[Diagnosis and therapy of carpal tunnel syndrome--guideline of the German Societies of Handsurgery, Neurosurgery, Neurology, Orthopaedics, Clinical Neurophysiology and Functional Imaging, Plastic, Reconstructive and Aesthetic Surgery, and Surgery for Traumatology].

Evidence-based supradisciplinary guideline that deals with the epidemiology, pathogenesis, symptoms, clinical and electrophysiological diagnosis, supplementary imaging investigations, differential diagnosis, conservative and surgical treatments, prognosis and course along with complications and revision surgery. The recommendations on investigation and treatment are based on a comprehensive literature search with critical evaluation and two consensus methods (expert group and Delphi technique) within the participating specialist societies. Besides this long version, a short version and a patient version can be viewed through the AWMF platform.

Surgical treatment of the boutonnière deformity.

Objective: Complete restoration of extensor function.

Indications: Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function.

Contraindications: Contracture of the PIP.

[Lipoma as a rare cause of nerve compression syndrome in the hand and forearm].

We report on three patients who were operated on peripheral nerve compression syndromes in the hand and forearm caused by a lipoma. After surgical removal of the lipoma, distinct improvement or even recovery of symptoms was observed.

[Acute perilunar dislocations: algorithm for treatment].

In most cases, perilunar dislocations of the wrist are caused by high speed accidents. Usually these injuries occur by a fall on the dorsiflexed superextension of the hand. The instability caused by injuries of various erticular structures (ligament, bone) show various developmental stages.

Results of flexor tendon repair of the hand by the motion-stable wire suture by Towfigh.

We compared the motion-stable wire suture by Towfigh (MSWST) with a modified Kessler suture (MKS) by following up flexor tendon repairs (MSWST, n = 21/39 digits; MKS, n = 20/31 digits). For MSWST we found 31 (79.5%) "excellent", 3 (7.

[Hypercalcinosis of the hands in scleroderma. 2 case reports].

Hypercalcinosis of the hand in association with scleroderma represents a rare and benign soft-tissue calcification. Reported are two cases of symmetric affection of soft-tissue layers of both hands in association with scleroderma. Superinfection and exulcerations necessitated surgical treatment.

[Results of treatment after conservative and surgical management of proximal humerus fractures].

The proximal fracture of the humerus is still the domain of conservative treatment. In 80% of our patients the humerus fracture was not operated. The remaining 20% were treated surgically.

[Late results after surgical and conservative treatment of capsule ligament injuries of the finger joints].

Late results following operative and conservative treatment of 215 ligamentous injuries with injured metacarpophalangeal and interphalangeal joints are presented. These 215 cases represent 77,4% of all hand injuries which were treated in the years 1976 to 1981 at the Traumatological Department of Essen University. Mobility, stability, and function were used to evaluate and compare the late results.

[The treatment of deep hand infections].

Thirty patients with deep infections of the hand presented between 1982 and 1986 in our Department of Traumatology. Twenty infections were caused by neglected cut- or stab-wounds or animal bite injuries. Mostly Staphylococci or Streptococci were isolated from the wound culture.

[Aneurysms. A rare cause of ulnar nerve compression in the palm].

A case of an aneurysmatic dilatation of the ulnar artery with compression of the ulnar nerve in Guyon's canal is described. The etiology, symptomatology, and therapy are illustrated. Acute or chronic trauma in the hypothenar eminence caused pain not only here but also in the ulnar side of the hand with paraesthesia in the ulnar region.

[Carpal tunnel syndrome].

The carpal tunnel syndrome is the most frequent entrapment syndrome of peripheral nerves. Either a diminution of the volume of the whole carpal tunnel or increasement of the intracarpal structures can enhance the pressure on the median nerve and so develop a carpal tunnel syndrome. Fibrosis or thickening of the synovia of the wrist joint is the most common cause of the syndrome, that appears usually in women more than 50 years old.

[Genuine diffuse phlebectasias of the hand. Symptoms, differential diagnosis and case description].

A case is described of diffuse idiopathic phlebectasia and its clinical symptoms; dilatation of veins were located in superficial and deep systems. The arteries had no changes. Genuine diffuse phlebectasia must be differentiated from phlebarteriectasia and cirsoid angioma.

[Acute ischemia of the limbs caused by concomitant vascular injury in proximal shaft fractures with soft tissue damage].

Combined skeleto-vascular lesions of the proximal parts of the extremities endanger not only the limb but also life. Operative treatment has to be carried out as soon as possible. Stabilisation of the fracture has priority over vascular reconstruction.

[Irreducible dislocation of the metacarpophalangeal joint of the index finger].

Complete dorsal dislocation of the metacarpophalangeal joint of the index finger is rare and closed reduction of this peculiar dislocation is usually impossible. The injury is produced by striking of the outstretched index against a resistant object, usually in a fall on the hand. The base of the proximal phalanx is displaced over the dorsum of the metacarpal head.

[Reconstruction or arthrodesis following injuries of the wrist joint].

In fractures of the distal radius, standard operations including Kirschner-wire fixation, plating and fixation by external fixator may be carried out to restore the distal articular surface. Whereas the indication for Kirschner-wire osteosynthesis is limited, plating is used in irreducible fractures, in radius defects and in the case of a combination with fractures of carpal bones. In sprains and comminuted fractures the use of external fixator combined with Kirschner-wire and plating is the approved technique.

[Muscular rupture of the extensor pollicis longus].

Closed ruptures of the extensor pollicis longus tendon usually appear as a consequence of fractures of the wrist joint or the carpal bones or ensue from polyarthritic changes or result from a process of degeneration. Mechanical injury of the tendon is quite rare but can be observed after direct trauma or after operative treatment of a distal fracture of the radius. Closed traumatic ruptures of the extensor pollicis longus tendon in the absence of pathological changes are--in spite of the frequency of rotation injuries of the forearm--very rare.

[Indications and results of plate osteosynthesis of the distal radius].

Plating of the distal radius is indicated in: a) flexion fractures, b) irreducible intraarticular fractures, c) unstable extraarticular extension fractures, d) chisel fractures of the radial styloid process and the navicular bone, e) correction osteotomies after defective bone healing. The paper presents the final results of 124 radial plate fixations. 73.

[Ergotism causing peripheral arterial occlusion in the hand].

Ergotamine is used today for the symptomatic treatment of migraine. It is known that the intake of ergotamine-containing medicaments in cases of migraine causes disturbance of the blood-flow to the peripheral arteries of the extremities. Most of these spastic occlusions are due to medicaments containing ergotamine tartrate.

[Muscle abnormalities on the back of the hand and their differentiation from soft-tissue tumors].

Anomalous muscles at the hand and forearm are described in several studies. They may be confused with ganglia or with other soft-tissue tumours. Two rare cases of atavistic muscles in the area of the back of the hand are described which caused intense pain of the wrist during some months.

[Isolated trapezium dislocation fracture after a serious traffic accident].

Fractures and luxations in the area of the carpal bones are in comparison with other fractures of the upper and lower extremities comparatively rare. Isolated fractures of luxations of the distal row of the carpal bones, by comparison with those of the proximal row, are still rarer incidents. Because of tight ligamentous unions between the carpal bones on the one hand and between the distal row of the carpal and the metacarpal bones on the other hand, a luxation or fracture is connected with a violent contusion or sprain.

[Primary repair of soft tissue injuries (author's transl)].

The primary treatment of an injured hand has great influence on later results, and also on secondary measures in reconstruction. In contrast to adults, children show a good healing of distal-pedicle flaps, after removal of fat and sparing the subdermal plexus. The choice of skin replacement must be made under careful consideration of site, function and the possibility of further measures for rehabilitation.