrankung kann in posttraumatische, postoperative, fortgeleitete und hämatogene Osteomyelitiden, unter Erfassung der patientenindividuellen Risiken, eingeteilt werden. Eine frühe Diagnose und eine adäquate Therapie sind notwendig, um die betroffenen knöchernen Strukturen sowie die Funktion der angrenzenden Gelenke zu erhalten. Ein mehrzeitiges operatives Vorgehen ist dabei häufig notwendig. Zufriedenstellende Raten der Infektionskontrolle und erfolgreiche knöcherne Rekonstruktionen können meist erreicht werden. Komplikationen, verbleibende Defizite und partielle Amputationen, auch bei angemessener Therapie der Osteomyelitiden, sind auf Grund der Schwere der Erkrankung aber nicht immer zu verhindern.

This review article addresses the epidemiology, ethology, clinic, diagnostics and therapy of infections of the wrist and small joints of the hand.

Zusammenfassung Verletzungen durch Bisse sind haufig und stellen zusammen mit den resultierenden Komplikationen etwa 1-2% aller Vorstellungen in Notfallambulanzen dar. In uber 75% sind die Hande betroffen. Im nordeuropaischen Raum werden Bissverletzungen vorrangig durch Hunde, Katzen und den Menschen verursacht. Aufgrund der vielfaltigen und komplexen Kompartimente sowie der geringen Weichteildeckung funktionell relevanter Strukturen fuhren selbst kleinste und oberflachliche Bissverletzungen an der Hand zu Infektionen. Jede Bissverletzung der Hand kann in der Folge zu fulminanten Infektionen und selten gar todlichen Verlaufen fuhren. Bis zu 40% aller Infektionen an der Hand gehen auf Bissverletzungen zuruck. Das Erregerspektrum aus der Mundflora des Bei ss enden ist vielfaltig und umfasst aerobe und anaerobe Bakterienstamme. Bissverletzungen stellen sowohl fur den Verletzten als auch den behandelnden Arzt eine gro ss e Herausforderung dar. Die Rate an Komplikationen steigt nachweislich mit einer verzogerten medizinischen Konsultation, dem Mangel an medizinischer Sorgfalt und einer inadaquaten Wundversorgung. In dieser ubersichtsarbeit diskutieren wir die Arten und Komplikationen von Bissverletzungen, ihr potenzielles Infektionsrisiko, deren Erregerspektrum und Erscheinungsbild sowie deren effektive Therapie. Abstract Bite injuries are common. Along with the resulting complications, they represent approximately 1-2% of all emergency department visits. In over 75%, the hands are affected. In Northern Europe, bites and subsequent infections are mainly caused by dogs and cats but also by humans. Up to 40% of all hand infections are caused to bite injuries. Due to the multiple and complex compartments as well as the low soft tissue coverage of functionally relevant structures, even the smallest and most superficial bite injuries of the hand lead to infections. Any bite injury to the hand may subsequently may result in a fulminant infection and, rarely, even death. The spectrum of pathogens from the oral flora of the biting animal or person is diverse and includes aerobic and anaerobic bacterial strains. Bite injuries represent a major challenge for both the injured person and the attending physician. The rate of complications has been shown to increase with delayed medical consultation, lack of medical care and inadequate wound care. In this review, we discuss the types and complications of bite wounds, their potential risk of infection, their pathogen spectrum and appearance, and their effective treatment.

ZusammenfassungVerletzungen durch Bisse sind häufig und stellen zusammen mit den resultierenden Komplikationen etwa 1–2 % aller Vorstellungen in Notfallambulanzen dar. In über 75 % sind die Hände betroffen. Im nordeuropäischen Raum werden Bissverletzungen vorrangig durch Hunde, Katzen und den Menschen verursacht. Aufgrund der vielfältigen und komplexen Kompartimente sowie der geringen Weichteildeckung funktionell relevanter Strukturen führen selbst kleinste und oberflächliche Bissverletzungen an der Hand zu Infektionen. Jede Bissverletzung der Hand kann in der Folge zu fulminanten Infektionen und selten gar tödlichen Verläufen führen. Bis zu 40 % aller Infektionen an der Hand gehen auf Bissverletzungen zurück.Das Erregerspektrum aus der Mundflora des Beißenden ist vielfältig und umfasst aerobe und anaerobe Bakterienstämme. Bissverletzungen stellen sowohl für den Verletzten als auch den behandelnden Arzt eine große Herausforderung dar. Die Rate an Komplikationen steigt nachweislich mit einer verzögerten medizinischen Konsultation, dem Mangel an medizinischer Sorgfalt und einer inadäquaten Wundversorgung. In dieser Übersichtsarbeit diskutieren wir die Arten und Komplikationen von Bissverletzungen, ihr potenzielles Infektionsrisiko, deren Erregerspektrum und Erscheinungsbild sowie deren effektive Therapie.

Zielsetzung Die Cone beam Computertomographie (CBCT) findet bereits breite Anwendung in der medizinischen Diagnostik. Die Beurteilung karpaler Ligamente könnte ein weiterer Einsatzbereich dieser Technik sein. Die folgende Studie untersuchte die diagnostische Sicherheit der CBCT Arthrographie vor dem Hintergrund etablierter röntgenbasierter Verfahren, der Mehrzeilenspiral-CT-(MSCT-) Arthrographie und der konventionellen Arthrographie, in der Diagnostik instabiler SL-Bandverletzungen.

Purpose The objective of this study was to evaluate the outcome of a special interdisciplinary hand therapy program depending on the time interval between trauma and rehabilitation. Patients and methods With use of self-assessed scores (Disability of the Arm, Shoulder and Hand Score [DASH-Score], European Quality of Life 5 Dimensions [EQ-5D]) and objective functional parameters (TAM = Total Active Motion for finger injuries, ROM = Range of Motion for wrist injuries, grip strength) the outcome of 76 patients with injuries of the fingers, wrist or a complex regional pain syndrome (CRPS) was analysed at the begin and end of an inpatient rehabilitation and at a follow-up examination after 12 to 16 weeks. The patients were divided into groups with an early (< 120 days after trauma) or late beginning of their rehabilitation. Results At the follow-up examination early beginners had a significant better DASH-Score as well as a ROM. At the end of the rehabilitation program and at the time of the follow-up examination significant more patients with an early as patients with a late start of the rehabilitation were back to work. Especially patients with CRPS and finger injuries benefit from an early start of the rehabilitation. Conclusion Compared to a late start an early start of a rehabilitation program after finger and hand injuries and a CRPS leads to better functional with special benefit for patients with a CRPS.

Background: Previous studies have discussed the diagnostic value of four dimensional kinematic CT in cases of carpal instabilities. This analysis compares calculated skin doses of 4D CT and conventional cineradiography of the wrist in cases of suspected SLL rupture. Methods: Retrospective calculation and interpolation of skin doses and effective doses for ten consecutive 4D CT examinations and 41 cineradiographies for suspected lesions of the scapholunate ligament. Standardised anterior-posterior and lateral cine sequences using a flat-panel digital subtraction imager and of 4D kinematic CT using a dual-source scanner were acquired and acquisition parameters recorded. We tested if the skin dose of 4D CT is different from cineradiography. Results: Median dose area product (DAP) of cineradiography was 135.34 cGycm2 resulting in a calculated median skin dose of 32.6 mSv (confidence interval 26.86-42.90 mSv) and an estimated effective skin dose of 3.26 µSv. CT dose index (CTDI) for 4D examinations was recorded to be 26.79 mGy and the dose-length product (DLP) was 150 mGy × cm. This resulted in an estimated skin dose of 34 mSv, which is covered by the confidence interval of cineradiography, and an effective skin dose of 3.4 µSv. Conclusions: Skin dose calculations are comparable for 2D cineradiography in two plains and 4D kinematic CT of the wrist. Calculated effective doses are < 0.01 mSv.

ZusammenfassungDiese Arbeit gibt einen Überblick über Techniken und Ergebnisse der Arthrodese des Finger- und Daumenendgelenkes unter Berücksichtigung der Indikation, des Zuganges, der Gelenkflächenpräparation, des Arthrodesenwinkels, der Vor- und Nachteile der einzelnen Techniken und der Nachbehandlung.

Zusammenfassung Die Osteomyelitiden im Bereich von Handgelenk und Hand sind weniger haufig als die Knocheninfektionen der langen Rohrenknochen, aber nicht selten. Viele Fragen zur Klassifikation, Pathogenese, Diagnostik, zum Therapiemanagement sowie den erreichbaren Behandlungsergebnissen sind bisher nur wenig ausreichend wissenschaftlich kontrolliert. Die Pathogenese der Erkrankung kann in posttraumatische, postoperative, fortgeleitete und hamatogene Osteomyelitiden, unter Erfassung der patientenindividuellen Risiken, eingeteilt werden. Eine fruhe Diagnose und eine adaquate Therapie sind notwendig, um die betroffenen knochernen Strukturen sowie die Funktion der angrenzenden Gelenke zu erhalten. Ein mehrzeitiges operatives Vorgehen ist dabei haufig notwendig. Zufriedenstellende Raten der Infektionskontrolle und erfolgreiche knocherne Rekonstruktionen konnen meist erreicht werden. Komplikationen, verbleibende Defizite und partielle Amputationen, auch bei angemessener Therapie der Osteomyelitiden, sind auf Grund der Schwere der Erkrankung aber nicht immer zu verhindern. Abstract Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning this disease. This includes careful consideration of the prevalence, pathogenesis, microbiology, diagnostic methods and the conservative, medical and surgical treatment. The emergence of the disease can subdivided in post-traumatic, postoperative, spread from contiguous infections and hematogenous. The individual patient-specific risk must be considered. Early diagnosis and correct management are essential to preserve bony structures and the articular function of the hand. A two-step surgical procedure is usually necessary, but uncertainties about the optimal treatment are still existing. Satisfactory control rates of the infection and successful bone reconstructions can be achieved. But complications, a limited range of motion and amputations of finger parts can still not be avoided in all cases.

ZusammenfassungEin Diabetiker, Träger eines Ports und mit Zustand nach Gonarthritis durch Pseudomonas aeruginosa, erlitt eine subakute Arthritis eines Handgelenks. Protrahiert gelang der kulturelle Nachweis von P. aeruginosa aus dem explantierten Port und dem betroffenen Gelenk. Der Fall zeigt, dass bei Patienten mit unklarer Handgelenkarthritis, Vorgeschichte einer septischen Arthritis mit P. aeruginosa und Risikofaktoren für eine hämatogene Streuung ein Rezidiv ausgeschlossen werden sollte. Die Therapie bestand aus Portexplantation, Débridement mit Synovialektomie des Gelenks und antibiotischer Therapie.