[Bone metastasis of bronchial carcinoma to the wrist. Case report]. / Skelettmetastase eines Bronchialkarzinomas am Handgelenk. Ein Fallbericht.

The case of a 54-year-old man is reported who suffered from a painful swollen wrist with signs of inflammation. Due to persisting symptoms and development of osteolysis at the wrist, surgical exploration and excision of a metastatic tumor was performed. It then took further two months to discover the primary tumor, a small-cell bronchogenic carcinoma. This case with its non-characteristic history emphasizes that in all cases of prolonged soft-tissue swelling, tumors originating from soft-tissue or bone or metastatic tumors must be considered in differential diagnosis.

[Retinaculum-plasty in dorsal wrist ganglion]. / Die Retinakulumplastik beim dorsalen Handgelenkganglion.

Pathogenesis and clinical manifestations are described. Ganglion extirpation often leaves larger defects in the joint capsule of the wrist, causing problems. A flap using parts of the retinaculum extensorum provides a reliable closure of the joint capsule defect and may reduce the risk of ganglion recurrences.

[Initial experience with the Meuli cementless total endoprosthesis of the wrist joint]. / Erste Erfahrungen mit der zementfreien Totalendoprothese des Handgelenkes nach Meuli.

The indications and the technique of implantation will be shown, and the results concerning function, pain reduction, and manual strength three years after surgery presented. Complications arose in cases with poor fixation of the cup prosthesis due to poor bone quality of the carpus. Operative salvage procedures are still possible.

[New osteosynthesis material in hand surgery]. / Neues Osteosynthese-Material in der Handchirurgie.

Stable internal fixation is an important principle of treatment in hand surgery. Titanium implants have proven themselves suitable and successful. Form and variety of implants satisfy all the demands for internal fixation. A recently developed "osteo-chip-system" will simplify handling.

[Septic aneurysm in a free flap]. / Septisches Aneurysma bei einem freien Lappen.

The indications for free flap transfer are well known, and include infected areas or large defects. In the case presented tissue destruction lead to a septic aneurysm with ischemia of the flap. After resection and new anastomosis the flap did not recover. The mistakes and its consequences are shown.

[Periarthritis calcarea of the finger joints]. / Periarthritis calcarea der Fingergelenke.

Calcium deposits close to finger joints are seen very often and are common in systemic diseases. There are also calcium deposits with no relation to other symptoms and therefore diagnosis is difficult. Between 1984-1988 we have analysed twelve such cases and explained the differential diagnosis and therapy. It seems important that these cases with typical clinical and radiologic findings are self-limiting and restitutio ad integrum is common without any therapy.

[Tuberculous bilocular cystic hygromas of the right hand and forearm]. / Tuberkulöses Zwerchsackhygrom der rechten Hand und des Unterarmes.

A rare complication of bone tuberculosis is bicameral hygroma of the hand and forearm. The transverse separation is caused by the retinaculum flexorum. Tendons can be destroyed by inflammatory changes of the synovial fluid. Experience with the few patients treated so far suggests that total extirpation combined with tuberculostatic therapy is necessary for the attainment of a cure.

[The fish hook technic--an aid in pulling tendon tissue through tight channels]. / Die Angelhakentechnik--Eine Hilfe zum Durchzug von Sehnengewebe durch enge Kanäle.

Pulling tendon grafts through narrow bone-holes often frays and tangles the tendon ends. The following knot technique results in a concentric compression of the tendon end. The line of pull is directed to the mid-portion of the implant and provides an axial force. The technique is demonstrated on the anatomic model as well as on clinical cases. The technique is simple to perform, involves minimal trauma to the implant, and requires only a very small drillhole in the bone to allow optimum tendon-bone contact and healing.

[Animal experiment studies of neurolysis of peripheral nerves]. / Tierexperimentelle Untersuchungen zur Neurolyse peripherer Nerven.

This animal study is intended to give information about nerve lesions caused by operation after using different kinds of neurolysis. It can be stated that simple nerve mobilisation leads to iatrogenic damage. The more neurolysis penetrates between the fascicular structure of the nerve, the higher the risk of lesion. After experimental internal neurolysis one can see a considerable atrophy of muscle as opposed to experimental external neurolysis. In the histochemical reactions, normal muscle and muscle after external neurolysis show a mosaic pattern of their fibre types. "Fibre type grouping", seen after internal neurolysis, refers to a phenomenon typical for a previously denervated and subsequently reinnervated muscle. Clearly, there is the possibility of regeneration after iatrogenic nerve damage caused by neurolysis.

[The Herbert system of screw osteosynthesis in fracture of the scaphoid bone]. / Das Herbert-System zur Schraubenosteosynthese der Kahnbeinfraktur.

Indications and different techniques in operating on fractures of the scaphoid are summarised. The "Herbert Scaphoid Bone Screw System" is described. Instrumentation, operative technique and typical clinical applications are shown. The advantages and disadvantages are discussed.

[Clear text-oriented documentation in hand surgery--integrated in the medical routine documentation service]. / Klartextorientierte Dokumentation in der Handchirurgie--integriert in den medizinischen Routineschreibdienst.

For reasons of contents and economy, the construction of medical documentation should be integrated into the secretary's routine work. An efficient and inexpensive microcomputer is able to facilitate and accelerate the typing work of a hand surgical section by the use of a modern data processing system. At the same time important data can be stored for documentation without being coded and with hardly any additional effort. The dates can be analysed according to different criteria (e.g. statistics of diagnosis/therapy, the recall of data of patients with certain diagnosis, yearly statistics and so on). Knowledge of data processing is not necessary.

[Use of the forearm island flap]. / Zur Anwendung des Unterarm-Insellappens.

The forearm island flap is an excellent procedure for closing all deep soft tissue defects in the hand. Good and reliable circulation results in healing without problems and elimination of infection. Reverse blood flow occurs in the radial artery and its concomitant veins. Branches of the cutaneous nerves provide sensory supply. Four cases are described.

[Giant-cell reaction of the short tubular bones of the hand and foot]. / Die riesenzellige Reaktion der kurzen Röhrenknochen von Hand und Fuss.

Giant cell reactions in the short tubular bones comprise mainly enchondromas, aneurysmal bone cysts and giant cell tumours. In both cases a history of trauma can be related. We therefore agree with Aegerter and Lorenzo that an intra-osseous haematoma due to minor trauma is likely to be of pathogenic significance.

[Improvement of suture technic in flexor tendon injuries. Clinical and experimental study]. / Uberlegungen zur Verbesserung der Nahttechnik bei Beugesehnenverletzungen. Klinishe und experimentelle Studie.

Multiple causes for the rupture of sutured tendons have been reported. At the time of exploration, loosening of the knot and breakage of the suture have been found to explain failure. A knot with four throws is frequently mentioned in various series as the smallest secure knot which can be made when employing a braided polyester suture material. Experiments have shown that the distance between the ends of the tendons affects the healing process and the tensile strength of the injured tendons. In order to avoid increasing the gap between the sutured ends of the tendons with the thick knot, it can be placed away from the cut surface of the tendons and displaced into the proximal or distal end of the tendons with a small additional incision. Through a longitudinal incision, the suture is easily passed in a criss cross fashion through the tendon and the knot can be buried in the tendon. This technique assures a very delicate and exact coaptation of the tendon ends. Almost 100% of the tendons remain intact during the healing phase. According to this experience, the risk of tendon rupture is reduced as a result of an increase in the tensile strength of the suture and the displacement of the knot away from the cut surface of the tendon.

[Tumor-like transformation of the median nerve in neural muscular atrophy]. / Tumoröse Umwandlung des Nervus medianus bei neuraler Muskelatrophie.

This paper reports a case of local enlargement of the median nerve in the upper arm due to the very rare condition of hypertrophic neuropathy. A characteristic feature of this affection of peripheral nerves, the cause of which is unknown, is the onion-skin-like hypertrophy of the Schwann cells and chronic neurogenic muscular atrophy. The examination of the nerve distension is described. The appropriate treatment is not known; however, the prognosis is favourable in cases showing very slow progression.

[Therapeutic regional anesthesia following an accidental intra-arterial injection. A case report on anesthesiologic care following incorrect injection of Reparil (sodium escinate)]. / Therapeutische Regionalanaesthesie nach irrtümlicher intraarterieller Injektion. Ein Fallbericht zur anaesthesiologischen Betreuung nach Fehlinjektion von Reparil (Natriumaescinat).

Symptomatology and therapeutic measures after accidental brachial intra-arterial injection of sodium escinate were explained by means of a case report. We obtained long-acting analgesia and sympathicolysis in the upper extremity by an anaesthesia of the ganglion stellatum followed by repeated interscalene plexus brachialis blockade. Even in very severe cases of accidental intra-arterial drug injection surgical procedures should be accompanied with therapeutic regional anaesthesia technics.

[Giant cell reaction of short tubular bones]. / Die riesenzellige Reaktion der kurzen Röhrenknochen.

This paper deals with the case of a so-called giant-cell reaction of the short tubular bones of a 31 year-old patient. Histologically, this rare benign disease falls under the category of tumor-like lesions of the bone. Clinically, the disease becomes evident through pain and swelling, and radiologically, a lytic bone process can be observed which may well perforate the cortical substance. The therapy consists in the total removal and the filling of the defect with autologous bone graft from the iliac crest, in some cases also by means of some additional autologous cancellous bone chips. The prognosis after surgical therapy is excellent. In the few cases which have to date become known, no cases of recurrence have been observed. Although the pathogenesis has not been clarified, thus far trauma and local disturbances of growth and/or development must be considered. Concerning differential diagnosis, one should distinguish above all the reaction from aneurysmal and juvenile bone cyst, as well as osteoclastoma.

[The cortico-cancellous bolting chip]. / Der kortiko-spongiöse Bolzungsspan.

For the bridging of major bone defects, a specially designed autologous cortico-cancellous chip from the iliac crest is recommended. Two cylindrical cones at both ends of the chip ensure firm interlocking with the bone. In combination with plate osteosynthesis, stability is achieved. Three typical traumatological examples illustrate the application and success of the procedure.