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U Lanz

Publications and source records attributed to U Lanz.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Reconstruction of the ruptured extensor pollicis longus tendon using a tendon interposition graft].

To restore function of the ruptured extensor pollicis longus (EPL) tendon, two operative principles have been described: reconstruction of the original tendon using a tendon interposition graft or a tendon transposition operation, most commonly transposition of the extensor indicis. From 1992 to 1998, we reconstructed the extensor pollicis longus tendon using an interposition graft in 58 patients. 48 patients were available for follow-up after a mean of 31 months. The mean age of the 25 women and 23 men was 49 years. The time between tendon rupture and reconstruction ranged from one to 40 weeks. The tendon rupture occurred in 19 patients following a radius fracture, in 22 patients without history of trauma and in seven patients it was due to a sharp injury. Using the clinical score of Geldmacher and Köckerling, five patients achieved a very good, 35 patients a good and eight patients a satisfactory result. No patient had a poor result. According to the statistical analyses, these results were independent of the age of the patients, the origin of the rupture or the time interval between rupture and tendon reconstruction. The average DASH score measured 14. Considering our results, secondary reconstruction of the original EPL tendon appears to be a valuable alternative to the commonly performed tendon transpositions. It yields good clinical results with little remaining functional impairment and without the need to sacrifice another functional motor. We strongly recommend this technique in patients who require an independent and strong extension of the index finger in their profession (surgeons, musicians) and in patients with severe trauma that does not allow the sacrifice of another intact motor unit.

Adolescent↗
PubMed2002

[Partial Fusion of the wrist - an alternative procedure to the total wrist arthrodesis].

Despite the important observations that have been made concerning biomechanics and function of the wrist joint in recent years, the surgeon is still confronted with a huge number of delayed posttraumatic disorders of this joint. In the past, total wrist fusion was the leading salvage procedure, whereas today several salvage procedures are available to solve these problems. Partial wrist fusions are supposed to stabilize the carpus, immobilize destroyed articulating surfaces while allowing motion in the unharmed parts of the wrist. Acknowledging pathobiomechanical laws, they have been used for a growing number of indications with a large benefit. The patients profit of better functional results than can be observed in patients with total arthrodesis of the wrist. Furthermore, partial wrist fusion provides a more stable situation and the absence of pain for a longer period of time. However, further studies evaluating the clinical outcome of these salvage procedures are necessary and to be expected in the near future.

Arthrodesis↗
PubMed2002

[Severe contracture of the proximal interphalangeal joint in Dupuytren's disease: does capsuloligamentous release improve outcome?].

Purpose. Evaluation of effectiveness of capsuloligamentous release in severe PIP joint contractures in Dupuytren's disease. Method. Prospective study to compare the clinical outcome of eleven patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom an additional capsulotomy was performed to reduce a residual flexion contracture of the PIP joint of 20 degree and more after release and excision of all diseased fascia, with the outcome of 32 patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom the PIP joint contracture could be reduced by fasciectomy alone. Preoperatively all patients had a severe flexion contracture (60 degrees or greater) of one PIP joint. All patients underwent standardized operative treatment and postoperative extension splinting program for six months. Follow-up examinations included assessment of active range of motion at two, four, ten, 16 and 24 weeks after surgery. Results. In the noncapsulotomy group, preoperative contracture averaged 70.6 degrees and intraoperative residual contracture averaged 2 degrees. In the capsulotomy group, preoperative contracture averaged 78.6 degrees. Intraoperative residual contracture averaged 61.8 degrees before and 2 degrees after capsulotomy. At the final follow-up examination, PIP joint flexion contracture averaged 15 degrees in the noncapsulotomy group compared to 16 degrees in the capsulotomy group. Conclusion. Residual flexion contracture of a PIP joint after release and excision of all diseased fascia in Dupuytren's disease can be reduced by capsuloligamentous release. The data of this study showed no significant differences in the outcome at the final follow-up examination between patients with and without capsulotomy. Therefore, we recommend capsulotomy as treatment of residual flexion contracture of the PIP joint in Dupuytren's disease.

Adult↗
PubMed2002

[Preoperative Intermittent Pneumatic Soft-Tissue Distraction in Patients with severe Dupuytren's Contracture].

PURPOSE: Evaluation of the outcome of preoperative intermittent pneumatic soft tissue distraction (IPD) in patients with severe contractures in Dupuytren's disease with special regards on recurrent deformities. METHOD: In a prospective study, nine patients with Dupuytren's contracture grade III and IV according to the classification of Tubiana were treated with a preoperative intermittent soft-tissue distraction using a pneumatic extension device followed by a standardized operative correction and follow-up program. Sixteen fingers were involved: grade I and II four fingers, grade III and IV twelve fingers. Nine fingers - grade III and IV seven fingers - in six patients had a recurrent deformity. RESULTS: The preoperative reduction of contracture simplifies the surgical treatment. Preoperatively using the IPD, the flexion contracture was reduced between 5 and 60 degrees. With an average of 29 (10 to 60) degrees, the improvement was greater in fingers with severe contracture (grade III and IV according to Tubiana) than in fingers with a minor contracture averaging 10 (5 to 25) degrees. In fingers with recurrent deformity, the reduction of the flexion contracture averaged 27 (5 to 60) degrees. There were no complications leading to break off of the distraction. CONCLUSION: The intermittent pneumatic distraction is a good alternative to the method introduced by Messina for preoperative soft-tissue distraction in patients with severe Dupuytren's contracture.

Aged↗
PubMed2002

[Scapholunate dissociation: treatment by dorsal capsulodesis].

Between December 1994 and December 1996, 26 patients with a scapholunate ligament injury (three with SLD 1. degrees, 16 with SLD 2. degrees and 7 with SLD 3. degrees ) underwent an operation for dorsal capsulodesis in the Klinik für Handchirurgie, Bad Neustadt/Saale. Mean follow-up was 24 months (16 to 37 months). Follow-up criteria were range of motion, grip strength, pain relief, and X-ray findings. Clinical outcome was evaluated using a personal questionnaire, the DASH- and a modified Cooney-Score. Although significant reduction of joint mobility compared to the opposite site was found in all cases (E/F 32 %, U/R 19 %), the reduction of pain was 30 %. Grip-strength was not altered. Thus, 86 % of the patients were satisfied with the result obtained. On X-ray, the scapholunate angle was raised in the SLD 3. degrees -group by 12 degrees postoperatively; in the group with dynamic instability, X-ray findings were normal. Overall, 19 % (5/26) needed further operations due to persistent pain.

Adult↗
PubMed2001

[Treatment of 3rd degree fingertip frostbite in a mountain climber with semi-occlusive dressings].

Deep frostbites of the fingertips mostly result in some form of amputation. To preserve functional length and to achieve good sensibility, we managed deep frostbites of five fingertips of a mountain climber with semiocclusive dressings. The method was described by Mennen and Wiese (1993) for the management of fingertip injuries. To our knowledge, the method has not been used so far in the treatment of frostbites. The two fingertips presenting only deep soft-tissue damage achieved a nearly normal recovery of pulp shape and sensibility. The three fingers with bone involvement required a long period of time for complete healing. In two of these fingers, additional bone shortening had to be performed.

Finger Injuries↗
PubMed2000

[Indication and results of ulna shortening osteotomy in ulnocarpal wrist joint pain].

The ulnar impaction syndrome is proven to be a common source of ulnar sided wrist pain. Ulna-shortening osteotomy represents a successful therapy for this kind of problem, both congenital or posttraumatic positive ulnar variance. Positive variance resulting from a distal radius fracture needs correct dorsal and radial angulation of the radius. In case of congenital positive variance arthroscopic debridement for decompression of the TFCC should be performed first. The adequate correction of the length is the major problem. Disorders of the distal radioulnar joint may result due to overcorrection. Oblique osteotomy using 7-hole-plates is our preferred treatment.

Adult↗
PubMed2000

[Post-traumatic carpal collapse. Follow-up and therapeutic concept].

Significant progress has been made in the understanding of carpal kinematics and posttraumatic disorders of the wrist. The importance of stabilization of the scaphoid is well known. More and more ligament injuries of the proximal carpal row have been diagnosed in cases of severe arthrotic changes. Long-standing scaphoid nounion or scapholunate ligament injuries can lead to progressive carpal collapse due to a break of the continuity of the proximal carpal row. SLAC-wrist (scapholunate advanced collapse) and SNAC-wrist (scaphoid nonunion advanced collapse) after missed fusion of scaphoid fractures should be differentiated. Severity of degenerative changes is classified into three stages. Salvage procedures preserving wrist mobility, like midcarpal fusion, are preferable to total wrist fusion because of the functional benefit. With complete excision of the scaphoid and fusion of the midcarpal joint, all arthritic joint surfaces are eliminated and motion is preserved in the radiolunate joint which is usually spared of degenerative changes.

Arthrodesis↗
PubMed2000

[Malunited fractures of the forearm during the growth period with special reference to the forearm longitudinal axis. Case reports].

Malunion of forearm fractures located in the distal third will remodel satisfactorily providing the child is less than twelve years of age. Complete correction of gross deformity cannot be anticipated in diaphysial fractures when the child is over five years of age. Malunion of fractures of the forearm in children can lead to permanent functional disability with limitation of forearm rotation. In the case of functional disability, there is an indication for corrective osteotomy at the age over twelve in malunion of a fracture located in the distal third and already after age five in gross deformity of fractures to the midshaft of the forearm.

Adolescent↗
PubMed2000

[Ischemic contractures of the forearm and hand].

This article gives an overview of anatomy, pathophysiology, aetiology, and diagnosis of the compartment syndrome and the resulting ischaemic necrosis of the upper extremity. The relation between compartment syndrome and infection is pointed out. Whereas the therapy of a manifest compartment syndrome is rather uniform consisting in decompression of the involved fascial compartment, the treatment of the ischaemic muscle necrosis is manifold. It depends upon severity and location of the disease. Only the mildest involvement can be treated by nonoperative measures. Surgically, neurolysis, excision of necrotic musculature and scar, muscular slide, elongating tenotomy, tendon transposition and free vascularized muscle transplantation have to be considered. Only the availability of all treatment options gives the surgeon the choice of treatment that fits the demands of the individual patient best.

Compartment Syndromes↗
PubMed2000

[Bone growth after finger replantation in childhood].

Following replantation in childhood, growth disorders of the affected epiphysis can influence function and aesthetic appearance of the hand. In a retrospective study long-term results of replantation in the upper limb in childhood were analysed with respect to factors influencing further growth. 22 patients with 29 replanted fingers were reviewed clinically and radiologically after an average interval of ten years. An average bone growth of 93% compared to the contralateral non-injured side was found. With the epiphysis affected, bone growth was reduced to 86% of the contralateral side. Analysis of single phalanges showed a growth rate of 71 to 100% in phalanges distal to the amputation and also in phalanges initially severed. Potential factors influencing bone growth were assessed separately. Best results were achieved in straight injuries without epiphyseal affection. An influence of anoxia time or number of anastomosed vessels could not be found. Even though replantation in childhood affects growing bone, almost normal bone growth can be expected afterwards.

Adolescent↗
PubMed1999

Patterns of subchondral bone mineralization in the wrist after midcarpal fusion.

Midcarpal fusion represents a salvage procedure in cases of advanced carpal collapse, which unloads the scaphoid compartment and redirects the load to the intact lunate compartment of the radiocarpal joint. The aim of this study was to obtain further information about the loading conditions in the living subject by evaluating the pattern of subchondral bone mineralization in patients who have undergone midcarpal fusion of the wrist. Between 4 and 42 months after the surgery, 9 male patients were examined by means of computed tomographic osteoabsorptiometry. All of them showed peak mineralization in the lunate fossa of the radius. Six patients had only one large density maximum in this fossa and no corresponding maximum in the scaphoid fossa. In accordance with our expectations, loading after midcarpal fusion was found to be transmitted mainly through the lunate compartment, a result that was observed even after as little as 4 months, and that thus confirmed subchondral bone mineralization as a valuable parameter for assessment of long-term stress distribution.

Absorptiometry, Photon↗
PubMed1999

[Dorsal intra-articular end-phalangeal fractures].

In a retrospective clinical study, thirty-six patients with a dorsal intraarticular fracture of the DIP-joint were examined. The fracture can be classified according to the size of the dorsal fragment as a mallet finger or as an intraarticular fracture with the tendency for dislocation. Subcutaneous tendon ruptures with a small dorsal fragment respond well to conservative treatment. Intraarticular fractures should be treated surgically. Anatomical reduction and joint stability are the treatment aims. In 21 patients, tension band wiring was performed, in eight cases percutaneous treatment with the "Hakendraht" was carried out.

Bone Wires↗
PubMed1999

[Results of corrective osteotomy of malunited extension fractures of the radius at the usual site].

BACKGROUND: There is an increasing interest in the corrective osteotomy for the malunited distal radius fracture. Already in the seventies we developed an operative technique for the correction of the malunited Colles' fracture. The technique is based on a special plate, which facilitates precise restoration of the angulation of the joint surface and the length of the radius. The purpose of our study is to investigate the results of our method and to compare them with results in the literature. PATIENTS AND METHODS: We examined retrospectively the patients with a malunited Colles' fracture corrected by our technique until August 1996. The investigated criteria were range of motion, grip strength, pain relief, and X-ray findings. RESULTS: Until August 1996, we have performed 124 corrective osteotomies for malunited Colles' fractures; 115 were carried out by our technique; 91 of them could be examined. The mean follow-up time was 4.5 years. The range of motion has improved in all planes, especially for flexion. Grip strength increased but still remained below the level of the opposite side. On X-ray, average dorsal tilt of the radiocarpal joint was 24 degrees preoperatively and was reduced to an almost normal palmar tilt of 7 degrees. Ulnar-plus variance was reduced from 6 mm to less than 1 mm. CONCLUSION: Corrective osteotomy of the distal radius is of great benefit and leads to improved hand function and diminished pain. The use of our special plate facilitates this ambitious operation considerably.

Adult↗
PubMed1999

[Morphological aspects of load bearing of the wrist joint after midcarpal partial arthrodesis].

Midcarpal fusion is a reliable treatment for advanced carpal collapse following scaphoid nonunion or scapholunate dissociation. It remains, however, unclear if the alignment of the fused carpal bones influences the redirection of load towards the lunate. The objective of this study was to assess the actual loading conditions after midcarpal fusion in patients by evaluating the patterns of subchondral bone mineralization in the distal articular surface of the radius. Nine patients, who were treated by midcarpal fusion with complete excision of the scaphoid, were examined after an average of 22 months postoperatively by means of CT osteoabsorptiometry. All patients showed peak mineralization in the lunate fossa of the distal articular surface of the radius. Six patients with correct carpal alignment had one large density maximum in the lunate fossa and none in the scaphoid fossa. Patients with incomplete correction of the radial translocation of the capitate, incomplete excision of the scaphoid, or incomplete correction of the extension position of the lunate, showed a second density maximum in the scaphoid fossa. These findings emphasize that a correct carpal alignment is necessary to achieve a complete unloading of the degeneratively altered scaphoid fossa.

Absorptiometry, Photon↗
PubMed1999

[Relocation of the median nerve after scarring along the carpal tunnel with hypothenar fatty tissue flap-plasty].

In our study, we present the data of eleven patients suffering from scarring of the median nerve, predominantly after open decompression of the carpal tunnel. Dysaesthesia in the palmar region and loss of grip strength prevented performing normal daily activities. All patients except one were relieved of the palmar discomfort and experienced an increase of grip strength allowing their return to work. The hypothenar fat flap has been shown to be a reliable source of local tissue to cover the median nerve. The sprouting of nerve fibers to the skin is prevented as well as median nerve readherence. We believe that the hypothenar fat flap provides sufficient regenerative conditions and coverage of the median nerve within the carpal tunnel in the surgical treatment of abundant scarring.

Adult↗
PubMed1999

[Bowers hemi-resection-interposition arthroplasty for treatment of post-traumatic arthrosis of the distal radio-ulnar joint after distal radius fractures].

UNLABELLED: Arthrosis of the distal radioulnar joint (DRUJ) is a common problem following fractures of the distal radius. The treatment options include the hemiresection-interposition technique (Bowers procedure) or Kapandji-Sauvé procedure. In a retrospective study, we assessed the results of the Bowers procedure. MATERIAL AND METHODS: From 1992 to 1997, 24 patients were treated by the hemiresection-interposition technique (Bowers procedure) for arthrosis of the DRUJ following fracture of the distal radius. The average follow-up time was 30.5 (9 to 55) months. RESULTS: The average preoperative pronation was 67 degrees, the supination 45 degrees. Postoperatively, we found a pronation of 80 degrees and a supination of 62 degrees. Grip-strength compared to the opposite site could be improved from 38 to 57% postoperatively. Pain was reduced markedly in 78% of the patients. However, ten patients developed a postoperative instability of the distal ulna. In only two patients did painful instability necessitate revision procedures. CONCLUSION: The hemiresection-interposition technique is a salvage procedure for the destroyed DRUJ, leading to good clinical results in most patients. Painful instability of the distal ulna and remaining functional deficits can be the reasons for failure. Therefore, adequate primary reduction of fractures of the distal radius or secondary reconstruction of the anatomy is necessary to prevent secondary arthrosis of the DRUJ.

Adult↗