Arthroscopic surgery of the metatarsophalangeal first joint.

Arthroscopic surgery of the metatarsophalangeal first joint was used to treat a dorsal impingement syndrome of the hallux by removing the dorsally located osteophytes. Also, osteochondritis dissecans, painful sesamoid bones resistant to conservative therapy, and hallux rigidus were arthroscopically treated in a prospective study enrolling 24 consecutive patients. Seventeen patients were high-level athletes. Pain, swelling, sports, and work involvement were recorded. The operative technique is described. There was one persistent loss of sensitivity of the hallux. In the dorsal impingement group, 8 of 12 patients had a good or excellent result after a minimum follow-up of 2 years. In patients with osteochondritis dissecans, 3 of 4 showed good or excellent results. In hallux rigidus and sesamoid bone removal the results were less favorable. As in all arthroscopic procedures there was a fast rehabilitation and work resumption. Especially in athletes arthroscopically, treatment of a dorsal impingement syndrome or osteochondritis dissecans can be recommended because of the diminished chance of scar fibrosis.

[Thoracic sympathectomy in palmar hyperhidrosis: comparison of open with thorascopic procedure]. / Die thorakale Sympathektomie bei der Hyperhidrosis palmarum: Vergleich / thorakoskopisches Vorgehen.

Between 1976 and 1994 we performed 26 thoracic sympathectomies for treatment of therapy-resistant palmar hyperhidrosis. Until the end of 1992 the operation was performed using an open transaxillary approach, since 1993 sympathectomy was done by video-assisted thoracoscopy. Both procedures consisted in excision of the thoracic ganglia T2 to T5. The only complication was a pneumothorax in the open surgery group (successfully treated by drainage). Compensatory sweating occurred in 70% of our patients, compared to results in the literature of 60-90%. We did not note further complications, e.g. no Horner's syndrome. All of our patients were satisfied with the result of the operation. Comparison of the two collectives shows significant advantages for video-assisted thoracoscopic surgery. the procedure is easier to perform, exposure is better, cosmetic results are favourable, operation-time and hospital stay are reduced.

[Extirpation of the pisiform bone: indications and results]. / Pisiformeexstirpation: Indikation und Resultate.

We have treated 26 patients with pain around the pisiform bone. From this experience, we have attempted to define diagnostic criteria and a therapy rationale. The diagnosis was made from clinical, radiographical and scintigraphic data. Therapy consisted of denervation combined with extirpation alone, or arthrodeses. The results correlated with the etiology of the pisiform bone pathology. The outcome in patients with idiopathic arthrosis and in patients with instability was good; the result was fair in patients with insertion-tendinitis of the flexor carpi ulnaris. In patients with posttraumatic arthrosis the results were unsatisfactory; however, the number of patients in this last group was small.