[Capitate Non-Union: One of the Causes of Carpal Tunnel Syndrome]. / Kapitatumpseudarthrose als mitauslösendes Moment eines Karpaltunnelsyndroms.

We report on a carpal tunnel syndrome in a 50-year-old woman, presumably caused in part by a 35-year-old asymptomatic capitate non-union. The carpal tunnel was released and a large exostosis removed. 3 weeks after the operation the patient was free of symptoms.

[Transposition of the Ring Finger after Severe Hand Injury]. / Ringfingertransposition nach schwerem Handtrauma.

We report a severe hand injury with a fracture of the third metacarpal bone, destruction of the metacarpophalangeal joint of the fourth finger, amputation of the little finger of the right hand and several tendon injuries, in an active musician. The fourth metacarpal bone was offset close to the base, the hand narrowed, and the ring finger transferred to the base of the little finger. The outcome was very favourable.

[Compression of the ulnar nerve at Guyon's canal caused by a pseudoaneurysm of the ulnar artery following trauma]. / Kompression des Nervus ulnaris in der Loge de Guyon durch ein traumatisches Aneurysma spurium der Arteria ulnaris.

We repor there on a 16-year-old patient who presented with pain and swelling in the hypothenar eminence as well as loss of sensibility in the fingers of the region innervated by the ulnar nerve; this happened 2-3 weeks after an injury by a glass splinter in his proximal palm. A pseudoaneurysm could be verified by duplex sonography. The patient wished to avoid any graft for arterial bridging for religious reasons. On the basis of an the Allen test preoperatively and the intraoperative findings, an adequate blood supply of the finger by the radial artery was expected. Thus, in respect to the patients wish, the aneurysm was resected without bridging. The patient recovered perfectly. 4 years later, an MR-angiography showed the deep and superficial transverse palmar arc to be supplied by a voluminous radial artery. The ulnar finger arteries originated from the deep arc, the radial finger arteries from the superficial arc. In this paper, the criteria pro and contra grafting the ulnar atery at Guyons's canal will be discussed.

[Closed rupture of the intrinsic flexor tendon of the little finger]. / Gedeckte Ruptur der tiefen Beugesehne des Kleinfingers.

Closed ruptures of the deep flexor tendons are rare, even though they occur more often than those of the superficial flexor tendons. We report about a closed distal rupture of the deep flexor tendon of the little finger as experienced by a 50-year-old man who suffered an injury at work. The proximal stump allocated to the torn flexor tendon of zone I had noticeably pulled back to the middle of the palm of hand, and had come to rest around the tendon of the ring finger. We illustrate the problems linked with diagnosis, care and follow-up treatment of such a case.

[Ossification in the carpal tunnel as a rare cause for untypical carpal tunnel syndrome]. / Ossifikation im Karpalkanal als seltene Ursache für ein atypisches Karpaltunnelsyndrom.

There are typical causes for carpal tunnel syndromes as well as a series of rare causes. Furthermore, the clinical image can also be untypical. This report is about a 59-year-old female patient with an untypical clinical symptomatology and with a rare cause: there was no major pain during the night or in the morning, no paraesthesias and no impairment of the fine motor skills, nevertheless, there were rapid paraesthesias and pain in the first three fingers of the right hand immediately after hyperextension of the wrist. Although the discomforts had already existed for 2 years they were not recognised properly because they were untypical and incomplete and neurography was negative. 3 years later in a renewed examination X-ray pictures of the carpus were taken and a 4 x 6 x 8 mm big ossicle on the ground of the carpal canal was found, the computed tomography and the intraoperative situs confirmed the image. The histology gave the diagnosis of a loose osteochondral body. Postoperatively the patient was quickly was free of the symptoms.

[The reamer--a new instrument for simplified harvesting of donor bone from the iliac crest]. / Beckenkammfräse--Ein Instrumentarium zur vereinfachten Gewinnung von Beckenkammtransplantaten.

Harvesting donor bone from the iliac crest site to fill gaps in bone defects is a simple operation but there are still reports of many complications occurring in the bone harvesting process. We now describe a procedure that significantly decreases the morbidity of the donor site. Reports on the iliac crest miller modified according to Krimmer that was applied on 40 patients (average age: 68 years) afforded results that were compared with data collected from the use conventional methods (average age: 65 years). The average length of the skin incision of 41 mm was significantly shorter than the incision length recorded in connection with the conventional methods, namely 79 mm. The harvesting time was limited to 7.6 minutes instead of 18 minutes und thus was also significantly shorter. The postoperative pain as measured on the basis of a visual analogue scale (0 to 100 points) was as follows: pain records were lower than those of the control group by 29 points on the second day following the operation, by 25 points on the fourth day, and by 17 points on the 12th day following the operation. No complications were observed. In the control group there were three haematomas, two cicatricial dehiscences, one cicatricial keloid and one loss of sensibility. This new procedure fulfils the demands for a minimally invasive technique.