[Traumatic and degenerative tendon lesions of the hand]. / Traumatische und degenerative Läsionen der Sehnen an der Hand.

Tendon lesions are the second most common injury in the hand and therefore an important factor in orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons; nevertheless, also less frequent injuries such as damage to the functional system of tendon sheath and pulley or dull avulsions need to be considered. Besides the clinical examination, ultrasound and MRI have proven to be important diagnostic tools. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger "intrinsic" tendon healing to guarantee a good outcome.

[Pulley injuries in sport climbers]. / Verletzungen des Ringbandapparates bei Sportkletterern.

The closed traumatic rupture of finger flexor tendon pulleys in rock-climbers represents a new complex finger trauma first observed in the mid 1980s. While initially the diagnostic and therapeutic approaches varied, nowadays a standard proceeding is being applied. After clinical suspicion and eliminating the possibility of a fracture by normal radiographs, pulley strains as well as singular or multiple pulley ruptures can be diagnosed using ultrasound. If the ultrasound fails to give a definitive diagnosis, an MRI should be performed. In the case of a singular rupture, a conservative treatment with initial immobilisation and early functional therapy is indicated. In the case of a multiple pulley rupture, a surgical reconstruction is mandatory. We favour the "loop and a half" technique of Widstrom and colleagues 1989 and, alternatively, the Weilby repair 1978. Post-operative initial immobilisation and early functional treatment under external pulley protection should be performed.

[Therapy of injuries of the pulley system in sport climbers]. / Zur Therapie von Ringbandverletzungen bei Sportkletterern.

OBJECTIVE: Closed traumatic ruptures of finger flexor tendon pulleys are frequent in rock climbing. The objectives of this study were to characterise this injury and to formulate diagnostic and therapeutic guidelines. An algorithm and a grading system are analysed for validation. METHODS: 122 pulley injuries were prospectively evaluated. After standard radiographs, a dynamic ultrasound examination was performed in all climbers. In ten cases an additional MRI was necessary. All patients were classified according to the pulley injury score. Grade I-III injuries received conservative and grade IV injuries received operative therapy. 88 patients were re-evaluated, including all grade IV patients. RESULTS: 48 climbers had pulley strains, and 74 had ruptures (a single rupture in 90.5 % of the cases and multiple ruptures in 9.5 %). According to the pulley-injury-score, 39 % were grade I, 25 % were grade II, 30 % were grade III and 6 % were grade IV injuries. 115 patients underwent conservative therapy, of which 81 were re-evaluated. 8/81 complained three months after the injury about consistent pain, mostly caused by tendinitis. All grade IV injuries underwent surgical reconstruction, in two cases through Weilby's repair, in three cases through the "loop and a half" technique and in two further cases with a combination of the two. According to the Buck-Gramcko Score we had four excellent, two good and one fair result. The functional result was excellent in one, good in five and fair in one case. CONCLUSIONS: The use of the diagnostic-therapeutic algorithm as well as the grading system proved to be highly suitable. The good results achieved with the conservative treatment in grade I - III injuries justify this approach.

[Accident statistics at "indoor climbing walls"]. / Unfallstatistik an "Indoor-Kletteranlagen".

During a period of 6 month the risk of significant injuries on indoor climbing walls was survived. A total of 25,163 visitors were registrated at the 10 walls. Overall only 4 significant injuries were found, the injury-risk per visit was 0.016%.

[Normal variants of tibial arteries--anastomotic problems in microvascular tissue transfer]. / Normvariante der Unterschenkelarterien--Anschlussprobleme bei mikrovaskulärem Gewebetransfer.

A rare variation in the branching of the popliteal artery is presented. The importance of preoperative angiography for microvascular reconstruction is shown.