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Zusammenfassung Hintergrund Mittelgliedbasisimpressionsfrakturen der Finger stellen aufgrund häufiger Subluxationen und der zentral imprimierten Fragmente ein Problem dar. Zwei minimalinvasive Verfahren stehen zur Verfügung: 1. die bisher wenig bekannte intramedulläre Aufstopfmethode nach Hintringer, 2. der verbreitete Distraktionsfixateur nach Suzuki. Ziel dieser Untersuchung ist der Vergleich der Behandlungsergebnisse beider Verfahren. Methoden Das nachuntersuchte Kollektiv umfasst 42 Patienten, bei denen operativ eine Mittelgliedbasisimpressionsfraktur versorgt wurde. Dabei erfolgte 28-mal eine intramedulläre Aufstopfung mit perkutaner Kirschner-Draht-Retention (Gruppe A) und 14-mal die Versorgung mittels Fixateur nach Suzuki (Gruppe B). Untersucht wurden die Funktion, das radiologische Ergebnis und die subjektiven Beschwerden. Ergebnisse Es zeigt sich, dass in Gruppe A nach Einteilung der „American Society for Surgery of the Hand“ (ASSH) 81 % der Patienten ein gutes Ergebnis erreichen, in Gruppe B hingegen 50 %. Für das Mittelgelenk ergeben sich im Median 82,5° Bewegungsumfang nach Aufstopfung und 47,5° nach Suzuki Anlage. Im Median konnte in der Gruppe A die Impression von 2,35 auf 0,5 mm reduziert werden, in Gruppe B hingegen nur von 1,6 auf 1,15 mm. Einschränkungen durch Schmerzen gaben in Gruppe A 2 von 28 Patienten an und in Gruppe B einer von 14. Diskussion Mit der Aufstopfmethode nach Hintringer lassen sich Mittelgliedbasisimpressionsfrakturen gut behandeln. Die dorsale Subluxation kann ausgeglichen werden, und zentral imprimierte Fragmente lassen sich besser reponieren und retinieren als mit dem Distraktionsfixateur. Darüber hinaus sind die radiologischen Verlaufskontrollen besser zu beurteilen als bei liegendem Distraktionsfixateur.

Beugesehnenverletzungen bei Kindern haben eine geringere Inzidenz als bei Erwachsenen. Die klinische Diagnosestellung bei Kindern erfordert ein hohes Mas an Erfahrung. Unversorgte Beugesehnenverletzungen fuhren zu Wachstumsstorungen des betroffenen Fingers. Entsprechend sollte bei offenen Verletzungen im Bereich der kindlichen Hand die Indikation zur operativen Exploration groszugig gestellt werden. Wie bei Erwachsenen ist die Notfallversorgung der verletzten Sehnen selten indiziert. Die verschiedenen Nahttechniken und Nachbehandlungsschemata werden in der Literatur unterschiedlich bewertet. Im Ulmer Algorithmus werden die Sehnen bei Kindern mit einer Kernnaht in Zweistrangtechnik und epitendinoser fortlaufender Naht versorgt. Bei Kindern unter 6 Jahren erfolgt eine 3-wochige postoperative Ruhigstellung der versorgten Hand mithilfe eines Faustverbandes. Kinder im Schulalter werden uber 5 Wochen dynamisch nach Kleinert nachbehandelt. Die Ergebnisse sind mit denen anderer Nachbehandlungsschemata vergleichbar.

Depressed fractures of the base of the middle phalanges are problematic because of frequent subluxations and centrally depressed fragments. There are two minimally invasive procedures available: 1) the less known intramedullary padding technique according to Hintringer and 2) the widely used distraction fixator of Suzuki. This article describes the technique and outcome of these two procedures.The follow-up collective included 42 patients after treatment of a depressed fracture of the base of the middle phalanx. An intramedullary padding with percutaneous Kirschner wire retention was performed 28 times (group A) and treatment with a Suzuki fixator 14 times (group B). The study examined the hand function, the radiological results and the subjective pain level.According to the American Society for Surgery of the Hand (ASSH) classification 81% of the patients in group A achieved a good result but in group B the same result was achieved by only 50% of the patients. The median range of movement in the proximal interphalangeal joint was 82.5° after intramedullary padding and 47.5° after Suzuki fixator. In median, the impression was reduced from 2.35 mm to 0.5 mm in group A, but only from 1.6 mm to 1.15 mm in group B. Pain was a limiting factor in 2 out of 28 patients in group A and 1 out of 14 patients in group B.The intramedullary padding technique according to Hintringer enables good treatment of depressed fractures of the base of the middle phalanx of the finger. Repositioning of dorsal subluxations can be performed and centrally impressed fragments can be reduced better than by using the Suzuki dynamic fixator. In addition, the radiological course assessments can be assessed better than with the distraction fixator.

Injuries to the flexor tendons in children are less common than in adults. The clinical examination and diagnostics require extensive experience. Leaving flexor tendons untreated will result in growth disorders of the affected finger. Therefore, the indications for operative exploration of any type of open injury in a child's hand should be liberally applied. As for adults the primary treatment of flexor tendon injuries as an emergency is rarely indicated. In the recent literature various tendon suture techniques and rehabilitation protocols have been differently assessed. According to the Ulm algorithm flexor tendon injuries in children are treated by a 2-strand core stitch technique followed by a continuous circular suture. Children under 6 years of age are postoperatively immobilized for 3 weeks with a fist bandage. Children older than 6 years are treated like adults with a dynamic aftercare as described by Kleinert for 5 weeks. The results are comparable with those of other aftercare protocols.

The purpose of this study was to analyse motion patterns of the finger joints dynamically while making a fist. 10 subjects were examined using the TUB-sensor glove, which was equipped with 14 joint angle sensors. The median time it takes the finger joints to complete flexion until reaching the state of a closed fist ranges between 0.5 to 1.0 s. A specific pattern can be seen for every finger. The PIP and DIP joints appear to be linked, with the DIP trailing the PIP joint. At the thumb the IP is trailing the MCP joint. The MCP joint shows more variation at the beginning of flexion: while in some cases it initiates movement in a finger, in other cases its flexion falls behind the PIP joint movements. The completion of flexion is achieved by the MCP joints, with the PIP and DIP joints reaching their end of motion first. The range of motion (ROM) at the MCP joints shows a finger-dependent median of 79-97°. At the PIP joints the median lies between 87° and 90°, at the DIP joints between 52° and 68°. At the thumb it is 21° for the MCP and 24° for the IP joint. The linkage between PIP and DIP joints can also be seen when analysing the ROM. The coupling ratio amounts to 0.77 at the index finger, 0.75 at the middle and ring finger and 0.57 at the small finger.

The purpose of this study was to analyse motion patterns of the finger joints dynamically while making a fist. 10 subjects were examined using the TUB-sensor glove, which was equipped with 14 joint angle sensors. The median time it takes the finger joints to complete flexion until reaching the state of a closed fist ranges between 0.5 to 1.0 s. A specific pattern can be seen for every finger. The PIP and DIP joints appear to be linked, with the DIP trailing the PIP joint. At the thumb the IP is trailing the MCP joint. The MCP joint shows more variation at the beginning of flexion: while in some cases it initiates movement in a finger, in other cases its flexion falls behind the PIP joint movements. The completion of flexion is achieved by the MCP joints, with the PIP and DIP joints reaching their end of motion first. The range of motion (ROM) at the MCP joints shows a finger-dependent median of 79-97°. At the PIP joints the median lies between 87° and 90°, at the DIP joints between 52° and 68°. At the thumb it is 21° for the MCP and 24° for the IP joint. The linkage between PIP and DIP joints can also be seen when analysing the ROM. The coupling ratio amounts to 0.77 at the index finger, 0.75 at the middle and ring finger and 0.57 at the small finger.

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. On the other hand there are the "precision grips", which only show a force distribution at the distal sensors. Therefore Napier's concept of the existence of primarily 2 gripping patterns, which is based on visual analysis, can be verified objectively. For the "power grips" the force distribution is shifted further distally with increasing size of the objects. In conclusion, their distribution pattern shifts towards the pattern of the "precision grips". 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.