Eine künstliche Hand

Ohne Zusammenfassung (Mit 2 Abbildungen.)     

Hand Surgery in the next millennium

新的千年预示着更大的进步和希望。新观点和新技术的引入，将对未来的手外科学产生巨大的影响。(1)　生物相容性物质的进展　新的移植物如假关节有诸多优点，如生物相容性、稳定性、活动性好，更个体化，更快整合以利于早期活动。骨折内固定物具有可吸收性而无须取出。骨替代物含有特异的生长因子，能定时释放促进血管的长入。(2)　非侵入性或低侵入性手术的广泛应用　如关节镜变得更小而影像质量更高，手术入路日趋变小，小切口手术的适应证日渐扩大。(3)　安全的异体移植　由于免疫排异反应的控制，异体组合组织、部分或全部肢体移植将很安全。(4)　骨、肌腱、神经和复合组织的组织工程再造　随着人类基因解码，可以利用自体干细胞“建造”人体任何组织，这些合成物因与受体在基因上完全相同而不存在免疫排斥问题。(5)　患者个体化计算机模型的应用　利用患者个体化计算机模型，可模拟各种手术并评价其效果，以选择最佳术式。(6)　信息技术的应用　利用其来获取知识，甚至可随时查询出某一特定病例的治疗方案。(7)　计算机辅助下的外科教育和培训　利用计算机辅助模拟系统，如三维实时外科模拟器来学习、训练及评价外科手术技术。(8)　虚拟现实在手术中的应用　随着计算机处理能力和速度的大幅度提高，可将任何数字化的影像转成实时虚拟现实，使手外科医生能在术中看到任何解剖结构，使手术更精确，并避免发生副损伤。新世纪手外科专家真正的将来不在于上述技术的进展，而在于现在这一代手外科专家去吸引最优秀最聪明的大学生、医学生和住院医生去学习这个专业，这可通过手外科领导的模范作用来实现。正如爱因斯坦所说树立榜样不是影响他人的主要方式，而是唯一方式。     

Intramuskuläre Angiome der Hand

Intramuscular angiomas are rare vascular tumors with locally aggressive growth between the fibers of muscle. A malignant aspect poses a danger for the function of the hand.We report the case of a 32-year-old woman with a painless tumor in the thenar. Physical examination showed a 2 x 3 x 5 cm fixed and engorged swelling. Perfusion and sensibility were intact. The flexion and opposition of the thumb were reduced. CAT showed a tumor of the thenar with a solid structure with signal enhancement after administration of contrast medium. Histologic examination after local resection showed an intramuscular angioma.Intramuscular angiomas have a malignant aspect because of the rapid and infiltrative growth followed by functional impairment, pain, and deformity. A high rate of recurrence is described. Thus, radical excision is indicated.     

Hand surface area--do racial differences exist?

The patient's own palm is used as a template in assessing small patchy burns and is traditionally believed to be 1% of body surface area. This does alter with the patient's age, sex and BMI and there have been suggestions that it can also differ between ethnic groups. We undertook this study to see if there were any differences in the hand surface area between Caucasians, Orientals and Asians. It was done by tracing the hand outline and calculating the surface area. The study showed that there was no significant difference between the three ethnic groups in terms of hand surface area.     

Primärversorgung von Sehnenverletzungen der Hand

Tendon injuries of the hand are common and their treatment is surgically challenging. Precise knowledge of the anatomy of the extensor and flexor tendons in the hand is necessary to be able to perform a detailed clinical examination and to estimate adequately the extent of injury. Depending on the injury pattern, various conservative and surgical treatment options must be considered. Concerning the overall concept of the supply of tendon injuries of the hand, follow-up treatment is crucial to achieve an optimal functional outcome. It should be noted, however, that the results are influenced by the following: extent of the injury, mechanism, exact anatomical location, associated injuries, and finally the participation of the patient in the follow-up treatment.     

Referring Physicians’ Knowledge of Hand Surgery

Hand surgeons rely on referrals from general providers. Appropriate referral is dependent upon referring physicians having an understanding of the problem and available treatments. This study evaluates the referring physicians’ knowledge and perceptions of basic hand problems and their treatment. This study also evaluates the impact of a brief lecture on our referring physicians’ understanding of hand issues. A survey instrument was administered to referring physicians. The instrument addressed general hand knowledge and perceptions toward hand surgery. The physicians also attended a lecture on general hand problems and their treatments. The survey was repeated 2 weeks post-lecture. Subjects had a pre-lecture knowledge score of 65% correct and post-lecture a score of 85%, p < 0.05. The participants were knowledgeable about common hand problems, such as carpal tunnel syndrome. Knowledge gaps did exist, for example, only 37% recognized the symptoms of basilar thumb arthritis. Initially, the referring physicians had less positive views about surgical interventions, such as surgery to help the pain of basilar thumb arthritis. After the lecture, the responders had significantly more favorable attitudes toward surgery. This study found that referring physicians had variable knowledge about common hand problems, and they had doubts relating to the efficacy of some hand surgeries. This study also found that a directed lecture improved these providers’ knowledge and their perceptions of hand surgical interventions. Hand surgeons can improve their referring physicians understanding and perceptions of hand surgery through a directed grand rounds type lecture.     

Die enchondral-dysostotische Hand im Röntgenbild

Ohne ZusammenfassungMit 28 Textabbildungen (32 Einzelbilder)     

Hand transplantation. A future clinical option?

Transplantation of a vascularized limb or its components is defined as composite tissue allotransplantation, and is one of the newest areas in surgery. To date, 24 hands have been transplanted onto 18 recipients. The initial results have been promising, and hand transplantation may become an important procedure for functional restoration of upper limbs. However, the ethical aspects of using chronic immunosuppression for a condition which is not life threatening have been the subject of debate. In this article, we review the field of composite tissue allotransplantation.     

Hand surgery in China：advances and prospects

Limb(finger)replantaion China has been in the lead in this field for thepast 30 years.The major achievements include: 1.Replantation has been succeeded not only inyoung adults,but in very young and very aged patientsas well.Digital replantation in a seven-month-old babyand replantation of completely severed limb after rotato-ry avulsion in an eighty-six-year-old patient is theyoungest and oldest successful case.     

Prim?rversorgung komplizierter Beugesehnenverletzungen an der Hand

Complicated flexor tendon injuries are classified into lacerations, avulsions, ruptures, and defects. They are often a challenge for hand surgeons and frequently they present unsatisfactory functional results postoperatively. Lacerations and avulsions are usually treated by pull-out sutures and suture anchors. In ruptures, the causality should be sought. Tendon-linking, transposition and tenodesis/arthrodesis are the domain of rheumatoid arthritis. The primary transplantation of tendons is rarely indicated, ideally in non-contaminated flexor tendon defects in zones III-V with an uninjured surrounding soft tissue situation. Postoperative rehabilitation programs are very the same as in normal flexor tendon injuries.     

Ulnar Styloid Fracture Accompanying Distal Radius Fracture Does Not Affect Hand Function,but What About Hand Dexterity?

Introduction  Hand dexterity is not addressed in patients with distal radius fracture (DRF) accompanied with ulnar styloid fracture (USF) in literature. This study aimed to determine whether an associated USF following a DRF has any effect on hand dexterity. Materials and Methods  Patients diagnosed with DRF were included in the study and were divided into two groups according to the USF presence (USF group and non-USF group). Pain, range of motion, Quick-DASH (Quick-Disabilities of the Arm, Shoulder, and Hand), handgrip and pinch strength, Purdue Pegboard test, and Jebsen Taylor Hand Function test were measured in the sixth month. Results  A total of 125 patients, 68 females (54.4%) and 57 males (45.6%) were included in the study. The mean age of the patients was 47.15 ± 13.41 (18–65) years. There were 60 patients (48%) in the USF group and 65 patients (52%) in the non-USF group. No significant difference was found in pain, range of motion, Quick-DASH and handgrip and pinch strength between the groups ( p > 0.05). The hand dexterity tests showed no statistically significant difference between the groups in the sixth month ( p > 0.05). Discussion  Hand function can be determined more accurately by assessing hand dexterity. In this study, it is emphasized that concomitant USF does not lead to poorer hand dexterity.     

Europäische Hand Trauma Center der FESSH

DGH-Mitteilungen

Europ?ische Hand Trauma Center der FESSH     

Multiple symmetrische Synostosen an Hand und Fuß

Zusammenfassung Bericht über 2 Fälle von symmetrischen Synostosierungen von Hand- und Fußwurzelknochen, vergesellschaftet in einem Falle mit einer Subluxation des Radiusköpfchens, im anderen Falle mit einer Anlage zur Subluxation sowie in beiden Fällen mit geringer Bewegungsminderung der Schultergelenke. Erörterungen über die Entstehungsart, Klinik und Behandlung der Veränderungen.Mit 6 Textabbildungen (8 Einzelbilder).     

Volkmannsche und lokale ischämische Kontrakturen der Hand

Ohne Zusammenfassung