Martin Franz Langer

Universitätsklinikum Münster | UKM · Klinik für Unfall-, Hand- und Wiederherstellungschirurgie

Bei zwei jungen Frauen mit einer Lunatumnekrose wurde ein osteochondrales Transplantat aus dem Os scaphoideum in die Fossa lunata (Stadium IV nach Lichtman) eingesetzt, um noch eine PRC (=proximal row carpectomy) ausführen zu können. Der postoperative Verlauf und die Ergebnisse dieser beiden Patientinnen unterschieden sich bisher nicht von den Resu...

Pyogenic or suppurative flexor tenosynovitis is a closed space infection of the hand. If not recognised early and treated appropriately, this infection can result in significant morbidity and loss of function. This comprehensive review contains clinically relevant information on the special anatomy, pathophysiology, diagnosis and differential diagn...

Objective Reconstruction of prehension after remote flexor tendon injury or flexor tendon destruction after disease or infection. Indications Absence of passive motion of proximal and distal interphalangeal joints. Uncooperative patient. Children under 5 years of age. Acute local or serious systemic infection. Injury of both digital nerves; circula...

Operationsziel: Stadiengerechtes Vorgehen und schonende Beseitigung des Infektionsherdes im Bereich der Nageltaschen. IndikationenJede eitrige Infektion des periungualen Bereiches. KontraindikationenHerpesinfektionen [1, 12]. Jede eitrige Infektion des parungualen Bereiches sollte beseitigt werden. OperationstechnikEröffnung der Eiterblase, Rese...

Accurately performed anatomic and biomechanical studies as well as clinical experience during the last years have widened our knowledge about function and pathology of the distal radioulnar joint (DRUJ) making a differentiated treatment possible. In cases of trauma a rupture of the ulnar part of the triangular fibrocartilaginous complex (TFCC) freq...

Thirty-six patients were assessed after scapholunate ligament reconstruction using a portion of the extensor carpi radialis brevis through a dorsal approach. The median age was 53 years. Most (27/38) were graded as scapholunate advanced collapse Grade I. At a median of 47 months after treatment, hand function using the Disabilities of Arm, Shoulder...

Non-reconstructible radial head fractures with concomitant injuries and resultant instability of the elbow are often treated by implantation of a radial head prosthesis. Various prosthetic designs and implantation techniques are available. Several pitfalls have to be respected during implantation. This article provides tips and tricks for successfu...

Das bindegewebige Skelett der Hand ist ein hochkomplexes, mehrschichtiges System, das die gängige Literatur nur unzureichend im Zusammenhang darstellt. Die Kenntnis dieser aufeinander abgestimmten und ineinandergreifenden Systeme ist die Basis zum Verständnis der Entwicklung der Dupuytren’schen Kontraktur. Der Artikel stellt sowohl die gesunde Anat...

https://www.youtube.com/watch?v=qucC5KCKm1Q

Anatomy of the PIP joint on the Pulvertaft webinar by Carlos Heras-Palou now in YouTube https://www.youtube.com/watch?v=E3PeQdrbn9w

PurposeGoal of this study was the assessment of long-term outcome of arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears and the comparison with short- and mid-term results. Methods The study included nineteen patients (mean 49.2 years of age) with a mean follow-up time of 13.6 years (13.1–14.3 years). Exam...

Introduction: Although Covid-19 and especially lockdown periods have affected our everyday live, its impact on hand traumatology is under investigated. Materials and methods: We retrospectively analyzed all patients presenting at a FESSH accredited HTRC and level 1 trauma center in Germany during the Covid-19 lockdown period and an equivalent time...

View in the DIP joint with removed second phalanx head.

The collateral ligaments in the PIP joint and the shape of the PIP joint acting together as a perfect team.

Details about the anatomy of the DIP joint. in my chapter on "Anatomy and functional importance of finger joints. A short Atlas" in Schindele / Giddins / Bellemère - Arthroplasty in Hand Surgery. FESSH Instructional Course Book 2020

this is to show the range of motion (maximum), the best functional angle and the best angle for arthrodesis in a single illustration. I think it works and helps to explain a lot of things...

normal anatomy of the median nerve and the muscles supplied by the median nerve

It took a long time to create the best view on the nerve and to be still clear. From my chapter on "anatomy of the peripheral nerves" from the book "Chirurgie der peripheren Nerven kompakt" 2021

Nerves and vessels and some lines of the anatomy of the medial side of the foot and ankle from my chapter on the anatomy of the peripheral nerves in the book "Chirurgie der peripheren Nerven kompakt"

Illustration for my Chapter on "anatomy of the peripheral nerves" in the Book "Chirurgie der peripheren Nerven - kompakt " 2022 Springer

this important nerve is often injured during surgery because his anatomy is not known. Be careful!

Nerves of the lumbosacral plexus. from the book "Chirurgie der peripheren Nerven kompakt" in my chapter on anatomy of the peripheral nerves

perforating the fascia 8cm (length of the index finger) from the Styloid process of the radius and 4cm to the first division. 0.5mm dorsal and palmar of the 1. extensor compartment. Then you know where you can expect the nerve and : don't touch!!!!

local anaesthesia in cleched fist injury? my commentary: no!

Background Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. Purpose To determine the maximum amount of the coracoid that can be resected during arthroscopic coracoplasty...

Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn...

Anatomie und Biomechanik von Handgelenksverletzungen

diagnostic criteria in wrist injuries

most important wrist injuries - diagnosis and treatment

Due to the crucial role of the thumb for gripping, osteoarthritis of the first carpometacarpal joint leads to a substantial impairment of hand function. There are effective nonoperative and joint-preserving surgical treatment options for early stages of the disease. In advanced cases, after exploiting conservative treatment, carpometacarpal thumb a...

Introduction: Thyroid ima artery is a variant artery found on the anterior surface of the trachea. The aim of this meta-analysis was to obtain pooled prevalence data of the thyroid ima artery and discuss its clinical importance especially for tracheostomy. Methods: A systematic literature search was performed through five electronic databases until...

Cover illustration of microsurgery of a peripheral nerve

This is an illustration of my chapter about surgical anatomy of the peripheral nerves from the book "Antoniades, Harhaus, Assmus - Chirurgie der peripheren Nerven", Springer 2021

the thenar branch of the median nerve (motor nerve to the thenar muscles) is exactly at the point where tip of the flexed middle finger touches the palmar skin, which was discovered by Erwin Brug.

Nichts ist für die Chirurgie der peripheren Nerven wichtiger als sehr profunde Kenntnisse der topografischen und funktionellen Anatomie. Die Schnittführungen der Zugangswege sind bei guten Anatomiekenntnissen exakter und kürzer, die Präparation zu den Nerven gezielter, schonender und damit die postoperativen Vernarbungen geringer. Die Operationszei...

Zusammenfassung Die Indikationsstellung zur Weichteildeckung im Bereich des Fußes und des Sprunggelenkes erfolgt zum einen akut nach Komplexverletzungen des Fußes, zum anderen bei chronischen Defektsituationen. Das Management erfolgt in der Regel durch ein mehrzeitiges, interdisziplinäres und interprofessionelles Therapieregime. Vor einer definitiv...

Zusammenfassung Für Chirurgen in der Klinik und Praxis ist der Umgang mit Nahtmaterial das „tägliche Brot“. Daher könnte man annehmen, dass die Kenntnisse dieses Materials kompetent und umfassend sind. Die tägliche Erfahrung zeigt indes ein anderes Bild. Oft sind die Kenntnisse bezüglich Nadelform, Nadelbeschaffenheit sowie Nadelgröße nur marginal...

Anatomy and Functional Importance of Finger Joints. A short Atlas

how to treat infections of the distal phalanx? felons and paronychia. step by step in detail

Objective Creation of a pain-free, flexible and stable (pseudo) joint between the carpus and the base of the 1st metacarpal bone.IndicationsPainful carpometacarpal (CMC)‑I joint due to primary or secondary osteoarthritis, CMC‑I instability.ContraindicationsCarpal instability, local infection, tumors.Surgical techniqueResection of the trapezium (and...

Introduction Biomechanical evaluation of the viscoelastic properties tissue deformation, stiffness, and maximum breaking load of the human A2 pulley. We hypothesized that the A2 pulleys of index, middle, and ring fingers exhibit no difference regarding the aforementioned biomechanical parameters. Methods Forty-one A2 pulleys of 14 upper extremitie...

Zusammenfassung Die Infektionen des Fingerendglieds sind nicht zu unterschätzen, da es zahlreiche Differenzialdiagnosen zu beachten gibt, die besser nicht (sofort) operiert werden sollten, sondern erst eine spezielle und häufig interdisziplinäre Diagnostik (dermatologisch – histologisch – radiologisch – internistisch) benötigen. Darüber hinaus find...

Zusammenfassung Die Infektionen der Beugesehnenscheide gehören immer noch zu den gravierendsten und folgenschwersten Infektionen an der Hand. Wenn die typischen Kardinalzeichen einer Beugesehnenscheideninfektion nach Kanavel bestehen, sollte unverzüglich die Indikation zur Operation gestellt werden. Die Folgeschäden einer verzögerten oder verspätet...

Zusammenfassung Infektionen der Endglieder sind unter allen Handinfektionen am häufigsten. Unterschieden werden die dorsalen Infektionen, die sich im Bereich des Nagelwalls entwickeln und Paronychien genannt werden, und die palmaren Infektionen, die die Fingerbeere oder Fingerkuppe betreffen. Die akuten Paronychien müssen je nach Infektionsort gezi...

The review of the historical development of functional reconstructive surgery using tendon and nerve transfers in the period between the end of the nineteenth and the beginning of the twentieth centuries provides a fascinating insight into the beginnings of orthopaedic and surgical specialties and the pioneering achievements of our predecessors. Th...

Due to the exposed situation of the extension side of the metacarpophalangeal joint when the fingers are bent, injuries in this region are not uncommon. The extensor apparatus lies directly below the skin and the various parts can be easily injured. Due to the complex anatomical structure, the different clinical appearances and the various forms of...

Extensor tendon injuries of the thumb include lesions of the tendons of the extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus muscles. The latter is practically only affected in open injuries. Open injuries require a tendon reconstruction by suture followed by immobilization in the distal and an adequate aftercare depe...

Geschichte der Schienenversorgung an der Hand

With the exception of the relatively frequent fractures of the scaphoid bone, isolated fractures of individual carpal bones are rare. Because these injuries are uncommon and because of the complex anatomy and function of the carpus, treatment of carpal bone fractures can be challenging. Carpal bone fractures generally occur in young, sports active...

Objective Reliable wound coverage of the fingertip and palmar aspect of the middle finger with a sensate flap in order to restore early function.IndicationsPalmar, oblique pulp defects or amputations at the distal finger phalange with uncovered bone, tendons, and/or neurovascular structures.ContraindicationsPeripheral perfusion deficiency, size of...

Der Einsatz individuell adaptierter Schienen ist ein wichtiger Baustein in der Handrehabilitation und trägt maßgeblich zum Behandlungserfolg bei Handverletzungen und Handerkrankungen bei. Damit eine Schienenversorgung erfolgreich am Patienten zum Einsatz kommen kann, müssen nicht nur gute anatomische Gegebenheiten der Hand und ihrer Funktion bekann...

Zusammenfassung Die Handchirurgie vereint Kompetenzen der Mikrochirurgie, Frakturheilkunde, Nerven- und Sehnenchirurgie und widmet sich dem im Alltag so essentiellen Funktionsorgan: der Hand. Ein so hochspezielles und bedeutsames Fach fußt auf den Wurzeln wissenschaftlicher Arbeiten und Meilensteinen aus der Vergangenheit. Als Nachtrag zum 58. Kong...

PurposeThe goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability.Methods The study included ten patients (mean 38.7 years of age) with a mean follow-up time of 11.2 years (9.3 years to 14.3 years). Examination parameters included Disabilities of Arm, Sho...

Background Carpal tunnel syndrome, a compressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, a compressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strat...

(Partial) arthrodeses of the wrist have been proven cornerstones to treat many lesions for decades, especially in the case of revision surgery. Four-corner, scapho-trapezo-trapezoidal (STT), radio-scapho-lunate (RSL) and total wrist fusions are very common techniques in hand surgery. However, even these proven surgical procedures have significant n...

Objective Decompression of the median nerve by complete release of the flexor retinaculum and the distal antebrachial fascia. In the case of revision surgery providing of a scar-free covering of the median nerve, if necessary.IndicationsCarpal tunnel release is indicated for symptomatic patients with painful paraesthesia or neurological deficits af...

Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost i...

Background Animal models are one of the first steps in translation of basic science findings to clinical practice. For tendon healing research, transgenic mouse models are important to advance therapeutic strategies. However, the small size of the structures complicates surgical approaches, histological assessment, and biomechanical testing. In add...

Zusammenfassung Für Revisionsoperationen bei Osteosynthesen der Hand braucht der Chirurg viel Kreativität, Erfahrung und technisches Geschick. Die Osteosynthesen im karpalen Bereich benötigen Stabilität und Ruhe, während die Osteosynthesen an den Fingern Stabilität für eine frühzeitige Beübung benötigen. Die Stabilität an den Fingern muss so erreic...

Cite this article: Bone Joint Res. 2020;9(2):77–78.

Cite this article: Bone Joint Res. 2020;9(2):79–81.

Die Rekonstruktion der palmaren Mittelgliedbasis mit einem „Hemi-Hamatum“-Transplantat ermöglicht die Wiederherstellung der Mittelgelenkstabilität unter Erhalt der Beweglichkeit. Indikationen sind akute und veraltete, palmare Mittelgliedbasisfrakturen mit einer Trümmerzone von über 40 % und dorsaler Subluxationsstellung, ohne Möglichkeit der primär...

Grundwissen und Bauanleitungen aus der Praxis für die Praxis Dieses Praxisbuch zeigt sowohl angehenden als auch erfahrenen Handtherapeuten, wie sie individuell angepasste Standardschienen für die obere Extremität anfertigen. Über 650 Abbildungen veranschaulichen die Konstruktionsschritte von statischen, statisch-progressiven und dynamischen Schiene...

Die sekundäre Rekonstruktion von Beugesehnen ist in den meisten Fällen sehr anspruchsvoll und langwierig. Indikationsstellung, Auswahl des richtigen operativen Verfahrens, operative Technik und Weiterbehandlung müssen individuell angepasst werden und sind meist sehr schwierig. Aufgrund von Voroperationen können intraoperativ unangenehme Überraschun...

Detailed Anatomy of the veins, arteries and nerves of the finger in lateral view (left), Arteries and veins from dorsal view (middle) arterial network from palmar view (right) My last cover Illustration for the fantastic JHS E.

Goal Anatomical reconstruction of the deep fibers of the distal radioulnar ligaments to stabilise the distal radioulnar joint. Indications Multidirectional instability of the distal radioulnar joint without the possibility for anatomic refixation of the distal radioulnar ligaments. Contraindications General operative contraindications, infection,...

Zusammenfassung Kahnbeinbrüche sind die häufigsten knöchernen Läsionen des Karpus. Da sie nicht selten wenig klinische Symptome hervorrufen, werden diese Frakturen bei unzureichender Diagnostik häufig übersehen und mangelhaft therapiert. Deshalb ist bei klinischem Verdacht ein Frakturausschluss mittels Schichtbildgebung obligat. Anhand der CT kann...

A fantastic nerve transposition - I love this

Finger Anatomy you have never seen before....

Objective Anatomic reduction and stabile fixation for immediate mobilisation and restoration of unrestricted function. Indications Instabile metacarpal fractures with or without malrotation, dislocated metacarpal fractures with malrotation or finger extension deficit, longitudinally shortened metacarpal fractures with finger extension deficit. Co...

Detailed anatomy of the finger nerves with Pacinian corpuscles.

distal radius fracture with an ulnopalmar fragment, fracture of the styloid process of the ulna due to the palmar radioulnar ligament of the TFCC, impression fracture of the scaphoid fovea

Flexor tendon suture technique in a finger zone 2. Left Modified Savage technique Right Tangs bulky suture after tension

Objective Anatomical open reduction and internal fixation using screw/plate osteosynthesis. Indications Extra-articular fractures with clinically evident malrotation of the finger, comminution fracture and/or loss of length, which cannot be treated non-operatively; fracture instability; intra-articular fracture with step off greater than 1 mm, whi...

Der Daumen steht, in neutraler Position, außerhalb der Ebene der übrigen Finger und spielt somit für die Funktion der Hand eine entscheidende Rolle. Weiterhin ermöglicht die einzigartige Geometrie des Sattelgelenks eine große Beweglichkeit des Daumens und ist für den Oppositionsgriff unabdingbar. Durch die hohen Freiheitsgrade, die große Krafteinwi...

Background Arthroplasty of metacarpophalangeal (MCP) joints is crucial for patients with rheumatoid arthritis. Motion preserving therapies are mandatory for this joint, since loss of function of the MCP joint is detrimental. Many protheses or spacers have been introduced over the last 80 years, but most of them have been dismissed due to major comp...

Anatomy of the ulnar nerve at the wrist with many many details

Objective Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. Indications Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpopha...

Die wichtigsten Ziele der Skaphoidrekonstruktion bei Pseudarthrosen sind die Beseitigung der „Humpback“-Deformität, die Wiederausrichtung der proximalen Handwurzelreihe und die stabile knöcherne Heilung des Skaphoids. Zu diesem Zweck ist in den meisten Fällen die Insertion eines Knochentransplantats erforderlich. Um die Heilungsrate zu erhöhen und...

JHS European Feb 2019 CMC-1 Arthrosis: - most painful grip - grind test - Eaton-Litter 1,2,3,4

Unter den Handwurzelknochen hat das Kahnbein (Os scaphoideum) die größte Bedeutung. Die häufigste Fraktur des Carpus ist der Kahnbeinbruch. Die ebenfalls häufige, ausbleibende Heilung dieses Bruchs führt wie die nichtgeheilte Ruptur des Bandkomplexes zwischen Kahnbein und Mondbein (Os lunatum) zu den folgenschwersten biomechanischen und damit gravi...

Syndaktyly in a childs hand with skin incision lines, Zeller-flap proximal

boutonniere deformity - fracture of dorsal part of second phalanx base.

Details of Dupuytren´s surgery

Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. Nevertheless, various malformations, such as malrotation, spur development, bone shortening, deviation of the axis and combinations of these individual deformities may appear in the course of time. Corrective osteoto...

Background: The functionality of the upper extremity is decisively based on rotation of the forearm. The rotation depends on the extent of motion of the distal radioulnar joint. Rotation enables complete and focused usability of the hand in order to cope with daily activities. The configuration of the distal radioulnar joint has developed over mil...

Background: Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. Methods: This review is based on pertinent publications retrieved by a selective search in the PubMed and Coc...

Background: The triangular fibrocartilage complex (TFCC) widens the radiocarpal joint and takes part in load transmission from the carpus to the forearm. It is thereby prone to degenerative changes. The painful situation that can accompany degeneration is called ulnar impaction. Diagnosis: Clinical examination helps differentiate between various...

Durch die Exposition der Hände im Alltag sind Defektverletzungen häufig. Die Verletzungsschwere reicht von kleinen Fingerkuppen- bis hin zu großen Hautweichteildefekten mit freiliegenden Sehnen, Nerven und Gefäßen. Meist ist das Ausmaß der Verletzung erst nach dem sorgfältigen Débridement einzuschätzen. Dem Chirurgen steht eine große Zahl an Verfah...

S3 Guideline on Compression Syndrome of N. ulanris at the Elbow. Association of Scientific Societies of Medicine Germany.

Precise knowledge of the anatomy of the fibrous skeleton of the hand is an absolute prerequisite for any treatment of Dupuytren’s contracture. The fibrous skeleton includes not only the palmar aponeurosis, but also numerous retinacula cutis, which are not shown in current anatomy books. Here, eponyms, of which Skoog’s fibers, the septa of Legueu an...