The article discusses, first of all, the reasons for a failure to detect a fresh fracture of the scaphoid bone which may be ascribed to the patient himself or of an iatrogenic nature. This is followed by guidelines for early detection of scaphoid fracture on the basis of the course taken normally by a fresh but untreated fracture of the scaphoid bone, thus providing pointers towards clarifying whether the fracture has a causal connection with a claimed accident. Signs of strengthening of the treated fresh scaphoid fracture are explained. Hints for the possible need for surgical treatment are derived from a differentiation between the traumatic cavity of the scaphoid bone and covered pseudarthrosis.
The article describes, first of all, the structure and mechanism of working of the tendon sheath, as well as its wall structure, pertaining to the triple-jointed fingers. This is followed by a description of the architecture of the superficial and deep flexor tendon. The next section of the article deals with the tendon sheath of the thumb and with the architecture of the long flexor tendon of the thumb. A clinically important tendon variant between flexor pollicis longus and flexor digitorum superficialis of the index finger is described. After the division into zones, the article goes into details of the mm. lumbricales, their anatomy and function, as well as with the phenomenon of the lumbricalis-plus finger.
The article proves on the basis of 40 cases that surgery following spray pistol injuries yields good results if it is initiated as early as possible, it is also shown that the prognosis worsens markedly with every hour that is wasted subsequent to the injury.
Knowledge of the blood vessel supply of the flexor sinews has been considerably enlarged by micro-angiograms. Arrangement of the vessels in the non-tendinous area of the hollow hand is different from that of the osteofibrous channels. The digitalis propriae form arcades, of which the vincula longa and brevia are responsible for segmental supply of the two flexor sinews at the triphalangeal fingers. Tendinous areas without vessels and poor blood supply are most probably supplied by means of diffusion. The intratendinous arrangement of the vessels has led to a change in suturing technique. The long flexor sinew of the thumb is supplied by blood vessels in the thenar region and at the base of the end phalanx.
A case of camptodactyly of three fingers in the left and four fingers in the right hand in a 20 year old patient is described. His mother showed the same appearances with great changes in the skeleton. This case emphasizes that an early operation is justified for the prevention of skeletal deformities.
The reported case is in its development, diagnostic, course, and legal aspect so extraordinary, that an explicit report is justified. The patient complained of pain in his right wrist region some days following an unusual work with a drilling machine for eight days. The X-rays six months later showed an irregular joint space between the lunate and triquetrum bone, while on his left wrist a synostosis between these bones was found. These changes seemed to be suspicious for a pseudarthrosis of a congenital synostosis, but this diagnosis led to a six years' controversy in several legal procedures. The different interpretations (judgements) by the attending doctors, specialists, and judicial experts, show again the importance of an exact early documentation with sufficient primary X-rays, eventually with comparison of the other hand. During treatment, nothing should be left undone which could support or refute especially an unusual diagnosis.
It is demonstrated in three clinical case reports that a subluxation of the scaphoid bone and a diastasis between the scaphoid and the lunate can occur in association not only with traumatic injury but with chronic inflammatory conditions of the wrist. In one case the etiology was purulent synovitis, in the 2nd an unspecific synovitis with serous exudate, and in the 3rd case rheumatoid arthritis.
