[Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon]. / Rekonstruktion der Extensor pollicis longus-Sehne mittels Extensor indicis-Transposition.

Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. All patients were clinically examined and a DASH questionnaire was answered by all patients. The method to reconstruct the EPL-tendon was the transposition of the extensor indicis-tendon. After the operations the thumb was put in a splint for four weeks in a "hitch-hiker's-position". 31 ruptures of the tendon (77.5 %) were a result of trauma. In 20 of them (50 %) a distal radius fracture had occurred. Clinical examination included measurements of the movement of the thumb- and index-finger joints, the grip strength and the maximal span of the hand. Significant differences were not found. The isolated extension of the index finger was possible in all patients. But it was reduced in ten cases which represent 25 %. Our results were evaluated by the Geldmacher score to evaluate the reconstruction of the EPL-tendon. 20 % excellent, 65 % good, 12.5 % fair and 2.5 % poor results were reached. The Geldmacher score was used critically. We suggest its modification for the evaluation of thumb abduction. The DASH score reached a functional value of ten points which represents a very good result. In conclusion the extensor indicis-transposition is a safe method to reconstruct the EPL-tendon. Its substantial advantage is taking a healthy muscle as the motor, thereby avoiding the risk of using a degenerated muscle in late tendon reconstruction. A powerful extension of the index finger will be maintained by physical education. Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.

[Long-term results of the palmar arthrolysis of the proximal interphalangeal joint]. / Langzeitergebnisse nach beugeseitiger Mittelgelenkarthrolyse1.

BACKGROUND: Palmar arthrolysis of the proximal interphalangeal joint is seldom carried out as an isolated treatment of contractures. The operation is usually performed in connection with treatment for a primary illness. Although intra-operative extension of the interphalangeal joint is normally completely achieved, the postoperative results show deficiencies in the extension. METHODS AND CLINICAL MATERIAL: The long-term results of 110 arthrolyses of the proximal interphalangeal joint of 102 patients are presented. The operations were performed on average 4.6 years ago. The analysis was made with standard questionnaires and self-made drawings along the side of the patients' maximally extended finger. RESULTS: "Successful operations" where performed on 76% of all released joints. The angle of the contracture was reduced by at least 10 degrees in these joints. The long-term results were compared in conjunction with results of injuries or operations of other illnesses: M. Dupuytren (primary), relapses of M. Dupuytren, lesions of the flexor tendons, camptodactyly, results of injuries due to the consequences of operations or other illnesses. The results in the group of lesions of the flexor tendons were on the whole unsuccessful. CONCLUSION: Even though thorough postoperative hand therapy(physiotherapy and use of splints) and above-average co-operation of the patients are prerequisites for a successful arthrolysis, it can be seen that the elimination of the underlying illness is of primary importance.