Low-profile locking-plate vs. the conventional AO system: early comparative results in wrist arthrodesis.

INTRODUCTION: Total wrist arthrodesis represents a reliable salvage procedure for severe painful conditions of the wrist. To date, wrist arthrodesis using a dorsal plate reaching from the distal radius to the third metacarpal is still recommended. A new implant (APTUS© 2.5 TriLock Wrist Fusion Plate, Medartis Suisse) that does not cross the third carpometacarpal joint (CMCJ-3) has been introduced recently. The purpose of this retrospective study was to compare both implants concerning early functional and clinical results. MATERIALS AND METHODS: A total of 20 patients underwent total wrist arthrodesis [10, using the new APTUS© implant (APT); 10 using the Depuy-Synthes© LCP plates (AO)]. The postoperative control interval was 18.2 and 37.2 months in APT and AO, respectively. Clinical assessment included functional parameters such as active range of motion (AROM) for pronation and supination, grip strength, and passive range of motion of the CMCJ-3. Additionally the DASH score and the Krimmer wrist score as well as pain levels at rest and under stress conditions were evaluated. RESULTS: All patients showed osseous healing without complications except one case of non-union in APT. There were no significant differences between both groups concerning grip strength, AROM of the wrist, pain levels, DASH- and Krimmer Score. APT showed a significantly increased passive range of motion of the CMCJ-3 compared to the unaffected contralateral side. CONCLUSIONS: The new implant shows similar functional results compared to the standard procedure. The main advantage of the new implant is the fact that no implant removal is necessary due to the unaffected CMCJ-3. Furthermore the mobility of the CMCJ slightly increased and showed positive impact on hand kinematics.

[Postoperative treatment and rehabilitation following flexor tendon injuries]. / Weiterbehandlung und Rehabilitation nach Beugesehnenverletzungen.

BACKGROUND: The ideal surgical and postoperative treatment for flexor tendon injuries, especially in zone 2, is still subject to continuous modifications and professional discussions. OBJECTIVE: Presentation of established rehabilitation concepts, specific problems and new treatment approaches with practical recommendations for application. MATERIAL AND METHODS: Comparison of commonly used treatment concepts by assessing surgical flexor tendon repair, splint choice and clinical application in patients. Discussion of new surgical approaches and standards and their influence on postoperative therapy after flexor tendon injuries. RESULTS: The Washington regimen has retained its status as the standard in the current follow-up treatment of flexor tendon injuries. New suture materials and techniques enable early active rehabilitation of sutured flexor tendons with good clinical results, such as increased range of motion for interphalangeal joint extension and improved distal interphalangeal joint flexion with overall acceptable frequencies of suture rupture. CONCLUSION: A stable tendon repair with smooth gliding is the foundation for treatment after flexor tendon injuries. After intraoperative active digital extension-flexion testing of the sutured tendon an early active rehabilitation approach should follow. New splint designs in combination with primary stable tendon suture techniques have the potential to improve the postoperative outcome, presupposing a reliable cooperation of the patient.

Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions.

INTRODUCTION: The diagnostic value of clinical tests and magnetic resonance (MR) imaging for the investigation of triangular fibrocartilaginous complex (TFCC) lesions is not clear due to a lack of clinical data. MATERIALS AND METHODS: We retrospectively analyzed 908 patients who underwent clinical tests and arthroscopy for suspected TFCC lesions at our institution. Further, MR imaging findings concerning the TFCC were gathered. We correlated clinical tests and MR imaging findings with those obtained during arthroscopy, and we calculated sensitivity, specificity, as well as positive and negative predictive values. RESULTS: In the whole cohort, the positive predictive values of all clinical tests were low, ranging from 0.53 to 0.55. The ulna grinding test had the highest sensitivity, but lowest specificity. Sensitivity and specificity of the ulnar fovea sign and magnetic resonance imaging were similar, ranging from 0.73 to 0.76, and from 0.41 to 0.44, respectively. To some degree, the diagnostic value seemed to depend on the Palmer class of TFCC lesion. CONCLUSIONS: According to this study, clinical tests and MR imaging findings are of very limited diagnostic value for the diagnosis of TFCC lesions.

Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate.

BACKGROUND: Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation. METHODS: 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis. RESULTS: No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications. CONCLUSION: Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.

[Acute scaphoid fractures : Management under consideration of the new S3-level guideline]. / Die frische Skaphoidfraktur : Management unter Berücksichtigung der neuen S3-Leitlinie.

BACKGROUND: Scaphoid fractures represent the most common carpal fractures and are often problematic and frequently lead to nonunion with osteoarthritis and collapse of the wrist. The reasons for the nonunion are manifold. Therefore, the main goal of diagnosis and therapy of acute fractures is to achieve bony union and to restore the anatomic shape of the scaphoid. In the long run, only this can preserve the normal function of the wrist. METHODOLOGY: The given recommendations are based on the new S3-level guideline of the AWMF (Association of the Scientific Medical Societies). This guideline was established with involvement of all relevant medical societies based on a comprehensive and systematic review of the literature and after a process of formal consent. The focus of the guideline is recommendations regarding diagnosis and therapy of acute scaphoid fractures. MAIN STATEMENTS: After careful clinical examination consequent imaging must be performed, starting with X­rays in three standard projections. Computed tomography is indispensable for proof of a fracture and for therapy planning. The classification of Herbert and Krimmer is based on the CT under special consideration of instability and displacement of the fracture. Thus, indication for operative and non-operative treatment is mainly CT-dependent. Non-operative treatment may be indicated only for stable fractures (type A). However, operative treatment is strongly recommended for all unstable fractures (type B). For fixation, double-threaded headless screws are preferred. The operative technique depends on the fracture morphology. CONCLUSION: Diagnosis and therapy of acute scaphoid fractures are primarily aimed at the prevention of nonunion and arthritic carpal collapse with painful impairment of the wrist function. To achieve this, the S3-level guideline contains explicit recommendations.

[Secondary tendon reconstruction on the thumb]. / Sekundäre Sehnenrekonstruktionen am Daumen.

Closed tendon ruptures of the thumb that require secondary reconstruction can affect the extensor pollicis longus (EPL), extensor pollicis brevis (EPB) and flexor pollicis longus (FPL) tendons. Treatment of rupture of the EPB tendon consists of refixation to the bone and temporary transfixation of the joint. In the case of preexisting or posttraumatic arthrosis, definitive arthrodesis of the thumb is the best procedure. Closed ruptures of the EPL and FPL tendons at the wrist joint cannot be treated by direct tendon suture. Rupture of the EPL tendon occurs after distal radius fractures either due to protruding screws or following conservative treatment especially in undisplaced fractures. Transfer of the extensor indicis tendon to the distal EPL stump is a good option and free interposition of the palmaris longus tendon is a possible alternative. The tension should be adjusted to slight overcorrection, which can be checked intraoperatively by performing the tenodesis test. Closed FPL ruptures at the wrist typically occur 3-6 months after osteosynthesis of distal radius fractures with palmar plates and are mostly characterized by crepitation and pain lasting for several weeks. They can be prevented by premature plate removal, synovectomy and carpal tunnel release. For treatment of a ruptured FPL tendon in adult patients the options for tendon reconstruction should be weighed up against the less complicated tenodesis or arthrodesis of the thumb interphalangeal joint.

[Complex regional pain syndrome following distal fractures of the radius : Epidemiology, pathophysiological models, diagnostics and therapy]. / Komplexes regionales Schmerzsyndrom nach distaler Radiusfraktur : Aktuelle Epidemiologie, pathophysiologische Modelle, Diagnostik und Therapie.

The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3­phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.

[High pressure injection injuries to the hand]. / Hochdruckeinspritzverletzungen an der Hand.

The severity of high pressure injection injuries to the hand is often underestimated in the initial clinical examination. Therefore, it is critical to obtain information about the course of the accident, the pressure involved and the injected substance. X-ray examination can reveal the injected substance or accompanying air in the tissues and therapy is usually surgical. All compartments should be released and all foreign material should be thoroughly removed. There is often a need for second look surgery. Wound closure should be achieved within 1 week and the decision about amputation should fall within 2 weeks. Hand therapy is essential beginning from the day after trauma and it may be continued for weeks or even months.From 1998 to 2008, 36 patients were treated after high pressure injection injury to the hand, 19 patients were transferred to the replantation centre immediately and 17 secondarily. These 19 injuries resulted in finger amputations and/or pain syndromes in 12 patients (33%) including 2 out of the primary group (10%) and 10 out of the secondary group (59%). It can be concluded that high pressure injuries to the hand should be treated in replantation centres.

[Soft-tissue sarcoma of the forearm and hand. Plastic surgical management]. / Weichgewebesarkome an Unterarm und Hand. Plastisch-chirurgische Behandlung.

Radical tumor resection (R0) is the main therapeutic goal in the treatment of sarcomas of the forearm and hand. Plastic reconstructive procedures play a key role in limb salvage by coverage of complex defects. Sophisticated reconstructive techniques are required with the forearm and hand. Twenty patients with soft-tissue sarcomas of the hand and forearm were treated in our department between January 1995 and January 2005. Eleven were male and nine were female. The average age was 48 years. The most common tumor was myxoid fibrous histiocytoma, followed by synovial cell sarcoma. Six patients received free microvascular transplantations to cover their defects. Mesh graft or primary closure was possible in three cases; one patient received a local flap and one a pedicled flap. In nine cases preserving the limb was not possible. Ten patients received radiation and four got chemotherapy (two with neoadjuvant chemotherapy). In 18 cases histologic R0 resection was possible, in two cases R1 resection. Two patients suffered from tumor recurrence after R0 resection. The average follow-up-time was 42 months. These results show the necessity of plastic surgical reconstruction of the forearm and hand as an integral component of modern sarcoma therapy. Multidisciplinary cooperation is mandatory for adequate treatment.

[Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps]. / Rekonstruktion kombinierter Knochen-/Weichteildefekte an Hand und Unterarm durch freie osteokutane Lappenplastiken.

PURPOSE: Complex defects of the forearm and hand often require microvascular reconstruction with composite osteocutaneous free flaps for limb salvage. Here, a postoperative outcome analysis of 15 patients is presented, who were treated by free composite tissue transplantation between 1992 and 2004 in a single institution. PATIENTS AND METHODS: The assessment focused on the range of motion, the pain and grip strength as well as on the patient's individual physical functioning and self perception, measured with the DASH questionnaire. Additionally complications, return to work and the donor site morbidity were documented. RESULTS: Reasons for the combined defects were trauma, infections or malignant tumors. The patients' average age was 38 years. The average osseous defect was 11.7 cm (range, 6 to 21 cm), all patients suffered from additional soft tissue defects. Microvascular osteoseptocutaneous fibula transplantations (n = 8), osteocutaneous scapular or parascapular flaps (n = 6) and osteocutaneous lateral arm flaps were performed for reconstruction. The mean hospitalisation time was 39.3 days (range, 18 - 73 d). All defects could be reconstructed in a one-step reconstructive procedure after sequential debridements or after radical tumour resection. Two patients developed a pseudarthrosis, one had to undergo an ablation procedure due to persistent infection; however, the flap was well perfused. Every patient had a markedly reduced hand function compared with the unaffected extremity, however the functional results were satisfactory with a mean DASH score of 25.3 (range, 0 to 42). This reflects only a moderate disability in activities of daily living. From the patients' point of view the functional results were more than acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction. CONCLUSION: This retrospective analysis demonstrates that limb salvage with osteocutaneous free flaps is an important tool in the armamentarium for the treatment of composite defects in the forearm and hand. Functional results are good and the patient's high individual satisfaction justifies the use of these difficult reconstructive procedures.

[Midcarpal partial arthrodesis with locking plate osteosynthesis]. / Mediokarpale Teilarthrodese mit winkelstabiler Plattenosteosynthese.

OBJECTIVE: Preservation of residual mobility and pain reduction in the wrist in advanced carpal collapse (scapholunate advanced collapse, SLAC or scaphoid nonunion advanced collapse, SNAC). INDICATIONS: Advanced osteoarthritis of the radiocarpal and intercarpal articulations, SLAC/SNAC stages 2-3. CONTRAINDICATIONS: Arthrotic alterations to the proximal joint surface of the lunate bone or the corresponding joint surface of the radius (lunate fossa). SURGICAL TECHNIQUE: Dorsal longitudinal incision and exposure of the wrist capsule using a radial pedunculated capsular flap. Resection of the scaphoid bone. Chondrolysis of the corresponding joint surface between the capitate bone and the lunate bone as well as between the hamate bone and the triquetral bone. Harvesting and insertion of radial cancellous bone. Repositioning of the lunate bone. Introduction of the plate and filling of the screwholes. Closure of the wrist capsule. Neutral placement of a lower arm plaster cast. Postoperative physiotherapy from out of the supporting cast to an extent of 20-0-20° extension-flexion. For protection the support cast should remain in place for 8 weeks. RESULTS: Complete consolidation of the bone in the X­ray control in all 11 patients 12 weeks postoperatively. No implant-based complications. In one case a postoperative carpal tunnel syndrome had to be surgically treated. The postoperative extent of mobility showed overall satisfactory results with extension-flexion of 53°â€¯± 18° (47% of the healthy side) and radial-ulnar abduction 30 ± 5° (58% of the healthy side). The postoperative values on the visual analog pain scale (VAS) were 0.7 ± 1.2 at rest and 4.3 ± 2.8 under load bearing. The gripping power was 19 ± 14 kg (56% of the non-operated side) and the disabilities of the arm, shoulder, hand (DASH) value was 33 ± 24.

Daclizumab for children with corticosteroid refractory graft-versus-host disease.

Daclizumab, a humanized IL-2 receptor antagonist, has been found to be safe and effective in adults with refractory graft-versus-host disease (GVHD); however, data describing its efficacy for refractory GVHD in children are limited. We report a series of 14 children who were treated with daclizumab for severe acute and/or chronic corticosteroid refractory GVHD. Patients were treated with 2 mg/kg weekly for 8 weeks followed by 1 mg/kg weekly for 4 weeks. Nine of 14 patients responded to daclizumab as measured by improvement of GVHD symptoms, and the ability to substantially wean corticosteroid dose. Five of 11 patients with acute GVHD had complete symptom resolution, and 2/11 had a partial response. Two of four patients with chronic GVHD had complete symptom resolution. In these patients, daclizumab was only effective in treating skin GVHD. Seven of the nine patients who had a complete or partial response eventually had recurrence of GVHD; however, the GVHD was less severe and no longer corticosteroid refractory. There was no infusional toxicity, and no infections that could be attributable to the drug. Daclizumab is a relatively safe and effective medication for corticosteroid refractory GVHD in children and larger studies are needed to evaluate its role in treatment.

[Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation]. / Prävalenz und Koprävalenz des Komplexen Regionalen Schmerzsyndromes (CRPS) und des Karpaltunnelsyndromes (KTS) in der Handrehabilitation.

BACKGROUND: In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated. PATIENTS AND METHODS: The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis. RESULTS: The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (p<0.0001). In the CRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group. CONCLUSION: CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients.

Versatility and reliability of combined flaps of the subscapular system.

One-stage reconstructions of complex or unusually large defects frequently require composite tissue transfers. The various components of these "chimeric" flaps facilitate three-dimensional reconstructions or the coverage of large surface defects. Data from 36 combined flaps from the subscapular arterial system are demonstrated in this series. Defect locations were evenly distributed between the upper and lower extremities. Eighty-three percent were two-component flaps, and 17 percent contained three or more various tissue components. Overall flap survival was 97 percent. Major complications included vascular revisions in four patients and seven secondary skin transplantations. Five cases contained osseous components. The independent mobility of skin, muscle, and bone proved to be a major advantage in the reconstruction of compound defects. Donor-site morbidity was acceptable; the most frequent donor-site complication was persistent seroma in 9 of 36 patients (25 percent). Patient satisfaction was high. Ninety-one percent were satisfied with the operative result and would undergo the operation again. Eighty-six percent accepted the aesthetic appearance of the donor site. The data demonstrate that these complex flap procedures are extremely reliable and versatile, thus avoiding multiple reconstructive procedures and achieving excellent reconstructive results with acceptable donor-site morbidity.

Scapholunate ligament repair using the Mitek bone anchor.

A retrospective study was done to assess the outcome after repair of completely ruptured scapholunate interosseous ligaments using the Mitek Mini G2 bone anchor. From 1994 to 1996. 12 patients underwent scapholunate ligament repair using the bone anchor. A follow-up assessment was done at a mean of 19 months postoperatively and revealed excellent or good results in eight patients, satisfactory in two, and poor in two patients, one of whom had developed lunate necrosis. One patient with an excellent functional result demonstrated recurrent dissociation of the scapholunate gap radiographically. The technique described proved to be simpler than conventional procedures in our hands, and yields similar functional results.

Fibulo-scapho-lunate arthrodesis as a motion-preserving procedure after tumour resection of the distal radius.

Free microvascular fibula transfer is an established method for reconstruction of the distal radius following tumour resection. If the radial articular surface is resected, fixation of the fibula to the carpus is either performed as a complete wrist fusion, or the fibular head is transferred together with the shaft to replace the radial joint surface, thus allowing some wrist mobility but providing only limited wrist stability. Fibulo-scapho-lunate fusion represents an alternative. This reconstruction in two patients provided excellent wrist stability and a functional range of midcarpal motion.

Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment.

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

[Plastic surgery defect coverage in the area of the pelvis and trunk]. / Plastisch-chirurgische Defektdeckung im Bereich des Beckens und des Rumpfes.

Complex defects of the trunk and pelvic region are rare, but are mostly the sequelae of serious conditions. Stable soft tissue coverage after radical debridement of all avital tissue may be of vital importance for the patient. The article will demonstrate the options of plastic surgery procedures that should be known by the general surgeon to be eventually integrated into a interdisciplinary therapeutic concept.

[Surgical concepts and results in necrotizing fasciitis]. / Chirurgisches Konzept und Ergebnisse bei nekrotisierender Fasciitis.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality of 30-50%. PATIENTS AND METHODS: From January 1996 to January 2000 12 patients underwent treatment for NF. The patients' charts were investigated retrospectively. RESULTS: In 7 patients the bacterial cultures showed a mixed, polymicrobial infection and in 5 cases only Streptococcus pyogenes. The NF was localized at the upper extremity (2), abdomen (3), back (1), hip (2) and lower extremity (4). The area involved was 8 (4-11)% of the total body surface. The surgical procedures in 12 patients were debridement (60x), local transposition flap (2), free muscle flaps (3), lower leg amputation (1) and split thickness skin graft (3x). Four patients developed streptococcal toxic shock syndrome and two died. In total there were four deaths with a mortality of 33%. In the "survivor group" the time to diagnosis was 2.8 (1-7) days, the time to radical surgery 3.3 (1-9) days. In the "mortality group" it was 6.8 (3-10) days or 9.3 (6-12) days. CONCLUSION: The prognosis of NF seems to be influenced by the site of the infection, because 4 out of 6 patients with NF of the abdomen, back or hip died, but all patients with NF of the extremities survived. The age of the patient is not a key parameter, because also young and previously healthy people also die from the streptococcal toxic shock syndrome. The interval between diagnosis and radical debridement appears to be the crucial factor in terms of prognosis, since early diagnosis and prompt, radical surgery improves the survival rate.

[Chronic compartment syndrome of the first dorsal interosseous muscle: 2 case reports]. / Chronisches Kompartmentsyndrom des ersten dorsalen Interosseusmuskels: Zwei Fallbeispiele.

Chronic exercise-induced compartment syndrome of the first dorsal interosseous muscle of the hand is a rare condition. The presented complaint is a dull muscle pain which can be increased by hyperextension of the index metacarpo-phalangeal joint and by repetitive key grip. Two patients complaining of these symptoms could successfully be treated by simple fasciotomy of the first dorsal interosseous compartment.