[Osteoid osteoma of the hand skeleton]. / Zum Osteoid-Osteom am Handskelett.

Two cases of osteoid osteoma in the hand are reported. One shows a rare localisation in the trapezium. Errors in the first diagnosis and the duration of the disease emphasize the difficulties one can encounter making the correct diagnosis of this tumor. The particular symptoms of osteoid osteoma when located in cancellous bone are discussed as well as the diagnostic aids of tomography and bone scan.

[Morphology and classification of cleft hands]. / Zur Morphologie und Klassifikation von Spalthänden.

It is the intention of this study to present a more profound investigation of the morphology of cleft hands and to provide a new classification based on the results of that investigation. After a short review of the literature, which shows the different opinions regarding heredity, pathogenesis and classification of cleft hand, the authors demonstrate their own patients with 35 cleft hands: The deformities were mostly bilateral and associated with cleft feet. In unilateral cases the right side was more common. Males were in the majority. This paper puts emphasis on the analysis of X-ray morphology. The authors are able to demonstrate that the cleft hand shows several peculiarities which have not been yet sufficiently respected. It was found out, that, apart from aplasia of the bones and soft tissue, synostosis is often the origin of clefting. In 40% of our cases the cleft was caused exclusively by synostosis, in a further 34% it derived partly from synostosis of the phalanges and the metacarpal bones. In the carpus we found osseous deformities surprisingly often, a feature which has hardly been mentioned in former studies. Among the numerous associated malformations emphasis must be placed on the osseous syndactylies and the central polydactylies, because they are closely related to the cleft hand as shown by Ogino. 18 of our own cases belong to this group. Our investigations lead us to the following classification: Cleft hand type 1: Cleft hands with osseous defects (aplasias) Cleft hand type 2: Cleft hands with synostosis Cleft hand type 3: Cleft hands with aplasias and synostosis Hands with central polydactyly and synostosis as preforms of the cleft hand could be classified in type 4. These phenomena form the beginning of the teratological row towards the completely developed cleft hand. In combination with Blauth's distribution of cleft hands, who distinguished the median and medio-lateral form (1976, 1978) this new classification enables each cleft hand to be placed into one of the different types, which are analysed: Type 1 mostly shows a medio-lateral form, is always combined with cleft feet and shows heredity in 50% of the cases. It cannot be classified by the Ogino method. Type 2 mostly shows a median form, is not frequently combined with cleft feet, heredity occurs in one third of the cases. This type can very often be classified by the Ogino method. Type 3 varies from case to case because of the different items of defects.(ABSTRACT TRUNCATED AT 400 WORDS)

[Sudeck syndrome of the hand. Historical review, treatment concept and results]. / Das Sudeck-Syndrom der Hand. Historischer Uberblick, Behandlungskonszept und Ergebnisse.

The literature on the etiology, pathogenesis, and therapy of Sudeck's atrophy is reviewed. The authors present their treatment regimen for reflex dystrophic hands that has been used successfully for more than twenty years. This program consists of a combination including drugs as well as physical and occupational therapy. Patients have to be guided psychologically. In-patient treatment is preferred. The ultimate aim of therapy is to restore the functional integrity of the affected hand. The choice of therapy depends on the stage of the disease. Removing pain and edema is the most important aim in stage I. This is achieved by immobilization of the affected extremity in an upward position, cooling the hand with ice, and careful physiotherapy supported by antiphlogistic drugs. In stage II the physiotherapy has to be intensified and should be supplemented by special balneologic (bathing) measures and functional splints. The ipsilateral shoulder can be affected and has to be treated adequately. In stage III additional surgical treatment might be helpful such as arthrolysis, arthroplasty, or arthrodesis of finger joints. The authors report on their results in seventy-seven dystrophic hands in a long-term follow-up between one and fourteen years. The results depend on the begin of the treatment in the different stages of the disease. Eighty-three percent of the patients were cured in stage I, only thirty-one percent in stage II, and no patient in stage III. The authors' experience using Calcitone shows that it has no influence on the functional results. Comparing their results to those obtained by others, the authors conclude that physical and occupational therapy are decisive in dealing with dystrophic hands.

The surgical treatment of partial tibial deficiency and ankle diastasis.

In cases of congenital partial tibial aplasia or so-called diastases of the lower leg, very good results are to be expected from tibia/fibula fusion in association with a repositioning of the foot. Form and function of the limb are significantly improved, with ortho-prosthetic fitting being considerably facilitated.

[Cleft foot with Y-shaped deformity of the third metatarsus. A case history.]. / Spaltfuß mit Y-förmigem Os metatarsale (Bifurcated metatarsal bone).

GOAL OF SURGERY: Correction of the deformity of the third metatarsus and of the malposition of the toes to improve form and function of the foot. INDICATIONS: Problems with shoe wear. Aesthetic appearance. (Limitation of function.) CONTRAINDICATIONS: None. PREOPERATIVE WORK UP: Drawing of surgery to be performed. POSITIONING AND ANAESTHESIA: Supine. General anaesthesia. SURGICAL TECHNIQUE: Excision of the distal half of the hypoplastic second metatarsus through a curvilinear dorsal incision. Osteotomy of the third metatarsus at the Y-junction and implantation of the mediodistal part into the proximal half of the second metatarsus. Corrective osteotomy of the third metatarsus at the Y-junction. Internal fixation of both metatarsi with transosseous, transarticular Kirschner wires. Four weeks later correction of the hallux valgus using the technique recommended by Kramer. POSTOPERATIVE MANAGEMENT: Below knee plaster of Paris. Removal of K'wires after consolidation of osteotomies. Progressive increase in weight bearing. Arch supports. POSSIBLE COMPLICATIONS: Injury to nerves, vessels or tendons. Wound infection. Delayed consolidation. Nonunion. Growth disturbances. RESULTS: 30 months postoperatively, when the patient was 13 years of age, both osteotomies had healed in good position: the foot looked nearly normal. At 21 years of age the patient has no problems. She is involved in sports and is satisfied with the result.

[Congenital digital syndactylia (author's transl)]. / Kongenitale Syndaktylien der Finger.

Congenital syndactylia of the fingers are discussed and the differential diagnosis is presented. While correction may be required for functional or easthetic purposes, the age of 4-6 years is recommended as the optimum time for correction. Early surgical treatment may be needed in cases of Apert's syndrome and in the case of congenital annular scars (amniotic bands). The operative technique is carefully described and general anaesthesia and exsanguination is recommended. Post-operative management is of equal importance and the fingers are dressed with vaseline gauze and a compression bandage. The author's experience is limited to 65 syndactylia operations and in only 3 of these was a repeat procedure necessary.

[The treatment of congenital foot abnormalities]. / Uber die Behandlung angeborener Fussfehlbildungen.

With the exception of club foot, flat foot and claw foot, this paper gives a review of principal foot malformations at birth, proceeding from the available radiographical and clinical findings, and also from the facts found during surgery. In addition, there is suggested a classification of various deformities, and there are defined major guidelines and instructions for treatment. As far as the rather frequent polydactylies are concerned, the author distinguishes between a distal phalanx type, an interphalanx type, a proximal phalanx type, a metatarsal type and a tarsal type, depending on the "level", each, where distal/proximal web separation between the fingers stops. It is possible to include also rather particular forms, such as the rudimentary type and the so-called multiplications in this classification. The major indications for the surgical treatment of polydactylies are problems in finding adequate shoes, and also the aesthetic appearance. The principal concern of surgical treatment is to remove additional toes. When there is in parallel a syndactyly or a congenital hallux varus, this may require great skill in the applied surgical technique. Various approaches of surgical treatment are demonstrated by a few examples. Feet oligodactylies are primarily encountered with fibula dysplasia or aplasia, or in cleft feet. In very severe cases it is possible to find just one toe. The actual deformities alone rarely require surgical treatment, but they often "hint at" further malformations in the reach of the root of the foot (synostosis) and of the lower limb. Cleft feet are also frequently impaired in form and function, with these deformities including less severe hypoplasia of a middle toe, e. g. with a somewhat deeper web separation, toe aplasia, metatarsus hypoplasia and aplasia, synostosis, and transversal bones, and even monodactylies with only ray V existing. Additional toes in the cleft foot is one of the rare exceptions. However, the combination of cleft feet and cleft hands is rather frequently encountered. Many cleft feet are nevertheless highly efficient, even without any surgical treatment. That is why there are only indications for a surgical treatment when there are severe foot deformities or most inconvenient misalignments of peripheral toes. Some of the "lobster like" feet are so wide that it is just not possible to wear normal shoes. In this case it is recommended to have surgical correction and to close the cleft. Feet of congenital giant growth are extremely rare, but they raise most complex problems as to adequate treatment. In many cases, an amputation of the additional parts cannot be avoided.(ABSTRACT TRUNCATED AT 400 WORDS)

[Our knee joint prostheses with patellar replacement]. / Unsere Kniegelenkprothesen mit Patellaersatz.

In the 13 years since the first Blauth total knee joint replacement was implanted, in August 1972, it has proved highly successful. This is borne out by the results of a prospective long-term study. Out of 488 patients who had been provided with such a prosthesis up to the beginning of 1984, 398, or 82%, were included in the study. Sixty patients had meanwhile died, and 24 could not be contacted. Six prostheses had to be removed. The follow-up quota of the surviving patients corresponded to 94%. The mean duration of observation was 40 months, with a minimum of 12 and a maximum of 144 months. Of the patients, 35% suffered from rheumatoid polyarthritis, and 61% from gonarthrosis. The mean postoperative flexion and extension values were 98-3-0 degrees. About 10% of the patients still claimed to suffer appreciable pain when starting to move and when bearing weight, as compared to approx. 95% preoperatively. Severe complications were 9 deep infections (2.3%) and 5 cases of aseptic loosenings (1.3%). There were no stress fractures or breakages of the prosthesis material in the patients follow up. A retropatellar pain syndrome was found in 8.3% of the patients, i.e., definite pain when standing up, on stairs, or when starting to move. For this reason the original design of the prosthesis was developed further and complemented, inter alia, by an artificial patella. The principal modifications are as follows: -The femoral section was given a concave shape in the sliding bearing of the kneecap and elongated proximally.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of the contracted thumb web space by means of an augmented transposition flap method]. / Zur Behandlung der verengten Daumenkommissur mit der "erweiterten Schwenklappenplastik"

The augmented transposition flap plasty consists of a Z-plasty, to which a triangular flap from the dorsal ulnar aspect of the thumb is added. Remaining skin defects have to be covered by thick split thickness skin grafts. This procedure has been successfully during the past five years for the release of congenital or posttraumatic first web contractures of moderate severity.

[Syndactylia recurrences and their treatment (author's transl)]. / Das sogenannte Syndaktylierezidiv und seine Behandlung.

Recurrences following correction of syndactylia are usually the result of inappropriate skin incisions, or of delayed wound healing. These recurrences are examplified by interdigital cutaneous and scar bridges which may result in contractures of even rotational deformities as the result of growth. Early and late syndactylia recurrences can be differentiated. Early operative treatment is recommended and splints and bandages or similar conservative measures are useless. Considerable experience, suitable instruments and adequate surgical technique are required for these corrections.

[Arthrolysis of the knee joint]. / Die Arthrolyse des Kniegelenks.

This publication consists of two parts, the first of which is concerned with the definition of arthrolysis as a mere soft tissue procedure. This is delineated from arthroplasty. In the second part, arthrolysis results are presented. Three different means of treatment are possible for knee joint stiffness: manual joint mobilization under anaesthesia, arthroscopic operation, and "open" arthrolysis. The authors concentrate on the third type of treatment because of the great amount of long-term experience they have made. In the majority of cases knee joint stiffness is caused by immobilization and posttraumatic and postoperative effects on the joint itself or in the area of the joint. Morphological findings are intraarticular adhesions in the recessus, as well as between the joint surfaces, retraction of the capsular-ligament system, and extra-articularly located impediments caused by shrinkage and scars in the muscles, tendons, and sliding laminas of the soft tissue. Open arthrolysis is indicated after failure of conservative treatment and in cases of severe stiffness of the knee joint. For operative arthrolysis many requirements must be met, which are specified in detail. The preoperative information about the treatment given to the patient is of particular interest. The operative methods, including postoperative management, are described only briefly, because the presentation of the results is the main purpose of this paper. Eighty-five patients (94%) who underwent open arthrolysis were personally examined. Information about the other patients was obtained from medical records such as the examination at discharge or the last presentation in the outpatient clinic. The average follow-up time was 5 years and 4 months ranging from 6 months to 14.25 years. The results are differentiated in many respects whereas the so-called relative improvement of joint mobility following an operation is of main interest. Well-defined criteria have been published and were applied. The results are listed according to the severity of joint stiffness. Four grades of joint stiffness are created, ranging from grade IV, the most severe form with a preoperative maximum of joint mobility of 30 degrees, to grade I with a maximum of 90 degrees joint mobility. In all, operative procedures led to an improvement in nearly 100% compared to the preoperative findings. The results are presented in relation to age, operative methods, previous operations, and different stages during the follow-up.