[Dysplasia epiphysealis hemimelica of the carpus]. / Dysplasia epiphysealis hemimelica der Handwurzel.

Dysplasia epiphysealis hemimelica is a rare benign osteochondromatous disorder which develops in childhood mostly on the epiphyses of the bones in the lower extremities. While the tarsal bones are often involved, it is very rare in the carpus. Four patients are reported. Two were treated operatively with good results. In consequence of the experience of Lamesch, an excision was not performed in the other two cases. The patients were followed up for many years with the findings of some reduction in size and figure. Therefore, it is recommended not to operate this special tumour as long as no functional disturbances will occur.

[The musician's hand: 2 case reports from the hand surgery clinic]. / Die Hand des Musikers--Zwei Fallberichte aus dem handchirurgischen Alltag.

Report of the hand surgical treatment in two musicians, which enabled them to continue with their occupation. A young cellist was no longer able to play his instrument due to a painful scar at the pulp of his left index finger. The surgical treatment, performed only after a period of hesitation, consisted in scar excision and reconstruction of a normal pulp by a palmar advancement flap. Following a fracture of the distal radius, healed in 35 degrees dorsal angulation, a violinist was not able to flex his wrist maximally as required for playing in high octaves. This was again possible after a corrective osteotomy with interposition of a corticocancellous bone graft from the iliac crest and an intensive program of postoperative excercises. The important role of the cooperation of the patient, particularly in the rehabilitation, is emphasized.

[Results of interphalangeal joint arthrolysis in patients with Dupuytren disease]. / Ergebnisse von Mittelgelenkarthrolysen bei Patienten mit Dupuytren-Erkrankungen.

The results of 226 arthrolyses of the proximal interphalangeal joints of ring and small fingers in patients with Dupuytren's disease are presented in a retrospective study. 52% of cases involved first operations, 48% were operations of recurrent diseases. Proximal interphalangeal joints of small fingers were more frequently affected than those of the ring fingers. Arthrolysis was carried out stepwise in Buck-Gramcko's technique. In 13% of the cases an additional temporary transarticular Kirschner wire fixation was carried out. The results were graded according to extension deficits and the distance from fingertips to distal palmar crease. The average pre-operative extension deficit was 65 degrees. The average extension deficit three months after operation was 35 degrees. The post-operative distance from fingertips to distal palmar crease was 2.5 centimeters. Ring fingers yielded better results than small fingers. A temporary transarticular Kirschner wire fixation did not lead to better results. In unfavourable cases however, this fixation seems to be indicated. Complications occurred in 27% of the cases, mainly involving wound healing.

The Hoffmann-Tinel sign. 1915.

The aim of this article is to show that the well-known Tinel sign is really a Hoffmann-Tinel sign. The translation of the two papers of Hoffmann, published in the same year that Tinel wrote his article (1915), is completed by a short biography of Paul Hoffmann.

The treatment of metacarpal synostosis.

One hundred nine patients with metacarpal synostosis were examined to determine the best treatment for this condition. The fourth and fifth metacarpals are most frequently affected, and bilateral involvement occurs often. Many anomalies are associated with synostosis, as well as many syndromes such as Apert's syndrome, central polydactyly, syndactyly, and partial absence of the hand. An osteotomy to split and separate the synostosis, a bone graft to lengthen the fifth metacarpal, collateral ligament reconstruction, and tendon transposition of the extensor digiti minimi quinti all appear to be valuable for the treatment of this rare congenital anomaly.

[Computerized tomography of the hand with high resolution technique]. / Computertomographie der Hand in hochauflösender Technik.

The results of 175 high-resolution computed tomography (CT) scans of the hand and wrist are analysed and compared to the results of conventional radiographs. Advantages of the procedure can be demonstrated when assessing pathological changes within the complex three-dimensional structure of the hand and wrist, and in the analysis of articular surfaces. In some cases, fractures and dislocations of the distal radioulnar joint and the carpal bones were missed in conventional radiographs. In cases of scaphoid fracture and nonunion, CT scans give valuable additional information surpassing the possibilities of conventional radiographs. For instance, bone healing after bone grafting can be better evaluated with a CT scan. Furthermore, preoperative planning is simplified, when tumors and cysts of the carpal bones can be located precisely using computed tomography.

[Distal radio-ulnar arthrodesis and Kapandji ulna segment resection in treatment of limited forearm rotation]. / Die distale radioulnare Arthrodese und Ellensegmentresektion nach Kapandji zur Behandlung der gestörten Unterarmdrehung.

Between 1986 and 1990 distal radioulnar arthrodesis with segment resection of the distal ulna (Sauvé-Kapandji Operation) was performed in 31 patients with posttraumatic changes of the distal radioulnar joint; 26 patients could be examined after 10 to 44 months. At the time of examination, all patients had bony fusion between distal radius and ulna; forearm rotation improved by 60.5%, 55% of the patients had significant pain relief. Grip strength also improved postoperatively, though never reaching values of the healthy hand. Two patients developed a bony regeneration, which was successfully reoperated upon in one case, 81% of the patients reported an improved wrist function.

Progress in the treatment of congenital malformations of the hand.

Treatment of congenital malformations of the hand and forearm has progressed not only from new procedures, but especially due to a new technique, namely microsurgery. Microsurgery enables skilled hand surgeons to operate on the tiny hands of babies without damaging the anatomical structures. The optimal time for the correction of many deformities is during the first 2 years of life. This gives excellent adaptation of the corrected structures to their altered function, especially in combination with a long period of further growth. Several new procedures are described which have been made possible only since the introduction of microsurgery, either by microvascular anastomoses or by meticulous dissection technique (toe transplantation, proximal toe phalanx transplantation, nail wall formation in complex syndactyly, transposition of digital parts in polydactyly and radial club hand).

On the priorities of publication of some operative procedures on the distal end of the ulna.

A search of the relevant literature concerning various procedures done to the distal ulna in post-traumatic conditions has shown that several terms are inappropriate to the procedures they describe. This paper tries to clarify the situation and help in correct citation.

Proximal toe phalanx transplantation for bony stabilization and lengthening of partially aplastic digits.

In congenital malformations the lengthening of partially aplastic digits, by on-top plasty of a bone graft or the bony stabilization of finger stumps consisting of soft tissues without skeletal elements, is extremely difficult. The usual bone graft, taken from the iliac crest or the fibula, will undergo resorption and will have disappeared a few months postoperatively. Experience has shown that the proximal toe phalanx will with-stand any resorption if it is taken whole, covered by its periosteum. Another advantage is the possibility of the construction of a new joint between the metatarsophalangeal articular surface of the toe phalanx and the distal end of the recipient bone in the hand, which is usually covered by cartilage. Flexor and extensor tendons exist in most cases. Between 1976 and 1988, 69 transplantations of proximal toe phalanges were performed in 43 children. The indications were: boneless digital stumps or partial absence of digits in symbrachydactyly and ring constriction syndrome. Follow-up examinations of 40 patients with 63 transplanted phalanges at an interval of 36 months (12 to 160 months) has shown a 100% take of the bone graft provided it had not been split and the periosteum was undamaged. The earlier in life the operation was performed, the more postoperative growth was recorded. A joint construction was attempted in 46 digits with variable results; active mobility ranged from 0 degrees to 90 degrees. With the use of a tendon interposition, there is a less degree of shortening of the toes.

[The neurovascular pedicled abductor digiti minimi muscle flap for covering the median nerve or its branches]. / Der neurovaskulär gestielte Abductor digiti minimi-Muskellappen zur Abdeckung des N. medianus oder seiner Aste.

The authors report two cases in which a damaged median nerve or its branches were covered with an abductor digiti minimi muscle flap. This muscle has enough volume to protect the critical region of a damaged nerve at the wrist against stress by pressure.

Radialization as a new treatment for radial club hand.

"Radialization," a new technique for operative treatment of the radial club hand, is presented. It has been successfully used in 30 hands (23 patients) since 1979. It is named "radialization" because after all fibrotic tissues are excised, the hand and radial carpal bones are placed over the distal end of the ulna; the hand is fixed with a Kirschner wire in a position of moderate ulnar deviation. Usually, no carpal bones need to be removed. The improved mechanical forces are further stabilized by transposition of the radial wrist extensor and flexor to the ulnar side; this favors a better muscle balance. The optimal age for surgery is between 6 and 12 months.