[Interposition arthroplasty for the treatment of primary osteoarthritis: comparison of results using the technique of Epping and Weilby]. / Interpositions-Arthroplastik zur Behandlung der Rhizarthrose: Ergebnisvergleich der Techniken nach Epping und Weilby.

We compare clinically and radiologically two groups of total trapezectomy performed as treatment for the primary osteoarthritis of trapeziometacarpal joint combined in 83 cases (2000 to 2003) with tendon interposition arthroplasty type Weilby, in 51 cases (1987 to 1991) with Epping tendon interposition and ligament reconstruction arthroplasty in a retrospective study. In both groups we used a strip of the flexor carpi radialis tendon. The mean follow-up time in both groups is 33 months. Overall, both methods achieved similar results. The relief of pain and the patient satisfaction are better, stability and grip force are worse in the Weilby group. At least one year (12 to 57 months) after operation with the technique of Weilby, 88 % of the patients would prefer this method for the other side. It appears that there is no clinical and radiological benefit of ligament reconstruction. However, the two procedures studied yield equally good results in most cases, but we prefer the simple technique of Weilby and guess that the (missing) long-term results would be superior to the results after trapezectomy alone. Long-term results need to be evaluated.

[The thoracic outlet syndrome -- diagnostic tips, operative technique and results]. / Das Thoracic-outlet-Syndrom -- Diagnostische Hinweise, Operationstechnik und Resultate.

Experiences with more than 300 operations for TOS with a follow-up of at least one year are summarized. Detailed descriptions of the technique of operation with the supraclavicular approach and results of two groups of patients (106 and 66) are given: the first group was treated with supraclavicular or transaxillary approach and with scalenotomy combined with the resection of the first rib or without rib resection. The second group was operated by the supraclavicular approach without exception and always with the resection of the first rib. The results of the second group are better.

[Modified Krukenberg-plasty with callus distraction of the stump and complete skin closure of both forearm branches]. / Die modifizierte Krukenberg-Plastik mit Kallusdistraktion des Stumpfes und vollständigem Hautverschluss der Branchen.

In 1917, Hermann Krukenberg first reported on the conversion of a forearm stump into tongs by separating the ulna and radius in a bilateral forearm amputee. Up to now, this technique still has its indication in patients with bilateral loss of the hand or forearm. The main problem is still the coverage of both forearm branches with sensitive skin, especially when the muscles are preserved for surface management and strength. The two case reports of bilateral amputation injuries of the upper extremities illustrate our modification of the Krukenberg procedure. First, callus distraction of the short forearm stump by an external fixator was used in one case. After implantation of tissue expanders, enough sensitive skin was gained to resurface both arms of the Krukenberg forearm during a second procedure in both patients nearly completely.

Diagnostic validity of ultrasound in patients with persistent wrist pain and suspected occult ganglion.

Until recently, the presence of occult ganglions could be determined only by surgical exploration. This prospective study investigated the reliability of ultrasound in the diagnosis of occult ganglions in a patient series over 4 years. The sensitivity, specificity, and accuracy of ultrasound, as well as its positive and negative predictive values, were determined in 83 patients suspected of having an occult wrist ganglion and who had persistent pain and consented to an operation. Examinations were carried out with a 7.5-MHz linear probe and spacer. Outcome of surgery and histologic examination served as the gold standard in 168 patients who had undergone ultrasound; 89 underwent surgery. In 83 patients for whom enough information was available to allow statistical assessment, sensitivity, specificity, and accuracy rates of 88%, 85%, and 87% were respectively obtained. In dorsal wrist ganglions (75%), better results were obtained: a sensitivity rate of 93%, a specificity rate of 86%, and an accuracy rate of 91%. It was concluded that ultrasound of the wrist can be used as a first-line imaging procedure in clinically inconclusive situations and that ultrasound evidence of an occult dorsal ganglion is a reliable indicator for surgery.

[Covering soft tissue defects]. / Weichteildeckung.

In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.

[Results of basal joint arthrosis treatment with trapezectomy and Epping suspension-plasty. Clinical follow-up]. / Ergebnisse nach Rhizarthrosebehandlung mit Trapezektomie und Aufhängeplastik nach Epping. Klinische Nachuntersuchung.

Advanced osteoarthrosis of the trapeziometacarpal joint is usually accompanied by subluxation of the base of the first metacarpal, which is due to an instability of the first intermetacarpal ligaments. The repair of these ligaments is, therefore, of fundamental importance. In this way, instability and also proximalization of the thumb can be prevented while function is restored. Suspension arthroplasty using the Epping technique is one of the possible surgical options. It has been practised at the Cantonal Hospital in St. Gall (Switzerland) since the end of 1987. In this paper, the results of 51 arthroplasties in 49 patients with osteoarthrosis of the first carpometacarpal joint followed up for 32 months after operation are presented. An analysis of the results using both objective and subjective criteria shows that trapezectomy and suspension arthroplasty by Epping's method were able to eliminate or significantly reduce pain in a large majority of the patients. Furthermore, the function of the hand, which had been severely limited before the operation, was almost completely restored. Possible aetiologies of osteoarthrosis of the trapeziometacarpal joint and different therapies are discussed.

[Microvascular flap surgery in arterial occlusive disease]. / Mikrovasculäre Lappenchirurgie bei arterieller Verschlusserkrankung.

In the elderly, occlusive arterial disease is a contributing cause of posttraumatic soft-tissue defects of the lower limb. The reconstructive possibilities by microsurgical flap transplantation available are presented on the basis of 22 patients treated. Four failures were due to an almost or completely occluded peripheral outflow. Vein bypass was combined twice with an arterio-venous fistula, but occluded nevertheless.

[Reconstruction of grip function in bilateral complex explosion injury]. / Wiederherstellung der Greiffunktion bei doppelseitiger komplexer Explosionsverletzung.

Evaluation, therapeutical possibilities, and surgical planning for the restoration of bilateral grip function are described, based upon the case of a blind patient presenting after severe bilateral explosion injuries of the hand with grade 3-4 loss of thumbs and fingers. Finally, the given level of amputation and remaining components of the hand together with toe transplantation permitted restoring of power grip on one side and fine grip on the other side in combination with bone and soft-tissue procedures.

[Pseudoarthrosis of the scaphoid bone. Current reconstruction techniques]. / Die Skaphoidpseudarthrose. Neuere Rekonstruktionstechniken.

Newer reconstruction techniques for scaphoid non-union are directed at the extended objectives of reconstruction of form and length as well as healing of the fracture. The surgical techniques that fulfill these requirements are described with reference to recent literature.

[Thoracic outlet syndrome]. / Das Thoracic-outlet-Syndrom.

The thoracic outlet-syndrome (TOS) results from compression of the brachial plexus at the superior thoracic aperture. Sometimes it is accompanied by vascular symptoms. Every non typical peripheral compression syndrome, recurrent compression symptomatology or the presence of several irritable nerve segments should let TOS enter into the diagnostic considerations. Diagnosis is not simple and requires a synoptic approach using several investigations. Initial therapy is conservative. Surgical management implies good knowledge of anatomy and possible anomalies of the upper thoracic aperture.

[F. P. Weber syndrome of the hand. Clinical aspects--diagnosis--therapy]. / Das F. P. Weber-Syndrom an der Hand. Klinik--Diagnostik--Therapie.

The syndrome of congenital arteriovenous fistula with proportional giantism is named after Frederik Parkes Weber. Its special localization in the hand is presented and the extension of surgical skeletalization into the microsurgical domain is discussed. The author reports on eight own cases and five skeletalization operations.

[Concomitant carpal injuries in radius fractures. Nature and incidence, analysis of the last 10 years]. / Karpale Begleitverletzungen bei Radiusfraktur. Art und Häufigkeit, Analyse der letzten 10 Jahre.

Carpal involvement was detected in 47 cases amongst 2828 radius fractures in the last ten years at the St. Gallen Cantonal Hospital. A radiological correlate of this carpal involvement was found retrospectively in 18 cases. The number is likely to be very much higher with increased attention to this injury! The significance of exact diagnosis is underscored by the observation that the concomitant carpal lesion predominates in the further course and determines the fate of the wrist a long time after the radius fracture has healed up.

[Total or subtotal amputation of a long finger with destruction of the metacarpophalangeal joint--regaining function by replantation?]. / Totale oder subtotale Amputation eines Langfingers mit Zerstörung des Grundgelenks--Funktionsgewinn durch Replantation?

Destruction of the metacarpophalangeal joint represents one of the most unfavourable situations making it extremely difficult to attain useful finger function after replantation. Single fingers damaged in this way may therefore not be replanted. If several long fingers are affected, a slight residual mobility in the metacarpophalangeal joint can be attained by joint reconstruction or prosthesis implantation. If the thumb is destroyed at the same time or is not supplied along with the severed hand, heterotopic replantation of a long finger of which the metacarpophalangeal joint has been destroyed is a way of attaining an adequate thumb length.

Experimental studies of the porosity of the alloplastic vein replacement.

The vena cava inferior was replaced by alloplastic vein replacement materials in 60 beagle dogs divided in 6 groups. The wall-porosity varied from 50 to 280 ml/cm2 per minute in the textile prostheses (water porosity) (Groups 1-3), and from 30 to 60 micron fibril length in the expanded PTFE-prostheses. All textile prostheses (woven or knitted) are clearly inferior of expanded PTFE-prostheses. The fibril length of 60 micron represents an improvement in comparison with a length of 30 micron regarding the patency rate and the incorporation process, but it needs a special external support.