[Dysplasia epiphysealis hemimelica of the carpus]. / Dysplasia epiphysealis hemimelica der Handwurzel.

Dysplasia epiphysealis hemimelica is a rare benign osteochondromatous disorder which develops in childhood mostly on the epiphyses of the bones in the lower extremities. While the tarsal bones are often involved, it is very rare in the carpus. Four patients are reported. Two were treated operatively with good results. In consequence of the experience of Lamesch, an excision was not performed in the other two cases. The patients were followed up for many years with the findings of some reduction in size and figure. Therefore, it is recommended not to operate this special tumour as long as no functional disturbances will occur.

[The musician's hand: 2 case reports from the hand surgery clinic]. / Die Hand des Musikers--Zwei Fallberichte aus dem handchirurgischen Alltag.

Report of the hand surgical treatment in two musicians, which enabled them to continue with their occupation. A young cellist was no longer able to play his instrument due to a painful scar at the pulp of his left index finger. The surgical treatment, performed only after a period of hesitation, consisted in scar excision and reconstruction of a normal pulp by a palmar advancement flap. Following a fracture of the distal radius, healed in 35 degrees dorsal angulation, a violinist was not able to flex his wrist maximally as required for playing in high octaves. This was again possible after a corrective osteotomy with interposition of a corticocancellous bone graft from the iliac crest and an intensive program of postoperative excercises. The important role of the cooperation of the patient, particularly in the rehabilitation, is emphasized.

[Results of interphalangeal joint arthrolysis in patients with Dupuytren disease]. / Ergebnisse von Mittelgelenkarthrolysen bei Patienten mit Dupuytren-Erkrankungen.

The results of 226 arthrolyses of the proximal interphalangeal joints of ring and small fingers in patients with Dupuytren's disease are presented in a retrospective study. 52% of cases involved first operations, 48% were operations of recurrent diseases. Proximal interphalangeal joints of small fingers were more frequently affected than those of the ring fingers. Arthrolysis was carried out stepwise in Buck-Gramcko's technique. In 13% of the cases an additional temporary transarticular Kirschner wire fixation was carried out. The results were graded according to extension deficits and the distance from fingertips to distal palmar crease. The average pre-operative extension deficit was 65 degrees. The average extension deficit three months after operation was 35 degrees. The post-operative distance from fingertips to distal palmar crease was 2.5 centimeters. Ring fingers yielded better results than small fingers. A temporary transarticular Kirschner wire fixation did not lead to better results. In unfavourable cases however, this fixation seems to be indicated. Complications occurred in 27% of the cases, mainly involving wound healing.

[Free toe transplantation in congenital hand defects]. / Die freie Zehentransplantation bei angeborenen Handfehlbildungen.

From 1983 to 1990, 30 free toe transplantations were performed in 30 children suffering from congenital malformations of the hand. Especially the two severe forms of symbrachydactylia presented major indications. In addition to toe transplantation onto the ulnar ray, lengthening of the radial ray was frequently necessary. Whereas 25 transplantations were successful, there were one necrosis and four partial necroses of the toe. In the monodactylous form, all 15 children with successful transplantation showed good and very good functional results. Children suffering from the peromelic form could gain a grip function which could not have been achieved by prosthetic supply alone. The basal joint of the thumb is of major importance since most of the mobility of the two fingers is achieved in this joint. This is true even if the thumb has to be surgically formed. If there is no carpometacarpal joint, a toe transplantation should not be performed since the mobility in the toe joints would be severely limited.

The Hoffmann-Tinel sign. 1915.

The aim of this article is to show that the well-known Tinel sign is really a Hoffmann-Tinel sign. The translation of the two papers of Hoffmann, published in the same year that Tinel wrote his article (1915), is completed by a short biography of Paul Hoffmann.

Wrist denervation procedures in the treatment of Kienböck's disease.

In almost all papers on wrist denervation, indications for denervation in Kienböck's disease has been mentioned without exact data. A detailed analysis of our clinical data on 61 patients proved the positive effect with respect to pain relief. In the 47 patients in which the denervation was combined with other procedures, such as radial shortening, ulnar lengthening, lunate excision, and replacement by silicone or tendon, pedicled pisiform transposition, and STT arthrodesis, a very high rate of patients (76%) had no complaints or pain only with heavy manual work. Of these treated patients, 88% were very or remarkably satisfied. About the same success rate was found in cases in which the denervation was applied as a single procedure. The extent of denervation was different; therefore, it can be concluded that partial or complete denervation has its value as an additional or single procedure in the treatment of Kienböck's disease, especially in the advanced stages (Decoulx's stages III and IV).

The treatment of metacarpal synostosis.

One hundred nine patients with metacarpal synostosis were examined to determine the best treatment for this condition. The fourth and fifth metacarpals are most frequently affected, and bilateral involvement occurs often. Many anomalies are associated with synostosis, as well as many syndromes such as Apert's syndrome, central polydactyly, syndactyly, and partial absence of the hand. An osteotomy to split and separate the synostosis, a bone graft to lengthen the fifth metacarpal, collateral ligament reconstruction, and tendon transposition of the extensor digiti minimi quinti all appear to be valuable for the treatment of this rare congenital anomaly.

[Replacement of the long extensor tendon of the thumb by transposition of the index finger extensor tendon]. / Ersatz der langen Daumenstrecksehne durch Umlagerung des Zeigefingerstreckers.

Transposition of the extensor indicis seems to be the most common procedure for reconstruction of the ruptured or severed extensor pollicis longus (EPL) tendon. From 1959 to 1988, we performed 115 extensor indicis transpositions in 34 open EPL injuries and 81 subcutaneous EPL ruptures. The open injuries involved failed primary repair (n = 6) or untreated tendon injuries (n = 19). The subcutaneous ruptures occurred after distal radius fractures or other closed injuries of the wrist (n = 62), arthrosis or rheumatoid synovialitis (n = 8). Forty-seven patients returned for follow-up examination six months to 18 years after operation. The evaluation included twelve parameters involving thumb, index finger and overall hand function as well as subjective patient assessment. We found significant loss of motion and strength only in two cases, where the tension of the transposed tendon was obviously inadequate. A certain loss of independent index extension was without functional impairment. Although several authors prefer EPL reconstruction with an intercalated tendon graft, we recommend the extensor indicis transposition as a simple procedure with predictable satisfactory results.

[Computerized tomography of the hand with high resolution technique]. / Computertomographie der Hand in hochauflösender Technik.

The results of 175 high-resolution computed tomography (CT) scans of the hand and wrist are analysed and compared to the results of conventional radiographs. Advantages of the procedure can be demonstrated when assessing pathological changes within the complex three-dimensional structure of the hand and wrist, and in the analysis of articular surfaces. In some cases, fractures and dislocations of the distal radioulnar joint and the carpal bones were missed in conventional radiographs. In cases of scaphoid fracture and nonunion, CT scans give valuable additional information surpassing the possibilities of conventional radiographs. For instance, bone healing after bone grafting can be better evaluated with a CT scan. Furthermore, preoperative planning is simplified, when tumors and cysts of the carpal bones can be located precisely using computed tomography.

[Hamulus fracture: a frequently unrecognized injury. Presentation of diagnosis and therapy based on two case reports]. / Die Hamulusfraktur: Eine häufig unerkannte Verletzung. Darstellung der Diagnostik und Therapie anhand zweier Fallbeispiele.

Fractures of the hook of the hamate are rare injuries of the hand. They are caused by direct trauma to the palm, however there are some cases without history of trauma. While physical examination is often suspicious of fracture, standard X-ray films can fail to demonstrate the fracture. Bone scans show an increased uptake in the ulnar region of the wrist. The carpal tunnel view or computed tomography confirm the diagnosis. Operative treatment is recommended. Simple excision of the hook, bone grafting or internal fixation are possible procedures. The diagnostic problems are demonstrated in two case reports.

[Distal radio-ulnar arthrodesis and Kapandji ulna segment resection in treatment of limited forearm rotation]. / Die distale radioulnare Arthrodese und Ellensegmentresektion nach Kapandji zur Behandlung der gestörten Unterarmdrehung.

Between 1986 and 1990 distal radioulnar arthrodesis with segment resection of the distal ulna (Sauvé-Kapandji Operation) was performed in 31 patients with posttraumatic changes of the distal radioulnar joint; 26 patients could be examined after 10 to 44 months. At the time of examination, all patients had bony fusion between distal radius and ulna; forearm rotation improved by 60.5%, 55% of the patients had significant pain relief. Grip strength also improved postoperatively, though never reaching values of the healthy hand. Two patients developed a bony regeneration, which was successfully reoperated upon in one case, 81% of the patients reported an improved wrist function.

[Ischemic contracture of the forearm and hand. Staging and indications for surgical treatment]. / Ischämische Kontraktur des Unterarmes und der Hand. Stadieneinteilung und Indikation operativer Behandlungsverfahren.

Results of long-term follow up of 66 patients with ischemic contracture of the forearm and hand, all surgically treated in the "Unfallkrankenhaus Hamburg)) between 1961 and 1982, are presented. Whereas ischemic contracture of the forearm flexors resulted mainly from fractures, ischemic contracture of the intrinsic muscles of the hand was most often seen after pressure injuries. All patients in this study presented to us with fully established ischemic contractures. Muscle and nerve damage was retrospectively evaluated according to operative notes, and the degree of damage could be classified into four groups. Most frequently, neurolysis, scar excision and muscle-sliding operations were performed; furthermore, tendon lengthening, tendon transpositions, wrist arthrodesis and nerve grafting were indicated. Results were judged according to twelve separately measured functions, each measurement giving a possible score of three to six points. Muscle-sliding operations result in an improved score regardless of ischemic contracture stage. For a stage 2 contracture, a 20 point improvement can be expected. In stage 1 contracture--presenting with extension deficiency of four or more points--, complete recovery can be expected following a muscle-sliding operation. For isolated muscle injuries, tendon lengthening is recommended. For stage 2 contracture, the transposition of superficial to deep flexor tendons results in the same score as a muscle-sliding operation; however, the transposition procedure should be reserved for special indications. In stage 3 contracture, the muscle-sliding operation is the treatment of choice, with secondary procedures such as tendon transpositions and nerve grafts often being necessary. In stage 4 ischemic contracture, muscle-sliding operations may improve extension deficiency; however, wrist arthrodesis, especially in combination with extensor tendon transpositions, may be beneficial. No experience with free muscle transplantation was made during the study period.

Progress in the treatment of congenital malformations of the hand.

Treatment of congenital malformations of the hand and forearm has progressed not only from new procedures, but especially due to a new technique, namely microsurgery. Microsurgery enables skilled hand surgeons to operate on the tiny hands of babies without damaging the anatomical structures. The optimal time for the correction of many deformities is during the first 2 years of life. This gives excellent adaptation of the corrected structures to their altered function, especially in combination with a long period of further growth. Several new procedures are described which have been made possible only since the introduction of microsurgery, either by microvascular anastomoses or by meticulous dissection technique (toe transplantation, proximal toe phalanx transplantation, nail wall formation in complex syndactyly, transposition of digital parts in polydactyly and radial club hand).