[Neuropathy of the median nerve caused by intraneural haematoma after carpal tunnel release in an anticoagulated patient].

We report about the sudden onset of a median nerve neuropathy in an anticoagulated patient eight weeks after uneventful carpal tunnel release. Several differential diagnosis have to be considered: compression syndrome as well as iatrogenic damage of the median nerve due to the preliminary procedure or even concomitant disease can generate symptoms of peripheral neuropathy. We diagnosed an intraneural haematoma through surgical exploration.

[Long-term results following denervation of the wrist in patients with stages II and III SLAC-/SNAC-wrist].

Introduction: Mid-carpal arthrodesis, proximal row carpectomy and wrist arthrodesis are commonly cited in the literature as successful methods for pain reduction in patients with advanced carpal collapse (SLAC-/SNAC-wrist stages II and III). However, studies of isolated wrist denervation in patients who still possess good wrist mobility appear to be an underrepresented topic, especially in the German literature.

Purpose: Based on follow-up results, it was possible to establish to what extent patients benefit long-term from isolated wrist denervation, whilst retaining wrist mobility.

[Infections of flexor tendon sheath - treatment and results].

Infections of the flexor tendon sheath are rare. We report on 49 patients who were treated in a five-year period from 1996 to 2000. The follow-up period was 45 months on average.

[Finger reconstruction by microvascular second toe-to-finger transplantation in patients with traumatic loss of all fingers].

Purpose: To assess the utility of second toe-to-finger transplantation with neurovascular reconstruction in patients with loss of all four digits.

Method: Analysis of 24 toe-to-finger transplantations in 18 patients regarding over-all survival, complications and secondary procedures, sensibility, function, foot symptoms, and patient satisfaction. The original metacarpophalangeal joint was preserved in 50 % of the transplantations.

[Comparison of functional results after reconstruction of the thumb].

Between 1980 and 2000, 26 pollicizations of the index finger and 32 transplantations of the second toe were performed for reconstruction of the thumb after traumatic loss. Twenty-three patients with index finger pollicization and 26 patients with second toe transplantation could be reviewed after an average follow-up of 6.4 years.

[Aftercare following distal forearm fractures and carpal trauma].

Rehabilitation following operative or conservative treatment of fractures of the distal forearm and carpal trauma takes effect through adequate immobilization and ought to be maximized by a differentiated application of every means of physiotherapy, ergotherapy, and physical medicine available. Rehabilitation of the fractured distal forearm and carpal trauma are presented based on the therapeutic guidelines as applied by the Department of Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftliches Unfallkrankenhaus Hamburg.

[Therapy of the peromelic form of symbrachydactyly by double second-toe transplantation].

From 1989 to 2001 eleven children with the peromelic type of symbrachydactyly underwent a staged double second toes transplantation for restoration of two finger rays. The second toe of the feet were transplanted first to the small finger position and in the second step to the thumb position. One failure occurred in the first toe transplantation and another developed a venous thrombosis with partial necrosis and eventually a useless ray.

[Operative treatment of vulnerable scars and deep soft-tissue defects of the thumb with a free toe pulp neurovascular flap].

Because of the capability of opposition, the thumb is the most important digit of the hand. In case of deep soft-tissue defects of the pulp, it is necessary to reconstruct the palmar surface of the distal phalanx of the thumb using tissue with good sensibility. Between 1982 and 1998 at the Department of Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftliche Unfallkrankenhaus Hamburg, we used a free toe pulp neurovascular flap for reconstruction of the pulp of the thumb in nine patients.

[Covering defects of the basal finger area by pedicled flaps anastomosed to the doral metacarpal arteries].

Between 1993 and 1998, 12 distally based dorsal metacarpal artery flaps were used to cover defects of the fingers and palm. All flaps were raised from the dorsum of the hand. Eleven flaps allowed direct closure of the donor site area; one case required a full-thickness skin graft.

[Anatomy of the dorsal mid-hand arteries--anatomic study and review of the literature].

By dissections of 20 cold-preserved hands, we investigated the dorsal metacarpal arteries (DMA) with regard to reliability, origin and anastomoses. The first dorsal metacarpal artery showed a trifurcation with three vessels: Ramus ulnaris (A. metacarpalis dorsalis I), Ramus medialis and Ramus radialis (A.

Callus distraction in the hand skeleton.

From 1992 to 1996, 27 patients with traumatic amputations or malformations underwent lengthening of thumb and fingers. A total of 36 procedures were carried out. In several cases, deepening of the web space or bone transplantations proved to be necessary to improve general function or to compensate for missing bone structure.

[Intercarpal and radiocarpal resection arthroplasty and arthrodesis].

Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBOCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis.

Intercarpal and radiocarpal resection arthroplasty and arthrodesis.

Indications for intercarpal and radiocarpal resectionarthroplasty and fusions are osteoarthritis, KIEHNBÖCK'S disease, rheumatoid arthritis and several posttraumatic disorders of the wrist joint. The resection of carpal bones leads to severe instability patterns of the wrist. In conclusion we recommend resection-arthroplasty just for treatment of the thumb carpo-metacarpal osteoarthritis.

[Persistent scaphoid pseudarthrosis after surgical treatment: results of repeated bone transplantation].

From 1984 to 1993, 30 patients with persistent scaphoid non-union despite bone grafting procedures underwent additional reconstructive surgery. Twenty-five patients were followed-up between one and eleven years after revision with a mean follow-up time of 4.8 years.

[Comparison of various evaluation measures for assessment of treatment success after scaphoid injuries].

Different evaluation scores have been developed in order to assess treatment outcome of carpal injuries. The available scores are not comparable and differ in type and number of parameters. This is a retrospective study of 100 patients who presented with a fracture or a pseudarthrosis of the scaphoid from 1983 to 1997.

[Management and after-care of extensor tendon injuries of the hand].

The investigation and management of extensor tendons play a minor role compared to those of flexor tendons. The finger extension does not seem to be as important as the flexion. But the practical value of the hand is determined by both.

[Surgical treatment of scaphoid pseudarthrosis--long term outcome with the Herbert screws].

Between 1984 and 1993, 131 scaphoid nonunions were treated with iliac crest bone grafting and the Herbert-screw. 105 patients were followed between one and ten years with an average followup period of 4.5 years.

[Possibilities of preliminary treatment of infected soft tissue defects by vacuum sealing and PVA foam].

The vacuum sealing technique is a simple and cost-effective method in the treatment of traumatic and chronic soft-tissue defects. Wound cavities are filled with polyvinyl alcohol foam with embedded drainage tubes. The tubes are either drawn transcutaneously through the tissue, or placed epicutaneously, depending on the condition of the wound.

Ilizarov distraction-lengthening in congenital anomalies of the upper limb.

Nine patients underwent Ilizarov distraction-lengthening for congenital anomalies. All were late cases and had undergone other procedures. In five radial club hand patients with very short forearms, we achieved an average 5.

[The supinator syndrome].

Background: The posterior interosseous nerve syndrome is a rare compression neuropathy of the upper limb, which must be differentiated from tennis elbow. The aim of our study is to show etiology, symptoms, and diagnostic methods, and to illustrate the common operative techniques.

Patients And Methods: We examined retrospectively all patients of the Department for Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg, who underwent operative treatment because of posterior interosseous nerve syndrome between 1984 and 1992.

[Reconstruction of thumb through continuous lengthening of the first metacarpus.].

Goal Of Surgery: Reconstruction of the amputated thumb through continuous distraction with an Ilizarov ring fixator.

Indications: Traumatic loss of thumb at the level of the proximal half of the proximal phalanx.

Contraindications: Insufficient soft tissue coverage of stump.

[Results of interphalangeal joint arthrolysis in patients with Dupuytren disease].

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.

[A rare case of metastasis of urinary bladder carcinoma in the pisiform bone. A case report].

Metastases to the hand are rare. The incidence of secondary tumors in the hand is about 0.15%.