Treatment of irreversible lesion of the radial nerve by tendon transfer: indication and long-term results of the Merle d'Aubigné procedure.

Irreversible radial nerve paralysis should be treated by tendon transfer reconstruction to improve wrist and finger extension and stabilization of the thumb joints. Many different techniques and modifications are known and used. A total of 43 patients, all of whom underwent the Merle d'Aubigné procedure, were examined in a long-term follow-up study. Short-term and long-term subjective and objective results were evaluated. The improvement of the motions between initial and follow-up examinations could be demonstrated. Thirty-eight patients were able to return to their former jobs. Interestingly, the majority of the patients were able to move their fingers separately. This finding could be proved by the electromyography and explained by the counteracting flexor tendons. The overall findings indicate that the Merle d'Aubigné procedure is an excellent and reliable tendon transfer method.

[Quantification of variations in arm perfusion after plexus anesthesia with color doppler sonography]. / Quantifizierung der Perfusions-änderung des Armes nach Plexusanästhesie mittels Farbdopplersonographie.

The axillary brachial plexus block is a well-known technique for intra- and postoperative analgesia and sympathetic blockade in hand and microsurgery. The aim of this study was to show the influence of the axillary brachial plexus block on the blood flow as a side effect. METHODS. We used a colour-coded sonography unit (Toshiba) with a 7.5-MHz transducer. A total of 12 patients with no clinical signs of vascular diseases were enrolled in this study. We measured the peak blood flow velocity and the peak flow at the bifurcation of the brachial artery and vein and the proximal and distal radial artery before and after the plexus block. In addition, we were able to take the morphological aspects of the analysed vessels into consideration as we also used conventional sonography. This was done to detect any early signs of vascular malformation or arteriosclerosis, either of which might have affected the measurements. RESULTS. The average arterial peak blood flow after the plexus block was 1.9 times that before. On the venous side, the block effect caused an average increase of the blood flow to 8.6 times than before the block. In general, an additional and immediate effect of the block was a significant rise in blood flow velocity with an increase in cross-section area. CONCLUSIONS. The brachial plexus block combines two advantages: pain relief and pain management plus temporary sympathectomy. In conclusion, it prevents vasospasms and improves the circulation of the hand in patients undergoing reimplantation of limbs and those with nutritional disorders.

[Various tendon suture techniques and their follow-up care]. / Die verschiedenen Sehnennahttechniken und deren Nachbehandlung.

In this review of the most commonly applied techniques of surgical tendon repair, their development and modification are described. The most important issue is the connection of special suture material and surgical techniques that take into account the anatomical localization of the tendon as well as the mode of injury.

[The monitor findings of digitalized conventional wrist x-rays]. / Monitorbefundung digitalisierter konventioneller Handwurzelaufnahmen.

The study aimed at proving the reliability of monitor systems with the matrix of 1024 x 768 for the detection of scaphoid fractures compared to conventional X-ray. Moreover, we were interested in the significance of procedures of digital imaging post processing, depending in particular on the experience of investigators. 5 investigators with different levels of experience analysed 57 X-rays of the wrist. They compared conventional X-rays with images on a high screen monitor system after the digitalisation of these X-rays by a CCD-scanner and analysed untreated and treated images. A 5-point scale ROC analysis was used for evaluation. The analysis covered a total of 1740 evaluations. The untreated images seen on the monitor system proved slightly better than conventional X-rays. Post-processing has no evident advantage over untreated images. Differing levels of experience had no effect whatsoever on the identification of findings.

[Effectiveness of treatment of scaphoid pseudarthrosis in the impaired and damaged carpal bones and wrist]. / Die Effizienz der Kahnbeinpseudarthrosenbehandlung bei Vorschaden und Veränderungen im Bereich der Handwurzel und des Handgelenkes.

107 of 604 cases with scaphoid non-union had secondary arthrosis of the wrist before surgical treatment by the Matti-Russe technique. In contrast to earlier opinions the results of this retrospective study show that this procedure is indicated more frequently.

[Injury of the collateral ligaments of the metacarpophalangeal joint of the thumb and therapy]. / Die Verletzung der Seitenbänder am Daumengrundgelenk und deren Therapie.

The authors report on their experience on 176 patients with lesions of the ulnar collateral ligaments. Two samples were compared: the fresh rupture and immediate suture, and the old lesion treated by a special plasty with palmaris tendon (Bäuerle/Reill). The long term results (at least 2 years) of both collectives were nearly identical. The authors recommend immediate repair.

[Long-term results of 2-stage flexor tendon grafting]. / Langzeitergebnisse zweizeitiger Beugesehnentransplantationen.

The authors report the results of 85 two-stage tendon grafts (with Silastic rod preparation and subsequent tendon grafting) in which the evaluation was based upon the classification of Buck-Gramcko. The time between the end of treatment and physical evaluation varied from three to six years. The interpretation of the results was based on the analysis of the preoperative state according to the nature of the lesion and the severity of the injury (Boyes/Hunter). No distinct correlation between the type of injury and the functional results was found. In contrast a clear relationship was found between the final results and the preoperative state--good, scar, joint, multiple, salvage (Boyes/Hunter)--especially when nerves were involved. The high number of bad results even in cases with an excellent preoperative state is important for a critical approach to the technique. Nevertheless, in appropriate cases the method is undoubtedly of value.

[Nerve transplantations in the upper extremity with autologous grafts]. / Nerventransplantationen an der oberen Extremität mit autologen Transplantaten.

The paper deals with the technique and indications of interfascicular nerve grafting. The operative technique and problems as well as new ideas are described. When the results published in this operative technique are compared, the following tendency is seen: some teams of microsurgeons have nearly the same excellent results after transplantation as after primary suture, while other teams have significantly more failures with transplantation. The problems with follow-up studies and the different methods of postoperative examination are discussed, as are the results of some of the teams.

[Primary flexor tendon suture]. / Die primäre Beugesehnen-Naht.

The protracted controversy about whether divided tendons, particularly in the so-called no-man's land, should be treated primarily or secondarily, seems to be resolved. Primary tendon suture with immediate dynamic splintage has led to a significant improvement in the results and is preferred, with minor variations, by most hand surgeons. Following a description of flexor tendon anatomy, more recent discoveries about the physiology of tendon healing are discussed. Developing from this, the currently used refined techniques of primary tendon repair are described. Particular attention is given to an exact description of post-operative supervision and management. Immediate tendon repair and subsequent treatment with dynamic splintage after Kleinert have considerable advantages for function, reduction of operating time and reduction of time off work. So-called secondary tendon repair after fresh, clean flexor tendon division should no longer be performed. Referral of patients with flexor tendon injuries, even from considerable distances, appears indicated, not only because of the better results but also for economic reasons. The previously published results are briefly described and critically reviewed.

[Camptodactylia (author's transl)]. / Kamptodaktylie.

In the case of camptodactylia, the early congenital form must be differentiated from that encountered in adolescents. Mild abnormalities with limitation of extension up to 30 degeees do not need treatment. Those with limitation of 30-50 degrees can be treated conservatively with suitable splints. With increasing failure of contraction, when there is a family history, or an obvious contracture, the operative procedure must be adjusted to the individual case and the balance between flexor and extensors of the fingers must be re-established. With suitable operative technique, definite improvement can be achieved, even if a complete correction of the deformity cannot always be obtained.