Twenty-eight patients (average age 45 years) with posttraumatic ulnar impaction syndrome underwent ulnar shortening osteotomy of 3-15 mm. Contributing factors were malunited fractures of the distal radius in 20, diaphyseal fractures of the ulna and radius in 6, resection of the radial head and a traumatic tear of the triangular fibrocartilage in 1 patient each. Evaluation at an average follow-up of 20 months showed a high rate of satisfied patients (89%), but according to Chun's modification of the Gartland-Werley score there were 1 excellent (3.5%), 11 good (39.5%), 11 fair (39.5%) and 5 poor (17.5%) results. Degenerative changes of the distal radioulnar joint were associated with fair and poor results, and ulnar shortening osteotomy is only recommended in ulnocarpal impaction with an intact distal radioulnar joint. Osteotomy fixation with 3.5 mm dynamic compression plates enabled immediate postoperative mobilisation and resulted in a low complication rate. There was no advantage for the technically more demanding oblique as compared with a transverse osteotomy.

Purpose. Force effect (impact, extent of foot compartment deformation) and result (fracture pattern) for midfoot fractures in car occupants is known. An analysis of the processes in the foot was intended to improve car safety.hlateuiuls and mrthods. Eleven fresh, unfrozen, unpreserved intact human cadavers (age: 36.8 ( 16-61 ) years, gender: male, race: Caucasian) were studied 24-72 h after death. ln 3 cadavers ( 5 feet) the experimental design was established: entire cadaver fixed on a special tray in supine position, pendulum with bar impactor hitting the foot plantar to Lisfranc's joint. A custom-made pressure sensor was inserted in the ankle (A), talonavicular (TN) and calcaneocuboid (CC) joints (resolution: 1 cm', sampling rate: 500,'s).Results. Sixteen feet were measured; midfoot fractures were induced in 11 feet. The maximum pressure amounted to 1.22-2.55 MPa (2.04 i 0.412) at 0.005-0.195 s (0.067 f 0.059) after impact. The maximum pressure occurred in 8 (50%) cases in the ankle, in 7 (44%) of the TN and 1 (6%) of the CC joints. A comparison of the first 200 pressure samples after impact of all sensor fields resulted in higher forces in Chopart's joint than in the ankle (t-test: p < 0.001). These force differences were higher in cases wifh midfoot fractures (mixed model analysis of variance: p = 0.003).Conclusion. Due to considerable forces in Chopart's joint we recommend a modification of the actual crash test dummy lower extremity model with an additional load cell that detects forces in the longitudinal direction of the foot axis.

In a clinical, retrospectively randomised study, we compared the results of the operation for a carpal tunnel syndrome when one side only or both sides were simultaneously assessed in one session. Of the 125 patients examined, 47.2% had both hands operated on in one session, 52.8% had only one hand operated on in one session or both hands in two sessions. We found the bilateral simultaneous operation to be associated with better results concerning earlier return to work, earlier relief of symptoms and better patient satisfaction than the operation on one side only. These are explained by the necessity of using both hands for daily activities and thus a guaranteed functional follow-up treatment after the bilateral operation. In conclusion, we propose operating on both hands simultaneously whenever possible, even if the opposite hand presents with only a slight CTS, which would otherwise not be considered for operation yet.

The case of a patient with a 2-day history of symptoms suggesting acute carpal tunnel syndrome is presented. However, an urgent electroneurographic examination revealed median nerve compression at the forearm and magnetic resonance imaging confirmed compression by a mass proximal to the carpal tunnel. Surgical exploration showed a recently thrombosed aneurysm of an epineural vessel. Histological and, later, general and angiological investigations could not reveal the underlying cause of this aneurysm. Preoperative electrodiagnostic examination is recommended in acute peripheral nerve compression to prevent decompression at an incorrect site. If atypical nerve compression is suspected, magnetic resonance imaging may be indicated to detect localized nerve compression and its underlying cause.