[Resection arthroplasty of the carpometacarpal joint of the thumb - results of 132 cases]. / Resektionsarthroplastik des Daumensattelgelenkes - Bewertung von 132 Operationsergebnissen durch die Patienten.

BACKGROUND: Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for arthrosis of the trapeziometacarpal joint. To avoid proximalisation and to improve stability of the first metacarpal, tendon-sling resectional arthroplasties have gained general approvement. To further simplify surgery, we have used a surgical technique since 1995, that consists in a fixation of the first metacarpal with local capsular tissue. METHOD AND CLINICAL MATERIAL: From 2000 to 2001, 152 resections of the trapezium were performed in 147 patients with arthrosis of the first carpometacarpal joint. 48 surgical procedures included a tendon-sling arthroplasty; in 104 cases stabilisations of the first metacarpal were achieved by fixing local radiopalmar capsular tissue to the flexor-carpi-radialis tendon. After a mean follow-up of 30 months (18 to 41 months), patients were asked to complete a questionnaire concerning pain, physical strength, practical skills, maximal physical capacity and aesthetic result. The general surgical result had to be scored and the recovery time until the thumb could be used for activities of daily living had to be recorded. RESULTS: 132 of 152 questionnaires, 43 of the patients with tendon-sling arthroplasty and 89 of the patients with arthroplasty with local radiopalmar capsular tissue, were returned. After tendon-sling arthroplasty, 69.8 % of the patients judged their results to be good or very good, after stabilisation with radiopalmar capsular tissue 69.7 % of the patients valued their surgical results good or very good. Unsatisfactory results were found in 18.6 % of the patients after tendon-sling arthroplasty and in 19.1 % of the patients after stabilisation with radiopalmar capsular tissue. The thumb could be used for every-day life after a mean time of 6.7 months. There was no significant difference between the operative procedures. CONCLUSION: The collected data implies that resection-arthroplasty of the carpometacarpal joint of the thumb with stabilisation by radiopalmar capsular tissue yields similar results compared to tendon-sling arthroplasty.

[Operative treatment in hand infections]. / Operative Interventionen bei Infektionen an der Hand.

Bacterial infections in the hand may begin slowly after innocent wounds. They may spread rapidly especially following risk wounds. Destruction of anatomical structures causes local defects, severe loss of function and septicemia is possible. Causes, pathophysiological, clinical signs, and therapeutical management are described. It is most important and un-dispensable to have an early and exact diagnosis and consistent therapy: immediate radical surgical debridement, open wounds, antibiotic treatment, immobilisation and early mobilisation are necessary to have good results.

[The BIAX total wrist prosthesis as an alternative to arthrodesis in degenerative and posttraumatic arthritis--early results in twenty-one patients]. / Die BIAX-Handgelenkprothese als Alternative zur Arthrose bei degenerativer und posttraumatischer Arthrose--Frühergebnisse bei 21 Patienten.

The BIAX total wrist prosthesis was first implanted 1983 by Beckenbaugh in the United States. From a total of twenty-one BIAX-prostheses between March 2001 and February 2002, we have inserted eleven in patients for degenerative arthrosis, eight for posttraumatic arthrosis and two for rheumatoid arthritis of the wrist. The average age of the patients was 53.0 +/- 10.7 years with a follow-up between eleven and fourteen months on an average of one year. The motion of the operated joints was preserved on average. We have taken pain as the main criterion for the success of the operation and distinguished between pain at rest, in motion and under exertion. All patients showed a very good pain relief of 5 1/2 values from 6 1/2 before to one after surgery on a scale from one to ten. Pain relief is less under exertion, thus we are reserved with heavy workers of the implantation of the prosthesis. Apart from that, the indication corresponds to the arthrodesis of the wrist. The satisfaction of patients with the prosthesis is very high: 17 patients declared it was much better, three declared it was better and only one patient said it was unchanged. Complications occurred in six patients. The main complication was the postoperative dislocation of the prosthesis in three patients. After repositioning, the joints were long-term stable. The straight secured surgical technique is described in detail. For the majority of patients with posttraumatic or degenerative arthrosis, as well as with rheumatoid arthritis, the BIAX wrist prosthesis is recommended as a first-time operation as an alternative to wrist arthrodesis due to pain relief with preservation of joint motion and good acceptance among patients.

[Metastasizing chondrosarcoma of the pisiform bone: a case report]. / Metastasierendes Chondrosarkom des Os pisiforme: Eine Falldarstellung.

We report about a chondrosarcoma of the pisiform in a 39-year-old man. 1.5 years after exstirpation of the tumor, an extended recurrence developed. Two years after the first operation, an amputation was performed at midshaft of the upper arm. One year later, multiple metastases in both lungs were found.

[Complex hand injuries]. / Komplexe Handverletzungen.

Most problems in the treatment of complex hand injuries result from not clearly recognizing which structures are destroyed or preserved preoperatively. The plan for treatment depends on priorities. Beginning with reduction and osteosynthesis and after suture of tendons, restoring blood supply is most important. Nerve reconstruction is best done soon. But if suture without tension is impossible, secondary nerve grafting is to be preferred. Skin closure is to be done soon if possible. Otherwise we need skin grafts, local or free flaps.

[Surgical possibilities in managing large giant cell tumors of the wrist joint and carpal bones]. / Die operativen Möglichkeiten in der Versorgung grosser Riesenzelltumoren im Handgelenk und Handwurzelbereich.

Two cases with extensive giant cell tumors of the wrist and their one-step functional preserving operative treatment are presented. Special regard is put on the reconstruction of hand function with and without the use of microsurgical techniques.

[Intercarpal dislocation in early childhood. A case report]. / Interkarpale subluxation im frühen Kindesalter. Ein Fallbericht.

A case of intercarpal subluxation in a six-year old girl is described. The possibility and danger of open reduction is discussed. The potential complications are loss of bone density and growth arrest as a result of an injury sustained early in life.

[Infections of the hand]. / Infektionen der Hand.

Sometimes severe bacterial infections of the hand arise quickly and lead to damage of anatomical structures and loss of function. In this paper pathophysiology and clinical signs are presented. The most important priority in therapy is to prevent the infection from extending to deeper structures in the hand, such as tendon sheaths, and along them to the mid palmar space and Parona's space. The therapy most often indicated is therefore surgical treatment at the very beginning, depending on the severity of pain and swelling.

[Monomelic melorheostosis of the hand]. / Die monomelische Melorheostose der Hand.

Melorheostosis is a rare sclerosing bone dysplasia affecting children and adults. Concerning the etiology it seems to be a metameric abnormality of the tissue of mesodermal origin, which is initiated early in embryonic life prior to the formation of the extremity buds. The flowing hyperostosis is usually associated with limb deformity, soft tissue contractures, severe pain and stiffness of joints. Bone scanning complements standard radiologic studies and permits evaluation of the extent and activity of the disease. Conservative treatment is disappointing. Thus we recommend the excision of the exostoses at an early state to prevent further deformity as is shown in a clinical case report.

[Ergotamine-induced disorders of the peripheral blood circulation--a case report]. / Ergotamininduzierte periphere Durchblutungsstörungen--Ein Fallbericht.

Ergotism with severe arterial circulatory disorders, sometimes leading to amputation of the leg, is a severe complication following application of drugs containing ergotamine. Often the diagnosis is made by the typical angiographic findings. The history, clinical course and a new treatment in a very severe case is reported.

[Value of the skin and muscle pedicle in myocutaneous flaps]. / Zur Wertigkeit von Haut- und Muskelstiel bei myokutanen Lappen.

The value of a combined skin and muscle pedicle as opposed to the purely muscular pedicle is discussed using the example of the myocutaneous island skin flap of the M. latissimus dorsi in the neck-, shoulder-, and upper arm region. There is an indication scheme for the choice of flap pedicle depending on the tension and kinking of the flap or possible previous damage of the muscle pedicle.

Early cardiorespiratory prognostic patterns in multiple trauma patients.

Hemodynamic parameters were monitored for one week ( in greatest detail during the first 24 hours) in 50 severely injured people who had been admitted to the hospital for treatment within one hour after the accident and, as judged by the type of injury, had probably lost more than 1 1/2 liters of blood. The estimations included not only blood pressure, heart rate (HR) and shock index but also the cardiac index (CI), pulmonary arterial pressure (PAP), pulmonary capillary pressure (PCP), and parameters of oxygen transport were determined with the aid of Swan-Ganz catheters, CI, SI, and left ventricular stroke work index (LVSWI) were decreased, PAP, total pulmonary resistance (TPR), and total systemic resistance (TSR), were increased from the very beginning in the nonsurviving group, with a high prediction of vital outcome. The Swan-Ganz catheter is valuable in such cases in obtaining early prognostic evaluation and in controlling therapy - ie, volume replacement, vasodilation, and adrenergic therapy.

[Early changes of the coagulation system in multiple injuries and their modification with heparin and Trasylol]. / Frühveränderungen des Gerinnungssystems beim Polytrauma und seine Beeinflussung durch Heparin und TrasylolR.

In a prospective, randomized study 35 patients with multiple injuries were examined for early changes of blood coagulation. Parameters suggesting a consumption coagulopathy were lower in patients who died subsequently than in survivors. No therapeutic influence of low dose Heparin therapy or of the proteinase inhibiting substance TrasylolR could be demonstrated.

[Clinical and biometric studies of the adaptive response of shock parameters in patients with multiple injuries and its prognostic significance]. / Klinische und biometrische Untersuchungen über das Regelungsverhalten von Schockparametern bei Mehrfachverletzten und ihre prognostische Bedeutung.

In 35 patients with multiple injuries hemodynamic and renal function parameters measured early after trauma were analysed by biometric methods. Statistically significant prognostic results and differences in the cybernetic behaviour could be demonstrated.

[Cardiovascular parameters following severe multiple injuries]. / Herz-Kreislauf-Parameter nach schweren Polytrauma.

Cardiovascular parameters of 35 patients with multiple injuries are monitored over a period of 7 days. Pulmonary artery pressure, pulmonary vascular resistance, intrapulmonary shunts and cardiac output appear to have a significant prognostic value.