Arbeitsunfälle an der Hand

Trauma und Berufskrankheit - Bei einer Handverletzung ist neben der adäquaten operativen Versorgung die postoperative konservative Therapie für die Wiedererlangung der...     

Motorische Ersatzoperation bei Lähmung der Streckmuskulatur der Hand

Objective Restoration of extension of wrist and of the long fingers' metacarpophalangeal joints as well as of thumb abduction in patients with radial nerve palsy with the goal to improve hand function. Indications Irreparable damage of deep branch of radial nerve. As an additional procedure, after extensive interpositional nerve transplantation with uncertain prognosis. Request for speedy restoration of function. Loss of power of muscles innervated by radial nerve in instances of brachial plexus lesions after unsuccessful conservative or neurosurgical treatment. Contraindication Insufficient rehabilitation after conservative treatment or neurosurgical intervention. Inadequate passive motion of wrist or finger joints. Insufficient power of muscles innervated by median nerve. Lack of patient's cooperation and compliance. Surgical Technique Detachment of the flexor carpi ulnaris tendon from the pisiform bone, subcutaneous passage to the extensor digitorum communis tendons, and suturing to these tendons. Division of the palmaris longus tendon, and suturing to the extensor pollicis longus tendon. Results Between October 1997 and December 2001, we used this technique in twelve patients. Using the score of Haas, we obtained six excellent and six good results. The active wrist extension varied between 0° and 70° (average, 20°). The length of follow-up was between 3 and 48 months (mean, 14 months).     

Hautplastiken bei der Wiederherstellungscchirurgie der verletzten Hand — Indikation und Technik

Ohne ZusammenfassungMit 11 Textabbildungen     

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.     

Filetlappenplastiken als Möglichkeit der Defektrekonstruktion an der Hand

Fillet flaps offer an additional reconstruction opportunity for complex hand defects after trauma, burns, tumors or infections.This retrospective study elucidates the concept of fillet flaps and presents the results of an overall of 34 plastic surgical reconstructions of the hands in 31 patients. Pedicled axial pattern flaps were used predominantly, except 2 cross finger flaps.In 10 cases the defects were localized in the dorsal and in 9 cases in the palmar aspect of the hand. 14 finger defects and one of the ulnar hand were covered. Very few complications occured. In only 2 cases partial flap loss was observed. An additional wound infection required revision in one case. Another case was left to secondary healing.Prior to any amputation, possible use of spare parts for defect reconstruction should be considered as a matter of principle. Our data suggest that the concept of fillet flaps is suitable for the reconstruction of complex defects of the hands without additional donor site morbidity.     

Funktionelle und ästhetische Gesichtspunkte bei der Defektdeckung der Streckseite an Hand und distalem Unterarm mit freien Lappenplastiken

ZusammenfassungProblemstellung Die Defektdeckung funktionell wichtiger exponierter Strukturen an der Hand und am distalen Unterarm kann durch eine große Anzahl verschiedener freier Lappenplastiken erzielt werden. In der Literatur finden sich nur wenige Hinweise, welche Gewebekomponenten am besten zur Defektdeckung bezüglich Stabilität, Bildung eines Sehnengleitlagers, Erhalt einer gelenkübergreifenden Hautelastizität und ästhetischen Formbarkeit geeignet sind. Ziel dieser retrospektiven Studie war es, Funktion und Ästhetik von Faszien-, Haut- und Muskellappenplastiken zu vergleichen.Patienten und Methode Von 1994–2002 wurden an unserer Klinik 56 Patienten mit einer freien Lappenplastik zur Streckseite von Hand und Unterarm versorgt. Unter diesen waren 20 Patienten mit 21 freien Lappenplastiken, für die die Studienkriterien zutrafen und nachuntersucht werden konnten. In Abhängigkeit von der gewählten Lappenplastikart wurden die Patienten in 3 Gruppen eingeteilt: Die Gruppe 1 mit 8 Patienten erhielt Faszien-, in Gruppe 2 mit 8 Patienten kamen Haut- und bei der Gruppe 3 mit 5 Patienten Muskellappenplastiken zur Anwendung. Der mittlere Nachuntersuchungszeitraum betrug 50 (4–103) Monate. Die Patienten beantworteten den DASH-Fragebogen und den client satisfaction questionnaire (CSQ8). Das ästhetische und funktionelle Ergebnis wurde evaluiert.Ergebnisse Bezüglich der Handgelenk- und Fingerbeweglichkeit zeigten die Faszienlappenplastiken die deutlich besten Ergebnisse. Bei der Kraftmessung erreichten Faszien- und Hautlappenplastiken gleich gute Werte. Patienten mit Hautlappenplastiken erzielten die besten DASH-Werte. Hinsichtlich der ästhetischen Ergebnisse schnitten Faszien- und Hautlappenplastiken wesentlich besser als Muskellappenplastiken ab. Die Spendergebietsmorbidität war bei den Faszienlappenplastiken am geringsten und bei den Hautlappenplastiken am stärksten ausgeprägt.Schlussfolgerung Haut- und Faszienlappenplastiken zeigten die besten funktionellen und ästhetischen Ergebnisse. Faszienlappenplastiken hatten mit Abstand das beste ästhetische Resultat bezüglich der Empfängerstelle. Wir empfehlen die Verwendung von freien Faszien- bzw. Hautlappenplastiken zur Defektdeckung auf der Streckseite an Hand und distalem Unterarm als erste Wahl, aufgrund ihrer Vorteile in dieser Körperregion, die eine dünne und geschmeidige Deckung erfordert.     

Die Arthrodese des Hüftgelenkes bei der Behandlung der schweren einseitigen Arthrosis deformans

Ohne Zusammenfassung Mit 9 Textabbildungen (=19 Einzelbildern)     

Traumatische und degenerative Läsionen der Sehnen an der Hand

Tendon lesions are the second most common injury in the hand and therefore an important factor in orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons; nevertheless, also less frequent injuries such as damage to the functional system of tendon sheath and pulley or dull avulsions need to be considered. Besides the clinical examination, ultrasound and MRI have proven to be important diagnostic tools. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger "intrinsic" tendon healing to guarantee a good outcome.     

Botulinumtoxin A bei der Behandlung der infantilen Zerebralparese

Botulinum toxin A represents a significant development in the management of children and adolescents with spastic cerebral palsy. Prerequisites for an adequate result are a correct indication, an exact injection technique and an intensive post-treatment programme. Spastic muscle overactivity and the constant tendency of the involved muscles to shorten with growth cannot be treated by only one method. Therefore a multilevel approach and an integrated treatment schedule including plaster of Paris, orthoses and physiotherapy are currently the best ways to modify the disease process. The inclusion of objective clinical documentation techniques combined with 3-D instrumented gait analysis allows the determination of the indications more exactly and for monitoring the post-treatment results. If started early and correctly, this integrated management approach has the potential to modify the natural history of the disorder, and to reduce the frequency of later surgery.     

Der Fixateur externe zur Rekonstruktion der Fußstatik bei neurogenen Osteoarthropathien

The localization of neurogenic osteopathy in the hindfoot often results in deformities which cannot be corrected by conservative methods. Indications for operation are recurring ulcers, deep infection, and reduced stability with progressive deformity. The aim of this study was to ascertain whether external fixation enables reestablishment of foot stability even when the osteoarthropathic processes have not entirely ceased. A bilaterally mounted Hoffman 2 fixator was used for open repositioning and restabilization on 14 patients with osteoarthropathy of the hindfoot: 12 had diabetes mellitus and 13 had florid processes. Revision with axial correction was necessary in 2 patients. One underwent amputation according to Syme and received a prosthesis. Thirteen were completely remobilized: ten were fitted with an orthosis and three with a rigid orthopedic shoe. Complicated deformities of the hindfoot from neurogenic arthropathy can be satisfactorily restabilized in the edematous and demineralizing stages by surgery and the application of external fixation.     

Dicke Chance – die operative Behandlung der schweren Adipositas bei posttraumatischer Osteoarthrose

In times of plentiful nutrition an environmental advantage turns into a problem - obesity. Apart from an increase in morbidity and overall mortality the development of osteoarthrosis is well documented. Pre-arthrotic conditions may arise from trauma and can lead, depending on the pattern of injury, to full-blown arthrosis. The presence of obesity can play the role of a relevant progressive factor in this setting.Here we report about the case of an obese man (BMI 53.5 kg/m(2)), who suffered a fracture of the femoral head with acetabular participation (Pipkin IV) as well as a fracture of the tibial plateau. Operative management and rehabilitation were followed by gastric bypass surgery for weight reduction. The case is discussed with regard to the present literature.     

Bedeutung der Behandlung des linken Vorhofohrs bei Vorhofflimmern

The left atrial appendage (LAA) not only supports pressure and volume control functions but also entails a significant risk for stroke. Various techniques for LAA closure are currently utilized in the context of treatment of arrhythmia. Based on the results of recent studies interventional devices appear to be less reliable in terms of completeness of closure when compared to surgical methods, particularly in cases of certain anatomical configurations of the LAA. Surgical techniques for LAA resection are performed increasingly more often by minimally invasive approaches. Various single center publications of limited study sizes imply a reduced risk of stroke after LAA resection, which questions the need for long-term anticoagulation following the procedure. The prospective randomized LAA Occlusion Study (LAAOS) III, which will include data from 4700 patients with atrial fibrillation, aims to investigate the indications for LAA resection in terms of reduced risk of stroke.     

Grenzen der Rekonstruktion �C Prothesen

Fractures of the proximal humerus are common, particularly seen in elderly, female patients. Using open reduction and internal fixation good clinical results can be achieved in general. But even today not every problem has been solved in the treatment of proximal humeral fractures. Varus displaced fractures are particularly challenging, especially when the medial column is destroyed. Anatomical reduction of the humeral head and medial bone contact are crucial for a good surgical outcome. Otherwise a secondary varus collapse and/or an implant failure are predictable. Further challenges are the intra-articular fracture patterns, as well as fractures with an initial ischemic humeral head. The indications for prosthetic replacement are always present if an initially stable internal fixation could not be achieved. The reverse fracture prostheses represent an increasingly common treatment option; however, the indication should be reserved for the elderly over 75 years.     

Die Sp��l-Saug-Drainage zur Behandlung von Infektionen der Beugesehnenscheide an der Hand

Objective

Treatment of pyogenic flexor tenosynovitis within the osteofibrous channel of the thumb and finger by insertion of a closed irrigation system.

Indications

Pyogenic tenosynovitis of the flexor tendons of the hand.

Contraindications

Necrosis of the flexor tendons or flexor tendon sheath, gangrene of the finger, extensive loss of soft tissue.

Surgical technique

Insertion of a flexible irrigation catheter via a guide wire into the flexor tendon sheath and a vacuum suction drain into the finger or the palm of the hand. Extensive exploration of the flexor tendon sheath is not mandatory.

Postoperative management

On days 0?C3 continuous irrigation, on day 4 change of the irrigation catheter to suction, on day 5 removal of the irrigation catheter, on day 6 removal of the suction drain, on day 7 start of exercise. Irrigation volume: about 500?C1500?ml/24?h isotonic solution.

Results

Of 35?patients treated for flexor tenosynovitis by closed irrigation, 33?were reviewed. There were 19?male patients and 14?female patients. The average age at the time of surgery was 51 (8?C85)?years. Hospital stay was 8.9 (3?C26)?days on average. At the time of follow-up, the average grip strength was 84% (23?C163%) of the unaffected side. Pain at rest was 0.2 (0?C4), pain during exercise 1.2 (0?C8) on the analogue scale, the DASH score was 16.8 (0?C58) points. According to the rating system for flexor tendon function, there were one poor, one fair, five good, and 26 excellent results.     

Enzymatisches Débridement als Therapieoption bei tiefdermalen Verbrennungen der Hand

Die Unfallchirurgie - Die Hände sind als exponierte Körperareale häufig bei Brandverletzungen und thermischen Schädigungen anderer Genese betroffen. Eine große Rolle...     

Rezidivierende Lungenembolien bei Aneurysma der Vena poplitea

Aneurysms of the popliteal vein usually occur within the context of angiodysplastic syndromes. The first symptom of an isolated aneurysm may be pulmonary embolism. Recurrent pulmonary embolism without thrombophilia requires more specific diagnostics.The rate of recurrent pulmonary embolism is high when no therapy is applied. Surgical treatment results in healing.     

Die Arterektomie bei schweren arteriellen Verschlußerkrankungen der unteren Gliedmaßen

Zusammenfassung Die Arterektomie dient der Unterbrechung vegetativer (und sensibler) in der Gefäßwand selbst und in der gemeinsamen Gefäßscheide verlaufender Nervenbahnen.Die Arterektomie stellt einen wichtigen Zweiteingriff nach vorausgegangener Sympathektomie dar, weil sie auf anderen Wegen als die Sympathektomie zusätzliche Gefäßerweiterungen in der Peripherie und auch Unterbrechung zentripetaler Schmerzreizleitungen bewirkt.Der Vorteil einer zeitlichen Nachordnung der Arterektomie nach der Sympathektomie wird durch die Ergebnisstatistik und klinische Beispiele belegt und nachgewiesen,daß bei der Alternative Amputation oder Arterektomie noch zahlreiche Kranke, zum Teil sogar auf Lebenszeit — vor einem Gliedverlust bewahrt werden konnten.Mit 4 Textabbildungen     

Biomechanische Aspekte radikaler Resektionen und deren Rekonstruktion an der thorakolumbalen Wirbels?ule

The total number of spinal tumors has increased over the past decade. However, the average survival time of tumor patients has increased due to improvements in the multidisciplinary treatment regimes. Therefore, radical tumor resection and complex reconstruction were developed in spinal surgery. Various reconstructive options for the throracolumbar spine are nowadays available and are depicted in this article. The success of complex reconstructive surgery relies on biomechanical principles and reconstruction is dependent on the size and location of the lesion, bone porosity and implant systems used. Special emphasis of this article focuses on en bloc vertebrectomy which is the most radical approach of spinal tumor surgery. The biomechanical aspects of different types of lesions and the reconstructive options are discussed in the context of the currently published literature.