bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of a Bilobed Flap in the Correction of Radial Club Hand
Authors: EVANS D. M. , GATELEY D. R. , LEWIS J. S.
Published: September 2005

A new incision is described for the correction of radial club hand. By the use of a bilobed flap, redundant skin is transferred from the ulnar side of the wrist to the radial side, where there is tension as the wrist becomes straight. The flap has been shown to be safe and effective in six consecutive cases, and access to the wrist and surrounding soft tissue structures is excellent.
Congenital Perforations of the Triangular Fibrocartilage of the Wrist
Authors: TAN A. B. H. , TAN S. K. , YUNG S. W. , WONG M. K. , KALINGA M.
Published: September 2005

A cadaveric study of the triangular fibrocartilage of the wrist in the foetus and infant revealed a high incidence of congenital perforation. In the second half of the study, wrist arthrography in foetal and infant cadavers with crown-rump length of more than 20 cm followed by dissection of the wrist joints showed good correlation between the two. In 60 cadavers there were 11 with bilateral perforations and five had unilateral perforation. This gave a total of 27 perforations in 120 wrist joints studied.
Scapho-Trapezoid Arthritis
Authors: IRWIN A. S. , MAFFULLI N. , CHESNEY R. B.
Published: September 2005

Scapho-trapezoid osteoarthritis may accompany osteoarthritis of the CM joint of the thumb. If the scapho-trapezoid joint is not excised when performing an excision of the trapezium with ligament reconstruction and interposition of the tendon of the FCR, the procedure may be unsuccessful. We describe three patients with four thumbs in which scapho-trapezoid osteoarthritis was associated with basal joint arthritis. In one patient, it was not recognised pre-operatively and persistent post-operative pain dictated further surgery. In the other patients, the scapho-trapezoid joint was excised primarily, with resolution of the pain. In the pre-operative assessment, the scapho-trapezoid joint should be carefully studied to prevent failure of the procedure.
Pins and Plaster vs External Fixation in the Treatment of Unstable Distal Radial Fractures
Authors: HUTCHINSON D. T. , STRENZ G. O. , CAUTILLI R. A.
Published: September 2005

90 unstable fractures of the distal radius were studied in a randomized, prospective manner. Follow-up consisted of patient questionnaire, medical record review, therapist evaluation and radiography at 4 months, 1 year and 2 years post-operatively. Overall results were good or excellent in 94%. No significant differences were found between treatment groups (external fixation and pins and plaster) in final results, range of motion, intrinsic tightness, grip strength, or the presence of arthritis. The complication rate was high for both groups (45%), and half of the complications were major. External fixation maintained radial length more effectively (significantly in those patients followed for 2 years) but was associated with higher initial costs (20 times) and a greater number of minor complications.
Combined Central Slip and Volar Plate Injuries at the PIP Joint
Authors: LO I. , RICHARDS R.S.
Published: September 2005

PIP joint injuries are common. We describe an unusual injury in which an apparent volar plate avulsion injury was associated with a dorsal, central slip avulsion fracture. We postulate that the mechanism of injury would appear to have been forced flexion with the central ship being avulsed and the volar plate fracture occurring as a secondary impingement fracture. Our two cases were treated with full extension splinting with satisfactory results.
Upper Arm Tourniquet Pain in Local Anaesthetic Surgery
Authors: OGUFERE W. E. , GIDDINS G. E. B. , THOM J. S.
Published: September 2005

A prospective study was performed on 100 consecutive patients (110 procedures) of the perception of pain from an arm tourniquet during a local anaesthetic procedure. This was assessed subjectively, and objectively using a visual analogue scale. For tourniquet times up to 20 minutes, the tourniquet was well tolerated with only one failure (1% of patients) and all successful patients stated that they would be happy to have a similar procedure again.

Unlike previous studies, there appeared to be no correlation between time of tourniquet use and the pain perceived. Rather, there appeared to be an idiosyncratic response to the tourniquet which was borne out by the ten patients who had bilateral procedures at least 6 weeks apart and showed consistently repeatable scores.
Treatment of Pseudarthrosis of the Distal Phalanx with a Compression Screw
Authors: BOTELHEIRO J. C.
Published: September 2005

Five cases of painful diaphyseal pseudarthrosis of the distal phalanx were treated with a longitudinal compression AO mini screw, without bone graft, and all healed uneventfully in 3 to 4 months.
Intraneural Ganglion of the Posterior Interosseous Nerve with Lateral Elbow Pain
Authors: HASHIZUME H. , NISHIDA K. , NANBA Y. , INOUE H. , KONISHIIKE T.
Published: September 2005

We report an intraneural ganglion of the posterior interosseous nerve causing lateral elbow pain. The cystic lesion was identified by magnetic resonance imaging, and surgical exploration using the microscope permitted complete extirpation of the cyst without damage to nerve tissue. The patient experienced complete relief from pain, with full preservation of function.
Acute Posterior Interosseous Nerve Palsy Caused by a Synovial Haemangioma of the Elbow Joint
Authors: BUSA R. , ADANI R. , MARCUZZI A. , CAROLI A.
Published: September 2005

A case is described of spontaneous posterior interosseous nerve palsy of acute onset. The initial symptoms made it difficult to distinguish the condition from tendon rupture.

The diagnosis was established using ultrasound, nerve conduction studies and MRI. The patient underwent surgery to decompress the posterior interosseous nerve and the histological examination identified the tumour as a synovial haemangioma. 12 months after the operation, the patient had made a complete recovery, confirmed by EMG.
Partial Trapeziectomy and Interpositional Arthroplasty for Trapeziometacarpal Osteoarthritis of the Thumb
Authors: MENON J.
Published: September 2005

Partial excision including the articular surface of the trapezium and interpositional arthroplasty using one half of the flexor carpi radialis tendon was done in 36 hands. The joint capsule was reattached to the trapezium and the thumb immobilized for 4 weeks post-operatively. No ligament reconstruction was done. 30 hands (83.6%) had complete relief of pain. The average post-operative pinch strength was 11 lb. Three patients who complained of weakness of pinch had hyperextension of the MP joint. Correction of MP hyperextension is recommended to improve pinch strength. The outcome of this operation is comparable to any of the techniques described in the literature. The technique is simple and easy to perform. Since the capsule is closed the operation is truly an interpositional arthroplasty.
Articular Pigmented Villonodular Synovitis of the Mp Joint of the Hand
Authors: LISANTI M. , ROSATI M. , PARDI A.
Published: September 2005

Two cases of pigmented villonodular synovitis (PVNS) affecting MP joints are reported with unusual radiological changes.
Anterior Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome
Authors: PASQUE C. B. , RAYAN G. M.
Published: September 2005

48 patients with 50 involved limbs were retrospectively analyzed to determine factors influencing the outcome of surgical treatment for cubital tunnel syndrome. All patients were treated by anterior submuscular transposition of the ulnar nerve with Z-lengthening of the flexor-pronator origin. There were 24 men and 24 women with an average age of 42 years± 16.4 years (range, 5–75 years). The average follow-up time was 58 months (range, 12–156 months). A grading system was used pre- and post-operatively based on the severity of subjective complaints and objective findings. 92% of the patients were satisfied, or satisfied with some reservations, and only 8% were dissatisfied. All patients had either fair or poor pre-operative grades. 84% had excellent or good post-operative grades and only 16% had fair grades. There were no recurrences or poor post-operative grades in our series. Workers’ compensation status had no statistically significant adverse effect on postoperative patient satisfaction or post-operative grade. Anterior submuscular transposition of the ulnar nerve in this series provided satisfactory subjective outcome, relief of symptoms and adequate decompression of the ulnar nerve at the elbow.
Ring Removal from the Oedematous Finger
Authors: MULLETT S. T. H.
Published: September 2005

This paper reviews the literature on the techniques for removing a ring from a swollen finger. A new technique using a serf-adherent compression bandage is described.
Treatment of the Upper Limb in Charcot–Marie–Tooth Disease
Authors: WOOD V. E. , HUENE D. , NGUYEN J.
Published: September 2005

Even though Charcot–Marie–Tooth (CMT) disease is seen frequently, relatively little has been written about the successful treatment of upper limb involvement using tendon transfers. It appears that there are several types of CMT disease and there is extreme variability in the clinical symptoms. The results of treatment were assessed by looking at four specific areas of hand function: decreased conduction velocity of the nerves, lack of opposition, weak pinch, and clawing of the fingers. A plan has been developed for tendon transfers that has worked well in clinical practice.
A Picropolychrome Staining Technique Applied to Dupuytren’s Tissue
Authors: FITZGERALD A. M. P. , KIRKPATRICK J. J. R. , FOO I. T. H. , NAYLOR I. L.
Published: September 2005

Although the histology of Dupuytren’s tissue is well-documented, conventional stains do not distinguish between the different types of collagen which biochemistry and immunochemistry suggest are present. Dupuytren’s specimens [nodules ( n = 26), cords ( n = 15) and dermofasciectomies ( n = 6)] were stained with haematoxylin and eosin, Van Gieson’s, Mallory’s, Masson’s, and Herovici’s picropolychrome stain, and examined for both cellularity and collagen staining characteristics. All stains illustrated the marked cellularity of the nodules, contrasting with a paucity of cells within the cords. The first four stains demonstrated uniformity of the collagen staining within the tissues. Herovici’s picropolychrome, however, showed distinct staining patterns for the dermis, nodules and cords, with both purple/red and blue areas. Other studies suggest that those fibres stained purple/red and blue are types I and III collagens respectively. These findings may shed further light on the tissue of origin of Dupuytren’s disease.
An Extended First Dorsal Metacarpal Artery Neurovascular Island Flap
Authors: GEBHARD B. , MEISSL G.
Published: September 2005

A case of severe traumatic injury to the thumb treated by an extended variation of the first dorsal metacarpal artery neurovascular pedicled island flap is reported.
Kirschner Wire Placement in the Emergency Room
Authors: STARKER I. , EATON R. G.
Published: September 2005

To evaluate the safety of inserting Kirschner wires into bones or across joints in a setting other than a completely sterile operating theatre, a prospective study of all hand fractures treated by closed reduction and internal fixation was conducted in a mid-city Emergency Department. Indications for percutaneous fixation were displaced, unstable long bone fractures of the hand.

71 fractures in 68 patients were treated, and in 91% the fixation crossed a joint. No patient developed osteomyelitis or pyarthrosis, and there was no deep pin track sepsis. Seven patients with open fractures healed without infection or delayed union. Patients in whom data were available obtained 90% to 95% of the motion of the contralateral digit. The taboo against percutaneous fixation of fractures in a non-operating theatre setting is not warranted. The procedure can be performed with minimal complications in an out-patient setting.
Low Field MRI and Scaphoid Fracture
Authors: LEPISTÖ J. , MATTILA K. , NIEMINEN S. , SATTLER B. , KORMANO M.
Published: September 2005

18 consecutive patients suspected of and treated for an acute scaphoid fracture were examined by lowfield MRI. This showed 11 fractures while seven scaphoids were considered normal. T1 weighted images showed a fracture as an area of decreased signal intensity. Two radiologically obvious fractures produced normal MR images. These fractures proved to be the result of old trauma. A wide spectrum of additional traumatic lesions in the wrists, not detected by routine X-ray analysis, were also demonstrated. These included seven fragmented triangular fibrocartilages (TFC), torn scapho-lunate ligaments in four cases and one torn triquetro-lunate ligament. Bone bruises of other carpal bones and seven other carpal fractures were also detected.

Low field MRI can be used to show scaphoid fractures and allows diagnosis of additional or simulating lesions.
Palmar Dislocation of the Trans-Scaphoid-Lunate Unit
Authors: EKEROT L.
Published: September 2005

A rare case of total palmar trans-scaphoid-lunate dislocation is reported. Open reduction, bone grafting and internal fixation were followed by uneventful healing. At follow-up 70 months after injury there is no osteonecrosis and the wrist function is almost normal.
Exposure to Air during Surgery Inhibits Cellular Activity in Flexor Tendons
Authors: ABRAHAMSSON S-O.
Published: September 2005

In order to investigate the cellular effects of exposure to air during surgery and to compare the effects of simultaneous irrigation with physiological saline, the deep flexor tendons of both forepaws of 12 rabbits were surgically exposed. In one experiment, the extent of surgical exposure and, in a second experiment, the time of exposure was evaluated. Treated segments of the flexor tendons were collected and labelled in vitro for determination of the ability to synthesize DNA, proteoglycan, collagen and non-collagen protein.

With increasing surgical exposure in vivo, an increasing rate of cellular proliferation was observed in segments of the exposed deep flexor tendons examined in vitro. Synthesis of matrix components and the rate of cellular proliferation were reduced by 50% after 40 to 100 minutes of exposure to air and by nearly 100% after 120 minutes of exposure. In contrast, irrigated tendons retained their cellular capacity to proliferate.
Syndactyly Correction without Skin-Grafting
Authors: Ekerot L.
Published: September 2005

Syndactyly correction results in skin deficiency. Skin grafting is avoided by the use of an extended dorsal interdigital flap for the web and approximation of the side flaps to cover the length of the digits. The technique has been used in 17 cases with all varieties of syndactyly. There were no early complications. The follow-up averaged 2 years. There were two cases of web creep but no contractures. The method combines the advantage of direct suture with an acceptable frequency of web creep.
Radial Nerve Palsy Caused by Injections
Authors: Gaur S. C. , Swarup A.
Published: September 2005

Fifty-six cases of radial palsy due to injections have been seen during the last 13 years. Thirteen patients recovered spontaneously. Seven patients were treated by neurolysis, of which five had full recovery in 1 year. The remaining patients were treated by modified Robert Jones transfers. In ten cases flexor carpi ulnaris was spared as a strong flexor of the wrist, which improved the results in heavy manual workers. Radial nerve palsy caused by injection is an avoidable injury. There is a need for proper training of paramedical workers.
Clinical Assessment of Scaphoid Injuries and the Detection of Fractures
Authors: Grover R.
Published: September 2005

Difficulty in interpreting X-rays following carpal injury emphasizes the importance of clinical assessment in diagnosing scaphoid fractures. The classical sign of tenderness in the anatomical snuffbox is not specific and leads to many unnecessary out-patient reviews. A prospective comparison was made between anatomical snuffbox, scaphoid tubercle and scaphoid compression tenderness as indicators of scaphoid fracture in 221 patients with suspected scaphoid injury. Swelling was determined by measuring the difference in circumference at the wrist joint to compare between fracture and soft tissue injury.

Scaphoid compression tenderness was found to be the most accurate test with a sensitivity of 100% and a specificity of 80%. Swelling of the wrist joint was significantly greater when there was a fracture, compared to soft tissue injury alone, even when the initial X-ray was normal. This was independent of any physiological variation in circumference between dominant and non-dominant sides.

Scaphoid compression tenderness is therefore suggested as the most accurate indicator of scaphoid fracture and marked swelling should raise suspicion even if the X-ray is normal.
Osseous Localization of Rosai-Dorfman Disease
Authors: Rasool M. N. , Ramdial P. K.
Published: September 2005

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a disease of bone marrow stem cell origin which primarily affects lymph nodes. Solitary bone lesions are rare and can cause diagnostic difficulties. A primary lesion in the right index finger of a 10-month-old child is reported.
Acute Stretching of Peripheral Nerves Inhibits Retrograde Axonal Transport
Authors: TANOUE M. , YAMAGA M. , IDE J. , TAKAGI K.
Published: September 2005

The conjugation of horseradish peroxidase with wheat germ agglutinin was used to identify the effect on retrograde axonal transport of stretching the rat sciatic nerve indirectly by 10% and 20% femoral lengthening with a unilateral external fixator. To investigate the relationship between retrograde axonal transport and blood flow in the stretched nerve, nerve blood flow in the sciatic nerve was measured by a hydrogen washout technique. At 11% strain (20% femoral lengthening), the numbers of horseradish peroxidase-labelled motor neuron cells and nerve blood flow had decreased by 43% and 50%, respectively. Histological examination demonstrated ischaemic changes, but not mechanical damage. However, at 6% strain (10% femoral lengthening) there were no significant abnormalities. These findings suggest that the inhibition of retrograde axonal transport can be induced by acute stretching of the peripheral nerve and that circulatory disturbance is the main cause of the inhibition of retrograde axonal transport at the low strain.
Dupuytren's Disease Affecting the Wrist
Authors: SIMONS A. W. , SRIVASTAVA S. , NANCARROW J. D.
Published: September 2005

A unusual example of Dupuytren's disease occured in a black patient with a strong diathesis. The disease affected the insertion of flexor carpi ulnaris at the wrist as well as the palm.
Closed Rupture of the Flexor Digitorum Profundus Tendon of the Little Finger Caused by Calcification of the Triangular-Fibrocartilage
Authors: FUKUI A. , KIDO A. , INADA Y. , MII Y. , TAMAI S.
Published: September 2005

A case of rupture of flexor digitorum profundus tendon of the little finger caused by calcification of the triangular fibrocartilage (TFC) is reported. At operation, a round defect of the TFC and rupture of the flexor digitorum profundus tendon (FDP) of the little finger were observed. The defect of TFC was repaired using the palmaris tendon and FDP of the little finger was woven into FDP of the ring finger. Eleven months after operation, the patient had almost full flexion and extension of the distal and proximal interphalangeal joints.
Complete Palmar Dislocation of the Lunate in Rheumatoid Arthritis
Authors: ARNER M. , JONSSON K. , ASPENBERG P.
Published: September 2005

We report a case of complete palmar dislocation of the lunate in a rheumatoid patient. X-rays showed a normal bone structure of the lunate without sclerosis or collapse and on MRI an almost normal signal intensity was found. The lunate was removed. Histological examination showed complete necrosis of both marrow and bone cells, and tetracycline labelling showed no fluorescence. This case illustrates that neither X-ray nor magnetic resonance imaging (MRI) can detect complete bone necrosis. When X-ray or MRI changes do occur, these are indications of cellular events following some degree of spontaneous revascularization.
Treatment of Traumatic Radioulnar Synostosis by Excision, with Interposition of a Posterior Interosseous Island Forearm Flap
Authors: SUGIMOTO M. , MASADA K. , OHNO H. , HOSOYA T.
Published: September 2005

A 21-year-old man had proximal radioulnar synostosis 10 months after fracture of the proximal radius and the ulna. The bony bridge was excised and a direct posterior interosseous island flap was interposed as a biological barrier. One year after surgery, the range of forearm rotation was 65°. There was no radiographic evidence of recurrence.
Absence of Nails with Absent Distal Phalanges
Authors: WOOD V. E.
Published: September 2005

A child with absence of all nails associated with missing terminal phalanges is reported.
Melorheostosis of the Hand
Authors: SHARMA R. , BURKE F. D.
Published: September 2005

We report a case of melorheostosis of the hand which showed a sclerotomal pattern of involvement, with swelling and pain. Surgical debulking resulted in correction of the deformity and relief of pain.
Bilateral Scaphoid Exostoses
Authors: HARRIS N. J. , BELL M. J.
Published: September 2005

We report a case of bilateral symptomatic scaphoid exostoses associated with osteoarthritis of the wrist. These were treated by surgical excision with good short-term results.
Wrist Denervation
Authors: FERRERES A. , SUSO S. , ORDI J. , LLUSA M. , RUANO D.
Published: September 2005

In 1966, Wilhelm published a technique of denervation of the wrist joint based on his own anatomical studies of 1958. Other authors have published their experience in wrist denervations with similar results, but there are some discrepancies in descriptions of the innervation of the wrist.

We have studied the innervation of the wrist by dissection under magnification on 20 cadaver limbs and by histological examination of five human foetal wrists. Based in our anatomical findings, we have demonstrated that Wilhelm's technique does not achieve total denervation of the wrist.
Does Peri-Operative Guanethidine Prevent Reflex Sympathetic Dystrophy?
Authors: GSCHWIND C. , FRICKER R. , LACHER G. , JUNG M.
Published: September 2005

The use of intravenous guanethidine blocks is an accepted treatment for established reflex sympathetic dystrophy (RSD). Some units administer intravenous guanethidine peri-operatively with the intention of protecting their patients from post-operative dystrophy. There have been no studies confirming this protective effect of peri-operative guanethidine. Between 1992 and 1994 we performed a prospective randomized double blind study in 71 patients undergoing fasciectomy for Duputyren’s disease. Peri-operative guanethidine did not prevent post-operative RSD in our series.
Clinical Disorders and Pressure-Pain Threshold of the Forearm and Hand among Automobile Assembly Line Workers
Authors: BYSTRÖM S. , HALL C. , WELANDER T. , KILBOM Å.
Published: September 2005

The prevalence of forearm and hand disorders was examined by questionnaire and clinical examination in 199 automobile assembly line workers and in 186 controls. The pressure-pain threshold, hand grip force and hand anthropometry were also studied. There was an increased prevalence of de Quervain’s disease for male automobile assembly line workers, and of carpal tunnel syndrome in female workers. The prevalence of symptoms in the forearm and hand during the last 7 days were twice as high among automobile assembly line workers than controls for both men and women. The occurrence of symptoms in the last 7 days was associated with de Quervain’s disease, carpal tunnel syndrome and sick-leave due to forearm or hand problems, and it also influenced activities of daily living. Hand grip strength and anthropometries were not associated with findings in the clinical examination or the occurrence of symptoms in the last 7 days. Low pressure-pain threshold was not associated with findings in the clinical examination, except for reported occurrence of symptoms in the last 7 days for women. Pressure-pain threshold as an indicator of tissue damage is discussed.
Soft Tissue Infections of the Upper Extremities with Special Consideration of Abscesses in Parenteral Drug Abusers
Authors: SIMMEN H. P. , GIOVANOLI P. , BATTAGLIA H. , WÜST J. , MEYER V. E.
Published: September 2005

Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem. Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment. Special attention was paid to infections associated with parenteral drug abuse. During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study. Conservative treatment consisted of immobilization and antibiotics. Radical débridement with removal of all necrotic tissue was the guideline for operative care. In addition, for both regimens a penicillinase-resistant antibiotic was administered. A total of 415 patients (271 men and 144 women; mean age 36.7 ± 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive. Infections of fingers (excluding paronychia), paronychia, and abscesses at injection sites were the most common diagnoses. Operative and conservative treatment were performed in 285 and 130 patients respectively. Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus. Anaerobic bacteria and yeasts were of minor importance. Therefore, a penicillinase-resistant antibiotic is a good initial choice.
Mycobacterium Marinum Infection of the Finger
Authors: PHILLIPS S. A. , MARYA S. K. S. , DRYDEN M. S. , SAMUEL A. W.
Published: September 2005

A case of Mycobacterium marinum infection of a finger is described. This is a rare condition in the UK. The relevant literature is reviewed.
The Neurovascular Tranquilli-Leali Flap
Authors: ELLIOT D. , MOIEMEN N. S. , JIGJINNI V. S.
Published: September 2005

A modification of the flap first described in 1935 by Tranquilli-Leali and described again by Atasoy et al (1970) is presented. The relative indications for use of the original and the modified flap are examined in the light of our experience of 116 flaps over a period of 4 years.
Outcomes of Hand Surgery
Authors: MACEY A. C. , BURKE F. D. , Abbott K. , Barton N. J. , Bradbury E. , Bradley A. , Bradley M. J. , Brady O. , Burt A. , Brown P. , Bugby J. , Elliot D. , Evans D. M. , Fess E. , Foster A. , Gwilliam L. , Harris S. , Jerosch-Herold C. , Kelly C. , Kennedy S. , Leveridge A. , Lunn P. G. , Marsh D. , Woodbridge S.
Published: September 2005

The findings are presented of a conference on Outcomes of Hand Surgery organized by the audit committee of British Society for Surgery of the Hand in 1993. Measures of outcome in terms of movement, power, sensibility, pain, activities of daily living, complications and patient satisfaction are considered, and an example of a patient evaluation measure given as an appendix.
Surgical Treatment of the Divided Flexor Digitorum Profundus Tendon in Zone 2, Delayed More than 6 Weeks, by Tendon Grafting in 50 Cases
Authors: SAKELLARIDES H. T. , PAPADOPOULOS G.
Published: September 2005

The surgical treatment of the divided FDP tendon, more than 6 weeks old, in zone 2 is reviewed in 50 patients. The method used was the excision of the divided FDP tendon and the insertion of a thin tendon graft. There were 50 patients in this study; 36 were male and 14 female, aged from 18 to 60 years. All patients were markedly disabled because of loss of strength of the involved finger. Follow-up ranged from 1 to 25 years following tendon grafting. In 35 patients plantaris tendon was used and in 15 patients palmaris longus. Definite advantages were found in using the tendon grafting procedure; strength, dexterity, pinch and grasp were markedly improved. Functional results were evaluated by the Boyes method, with the Pulvertaft method as a secondary assessment. Among the 50 patients, 80% had excellent and good results (excellent 32%, good 48%) and 20% fair.
Histopathology of Kienböck’s Disease
Authors: HASHIZUME H. , ASAHARA H. , NISHIDA K. , INOUE H. , KONISHIIKE T.
Published: September 2005

Histopathological studies of extracted whole lunate bones obtained from 10 patients with Stage 3 Kienböck’s disease at surgery for tendon-ball replacement were correlated with magnetic resonance imaging (MRI), computed tomography (CT) and tomography images made prior to surgery. A reforming zone, or a reactive interface between the reactive new bone and granulation tissue formation, and new vascularization were observed surrounding the bone necrosis area showing empty lacunae, fatty necrosis, and disappearance of osteoid. Findings of CT, tomography and microradiography of slices of extracted lunate bone confirmed that fractures of the articular cartilage and the subchondral bone occurred secondarily by overloading, and showed the extent of the collapsed area of the lunate. MRI showed complete loss of signal intensity in T1 images of the lesion of the lunate in advanced Stage 3 Kienböck’s disease. MRI is at present unable to distinguish bone necrosis, the histological reactive interface or surrounding hyperaemia in detail. However, the low-intensity arc, or the reactive interface present on MRI in early Stage 3, sometimes correlates with the histological findings of osteoid and granulation zones.
The Role of Arthroscopy in the Investigation of Wrist Disorders
Authors: JONES W. A. , LOVELL M. E.
Published: September 2005

The findings at arthroscopy of the wrist in 48 consecutive cases carried out over a 4.5 year period have been retrospectively reviewed.

In correlating the clinical and arthroscopic findings in the 36 patients with wrist instability and triangular fibrocartilage injuries we found concurrence in 28 of the cases. In the six patients in whom we were unable to make any provisional clinical diagnosis we did not find arthroscopy helpful.

Arthroscopy usefully influenced the management in two of the six patients in whom the articular surface was assessed.

We feel that a careful clinical examination of the wrist is the mainstay of diagnosis in wrist disorders. Arthroscopy remains useful in selected cases but has a limited specialized role which should continue to be provided from specialist centres.
The Capitohamate Ligaments
Authors: RITT M.J.P.F. , BERGER R.A. , BISHOP A.T. , AN K.N.
Published: September 2005

The physical attributes of the three capitohamate interosseous ligaments were tested in a computer-controlled multi-axis testing machine using 12 human cadaver specimens. After an intact test run, selected ligaments were cut in random sequence and the test repeated. The remaining ligaments were tested to failure with servohydrolic stress at 5 mm/second.

In the intact joint complex, the average dorsopalmar rotational displacement was approximately 9° in each direction. Under the load limit, the dorsopalmar translational displacement averaged 0.9 mm and 0.5 mm respectively, proximal–distal translational displacement averaged 0.8 mm and 0.4 mm respectively, and distractional displacement averaged 0.3 mm.

Based on the sequential sectioning it was found that the dorsal ligament provided 76% (SD 14) of the rotational resistance with palmar rotation of the capitate and 44% (SD 19) of translational constraint with palmar translation of the capitate. The deep ligament provided 51% (SD 15) of the rotational resistance with dorsal rotation of the capitate and 63% (SD 24) of translational resistance with dorsal translation of the capitate. With proximal—distal translation, the dorsal ligament was the most important constraint in each direction. In resisting distraction, each of the three ligaments was equally effective. Failure testing showed the deep ligament was strongest at 289 N, followed by the palmar at 171 N and the dorsal at 133 N.
The Galeazzi-Equivalent Lesion in Children Revisited
Authors: IMATANI J. , HASHIZUME H. , NISHIDA K. , MORITO Y. , INOUE H.
Published: September 2005

A fracture at the medial end of the distal third of the radius with an epiphyseal separation of the distal ulna in a 16-year-old boy is described. This injury, known as the Galeazzi-equivalent lesion in children, is characterized by complete distal ulnar epiphyseal separation without rupture of the distal ligamentous stabilizing system between the radius and ulna, which includes the triangular fibrocartilage complex, interosseous ligaments and periosteal tube of the ulnar. The Galeazzi fracture-dislocation and the Galeazzi-equivalent lesion appear to be completely dissimilar in their pathological anatomy. We suggest calling the latter a “pseudo-Galeazzi injury”.
The Direct Midlateral Approach with Lateral Enlargement of the Pulley System for Repair of Flexor Tendons in Fingers
Authors: MESSINA A. , MESSINA J. C.
Published: September 2005

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The incision runs directly behind the neurovascular pedicle, which is left in the palmar skin flap of the anterior compartment of the finger, in order to ensure its blood supply and sensibility. The transverse digital lamina of Landsmeer’s skin anchoring system and Cleland’s ligament are preserved and are used to perform a lateral enlargement of the pulleys after tendon repair. The technique allows wide surgical exposure of the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the technique of choice) and reduces postoperative impingement in zone 2.
Dupuytren’s Disease Occurring after a Surgical Injury to the Hand
Authors: LANZETTA M. , MORRISON W. A.
Published: September 2005

We report three clinical cases in which Dupuytren’s disease was triggered by surgical trauma. All patients developed the contracture between 3 weeks and 3 months after operation for unrelated / pathology of the hand. They had significant swelling of the hand postoperatively, preventing full mobilization. They did not have a strong diathesis for the disease. Since the appearance of the contracture, they have not developed the disease in the contralateral hand or anywhere else in the body. In one case, a similar operation on the contralateral hand has not provoked onset of the disease.
The Unstable Capitolunate and Radiolunate Joints as a Source of Wrist Pain in Young Women
Authors: APERGIS E. P.
Published: September 2005

A retrospective study of 12 young women (14 cases) complaining of chronic wrist pain, obscure numbness and reduction of grip strength is presented. The average duration of the complaints was 7.3 years. All wrists were in VISI alignment, with normal motion series and normal intrinsic interosseous ligaments demonstrated arthrographically. The dorsal-displacement stress test showed subluxation of the capitolunate (in nine cases) or both the capitolunate and the radiolunate joints accompanied by a marked feeling of apprehension. Surgical management consisted of ligamentous reefing of the whole palmar aspect of the midcarpal joint and the radiolunate joint when needed. Additionally, a neurectomy of the terminal branch of the anterior interosseous nerve was done in four cases. The result was excellent in eight cases, good in five cases and fair in 1 case. Young women with “delicate” wrists and obscure wrist pain may have isolated instabilities of the capitolunate and radiolunate joints. In cases that do not respond to conservative measures ligamentous reefing should be considered.
Irreducible Fracture of the Neck of the Fifth Metacarpal
Authors: WATANABE K. , NISHIKIMI J. , MURO T.
Published: September 2005

We report a rare case of fracture of the neck of the fifth metacarpal which required open reduction. The radial and ulnar collateral ligaments entrapped the displaced metacarpal head. This patho-anatomy resembles that of rotational supracondylar fractures of the proximal phalanx.
Nerve Growth Factor Enhances Nerve Regeneration through Fibronectin Grafts
Authors: WHITWORTH I. H. , BROWN R. A. , DORÉ C. J. , ANAND P. , GREEN C. J. , TERENGHI G.
Published: September 2005

Soluble fibronectin and nerve growth factor (NGF) promote axonal regeneration when placed in silicone tubes. We investigated the ability of orientated fibronectin mats to bind and release bioactive NGF and the possibility of augmenting axonal regeneration following axotomy by using fibronectin conduits impregnated with NGF. The release of NGF was quantified using a fluorometric ELISA and bioactivity confirmed with a neuronal culture bioassay. Immunohistochemical techniques and computerized image analysis were used to assess the rate and volume of axonal and Schwann cell regeneration. The delivery of NGF to the site of injury produced an increase in the rate ( P≤0.007) and volume ( P≤0.004) of both axonal and Schwann cell regeneration when compared to conduits of plain fibronectin. We conclude that the local delivery of NGF by impregnated fibronectin conduits enhances axonal regeneration.
Metastases to the Hand from Carcinoma of the Lower Alveolus
Authors: VISWANATHAN P. N. , RANGAD F. , ROUL R. K.
Published: September 2005

A case of carcinoma of the lower alveolus metastasizing to the phalanges of the hand is reported. The possible mechanism of such metastases, the clinical and radiological features and the role of fine needle aspiration cytology are discussed.
Metastatic Tumours of the Hand
Authors: CASTELLÓ J. R. , GARRO L. , ROMERO F. , CAMPO M. , NÁJERA A.
Published: September 2005

Six metastatic tumours of the hand are reported. Five were located in long bones of the hand and one in the soft tissues without bone involvement. The primary tumours arose in the lung, kidney, hard palate, larynx and pharynx. Treatment was palliative and consisted of amputation for distal lesions and local excision and/or radiation for proximal lesions when symptomatic. Short-term prognosis was poor with a median survival of 7 months. In two patients, hand metastases were the first sign of malignant disease.
Ulnar Lengthening and Radial Recession Procedures for Kienböck’s Disease
Authors: TRAIL I. A. , LINSCHEID R. L. , QUENZER D. E. , SCHERER P. A.
Published: September 2005

Twenty patients with Kienböck’s disease who had undergone a joint levelling procedure, were reviewed at a mean of 11 years following surgery. Clinical and radiological evaluation revealed good long-term results with all patients complaining of less pain than before surgery and with statistically significant increases in range of motion and grip strength.

Radiologically a significant number of patients were found still to have lunate fractures and fragmentation. In addition, 13 patients have developed new bone formation in the lunate fossa, and 12 show osteoarthritic changes, particularly at the radioscaphoid interface. Radial shortening was felt to be superior to ulnar lengthening in that there were fewer problems with bone union.
First Carpometacarpal Joint Arthritis
Authors: LIVESEY J. P. , NORRIS S. H. , PAGE R. E.
Published: September 2005

Trapeziectomy followed by reconstruction of the intermetacarpal ligament using a small slip of extensor carpi radialis longus tendon and a wide slip of flexor carpi radialis for tendon interposition (group A) is compared with trapeziectomy followed by palmaris longus tendon interposition (group B). Group A included 11 hands in nine patients. Group B included eight hands in eight patients. Significant pain at the base of the thumb and 1st carpometacarpal joint degeneration were indications for surgery. Outcome was assessed by subjective questioning, objective clinical measurement and radiography. Group A appeared to have a slower recovery but later developed a stronger hand, better dynamic thumb function despite reduced movement and the resting trapezial space was better preserved. Calcification within the trapezial space correlated with better results but this took 3 years to occur. Patients in group B had greater relief of pain and were more consistently satisfied at an early stage.
Late Complications after Open Carpal Tunnel Decompression
Authors: KLUGE W. , SIMPSON R. G. , NICOL A. C.
Published: September 2005

66 patients (89 hands) were assessed at least 10 months after open carpal tunnel decompression. Tender scars were found in 19% of the hands and 4% were affected by pillar pain. Grip strength was reduced in more than half of the operated hands. Hypo- and anaesthesia in the scar area were affecting 7% but were not considered disabling. In 18% of the cases there was incomplete relief of primary symptoms.
Nerve Injury Following Steroid Injection for Carpal Tunnel Syndrome
Authors: TAVARES S. P. , GIDDINS G. E. B.
Published: September 2005

Two cases of nerve injury are reported following steroid injection as treatment for carpal tunnel syndrome. One caused an ulnar nerve lesion that recovered well. The other caused a more severe median nerve lesion which responded poorly to conservative treatment. Steroid injection for carpal tunnel syndrome is generally safe but nerve injury may occur and is difficult to treat.
Fasciculated Intramedullary Pinning of Metacarpal Fractures
Authors: MANUEDDU CA , DELLA SANTA D.
Published: September 2005

We reviewed 20 patients with 23 displaced extraarticular fractures of the distal end of the long metacarpals, treated by fasciculated pinning. At a mean follow-up of 5 years, all the patients were subjectively satisfied with the result. All the patients but one, who fractured four metacarpals, had a normal range of motion. The average grip strength was 43.4 kg for the operated side compared to 43.4 kg for the uninjured hand. Radiologically, the fractured fifth metacarpal had a shortening of 2.2 mm compared to a control group, whereas the volar angulation was 16.6° (13.2° for the control group).

The technique of intramedullary fasciculated pinning is a reliable alternative when conservative treatment of fractures of the metacarpal neck has failed or is inappropriate. The procedure provides sufficient stability to allow early mobilization and a good functional result.
A Comparison of Methods of Treatment of Pip Joint Contractures in Dupuytren’s Disease
Authors: BREED C. M. , SMITH P. J.
Published: September 2005

An analysis of the different methods of treating residual flexion deformity at the PIP joint level after digital fasciectomy in 75 PIP joints has shown that gentle passive manipulation alone gives better results with fewer complications than more aggressive surgical intervention.
Excursion of the Ulnar Nerve at the Elbow Following Epicondylectomy or Transposition
Authors: TSUJINO A. , ITOH Y. , HAYASHI K.
Published: September 2005

We studied the excursion of the ulnar nerve at the elbow following various surgical treatments for ulnar nerve compression in a cadaver model. The ulnar nerve length was measured in various positions of flexion in four situations: the normal anatomical position, following epicondylectomy and following submuscular and subcutaneous transposition. The changes in ulnar nerve length from 0° to 120° of flexion in the anatomical position and after epicondylectomy were significantly less than in the other situations. There was no significant difference in length between the normal anatomical situation and after epicondylectomy. On the theory that the least nerve excursion is better in the treatment of a nerve palsy, we recommend simple decompression or medial epicondylectomy for the treatment of tardy ulnar nerve palsy at the elbow.
Florid Reactive Periostitis of the Thumb
Authors: RIAZ M. , McCLUGGAGE W. G. , BHARUCHA H. , SMALL J. O.
Published: September 2005

A case of florid reactive periostitis of the thumb is presented. This is a rare pseudosarcomatous lesion which generally has a benign radiographic appearance, but on histology it may be mistaken for a malignant process. The clinical behaviour may simulate a malignant tumour but after local excision there is very little propensity for recurrence. Local resection is the recommended treatment. Surgeons and pathologists should consider the possibility of florid reactive periostitis before making a diagnosis of sarcoma in the hand.
Clinical Outcome of Digital Replantation using the Fibrin Glue-Assisted Microvascular Anastomosis Technique
Authors: ISOGAI N. , COOLEY B. C. , KAMIISHI H.
Published: September 2005

A series of 36 digital replants is reported in which microvascular anastomoses were each performed with four to six stitches and topically applied fibrin glue. Thirty-two digits survived, comparable to survival with conventional microvascular anastomosis. The average operative time per replanted digit was 3.2 hours, considerably less than documented with standard replantation technique (4.5 hours per digit). These clinical findings indicate that fibrin glue-assisted microvascular anastomosis does not compromise replant outcome and can reduce the operative time by reducing the number of microsutures that need to be placed in each anastomosis.
Venous Pumps of The Hand
Authors: SIMONS P. , SMITH P. COLERIDGE , LEES W. R. , MCGROUTHER D. A.
Published: September 2005

Oedema remains one of the most common causes of hand stiffness. Local venous return is intimately associated with oedema formation and management. To elucidate, the underlying mechanisms of venous return, the venous pumping systems in the hand were objectively and quantitatively investigated using Doppler ultrasound, cadaveric dissection and venography.

It was demonstrated that functionally there are three independent venous systems: the superficial palmar, deep palmar and dorsal veins, which are activated by palm compression, isometric intrinsic muscle contraction, and dorsum compression, respectively. Each system was investigated independently and found to increase venous blood velocity in both the cephalic and ulnar veins. These systems were also shown to act in synergy, producing the greatest velocity increase when concurrently activated during fist-clenching. The volume of blood pumped during fist-clenching could also be potentiated by preloading by digit abduction. The clinical applications of these findings are discussed.
The Motion Analysis System and The Maximal Area of Fingertip Motion
Authors: CHIU H-Y. , SU F. C.
Published: September 2005

We have used the motion analysis system to evaluate the maximal area of fingertip motion. Some modification in setting the cameras and use of a smaller marker is required. In this series, 58 examinations have been accomplished on 28 fingers with various traumatic injuries. The closed curve derived from the motion analysis system and the area calculated from it were easier to interpret and could be compared in serial examinations. A high linear correlation between the fingertip motion area and total active motion was found. The computer-aided motion analysis system complements the traditional methods of assessing an injured finger.
Diagnosis of Closed Central Slip Injuries
Authors: RUBIN J. , BOZENTKA D. J. , BORA F. W.
Published: September 2005

Four non-invasive tests for central slip integrity were analysed using 20 fresh frozen cadaver fingers. A pre-boutonnière deformity was simulated by dividing the central slip. A passively correctable boutonnière was simulated by dividing the central slip, triangular ligament and oblique fibres of the extensor expansion. The test described by Boyes, which evaluates distal interphalangeal joint flexion, was found not to be reliable for the diagnosis of either injury. The test described by Elson, which evaluates distal interphalangeal joint rigidity while actively extending the flexed proximal interphalangeal joint, was the only manoeuvre which was able to discern central slip integrity in both simulated injuries. The central slip tenodesis test and testing resistance of active proximal interphalangeal joint extension should be performed with the proximal interphalangeal joint in flexion to weaken the effectiveness of the lateral bands.