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The "classical" resection-interpOS1tlon plasty was over decades the
only possibility for the reconstruction of joints at the upper
extremities and at the foot. Results are good at the elbow, wrist
and at the toe joints, they don't satisfy at the shoulder and at
the ankle joint. For the joints of the upper extremities
alloplastic methods were developed, too, using the durable and not
tissue damaging metall alloy Vitallium. Today these can stand a
competition with the classical arthroplasty. Also the homoplasty of
the joints of the upper extremities is reactivated nowadays. The
paper tries to show the different methods of arthroplasties at the
upper extremities and at the foot used today and to balance them.
Prof. Dr. H. MITTELMEIER Orthopadische Universitatsklinik 665
Homburg/Saar Landeskrankenhaus Literatur ALBEE, F. H.: Arthroplasty
of the elbow. J. Bone Jt Surg. 15,979 (1933). BRANDES, M.: Zur
operativen Therapie des Hallux valgus. Zbl. Chir. 56, 2434 (1929).
BRAV, E. H., McFADDIN, J. G., MULLER, J. A.: The replacement of
shaft defects of long bones by metallic prostheses. Amer. J. Surg.
95, 75 (1958). CAMPBELL, W. c.: Arthroplasty of the elbow. Ann.
Surg. 76, 615 (1922). CARR, C. R., HOWARD, J. W.: Metallic cap
replacement of radial head following fracture. West J. Surg. 59,
539-546 (1951). CLAYTON, M. L.: Surgery ofthelower extremity in
rheumatoid arthritis. J. Bone Jt Surg. 45A, 1517 (1963). EDEN, R.:
Zur Operation der habituellen Schulterluxation. Dtsch. Z. Chir.
144, 268 (1918)."
Some measures are absolutely essential during primary care of
injured hands in order to achieve primary healing (e. g., immediate
closure of the wounds), whereas under certain circumstances other
procedures may be endanger healing and should preferably be carried
out secondarily (e. g., suturing of tendons and nerves). The author
attempts to arrive at certain principles for the primary care of
severely injured hands. On the basis of examples the author
demonstrates in what manner the basis for sub- sequently necessary
reconstructive procedures is created by planned primary care. Both
procedures may be regarded as "reconstruction in two steps" and can
be ca, rried out without unnecessary loss of time. The technique of
dressing, type and duration of immobilization and follow-up
treatment are also factors for the achievement of a good functional
result. Dr. D. BUCK-GRAMCKO Handchirurg. Abteilung
Berufsgenossenschaftliches Unfallkrankenhaus 205 Hamburg 80,
Bergedorfer Strasse 10 N euere Operationstechniken in der
Beugesehnenchirurgie Von W. PIEPER Der Erfolg einer Beugesehnennaht
und Beugesehnenplastik im Verlaufe eines Fingers oder der Hand
hangt, wie wir wissen, davon ab, dass die Naht- stelle und das
Transplantat moeglichst narbenarm in das Sehnenlager ein- heilen.
Die Gefahr der Vernarbung besteht wahrend der fur die Heilung der
Sehnennahtstelle bzw. Einheilung des Sehnentransplantates
notwendigen dreiwoechigen Ruhigstellung. Erst nach dieser Zeit sind
die Sehne und das Tranplantat auf Zug und Dehnung fur die Bewegung
belastungsfahig.
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