Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen
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Handchir Mikrochir Plast Chir · Oct 2011
Randomized Controlled Trial Comparative Study[Resection, interposition and suspension arthroplasty for treatment of Basal joint arthritis of the thumb: a randomized and prospective comparison of techniques using the abductor pollicis longus- and the flexor carpi radialis tendon].
The operative treatment of thumb carpometacarpal joint arthritis may include resection-suspension-interposition-arthroplasty. Although quite a technically demanding procedure, a suspension arthroplasty using a strip of the flexor carpi radialis tendon is quite a popular technique. Other techniques, which use the abductor pollicis longus (APL) tendon, is also widely accepted. ⋯ After 8 months both groups had comparable subjective results (APL-group: VAS 2.3 points, DASH 24 points; FCR-group: VAS 1.9 points, DASH 20 points) as well as functional results (APL-group: radial abduction 55.3°, key-grip strength 8.1 kg, pinch-grip strength 5.5 kg; FCR-group: radial abduction 55.8°, key-grip strength 7.2 kg, pinch-grip strength 4.7 kg). Radiologically both groups showed an approximate 50% reduction in the height of the trapezial space. In resection-suspension-interposition-arthroplasty of the 1st CMC joint, similar results can be obtained using the technically less demanding APL-procedure when compared with the FCR-technique 8 months postoperatively.
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Handchir Mikrochir Plast Chir · Jun 2011
Review Case Reports[Coronal fracture dislocation of the hamate and the base of the fourth metacarpal bone: a rare form of carpometacarpal injury].
Fractures of the hamate body and the base of the fourth metacarpal bone in the coronal plane with or without a dislocation of the base of the fifth metacarpal bone are rare. Clenched fist punches are considered to be the main cause. The diagnosis of the fracture dislocation is often missed on routine radiographs. ⋯ Screw or K-wire fixation with postoperative cast immobilisation for 6 weeks and consecutive hardware removal has been found to result in excellent clinical and radiological outcomes. This study presents 2 cases of coronal fractures of the body of the hamate and the base of the fourth metacarpal bone with subluxation of the hamatometacarpal V joint. Anatomy, epidemiology, classification, mechanism, clinical symptoms, diagnostic features, and therapy options for these injuries are discussed.
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Handchir Mikrochir Plast Chir · Jun 2011
[Assessment of force patterns of different primary grips through dynamic force measurement using a sensor glove].
The present study analyses force distribution patterns during primary grips. 10 subjects were examined using the TUB-sensor glove, which was equipped with 10 pressure sensors. 5 proximal sensors at the MCP joints and 5 distal sensors at the DIP joints were attached palmarly. 9 different gripping motions were examined: the cylinder grip using 4 different objects, the pinch grip and 4 different kinds of precision grips. The force distribution patterns can be clearly divided into 2 groups. On the one hand there are the "power grips", in which the force is distributed over the proximal and distal sensors. ⋯ At the small finger the distal sensor is already dominant during the "power grips" of smaller objects. The thumb plays a subordinate role during the "power grip" of smaller objects, since these grips are similar to the "closing fist motion" and the objects can be held between the fingers and the palm of the hand. However, with increasing object sizes the thumb gains more importance, since its opposing movement is now required to accomplish the grip.
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Most cases of obstetrical brachial plexus palsies are mild traction injuries which resolve under physical therapy within several weeks or months. Severe ruptures or avulsion injuries of the plexus can lead to lifelong impairment of the upper extremities. Hence, in severe brachial plexus injuries the indications for brachial plexus reconstruction should be evaluated, early. ⋯ Because of its good adjustment options, the use of low temperature thermoplastic is steadily increasing. This contribution presents an overview of our currently used splints, new technical developments in our experience with more than 200 patients with obstetrical brachial plexus palsy. We present our experience with the most common splints for the use in fixation after birth-related brachial plexus surgery, subscapularis release, trapezius muscle transfer and functional improvement of hands with a lack of wrist extension.