[MRI evaluation of carpal tunnel morphology after carpal tunnel release by a retinaculum lengthening technique]. / Magnetresonanztomographische Beurteilung der Karpaltunnelmorphologie nach Medianusdekompression mittels einer retinakulumverlängernden Technik.

AIM: The benefits of maintaining the pulley function of the flexor retinaculum in carpal tunnel release by lengthening or reconstructing it have been described. Quantitative MR imaging was used to investigate the morphological changes after open carpal tunnel release by such a retinaculum lengthening technique. METHOD: Ten patients had bilateral carpal tunnel MRI pre- and postoperatively. The MRI examinations were performed with a 1.5 Tesla imaging system and wrist coils. Carpal tunnel volume, carpal arch width, median nerve position and flexor tendon position in relation to the hamate-trapezial axis were recorded . RESULTS: Like other methods of carpal tunnel release with complete division of the flexor retinaculum, the retinaculum lengthening technique showed a significant postoperative increase of carpal tunnel volume. Carpal arch width increased only slightly. There was a significant palmar displacement of the median nerve but not of the flexor tendons. CONCLUSION: The findings support the hypothesis that maintenance of the pulley function of the retinaculum may lead to an early postoperative recovery of grip strength. In spite of some difficulties in application quantitative MR imaging may be a useful tool in evaluating the carpal tunnel morphology.

Minimally invasive fixation versus conservative treatment of undisplaced scaphoid fractures: a cost-effectiveness study.

This study compares the direct and indirect costs of conservative and minimally invasive treatment for undisplaced scaphoid fractures. Costs data concerning groups of non-operated and operated patients were analysed. Direct costs were higher in operated patients. Although highly variable, indirect costs were significantly smaller in operated patients and the total costs were higher in non-operated patients. In conclusion, operative treatment of scaphoid fractures is initially more expensive than conservative treatment but markedly decreases the work compensation costs.

Proximal fractures of the fifth metacarpal: a retrospective analysis of 25 operated cases.

The clinical and radiological outcomes of 25 surgically treated fractures of the proximal third of the fifth metacarpal were retrospectively analysed. Many different methods of osteosynthesis were used. At follow-up after a mean of 3.3 years, 15 of 25 patients had no pain. Most patients regained a nearly full range of motion in the adjacent joints and more than 90% of the contralateral grip strength. X-ray signs of degenerative arthritis in the metacarpohamate joint were observed in 10 of 25 patients. Pain was found to be directly correlated with the presence of degenerative changes.

Cross stitch peripheral tendon repair: a mechanical comparison with core stitch techniques.

The purpose of this experimental study was to compare certain mechanical properties of a true epitendineal cross stitch suture with simple and double locking core tendon repairs. Using tensile strength and tendon lengthening until gap formation as measurement parameters, these three types of repair were tested in human flexor and extensor tendons from fresh cadavers. The peripheral cross stitch and the locked core repairs were found to have a greater lengthening capacity than the simple core suture, whereas the latter significantly better withstood axial load. Our findings established that, at least when used as a true epitendinous suture, the cross stitch technique alone was not suited for the repair of severed tendons. However, its design is particularly useful in preventing the suture site from potentially restrictive bulking.

An experimental study of nerve grafting combined with silicone tubes in the rat model: Functional outcome and specificity of muscle reinnervation.

Bridging large defects in mixed nerves is still an unsolved problem in reconstructive microsurgery. Two main aspects may be distinguished: one is to obtain an appropriate substitute for the lost neural tissue, the second to direct fibers toward their previous end-organs with the highest possible specificity. In the present study, sural nerve block grafts were combined with enclosed gaps at one or both ends of the grafts. Functional outcome at the muscle level as well as the number of motor axons and their cross-sectional distribution were assessed after 3 months. The presence of a proximally placed tube was found to decrease significantly the maximal tetanic force of the tibialis anterior muscle, whereas a distally placed one tended to improve it. Morphological data from acetylcholinesterase histochemistry correlated poorly with functional results but they gave some clues about possible roles played by the chambers, according to their position relatively to the grafts. No definitive evidence for an improved regeneration by use of silicone tubes in addition to the conventional grafts could be demonstrated.

[Nerve compression syndromes of the extremities]. / Nervenkompressions-syndrome der Extremitäten.

Peripheral entrapment neuropathies occur in high frequency and present clinically with a wide range of variations. They need to be recognized early enough in order to initiate correct therapy and so to obviate serious nerve lesions and possible neurological sequelae. This paper overviews the essentials of the compression neuropathies as they are encountered in both upper and lower extremities. Pathomechanisms , pathogenesis, evaluation considerations as well as differential diagnosis and basic treatment algorithms are emphasized.