[History of the carpus and carpal instability].

A concise history of our understanding of the wrist and carpal instability is presented. During the Middle Ages, the wrist is sometimes depicted as consisting of only one bone; Galen, however, showed that there are eight. At first, the carpal bones were simply numbered from one to eight.

[Spontaneous rupture of the extensor pollicis longus].

A review of the literature is followed by the analysis of a series of forty-four patients who were treated by extensor indicis transposition. Twenty-five patients could be reached for a clinical follow-up examination, nine further patients were interviewed by telephone; of the remaining ten patients, seven could not be reached and three had died. Excluded from the series were patients with rheumatoid arthritis.

[Soft tissue tumors of the hand].

This paper is based on the author's experience and a review of the most recent literature. First, the five most common tumors are discussed: ganglia, giant cell tumor, mucous cyst, hemangioma, and epithelial inclusion cyst. The less-common lesions are then discussed that present special problems in the hand, such as the glomus tumor or recurring digital fibromatosis of childhood among others.

Reoperation for carpal tunnel syndrome. A retrospective analysis of forty cases.

The causes of unsatisfactory results after surgery for carpal tunnel syndrome were retrospectively analysed in forty cases. The most common pathological finding was fibrosis and adhesions in the carpal canal. Technical errors were found in 43%.

[Ganglion in the discus triangularis. First description].

A fifty-four year old patient had persisting pain in the wrist following a distal radius fracture two years previously. A perforation of the discus triangularis was confirmed by arthrography, and the disc removed. Gelatinous fluid was found in the joint at operation.

[Osteotomy and osteosynthesis of the clavicle in brachial plexus surgery].

During the operative revision of the brachial plexus lesion the exposure is sometimes not wide enough without an osteotomy of the clavicle. The authors developed, therefore, a special technique consisting of internal fixation with a lag-screw prior to the oblique osteotomy of the clavicle. At the end of the operation stable internal fixation can be achieved within a few minutes.

[Motor, sensory electroneurographic and electromyographic results as well as somatosensory evoked potentials in comparison to clinical findings following nerve suture].

A group of 37 patients (total 41 nerves) with a traumatic transection of median or ulnar nerves at the wrist were reinvestigated clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. Clinically there was no relation between the time after the operation, and sensory recovery determined according to the schedule of Nicholson and Seddon (1957), two-point discrimination, vibration threshold. There was also no relationship between the time after suture, and the motor latencies as well as amplitudes of evoked muscle action potentials from the abductor pollicis brevis or hypothenar muscles.

[Carpal tunnel syndrome--a leading symptom in generalized tendomyopathy].

Among 75 of 100 patients with generalized tendomyopathy, carpal-tunnel syndrome developed in the course of the disease and was demonstrated both clinically and electromyographically, requiring operative intervention in 10%. Furthermore, 17 of 26 patients previously operated on for carpal-tunnel syndrome, had chronic tendomyopathy requiring treatment, and in six there was severe generalized tendomyopathy. Thus generalized tendomyopathy can be the precipitating underlying disease in a large number of cases with so-called idiopathic carpal-tunnel syndrome.

[Results of the surgical treatment of ulnar nerve neuropathy in the elbow area].

Osborne's decompression operation is used only in selected cases of cubital tunnel syndrome, where compression is obviously caused by the aponeurotic arch between the heads of flexor carpi ulnaris. In all the other cases, when there is subluxation or chronic dislocation of the nerve over the medial epicondyle, when there are adhesions in the postcondylar groove, when any other local cause or no cause at all is found, anterior transposition is preferred. More and more often we tend to use a subcutaneous transposition except in those cases where kinking would be unavoidable due to hypertrophy of flexor muscles.

[Interposition arthroplasties in the area of the proximal carpal row (lunate and scaphoid replacement/partial replacement].

Prostheses are recommended for replacement of the scaphoid. Results of tendon interposition after resection of small proximal fragments are unpredictable. Therefore alternative procedures like liquid silicone casts or replacement by a lunate prosthesis (or part of the prosthesis of the scaphoid) have to be evaluated.

Sensory electroneurographic parameters and clinical recovery of sensibility in sutured human nerves.

A total of 37 patients with traumatic transection of median or ulnar nerves at the wrist (total 41 nerves) were examined clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. There was a significant increase of cumulative amplitude with the time after suture, whereas maximum sensory nerve conduction velocity and maximum amplitude of nerve action potentials did not reveal such a correlation. The recovery of two-point discrimination, vibration threshold and sensibility scored according to the scale of Nicholson and Seddon were also not related to the passage of time after operation.

[Split skin-mesh transplants to cover burned hands].

Nonexpanded autologous mesh grafts of split thickness skin provide optimal wound drainage through their cuts. They also minimize disability from contraction and scarring when combined with Jobst compressive dressings. These properties assure good functional and cosmetic results in reconstructive surgery after burns.

[Reinterventions after surgery of the extensor tendons].

Tenolysis, tendon grafts or tendon transfer are the main procedures to be considered for secondary repair in zone 6. Tenolysis is also indicated when adhesions prevent gliding in zone 5. Here interposition of the extensor retinaculum may provide protection against deep scar tissue.

[Reoperation after surgery of flexor tendons].

After stabilizing operations such as tenodesis or arthrodesis used for lesions of flexor tendons in the hand, secondary operations to achieve more suitable angulation are mainly needed when there is elongation of the tenodesis. Complications are more frequent after mobilizing operations such as reinsertion, advancement, Z-lengthening, primary suture, tendon graft or tendon transfer. Tenolysis, the operation most frequently used, since contractures may occur after all the prementioned procedures, is treated in a separate paper.

Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome).

Entrapment of the median nerve in the proximal forearm is seen in two forms: the pronator teres syndrome, and the anterior interosseous nerve (or Kiloh-Nevin) syndrome. Both syndromes are rare, and they comprised approximately 1% of the compression syndromes of the upper limb which were treated operatively by the authors. The symptoms, signs, etiologies, and intraoperative findings are discussed.