We retrospectively analysed characteristics of 39 patients who presented with septic arthritis of the wrist between January 2015 and June 2021. There was a significant positive correlation between the number of risk factors, such as immunosuppression or diabetes, with Pseudomonas arthritis but not with the number of operations needed to treat the infection or the length of hospitalization. The duration of symptoms before admission at our hospital, C-reactive protein values at admission and infection with Pseudomonas were significantly correlated with the length of hospitalization, but Pseudomonas was detected in one patient only. Staphylococci were the most frequently detected bacteria and significantly correlated with the number of operations needed for treatment. Normal white blood cell counts or C-reactive protein values were frequently encountered. Level of evidence III

Background The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies. Patients and methods Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient’s range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes–Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively. Results Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups. Conclusion Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation. Level of evidence IV.

Soft tissue sarcomas (STSs) are tumors that are challenging to treat due to their pathologic and molecular heterogeneity and their tumor biology that is not yet fully understood. Recent research indicates that dysregulation of cyclin-dependent kinase (CDK) signaling pathways can be a strong driver of sarcogenesis. CDKs are enzyme forms that play a crucial role in cell-cycle control and transcription. They belong to the protein kinases group and to the serine/threonine kinases subgroup. Recently identified CDK/cyclin complexes and established CDK/cyclin complexes that regulate the cell cycle are involved in the regulation of gene expression through phosphorylation of critical components of transcription and pre-mRNA processing mechanisms. The current and continually growing body of data shows that CDKs play a decisive role in tumor development and are involved in the proliferation and growth of sarcoma cells. Since the abnormal expression or activation of large numbers of CDKs is considered to be characteristic of cancer development and progression, dysregulation of the CDK signaling pathways occurs in many subtypes of STSs. This review discusses how reversal and regulation can be achieved with new therapeutics and summarizes the current evidence from studies regarding CDK modulation for STS treatment.

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Background: Modern CT might deliver higher image quality than necessary for fracture imaging, which would mean non-essential effective radiation exposure for patients. We simulated ultra-low dose (ULD)-CT at different dose levels and analyzed their diagnostic performance for scaphoid fracture detection.Methods: 30 consecutive high quality CT with clinically suspected scaphoid fractures were assessed. ULDsimulations were made at 20%, 10% and 5% of original dose. Three readers at different levels of experience (expert, moderate, inexperienced) expressed their diagnostic confidence (DC; 5-point-Likert-scale) and analyzed the presence and classification of scaphoid fractures within Krimmer's and Herbert's classifications.Effective radiation exposure of the original data sets and ULD-CT were calculated.Results: At 20% and 10% dose the more experienced readers reached perfect sensitivity (100%) and specificity (100%), showing perfect agreement regarding fracture classification (1.00). Diagnostic performance decreased at 5% dose (92.86% sensitivity, 100% specificity; expert reader). The inexperienced reader showed reduced sensitivity and specificity at all dose levels. At 10% dose minimal DC of all readers was 3/5 and mean calculated effective radiation exposure was 1.11 [±0.36] µSv. Conclusions:The results suggest that ULD-CT at 10% dose compared to high quality CT might offer sufficient image quality to precisely detect and classify scaphoid fractures, if moderate experience of the radiologist is granted.