bluuebunny/crossref_metadata_2025 huggingface dataset:
A Quantitative Ultrastructural Study of Collagen Fibril Formation in the Healing Extensor Digitorum Longus Tendon of the Rat
Authors: Matthew Cara , Moore M. J. , Campbell Lorna
Published: June 2005

A study was made of collagen fibril populations in healing tendon using a window lesion in rat extensor tendon. Two environments were thus created. One (the lesion area) where stress levels were reduced; the other (the non-lesion area) where stress levels were increased. In both areas a population of small diameter (< 50 nm) collagen fibrils were synthesized. Lesion area fibrils increased their diameter only slowly. Non-lesion area fibrils added to a population which increased its diameter distribution comparatively rapidly. It is suggested that in the lesion area fibrils were synthesized in response to tissue damage and low levels of stress. These may be of type III collagen. In the non-lesion area fibrils were synthesized in response to raised levels of stress. These may be of type I collagen. Implications of these events, especially as they might relate to gap formation in flexor tendon surgery are discussed.
Clinodactyly of the Little Finger: A Simple Operative Technique for Reversal of the Growth Abnormality
Authors: Vickers D.
Published: June 2005

The traditional approach to clinodactyly has been either to accept the deformity or to perform an osteotomy. As an alternative to osteotomy, a resection of the mid-zone of the continuous epiphysis along with the underlying physis and its replacement by a fat graft (physiolysis) is simpler and allows further growth hi the phalanx. Twelve of these operations have been reviewed with a maximum follow-up of six years. Excellent functional and cosmetic results have been obtained. The renewed growth is manifest not only by an increase in length, but also by a decrease in the angular deformity and improvement of the articular surfaces. Osteotomy at maturity has only been necessary in one patient.
Musculoaponeurotic Variations along the Course of the Median Nerve in the Proximal Forearm
Authors: Dellon A. L. , Mackinnon Susan E.
Published: June 2005

31 cadaver arms have been dissected to study the variations in the anatomy of the muscles and fibrous arches which might cause compression of the median nerve in the forearm. Pronator teres always had a superficial head and usually a deep head. Flexor digitorum superficialis varied greatly in its site of origin.

The median nerve might be crossed by two, one or no fibro-aponeurotic arches. Gantzer's muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. No ligament of Struthers was found. Possible sites and causes of nerve compression are discussed.
Poor Correlation Between Functional Results and Radiographic Findings in Colles’ Fracture
Authors: TSUKAZAKI T. , TAKAGI K. , IWASAKI K.
Published: June 2005

We reviewed 83 consecutive patients with unilateral Colles’ fracture in order to identify factors that predict poor functional outcome. All fractures were treated by closed reduction and cast immobilization, and followed-up for at least 2 years. Our results showed that only final dorsal angulation was correlated to loss of flexion. In contrast to other reports, we could not find any relationship between radial shortening and loss of grip strength or loss of range of motion. In addition, the severity of initial displacement, involvement of radio-carpal or distal radio-ulnar joints, and the presence of ulnar styloid fractures or their non-union did not affect the functional outcome.
Resection Arthroplasty of the Proximal Interphalangeal Joint
Authors: ØSTGAARD S. E. , WEILBY A.
Published: June 2005

Palmar plate resection arthroplasty of the PIP joint, a new technique for operative treatment of destroyed PIP joints, is presented. By combining palmar plate arthroplasty with a flexor tenodesis a stable arthroplasty with adequate active motion can be performed. It can be used even in severely destroyed joints and still provide adequate post-operative stability and motion. Exercise can be started early.
Trapeziectomy and Ligament Reconstruction for Osteoarthrosis of the Base of the Thumb
Authors: NYLÉN S. , JOHNSON A. , ROSENQUIST A-M
Published: June 2005

100 thumbs with primary osteoarthrosis of the joints of the trapezium were treated by trapeziectomy and a FCR sling arthroplasty to reconstruct a first intermetacarpal ligament by the method described by Burton and Pellegrini (1986). Pain at rest remained in five. Some pain at or after exertion persisted in 46, and 49 became completely pain-free. 88 were satisfied with the procedure and there was a significant increase in pinch strength and in the ability to perform activities of daily life. It has become our preferred procedure for treating osteoarthrosis of the basal joint of the thumb.
Injuries to the Hand and Wrist. A Study of 50,272 Injuries
Authors: ANGERMANN P. , LOHMANN M.
Published: June 2005

This study reports the causes, characteristics and treatment of injuries to the hand and wrist presented to five accident and emergency departments in a 2-year survey of 13% of the Danish population. The rate of injury to the hand or wrist was 28.6% of all injuries, or 3.7 per 100,000 inhabitants per year. 34% of the accidents were domestic, 35% were leisure accidents, 26% were occupational and 5% were traffic accidents. Only 2% of the patients were admitted to hospital for further treatment or observation and 13% were referred to a hospital as outpatients. The most frequent causes for admission were fractures (42%), tendon lesions (29%) and wounds (12%).
Congenital Pseudarthrosis of the Ulna Treated by Free Vascularized Fibular Graft: A Case Report and Review of Methods of Treatment
Authors: MASTERSON E. , EARLEY M. J. , STEPHENS M. M.
Published: June 2005

Congenital pseudarthrosis of the ulna is an extremely rare condition for which current surgical techniques have been unsatisfactory in restoring a normal two-bone forearm. We report a case which was treated by excision of the ulnar pseudarthrosis and interposition of a free vascularized fibular graft with a skin island to monitor anastomotic patency. Forearm rotation has been restored and the potential for normal forearm growth has been preserved.
Functional Outcome of Upper Limb Tendon Transfers Performed in Children with Spastic Hemiplegia
Authors: ROTH J. H. , O’GRADY S. E. , RICHARDS R. S. , PORTE A. M.
Published: June 2005

Children with spastic hemiplegia often present with upper limb muscle imbalance. The purpose of this paper was to determine whether reconstructive surgery improved their functional ability. 17 children under the age of 16 years with spastic hemiplegia underwent reconstruction that included tendon transfers, tendon lengthenings and thumb metacarpophalangeal fusion. They were assessed pre-operatively and at an average follow-up period of 2.6 years. Children’s abilities were classified according to House’s functional rating scale. Tendon transfers improved functional grading by two grades, from good passive assist to fair active assist. Improvement in the arc of wrist motion and forearm rotation was also seen. Parental satisfaction was high. Reconstructive surgery improved the functional abilities in this group of children with spastic hemiplegia.
Early Corrective Surgery of the Wrist and Elbow in Arthrogryposis Multiplex Congenita
Authors: MENNEN U.
Published: June 2005

An early one-stage corrective surgical procedure for the elbow and wrist of patients suffering from arthrogryposis multiplex congenita is advocated. The procedure involves adequate proximal row carpectomy, tendon transfers to achieve a balanced wrist and a triceps to radius transfer for elbow flexion.

Experience with 47 limbs showed that the best results were obtained in children operated on between 3 and 6 months of age.
Ewings’s Sarcoma of the Thumb
Authors: JONES M. W.
Published: June 2005

A case of Ewing’s sarcoma of the thumb is reported, the literature reviewed and the appropriate treatment for this condition discussed.
Dupuytren’s Disease: A Legacy of the North?
Authors: WHALEY D. C. , ELLIOT D.
Published: June 2005

This study identifies four miracle cures set in Orkney and Iceland in the 12th and 13th Centuries and recorded in the sagas of the earls of Orkney and the bishops of Iceland, in which the condition of the hand which was healed bears a resemblance to Dupuytren’s disease. The possibility that one hand was cured by traumatic rupture of this condition and another treated by palmar fasciotomy is discussed.
Long-Term Results of Swanson Silastic Arthroplasty in the Rheumatoid Wrist
Authors: STANLEY J. K. , TOLAT A. R.
Published: June 2005

We report a long-term follow-up of 6 to 11.8 years (mean = 8 years) of our first 50 Swanson wrist arthroplasties. All patients had long standing sero-positive rheumatoid arthritis with a mean age of 48 years. A detailed clinical and radiologic assessment was carried out on all the wrists. There was excellent sustained pain relief (mean score = 1.7) with improved activities of daily living. A mean range of wrist movement of 25° of extension and 31° of flexion was obtained. The prosthetic fracture rate was 22% of which 14% were symptomatic and needed re-operation. Carpal collapse was seen in all wrists, but was often symmetrical and accompanied by radial new bone formation on X-ray (86%). We feel that our long-term results justify the continued selective use of the Swanson wrist in the low-demand patient with quiescent disease who desires pain-free limited mobility and sophisticated grasp.
Non-Union of the Scaphoid: Russe Graft vs Herbert Screw
Authors: Warren-Smith C. D. , Barton N. J.
Published: June 2005

The results of treatment in 50 consecutive patients with established non-union of the scaphoid are presented. All patients were treated under the care of a single consultant, for the same indications. Russe bone graft is compared with wedge bone graft plus Herbert screw fixation, in terms of union and function. Overall, a higher success rate was obtained by wedge graft plus Herbert screw, and a significantly better range of movement. However, Russe bone graft appears equally satisfactory for fibrous non-union.
Thumb Replantation: Survival Factors and Re-Exploration in 122 Cases
Authors: ARAKAKI A. , TSAI T. M.
Published: June 2005

We analyzed 122 cases of replantation following complete amputation of the thumb and correlated various factors with rates of survival. The overall survival rate of thumb replantation was 71%. The type of amputation markedly affected survival rate. In minimally damaged amputations, the time period from injury to the start of surgery was the only significant factor related to survival. Other factors such as age, smoking history, amputation level, the number of vessels reconstructed and the method used did not relate statistically to survival. With avulsion amputations, the survival rate of replantation at and proximal to the MP joint was significantly better than replantation distal to the MP joint. 20 thumbs required re-exploration for vascular compromise; nine of these were salvaged (45%).
The Limit of Graft Length in the Experimental use of Muscle Grafts for Nerve Repair
Authors: HEMS T. E. J. , GLASBY M. A.
Published: June 2005

In order to investigate whether there is any length limit for the success of freeze-thawed muscle grafts when used for peripheral nerve repair, an experimental study was undertaken in the rabbit. Previous work has shown 4 cm muscle grafts in the rabbit sciatic nerve to be successful. On this basis 5 cm and 10 cm muscle grafts were inserted into the common peroneal nerve and compared with 5 cm and 10 cm free nerve grafts.

Recovery was assessed after 250 days using whole nerve physiology, weights of innervated muscles, and histological examination of the nerve. At both 5 cm and 10 cm the nerve grafts performed significantly better than the muscle grafts, the 10 cm muscle grafts being totally ineffective.

The implications of these results for the application of freeze-thawed muscle grafting in peripheral nerve surgery and the possible factors limiting length of grafting are discussed.
An Anatomical Variation of the Palmar Cutaneous Branch of the Median Nerve
Authors: SIEGEL J. L. , DAVLIN L. B. , AULICINO P. L.
Published: June 2005

A case is presented of an anomalous course of the palmar cutaneous branch of the median nerve. Wide and meticulous exposure is necessary to avoid injury to all variations of this nerve and the use of a “safe” incision will not always avoid risk of injury.
Carpometacarpal Dislocation of the Thumb Associated with Fracture of the Trapezium
Authors: MODY B. S. , DIAS J. J.
Published: June 2005

Dislocation of the first carpometacarpal joint combined with a vertical intra-articular fracture of the trapezium is a rare injury. A case is described treated by open reduction of the trapezial fracture and reconstruction of the first intermetacarpal ligament using a slip of abductor pollicis longus tendon.
Minimal Tourniquet Pressure to Maintain Arterial Closure in Upper Limb Surgery
Authors: LEVY O. , DAVID Y. , HEIM M. , ELDAR I. , CHETRIT A. , ENGEL J.
Published: June 2005

Complications of the pneumatic tourniquet used during limb surgery result from excessive direct pressure. Traditional recommendations suggests parameters for maximum pressure and time limits rather than the minimal effective pressure to achieve a bloodless field. A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate haemostasis in the upper limb. The correlations between several possible influencing parameters (age, sex, arm fat thickness, extremity length, systolic, diastolic, and mean blood pressures) and the minimal pneumatic tourniquet pressure at which the peripheral pulse reappeared were studied in 50 patients undergoing surgery, using a Doppler stethoscope. The average Doppler Opening Pressure was 168.5 ± 42.7 mmHg and the only significant clinical variable was the mean blood pressure. From these results an equation was derived to predict the minimal effective tourniquet pressure. The mean calculated tourniquet pressure was 202.3 ± 34.2 mmHg, well below the 250 to 300 mmHg previously recommended. The technique consisted of inflating the tourniquet to a pressure of 300 mmHg, then reducing it to the calculated value. A bloodless field was maintained in all patients.
Scaphoid Non-Union: Factors Affecting the Functional Outcome of Open Reduction and Wedge Grafting with Herbert Screw Fixation
Authors: NAKAMURA R. , HORII E. , WATANABE K. , TSUNODA K. , MIURA T.
Published: June 2005

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensiner control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.
Triggering After Partial Tendon Laceration
Authors: AL-QATTAN M. M. , POSNICK J. C. , LIN K. Y.
Published: June 2005

Triggering and tendon flap formation were studied after a transverse laceration of 50% of the width of the flexor digitorum profundus tendons of the hind limb of 14 adult sheep at various intervals after injury. The tendon laceration was not repaired and there was no post-operative immobilization. Triggering was not caused by bulbous scar formation but by the bunching of the tendon fibres proximal or distal to the laceration site. This bunched part of the tendon appeared to become incorporated into the healing process, with gradual spontaneous resolution of triggering. Failure of incorporation of this bunched part resulted in the formation of a flap in two tendons.
Fingertip Injuries Management with Semiocclusive Dressing
Authors: MENNEN U. , WIESE A.
Published: June 2005

We have developed a simple, cheap and efficient method of management of fingertip injury using a semi-occlusive dressing (“Opsite”—Smith and Nephew). The fingertip is covered with the “Opsite” once a week only. The dressing provides a temporary “skin”, making the finger painless. This semi-occlusive “skin” allows the healing environment to reach an optimal milieu (e.g. pH, oxygen, tension, immunoagents) actively promoting granulation tissue formation and epithelization.

The result of 200 fingertip injuries treated with this method proves the development of a near normal pulp shape and useful epithelium within an average of 20 days.
Entrapment Neuropathy of the Palmar Cutaneous Nerve within its Tunnel
Authors: AL-QATTAN M. M. , ROBERTSON G. A.
Published: June 2005

A case of isolated entrapment of the palmar cutaneous branch of the median nerve is presented. At operation, a ganglion compressing the nerve within its tunnel was found. Symptoms were relieved with no recurrence at 2 years after decompression and excision of the ganglion.
Long-Term Results of Carpal Tunnel Decompression
Authors: HAUPT W. F. , WINTZER G. , SCHOP A. , LÖTTGEN J. , PAWLIK G.
Published: June 2005

The long-term prognosis of 60 patients operated on for carpal tunnel syndrome has been assessed in a prospective study with a median follow-up period of 5.5 years (range 2–11 years). Analysis of motor, sensory, trophic, and electrodiagnostic findings and assessment of pain were performed pre- and post-operatively using a standardized grading system. The results were generally favourable with a variable degree of improvement in 86% of cases. Statistical evaluation using multiple Dunn-Rankin tests revealed pain to be the most prominent pre-operative finding. On post-operative reexamination, pain was found to be improved to a significantly greater extent than any other variable. Analysis of several potential prognostic factors showed that pain lasting for more than 5 years prior to surgery indicates a poor prognosis. Only patients with diabetes mellitus exhibited a trend toward less pain relief.
Over-Distraction of the Radio-Carpal and Mid-Carpal Joints Following External Fixation of Comminuted Distal Radial Fractures
Authors: BIYANI A.
Published: June 2005

Seven patients with Frykman type 7 and 8 distal radial fractures, who had been treated with external fixation, were noted to have significant over-distraction of 5-8 mm in the radio-carpal and mid-carpal joints. One patient, who also had abnormal negative ulnar variance of 2 mm, had a fair result using modified Gartland and Werly (1951) criteria. The remaining six patients had good results, indicating that over-distraction does not significantly alter the final outcome, so long as a normal distal radio-ulnar relationship is maintained.
Spiral Fracture Fixation Techniques
Authors: MATLOUB H. S. , JENSEN P. L. , SANGER J. R. , GRUNERT B. K. , YOUSIF N. J.
Published: June 2005

The mechanical strengths of five common fixation techniques for spiral fractures have been tested. A total of 240 cadaver metacarpals and proximal phalanges were fractured and fixed by either crossed K-wires, interosseous loops, a dorsal mini-plate, a single compression screw or K-wire plus cerclage wire. Specimens were subjected to torsional and cantilever bending tests. A single compression screw provided the best overall fixation for the proximal phalanx. In addition, a single compression screw provided better fixation than any of the other techniques when proximal phalanges and metacarpals were subjected to torsional tests ( P<0.05). In apex dorsal bending tests of metacarpals, the screw provided fixation superior to interosseous wires, crossed K-wires, or dorsal mini-plates ( P<0.05). These results indicate that the use of a single compression screw provides the most satisfactory biomechanical advantage for spiral fracture fixation.
Hand Injuries from Inflation of an Air Bag Security System
Authors: ROTH T. , MEREDITH P.
Published: June 2005

Hand injuries have occurred due to inflation of an air bag during a high velocity car accident.
Treatment of Residual Instability and Extensor Lag in Polydactyly of the Thumb
Authors: KAWABATA H. , MASATOMI T. , SHIMADA K. , KAWAI H. , TADA K.
Published: June 2005

Extensor indicis tendon transfers were used in six cases with residual deformity of the thumb in polydactyly. The indication was extensor lag and instability of the interphalangeal joint. At mean follow-up of three and a half years, normal stability was improved. Full extension was achieved in three cases and two cases also derived some benefits from this operation. Alignment was improved in five cases.
Spontaneous Compartment Syndrome in a Patient on Long-Term Anticoagulation
Authors: GRIFFITHS D. , JONES D. H. A.
Published: June 2005

The case is reported of a 35-year-old lady on long-term anticoagulation with warfarin who developed a spontaneous acute compartment syndrome in the forearm. Despite a delay in diagnosis, an extensive decompression resulted in complete recovery.
Hand Injuries on Artificial Ski Slope
Authors: VAN GEERTRUYDEN J. P. , GOLDSCHMIDT D. P.
Published: June 2005

50 consecutive patients with injuries due to skiing on an artificial ski slope were seen in our emergency department over a 16-month period; 76% of these involved the hand or wrist. 52.5% of hand lesions were fractures and only one-third of the first ray injuries were sprains of the ulnar aspect of the MP joint. These data significantly differ from those known for skiing on snow.
Imaging the Position of a Screw within the Scaphoid
Authors: COMPSON J. P. , HEATLEY F. W.
Published: June 2005

In an audit of 68 scaphoid fractures with delayed and non-union that had been internally fixed using the Herbert bone screw, it was found that 39 had a significant fault in screw position. Poor intra-operatrve imaging was a major contributing factor. An anatomical and radiological study was therefore performed to evaluate which views were necessary in order to be confident about screw position. We recommend a minimum of four views. To display the proximal pole, an ulnar deviated postero-anterior (PA) view and true lateral; and to display the distal pole, a semi-pronated and semi-supinated view.
Eosinophilic Granuloma of the Hand
Authors: MILLER M. A. W. , WILLIAMS W. W.
Published: June 2005

The first reported case of eosinophilic granuloma of the hand is presented. A slowly expanding lesion of the right third metacarpal shaft was treated by biopsy and curettage. Histological examination confirmed the presence of eosinophilic granuloma. A bone scan showed that it was a solitary lesion. There has been no evidence of recurrence of the lesion during follow-up. Eosinophilic granuloma is a rare disease of the mononuclear phagocyte system, representing one of the clinical manifestations of Langerhans-cell histiocytosis. The lesions are usually associated with the skull, femur, mandible and ribs; this condition has not been previously reported in the hand.
Hypothenar Hammer Syndrome in Workers Occupationally Exposed to Vibrating Tools
Authors: KAJI H. , HONMA H. , USUI M. , YASUNO Y. , SAITO K.
Published: June 2005

Among 330 vibration-exposed workers, 24 cases of hypothenar hammer syndrome in 29 hands were diagnosed by arteriography. The right hand was involved in 13, the left hand in six, and both hands in five cases. The mean age was 55 years, mean duration of vibration exposure 19.4 years, and mean duration of episodic Raynaud’s phenomenon 6.4 years.

The vascular lesions of the ulnar arteries were classified into three major types with subtypes. Type 1: stenosis of the superficial palmar arch around the hook of the hamate. Type 2a: occlusion of the superficial palmar arch around the hook of the hamate. Type 2b: occlusion of both superficial and deep palmar arches around the hook of the hamate. Type 3a: occlusion of the ulnar artery at the proximal part of the wrist. Type 3b: occlusion of the ulnar artery near the wrist with the occlusion of the dorsal carpal branch of the ulnar artery.
Closed Continuous Irrigation as a Treatment for Infection in the Hand
Authors: NEMOTO K. , YANAGIDA M. , NEMOTO T.
Published: June 2005

A method of closed irrigation has been devised to treat infections in the hand. After adequate débridement, two tubes are placed in the infected area, an inlet tube and an outlet tube. For a small infection, one tube serves both purposes. The wound is closed completely. Irrigation with saline and antibiotic solution is continued for 1 week, extended up to 3 weeks in cases of severe infection. This method has been applied in 31 cases including pyogenic tenosynovitis, tuberculous tenosynovitis, pyogenic arthritis, osteomyelitis, bite injury, crush injury and amputation stump infection. Infection healed primarily in 29 cases. Further surgery was needed in two cases which healed finally.
Cubital Tunnel Syndrome Caused by Abnormal Insertion of Triceps Brachii Muscle
Authors: MATSUURA S. , KOJIMA T. , KINOSHITA Y.
Published: June 2005

Some cases of cubital tunnel syndrome are caused by anatomical abnormalities such as the epitrochleo-anconeus muscle or snapping and bulkiness of the medial head of the triceps brachii muscle. We report a rare cause of cubital tunnel syndrome that has not been reported previously. It was caused by an abnormal insertion of the medial head of the triceps muscle into the medial epicondyle. The clinical course and operative findings are described.
The Pins and Rubbers Traction System for Treatment of Comminuted Intraarticular Fractures and Fracture-Dislocations in the Hand
Authors: SUZUKI Y. , MATSUNAGA T. , SATO S. , YOKOI T.
Published: June 2005

The authors have developed a new skeletal traction system for comminuted intraarticular fractures and fracture-dislocations in the hand. The system consists of two or three Kirschner wires and rubber bands, and is easy to assemble. It is more compact and comfortable than the banjo splint, and equally effective, and it allows early motion of the affected digits.

A description of the technique is followed by the clinical results of seven cases of severe articular injuries in the hand. At the time of follow-up, the average range of the affected PIP joint motion was about 80° The final active motion of the injured DIP joint ranged from 0 to 40° in flexion and that of the affected thumb (trapezia1 fracture) was not limited. The average follow-up period was 13.1 months.
Predicting Palmar Radio-Carpal Ligament Disruption in Fractures of the Distal Articular Surface of the Radius Involving the Palmar Cortex
Authors: BERGER R. A. , AMADIO P. C.
Published: June 2005

12 adult cadaver wrists were dissected to identify the regions of origin of the four palmar radio-carpal ligaments. A non-dimensionalized value, called the radio-carpal ligament ratio (RLR), was defined as the width of ligament origin from the radius divided by the length of the capitate. Both values were measured directly from radiographs of the cadaver specimens. The RLRs for the four palmar radio-carpal ligaments were found to be statistically consistent.

We applied the RLR concept retrospectively to 20 wrists with intraarticular distal radius fractures requiring open reduction. It was found that those fracture patterns in which the fracture fragment ratios (FFR: widths of the fracture fragments divided by the length of the capitate) were outside the limits of corresponding RLRs had clear intra-operative evidence of palmar radio-carpal ligament disruption, while those with FFRs within the limits of corresponding RLRs were noted to have no ligament disruption.
The Incidence of Hospital-Treated Occupational Hand Injuries
Authors: SKOV O.
Published: June 2005

Previous studies have shown that young men have the highest frequency of occupational hand injuries. This study investigated their incidence and severity in relation to age and sex.

For occupational hand injuries in general the estimated incidence rate was 17.1 per 1,000 person years. The incidence was found to be higher among men than women in all age groups below 60 years. The incidence for minor injuries declines with increasing age, but the rates for significant injuries are independent of age.

The higher incidence rate for minor injuries among young patients could be real, but it could also be partly due to selection bias, if older patients with minor injuries consult the hospital for treatment less frequently.
Can Sensory and Motor Collateral Sprouting be Induced from Intact Peripheral Nerve by End-to-Side Anastomosis?
Authors: LUNDBORG G. , ZHAO Q. , KANJE M. , DANIELSEN N. , KERNS J. M.
Published: June 2005

The possibility that collateral sprouting could occur from intact axons in au undamaged sciatic nerve was studied in the rat by suturing either a 7-day predegenerated or a fresh nerve segment in an end-to-side fashion to the sciatic nerve proper. Following a 14- or 35-day recovery period, the pinch reflex test was performed on the transplanted segment to demonstrate the presence of sensory axons. The majority of cases, using a predegenerated nerve segment hut not a fresh segment, responded positively. Neurofilament staining and histological examination confirmed the presence of axons in the attached nerve segment. In another series of experiments, the proximal peroneal fascicle was ligated and cut. Following a 7-day predegeneration period the distal stump was sutured end-to-side to the ipsilateral tibia1 fascicle. After 90 days, stimulation of the tibia1 nerve proximal to the attached site induced substantial contraction in both the native gastrocnemius muscle and the foreign tibialis anterior muscle. These findings suggest that collateral sprouting may occur from intact axons, perhaps induced by factors emanating from the attached nerve segment, and subsequently make functional peripheral connections.
Compression of the Radial Digital Nerve of the Thumb
Authors: BERLEMANN U. , DUNKERTON M. C.
Published: June 2005

We report a case of digital nerve compression in the thumb caused by a fibrous band from flexor pollicis brevis to the sheath of flexor pollicis longus. After release of that band the patient was immediately symptom free.
Florid Reactive Mesenchymal Proliferation
Authors: EYNON-LEWIS N. J. , LYONS C. B. A. , HALAWA M. , HANLEY D. J.
Published: June 2005

Florid reactive mesenchymal proliferation describes a benign soft tissue tumour found in the hand as well as at other sites. The histological appearance and rapid growth of the lesion may lead to an incorrect diagnosis of malignancy. We describe a case in a 79-year-old lady, unusual because of her age at presentation and long history, and review the literature.
Regional Anaesthesia and Subsequent Long-Term Pain
Authors: WEEKS L. , BARRY A. , WOLFF T. , FIRRELL J. , SCHEKER L.
Published: June 2005

The incidence of long-term pain (between 1 and 48 weeks and at 2 year follow-up) unrelated to the surgical site following either regional brachial plexus or general anaesthesia was determined. In 834 patients with regional anaesthesia, the incidence (11.1%) was significantly higher than in the 86 patients with general anaesthesia (3.6%; P =0.03). The incidence of pain was not significantly different among four common techniques of positioning the needle tip in the axillary sheath (9.9 to 11.1%). Parascalene blocks had a slightly but not significantly higher rate (16.3%). A regional re-block was not associated with a higher incidence when compared to those blocked only once. A more distal local re-block was associated with a higher incidence of pain (23%). 2 years post-operatively, 0.5% of patients had pain related to the regional block. A significant proportion of patients developed some long-lasting post-operative pain following regional brachial plexus anaesthesia, although ultimate morbidity was minimal.
Long-Term Evaluation of Bennett’s Fracture
Authors: TIMMENGA E. J. F. , BLOKHUIS T. J. , MAAS M. , RAAIJMAKERS E. L. F. B.
Published: June 2005

18 patients with Bennett’s fracture were evaluated after a mean follow-up period of 10.7 years. Treatment consisted of closed reduction and K-wire fixation in seven cases and open reduction with osteosynthesis in 11 cases. Overall, symptoms were few and restricted mobility of the thumb could not be demonstrated. The strength of the affected hand was decreased in all patients regardless of the type of treatment. Osteoarthritis was found to correlate with the quality of reduction of the fracture, but had developed in almost all cases even after exact reduction. Exact reduction, either by the open or closed method, should be the aim of treatment of Bennett’s fracture.
The Results of External Fixation of the Radius in the Treatment of Comminuted Intraarticular Fractures of the Distal End
Authors: BISHAY M. , AGUILERA X. , GRANT J. , DUNKERLEY D. R.
Published: June 2005

14 unstable comminuted intraarticular fractures of the distal radius were treated by the use of the A/O mini-external fixator. The distal pins were inserted in the distal fragment, thus leaving the wrist joint free to mobilize. Clinical results were assessed at 3 to 12 months using the Sarmiento demerit point system. Nine were male and five female, with a mean age of 37 years. Ten fractures were closed and four were open.

11 patients (78.5%) had an excellent functional score and three (21.5%) had a good score. All patients had normal wrist morphology with an average radial length of 11 mm, radial angle of 23° and a mean volar angle of 12°. 12 patients had anatomical radio-carpal and radio-ulnar joints and two patients had a step less than 2 mm at the radio-carpal surface.

This method has proved in our experience to be reliable in maintaining the position as well as allowing early functional recovery.
Internal Splints for Prevention of First Web Contracture Following Severe Disruption of the First Web Space
Authors: LEES V. C. , WREN C. , ELLIOT D.
Published: June 2005

Different internal spring-splint configurations were examined to determine the most effective in preventing adduction contracture after severe injuries disrupting the first web space.
Traumatic Dislocations of the Distal Carpal Row
Authors: PAI C. H. , WEI D. C.
Published: June 2005

13 patients who sustained high-energy crush or blast injury of the carpal bones were reviewed after a mean follow-up period of 30 months. These complex injuries resulted in unusual disruptions of the distal carpal row and adjacent metacarpals. Frequent involvement of the carpometacarpal (CM) joints and violation of the proximal carpal row were also demonstrated. Nine were open injuries, with the majority accompanied by significant soft tissue damage. Treatment included either closed reduction or open reduction and Kirschner wire fixation, and soft tissue procedures as indicated. In this series, the majority of the open injuries gave unfavourable functional results despite adequate carpal, alignment. Several cases had disastrous outcomes related to associated vascular injuries. Closed injuries, on the contrary, followed a relatively benign course. Nevertheless, decreased grip strength persisted in both groups for a long time. Patients with such a complex carpal injury should expect a less favourable prognosis due to the severe nature of the trauma.
Chip Fractures of the Triquetrum
Authors: HÖCKER K. , MENSCHIK A.
Published: June 2005

Of 231 patients with fractures of the triquetrum, 65 were followed up after a mean period of 46.8 months. The fractures were classified and radiological and clinical follow-up was carried out. Pathomechanical aspects of the origin of the fracture were also considered. It appears that the chisel action of the dorso-proximal edge of the hamate striking against the fully extended and ulnar-deviated wrist is the major cause of the dorsal chip fracture of the triquetrum. Conservative therapy involving immobilization of the injured wrist for 3 weeks proved to be successful. If the bone fragment healed, it took 6 to 8 weeks. There was no indication for surgical intervention. We found no signs of post-traumatic instability of the joint. There was good vascularization of the bone, which excluded the possibility of avascular necrosis. All fractures involving the main body of the triquetrum united.
Remodelling of a Displaced Phalangeal Neck Fracture
Authors: MINTZER C. M. , WATERS P. M. , BROWN D. J.
Published: June 2005

Phalangeal neck fractures are uncommon in children. When these injuries to the proximal and middle phalanges are displaced and not treated operatively the fracture may heal in a malunited position with loss of motion at the IP joint. Remodelling in the area of the phalangeal neck is thought to be reduced because of its distance from the physis. In cases of malunion osteotomy of the phalangeal neck may be required to restore anatomy and motion. A case is described which demonstrates complete remodelling of a displaced middle phalangeal neck fracture in a child and recovery of a normal range of motion without operative intervention.
Extensor Tendon Sheath Stenosis Resulting in Triggering of the Little Finger
Authors: O’ROURKE P. J. , O’SULLIVAN T. , STEPHENS M.
Published: June 2005

An isolated constriction of the tendon sheath of extensor digiti minimi caused triggering of the little finger. Incision of the tendon sheath resulted in recovery of frictionless gliding of the tendon.
A Modification of the Zancolli Reverse Digital Artery Flap
Authors: MOIEMEN N. S. , ELLIOT D.
Published: June 2005

Indications for the use of the reverse digital artery flap described by Zancolli are considered, with a modification to the technique which leaves a more acceptable donor defect in the palm of the hand.
The Effect of Post-Operative Bleeding on Compartment Pressure
Authors: MARS M.
Published: June 2005

The effect of post-operative haemorrhage on intra-compartmental pressure has been studied in a primate model. The common practice of closing a wound and applying a compression bandage before deflating the tourniquet is shown to raise intra-compartmental pressure. Subsequent tourniquet release causes a further rise in pressure. Post-operative intra-compartmental pressure remains significantly higher during the first 3 hours of reperfusion in limbs bandaged prior to tourniquet release than in limbs in which the tourniquet is released and haemostasis gained before compression bandaging is applied.
Lunate Subluxation Associated with a Salter-Harris Type 2 Fracture of the Distal Radius
Authors: GIDDINS G. E. B. , SHAW D. G.
Published: June 2005

A case is reported of lunate subluxation in combination with a Salter-Harris type 2 fracture of the distal radius in a child.

Carpal subluxations or dislocations are rare in children. This combination has never been reported before. It significance lies in the combination of injuries, the more common of which led the lunate injury to be overlooked, emphasizing the importance of careful study of all available radiographs of an injury.
Closed Rupture of the Flexor Digitorum Profundus Tendon within the Carpal Tunnel
Authors: NAKAMICHI K. , TACHIBANA S.
Published: June 2005

We report a case of a closed rupture within the carpal tunnel of the flexor digitorum profundus tendon of the little finger. There was no underlying pathology.
The Modified Liverpool Total Elbow Prosthesis
Authors: DHAR S. , BEDDOW F. H.
Published: June 2005

We present the results of the modified Liverpool total elbow joint replacement. The humeral component of the original prosthesis was modified because of a high incidence of loosening. 19 patients who had total elbow joint replacement for rheumatoid arthritis were reviewed 8 years after surgery. 14 patients had the modified prosthesis implanted. There was dramatic relief of pain and improvement in function following surgery. There was a reduced fixed flexion deformity and an increased range of movement with the modified prosthesis. None of the humeral components of the modified prosthesis have as yet required revision. In selected patients therefore, this operation is a predictably successful procedure. Our follow-up confirms the ability of the modified prosthesis to provide a pain-free, stable and mobile joint.
Use of Silastic Sheet in Apert’s Syndactyly
Authors: STEFANSSON G. M. , STTLWELL J. H.
Published: June 2005

Patients with Apert’s syndrome usually have severe complex syndactyly affecting both hands. Surgical separation of the distal digital bony fusion often exposes bone and cartilage which can cause problems with graft take.

A case is presented where the bare divided bone between two digits was kept apart with a silastic sheet. On its removal 4 weeks later, the previously bare bone was covered with a membrane. This was covered with a full thickness skin graft with a complete graft take.
Axonal Regeneration through Heat Pretreated Muscle Autografts
Authors: HALL S. M. , ENVER K.
Published: June 2005

We have compared the regeneration of axons through frozen-thawed or heated muscle autografts in the sciatic nerve of adult rats. Our results have shown that axons regenerate through muscle grafts which had been either frozen-thawed or heated to 60°C prior to transplantation. However, axons failed to regenerate through muscle grafts which had been pre-heated to 80°C. We speculate that this difference may be related to the thermal lability of components of muscle basal lamina, such as laminin and fibronectin, which are known to play an important role in axonal outgrowth.
Flexor Tendon Injuries in Children
Authors: GROBBELAAR A. O. , HUDSON D. A.
Published: June 2005

Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister’s criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.
Double and Multiple Looped Suture Tendon Repair
Authors: TANG J. B. , SHI D. , GU Y. Q. , CHEN J. C. , ZHOU B.
Published: June 2005

We report our experience of using double or multiple looped sutures for primary tenorrhaphy combined with early active mobilization. In 46 patients involving 51 fingers with flexor tendon lacerations, double threads of the looped nylon suture were placed to repair injured FDP or FDS tendons, or three threads of looped nylon suture were made to repair the FDP tendons. Using White’s (1956) criteria, the results were good or excellent in 76.5% of fingers. The double and multiple looped sutures are of sufficient strength to sustain early motion, and cause little disturbance in the circulation. Satisfactory function following primary tendon repair can be expected with these new techniques.
Compression Neuropathy of the Motor Branch of the Median Nerve Due to an Anomalous Thenar Muscle
Authors: YAMANAKA K. , HORIUCHI Y. , YABE Y.
Published: June 2005

A case is described of compression of the motor branch of the median nerve caused by an anomalous thenar muscle.
Correlation of Clinical Signs with Nerve Conduction Tests in the Diagnosis of Carpal Tunnel Syndrome
Authors: BUCH-JAEGER N. , FOUCHER G.
Published: June 2005

In order to establish the need for nerve conduction studies, a prospective study has been performed on 112 patients with symptoms of carpal tunnel syndrome (172 symptomatic hands), seeking correlation with 11 clinical criteria taken either singly or in combination.

Even when the patient presents with a typical clinical presentation of carpal tunnel syndrome the diagnosis is only confirmed electrophysiologically in 61% of cases. Analysis of the sensitivity and specificity of various clinical tests and diagnostic manoeuvres has shown their mediocre reliability in establishing the diagnosis with a sensitivity of 58% and a specificity of 54% for Phalen’s test.

We consider nerve conduction studies to be an indispensable part of the pre-operative evaluation.
Trapezio-Lunate External Fixation for Scaphoid Fractures
Authors: GÜNAL I. , ÖZTUNA V. , SEBER S.
Published: June 2005

Trapezio-lunate external fixation for scaphoid fractures has been investigated experimentally and clinically. Six below-elbow fresh amputation specimens in which proximal, waist and distal scaphoid fractures were created, displaced, reduced and externally fixed were used for an experimental study and after 10,000 extension-flexion movements of the wrist, no displacement was observed. A strain-gauge study confirmed the strains at the fracture site.

Seven patients were treated in this way. No immobilization was necessary and all patients returned to their regular employment within 3 days and all fractures were united without displacement. The technique overcomes certain disadvantages of plaster fixation and internal fixation of scaphoid fractures.
The Use of a Shunting Catheter for a Ruptured Brachial Artery Following Open Elbow Dislocation
Authors: AL-QATTAN M. M. , ZUKER R. M. , WEINBERG M. J. , MCKEE N. , MCCALL J.
Published: June 2005

A rare case of rupture of the brachial artery with distal ischaemia following open elbow dislocation in a child is reported. The use of a shunting catheter successfully maintained the distal circulation until definitive brachial artery reconstruction was performed.