Our department treats all diseases and injuries concerning hands and forearms. Besides a wide range of surgical methods including minimal invasive arthroscopy (examination of joint) and complex hand and forearm replantations subsequent to amputation injuries, we also provide extensive conservative treatment methods.
Being a part of the nationwide trauma center, the department of finger-, hand- and forearm surgery is specialized in hand trauma patients. Severe hand injuries of all types are treated around the clock, 365 days a year.
For best results our department closely cooperates with physiotherapists and ergotherapists, and when dealing with severe diseases (CRPS) also with pain therapists and psychologists.
Arthroscopy / examination of joint
Arthroscopy of a joint via minimal invasive surgery accesses (key hole surgery) Key areas are hand joint, distal radioulnar joint and in rare cases thumb saddle joint.
On the one hand, arthroscopy allows examining injuries that are difficult to diagnose via conventional imaging methods, and sometimes treating them in the course of the surgery, on the other hand this procedure allows planning more complex surgeries e.g. partial fusion of the wrist joint, in order to achieve best possible treatment results in the final surgery.
A very frequent phenomena is injury of the so-called triangular fibrocartilage complex (TFCC), a structure in the ulnary wrist. This injury might be caused by minor falls onto the wrist and may result in pain making a movement of the joint impossible. Fresh injuries may be treated with arthroscopic reattaching. A partial resection (removal), comparable to meniscus surgery on the knee joint, may result in significant reduction of pain.
Severe injuries, infections or removal of tumors may result in major tissue defects (soft tissue and bones) requiring careful plastic surgery for covering the defect. The techniques involve short-time temporary vacuum dressings, split skin grafts, local flaps or free microsurgical tissue transfer.
A wrist injury causing chronic pain that cannot be cured may be treated with denervation of the joint. The method involves examining and separating the nerve fibers conducting pain signals from the bone to the brain by usage of magnifying glasses.
This method does not affect the sense of touch of the skin or result in reduced motion or strength, it is simply a disruption of the continuous pain caused by the damaged joint segment. This surgery may be carried out as an outpatient. Immobilisation of the wrist after surgery is not required.
Endoprosthetic joint replacement:
Complete joint replacement is required when a joint is completely destroyed, in particular due to age or rheumatic degradation of the joint. The surgery results in reduction of pain and maintaining a certain function of the joint. The total endoprosthesis for the hip joint are either synthetic titanium combinations or pyrocarbon implants.
So-called Swanson silicone prostheses are well accepted by rheumatic patients and may be implanted requiring little surgery and achieving extremely positive functional results. Total joint replacement is basically possible for the finger base and middle joints, in very special cases for the wrist and thumb saddle joint. The decision if and what type of prostheses may be applied requires a careful individual analysis considering the patient’s age, requirements and local tissue condition.
Correction of misalignments
In case the fractured bones have failed to grow together in correct position subsequent to an accident, the result may be sensitive problems in the biomechanics causing considerate functional malfunctions.
In such cases, a revision of surgery may serve to reconstruct the original shape and position of the joint in order to counter premature joint degeneration and functional loss. This mainly concerns the distal radius bone; however, displacement osteotomy (bony positional modifications) may be performed in the fingers as well.
Extended cartilage defects in the above-described joints may be fixed by using cartilage bone implants from healthy segments of the knee joint and implanting them into the destructed joint area.
This procedure is performed by using special diamond cutters in order to achieve optimal fitting accuracy of the retrieved cylindrical implant.
Motor replacement surgery
Motor replacement surgery involves moving muscles or muscle tendon units to other muscle groups. This substitute procedure is applied if nerves or direct tissue (muscles) are injured such that controlling and moving the corresponding muscles is no longer possible.
A replacement allows partial or complete reconstruction of function. A simple motor substitute replacement is e.g. the indicis transfer; in this surgery one of the indicis extensor tendons is transferred to the distal remains of the thumb extensor tendon thus restoring the extension of the thumb.
Nerve transplantation may be performed for an injury to a very large segment of nerve. It involves taking nerves with less important roles and transplanting them to restore function in a more crucial nerve that has been severely damaged. In the ideal case important functions that were affected by damage to a large segment of nerve may be restored or sensor deficiencies may be reduced.
Nerve transplantations are performed by means of surgical microscopes using extremely fine suture material hardly visible with the naked eye.
More and more fractures of the distal radius bone are subject to surgery in order to allow early function and to optimally reconstruct the joint surfaces. Despite more and more sophisticated implants the number of malfunctioning or malpositioned fractures is considerably high. Malposition of the distal radius bone, which constitutes an important part of the wrist, may result in a painful motional restriction of the wrist and joint for forearm rotation.
Besides the patient’s current problems this malposition favors early wear of the joint resulting in further functional restrictions. Subsequent to accurate analysis of malposition, the fracture zone will, in numerous cases, be separated and then stabilized in an anatomically correct position.
Not only because of our treatment philosophy according to the workman’s compensation clinic we have specialized in analysing and treating these malpositions. Careful planning involves personal examination of the patient and individual consultation. Ideally all documentation of the injury is available, including imaging reports from the point of time of fresh injury.
Rheumatic patients often suffer deformations of the hand. Tendons are reconstructed after spontaneous ruptures by means of tendon transpositions (tendon transfers), new centering of deviated tendons or endoprosthetic replacement of completely damaged joint segments. In early stages a performed synovectomy (removal of the inner surface of the joint) may result in significant slow-down of deterioration of the joint.
Deteriorations of the joint which cannot be reconstructed are treated with stiffening operations (fusion). The main objective is a pain-free condition for the patient.
There are numerous surgical procedures available; the right choice requires careful individual analysis in order to fuse as few joint segments as possible thus maintaining an optimal residual function of the hand. Numerous cases require prior arthroscopy in order to perform a successful surgery.