W. Axhausen

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., MUELLER, 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.

Der Symptomenkomplex des Morbus Crouzon und die bisher bekannte Therapie wird beschrieben. Zur Korrektur des Exophthalmus bei Morbus Crouzon werden die Erfahrungen mit dem malignen Exophthalmus sowie der "Blow-out"-Fraktur des Orbitalbodens zunutze gemacht. Neben der Entfernung des Orbitalbodens zur Ruckverlagerung des Bulbus wird die Gesichtsdeformitat durch Konturaufbau im Nasen-Oberkieferbereich sowie der Brauengegend verbessert. Literatur COLE, J. G.: In TRAUTMANN, R. c., J. M. CONVERSE, and B. SMITH: Plastic and reconstructive surgery of the eye and adnexe. Was hingt on: Butterworth 1962. CONVERSE, J. M.: Reconstructive plastic surgery. Philadelphia: Saunders 1964. CROUZON, 0.: Dysostose cranio faciale-hereditaire. Bull. Soc. Med. H6p. Paris 33, 545 (1912). FLIPPEN, J. H.: Cranial fucial dysostosis of Crouzon. Pediatrics 5, 90 (1950). FOGH ANDERSON, P.: Cranio-facial dysostosis as a dominant hereditary disease. Nord. Med. 18, 993 (1943). GILLIES, H., and S. H. HARRISON: Operative correction by osteotomy of recessed malar maxillary compound in a case of exycephaly. Brit. J. plast. Surg. 3,123 (1950). HIRSCH, 0.: Surgical decompression of malignant exophthalmus. Arch. O- laryng. 51, 325 (1950). KosTEcKA, F.: Ein Beitrag zur Dysostosis cranio facialis. Z. Stomat. 35, 113 (1937). KozIAK, P. H.: Cranio stenosis. Report of22 cases. Amer. J. Ophthal. 37, 380 (1954). LEw IN, M. L.: Facial deformity in acrocephaly and its surgical correction. Arch. Ophthal. 47, 321 (1952). MESSMANN, A.: Operative Behandlung des malignen Exophthalmus. Zbl. ges. Ophthal. 45, 161 (1940). MORAN, R. E.: The correction of exophthalmus and levator spasm. Plast. re- constr. Surg. 18, 411 (1956).