[Ulnar groove syndrome following elbow injuries]. / Sulcus ulnaris Syndrom nach Traumen im Ellenbogenbereich.

For a large scaled test 52 patients with anterior transposition of the ulnar nerve and 62 patients with elbow injuries were examined by questionnaire, physical examination and electroneurography. In conformity with existing literature 24 patients out of 52 suffering from cubital tunnel syndrome had an elbow trauma previously. To our great surprise in seven patients out of 46 with elbow injuries a cubital tunnel syndrome could be found for the first time. The cubital tunnel syndrome appears to be a frequent complication of elbow injuries. Besides the well known fractures of the medial epicondyle and pericondylar fractures leading to cubital tunnel syndrome, in our study fractures of the head of the radius and processus coronoideus were found quite often. Patients having typical anamnesis and complaints should be checked by electroneurography in order to permit a quick operation and to prevent incurable damages of the nerve. The diagnosis leading to operation of the elbow should however be made with greatest care. In case the operation is unavoidable, the ulnar nerve should be thoroughly checked and anterior transposition should be carried out.

[Clinical and neurologic results after surgical management of the cubital tunnel syndrome]. / Klinische und neurologische Ergebnisse nach operativer Versorgung des Ulnarisrinnensyndroms.

Fourty-two patients suffering from cubital tunnel syndrome were reexamined after anterior subcutaneous transposition of the ulnar nerve. In 25 patients, electrophysiological results could be compared pre- and postoperatively. Only few patients recovered completely, however, electrophysiological results showed an improvement in most of the patients. Sensory velocity proved to be more sensitive than motor velocity. We advice patients for early operation to avoid aggravation of symptoms, even if remission will be incomplete.

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.

We report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penile prosthesis. The result should have aesthetic value and be pleasing to the patient.

[Computerized tomography follow-up of the ante-torsion angle after femoral shaft fractures in the adult]. / Computertomographische Kontrolle des Antetorsionswinkels nach Oberschenkelschaftfrakturen des Erwachsenen.

Rotational deformities are common complications following fractures of the femoral shaft. Computed tomography for determination of the anteversion angle of the femoral neck has proved to be the most suitable way of quantifying rotational faults. Out of our inpatient collective, 45 patients who had undergone interlocking intramedullary nailing of the femur and 10 in whom dynamic compression plating had been performed were examined by clinical investigation and computed tomography. Patients impression and clinical findings proved to be less reliable. Computerized determination of the anteversion angle showed rotational deviations of more than 10 degrees in 18 patients with interlocking nails and in 3 with dynamic compression plates. According to our investigations, rotational deviations less than 20 degrees will not usually handicap the patient. Therefore, we suggest that use of the term "rotational fault" be restricted to deviations exceeding 20 degrees compared with the uninjured side.

[The disease factor of scapholunate dissociation]. / Zum Krankheitswert der skapholunären Dissoziation.

Scapholunate dissociation is the most common form of instability of the wrist. Its occurrence has been consistently attributed to previous trauma and is supposed to be treated by operation. In the present paper we show that chronic bilateral scapholunate dissociation without any symptoms is not rare. In two years we accidently found four cases with bilateral scapholunate dissociation. In such cases an operation cannot be successful. Therefore, we recommend that a specific trauma should be checked very carefully and roentgenograms of both wrists done.

[The relative value of electromyography (EMG) in the evaluation of the results of surgical repair of biceps tendon rupture in the arm]. / Der Stellenwert der Elektromyographie (EMG) zur Objektivierung der Ergebnisse operativ versorgter Bizepssehnenrupturen am Oberarm.

Ten patients treated for rupture of a biceps tendon were re-evaluated 2 years or longer after surgery. Four patients complained of loss of strength and increased fatigue. The concentric EMG examination and the technically more demanding Macro EMG technique showed normal motor unit action potential patterns in the muscle operated on and in the contralateral muscle used as control. The symptom weakness could not be explained by myopathic or neurogenic muscle changes. Concentric EMG had the same diagnostic yield as Macro EMG in this study. Concentric EMG is sufficient to scan for pathological findings within the biceps muscle. If any are present they should initially be interpreted as evidence of a further pathologic condition and not as sequelae of the tendon rupture.

[Diagnosis, therapy and results of biceps tendon ruptures]. / Diagnostik, Therapie und Ergebnisse nach Bizepssehnenrupturen.

During 1980 and 1988 a total of 29 male patients suffering from ruptures of the biceps tendons were treated operatively. In 21 cases the long tendon was involved, in two the short tendon, and in 6 cases the distal tendon. All ruptures of the long tendon and one of the short tendon had resulted from degeneration without any adequate trauma. Refixation of the long biceps tendon was performed with drill holes along the bicipital sulcus. In ruptures of the short and distal tendon various procedures were applied. Results of operative treatment were better in ruptures of the long biceps tendon than in ruptures of the short tendon. An operation may be successful even some months after injury.

[Intramedullary bundle nailing for stabilization of pathologic humerus fractures in malignant tumors]. / Die Bündelnagelung zur Stabilisierung pathologischer Humerus-Frakturen bei malignen Tumoren.

Pathological fractures of the humerus are mostly due to skeletal metastases or to malignant bone tumours. In most of the cases fracture stabilization as a palliative measurement is the only possible therapy. Our own collective during 1980 through 1987 includes 77 pathological fractures of the long bones, 23 of them located in the humerus. In eight of 15 fractures of the humeral shaft intramedullary nailing was performed, in two cases bone cement was used in addition.

[Managing pathologic femoral fractures in malignant bone tumors and skeletal metastases]. / Versorgung pathologischer Femurfrakturen bei malignen Knochentumoren und Skeletmetastasen.

In adults pathological fractures of the femur are mostly caused by skeletal metastases. In our own collective of femoral fractures 58 were caused by skeletal metastases and five by multiple myeloma. Average age was 59.8 years, women prevailed. In most of the metastatic fractures breast cancer was found to be the primary tumour. In all cases fracture stabilization as a palliative measure was the only possible therapy. Two patients could not be operated on because of other vital problems. In femoral neck fractures resection and endoprosthesis was the operative measure of choice. The pertrochanteric and subtrochanteric fractures were mostly treated by composites of cement and the 95 degrees condylar-plate. Also in shaft fractures cement-implant composites were performed with straight plates. Rarely, intramedullary nailing was done. Exercising stability could always be achieved, weight-bearing stability in most of the cases. The mean survival time was 7.2 months regarding 43 patients with well documented course. Six patients are controlled regularly, the operative treatment was done on an average 16 months before.

[Diagnosis and therapy of traumatic patellar dislocation in the athlete]. / Diagnostik und Therapie der traumatischen Patellaluxation beim Sportler Diagnosis and Therapy of Traumatic Dislocation of the Patella in Sportsmen.

Traumatic dislocations of the patella usually occur in sport activities. The review of our in-patient collective between 1980 and 1985 showed twenty traumatic dislocations of the patella among 1106 sport injuries. Most patients were adolescents. Seventeen of these injuries resulted from a typical valgus-flexion-external rotation-mechanism. Only three cases followed direct trauma. The therapy of choice in fresh traumatic dislocations of the patella in sportsmen is a suture of the medial retinaculum and if necessary refixation of osteochondral fragments. We performed operative treatment in sixteen of our own patients.

[Apophyseal injuries of the pelvis and tibia in adolescent athletes]. / Apophysenverletzungen an Becken und Tibia beim jugendlichen Sportler.

Pelvic and tibial avulsion fractures of the apophysis are typical though rare injuries of adolescent sportsmen. In apophyseal lesions of the pelvis, problems may arise in therapy rather than in diagnostics because treatment is conservative in most of the cases. In contrast, avulsion fractures of the tibial tuberosity usually require a surgical procedure. Among our own in-patient groups between 1980 and 1985, five injuries of the anterior inferior iliacal spina, one lesion of the ischial tuberosity, and five avulsion fractures of the tibial tuberosity were noted in adolescent sportsmen.