bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular Networks of the Periphery of the Fingernail
Authors: WOLFRAM-GABEL R. , SICK H.
Published: September 2005

The vascular networks of the periphery of the fingernail have been studied on fingers of adults, foetuses and neonates, by injecting the vascular system with gelatinous Indian ink. The nail is an avascular structure, partially covered by the nail wall. It is lying on the nail bed which is prolonged forwards with the hyponychium. Each part of the nail apparatus presents a characteristic vascular network derived from dorsal collaterals arising from the palmar digital vessels and from their arcades. These networks are papillary, pseudopapillary, reticular and subdermal. Their morphology and density vary according to their localization and correspond with histological variations of the different parts of the nail apparatus. Thus, the germinal part of the nail bed shows poor vascularization. It is responsible for the colour of the lunula. The sterile part and the hyponychium have dense vascular networks with glomus bodies.
Avascular Necrosis of the Proximal Scaphoid after Fracture Union
Authors: FILAN S. L. , HERBERT T. J.
Published: September 2005

We report four cases of late avascular necrosis (AVN) of the proximal part of the scaphoid following apparent healing of acute scaphoid fractures. One patient had been treated conservatively, by plaster immobilization, and the other three had undergone internal fixation of their acute fractures. The onset of symptoms associated with AVN varied, being as late as 2 years in one patient. Late AVN following healing of a scaphoid fracture does not appear to have been previously recognized, perhaps due to the fact that patients are seldom followed up for long enough. We feel that this condition is in many ways analogous to late AVN following femoral neck fractures and as such is a special complication related to the fact that both bones are intracapsular and have a precarious blood supply.
The Hand Injury Severity Scoring System
Authors: Campbell D. A. , Kay S. P. J.
Published: September 2005

A descriptive severity scoring system for injuries to the hand, distal to the carpus, has been designed. Each ray of the hand is assessed separately. Each ray’s score is then multiplied by a weighting factor for that ray and added to the scores of the other rays to obtain a total score for the injury. This system has been tested on a series of specimen injuries and compared with the opinion of experienced hand surgeons. A retrospective study of hand injuries has also been conducted, and the Hand Injury Severity Score (HISS) has been found to closely correlate with return to work. Four grades of increasing severity of hand injury have been described. Although this system has been designed as a research tool, it is envisaged that it would be a useful immediate measure of severity and a guide to likely outcome.
The Role of Dynamic Magnetic Resonance Imaging in the Detection of Lesions of the Ulnocarpal Complex
Authors: Gabl M. , Lener M. , Pechlaner S. , Judmaier W.
Published: September 2005

A prospective study of 32 patients was carried out to investigate the significance of dynamic magnetic resonance imaging (MRI) in diagnosis of triangular fibrocartilage (TFC) lesions. Tears of the TFC can be diagnosed well by means of static MRI and arthroscopy. Dynamic MRI examination has an advantage in evaluating the stability of the TFC and ulnocarpal impingement. By means of dynamic MRI it was possible to make a preoperative diagnosis of an ulnocarpal impingement in five patients, a diagnosis which was confirmed through arthroscopy in all cases. In three further patients, dynamic MRI showed ulnocarpal impingement caused by instability of the ulnar attachment of the TFC. This kind of impingement could not be ascertained arthroscopically.

Dynamic MRI extends the possibilities of evaluating obscure ulnar wrist pain. Its significance lies in the non-invasive examination of ulnocarpal impingement as well as the evaluation of TFC stability.
Correction of Syndactyly using a Dorsal Omega Flap and Two Lateral and Volar Flaps
Authors: D'Arcangelo M. , Gilbert A. , Pirrello R.
Published: September 2005

The long-term results of a technique for correction of syndactyly are reported. The technique consists of a dorsal omega flap and a palmar anchor forming two palmar and lateral flaps. A long-term review was made of 50 patients with a minimum of 8 years follow-up operated over a period of 10 years. A total of 122 web spaces in simple, complex and syndromic syndactyly were operated on. Most patients achieved satisfactory reconstruction of the web spaces, resulting in a web of good shape. At long-term review, web creep was recorded in eight webs, and skin contractures in three fingers. This study shows the technique to be effective in reconstructing web spaces and in minimizing the prevalence of complications.
Ulnar Neuropathy at the Wrist Associated with a Recurrent Branch through the Flexor Carpi Ulnaris Tendon
Authors: Papierski P.
Published: September 2005

A case of ulnar neuropathy associated with an anatomical anomaly of the ulnar nerve is reported.
Dupuytren's Disease in the Feet Causing Flexion Contractures in the Toes
Authors: DONATO R. R. , MORRISON W. A.
Published: September 2005

Plantar fibromatosis is a recognised form of Dupuytren's disease. Two cases are presented in which there were flexion contractures of the toes in the involved feet. This is an extremely rare form of this plantar affliction.
A Post-Traumatic Ankylosis of the Lunate and Scaphoid to the Radius
Authors: ROOLKER W. , BROEKHUIZEN A. H. , BOS K. E.
Published: September 2005

A case of post-traumatic radiocarpal ankylosis is described.
Avascular Necrosis of the Scaphoid Treated by Total Excision and Radial Advancement Osteotomy
Authors: GÜNAL I. , ÖZTUNA V. , KÖSE N. , SEBER S.
Published: September 2005

Total scaphoid excision and radial advancement osteotomy has been investigated in a eadaverie and clinical study. In three below-elbow fresh amputation specimens, the technique was utilized and stability was checked by radiographs. Instability on ulnar deviation was prevented by extensor carpi radialis longus tenodesis.

Four patients were treated in this way. The wrist was immobilized in a below-elbow splint for 45 days, then active motion was encouraged. After 10 months, three patients had excellent results and one patient had good result using the criteria of Cooney et al (1987).
Lunotriquetral Arthrodesis
Authors: SENNWALD G. R. , FISCHER M. , MONDI P.
Published: September 2005

12 male (mean age 28) and 11 female (mean age 32) patients treated with lunotriquetral (LT) arthrodesis were reviewed with a median follow-up of 28 months (range 18–40 months) for this retrospective study. At first presentation 12 patients were unable to work, and at follow-up only three men remained out of work. The relief of pain was significant ( P < 0.001) and the median Culp (1993) wrist score obtained 74 (min. 45, max. 96); however, only one patient was totally free of pain and seven men had to change their occupations. Men lost 455 working days, women 191, a highly significant difference ( P = 0.006). This loss correlated ( P = 0.007) with the LT angle measured in the frontal plane: all patients but one with a LT angle of less than 31° returned to work within 1 year, but only four with a greater angle ( P=0.007). This emphasizes the importance of correct positioning of the triquetrum, which seems hard to achieve with two AO lag screws. Furthermore, even two screws seem unable to ensure solid fusion as shown by the high rate of pseudarthrosis (57%). LT fusion cannot be considered as a routine procedure and results are not yet predictable. According to these results, we feel that a bone graft placed in a slot from lunate to triquetrum is the procedure of choice. In the presence of a chondromalacia in the ulnar midcarpal joint, a four bone fusion is primarily recommended.
Wrist Denervation
Authors: FERRERES A. , SUSO S. , FOUCHER G. , ORDI J. , LLUSA M. , RUANO D.
Published: September 2005

We have analyzed the results of 22 total wrist denervations following Wilhelm’s technique and a series of 30 patients treated with denervation of the posterior interosseous nerve alone. Results of denervation have been classified depending on the pain (visual analogue scale) as other parameters (mobility and strength) have not been found to have any statistical significance. Results after partial denervation are worse than results achieved by total denervation.
Rupture of an Anomalous Tendon Slip as a Cause of Forearm Pain
Authors: O’HARA J. J. , STONE J. H.
Published: September 2005

Rupture of an anomalous tendon slip between the FDS aponeurosis and FDP tendon to the ring finger was found in a young woman’s forearm upon surgical exploration after months of forearm pain and disability. Excision of the anomalous slip resulted in quick and complete recovery.
Rupture of the Flexor Pollicis Longus Tendon after 30 Years due to Migration of a Retained Foreign Body
Authors: YANG S. S. , BEAR B. J. , WEILAND A. J.
Published: September 2005

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.
Hook-Nail Deformity
Authors: DUMONTIER C. , GILBERT A. , TUBIANA R.
Published: September 2005

Sixteen patients presenting 18 hook-nail deformities have been treated by the advancement of a homodigital island flap. With an average follow-up of 31 months; Results were considered good or excellent in seven cases, fair in seven and poor in four. Six cases, although improved, had a marked recurrence of the deformity, six had a partial recurrence and six had almost no recurrence. Patient satisfaction was limited as the finger still had a short nail and a square shape.
Corrective Osteotomy for Post-Traumatic Malunion of the Phalanges in the Hand
Authors: BÜCHLER U. , GUPTA A. , RUF S.
Published: September 2005

Rotation, angulation, deviation, shortening or a combination of deformities can occur due to phalangeal malunion and can lead to impairment of hand function.

A historical cohort study of 57 patients who had phalangeal corrective osteotomies for post-traumatic malunion between 1978 and 1990 was undertaken. 59 rotational, radial/ulnar deviation, flexion/extension, length adjustment procedures, and combinations thereof were performed, using rigid internal fixation. Concurrent tenocapsulolysis was done in 50% of the cases.

Satisfactory correction was obtained in 76% of the patients. Bony union was obtained in all cases. A net gain in active range of motion was achieved in 89% of the patients. Excellent and good results were obtained in 96% of the patients who had corrective osteotomies for malunion involving only the bone and in 64% of the patients who had corrections for malunion with involvement of multiple structures (P < 0.01).
Total Wrist Fusion
Authors: FIELD J. , HERBERT T. J. , PROSSER R.
Published: September 2005

Twenty cases of total wrist fusion, performed for post-traumatic conditions, were reviewed objectively, subjectively and radiologically. All patients were satisfied with the position of the fused wrist and had good pain relief. All patients would have had the procedure sooner, having had an average of three operations on the wrist before the fusion. There was a high complication rate (45%), although only four patients required further procedures for those complications. Hand function, as assessed by the Jebsen and Purdue tests, was found to be poor; this may be due to a reduced range of finger movements. There was no correlation between position of fusion, carpal height or number of joints radiologically fused, and the pain score, grip strength or Buck-Gramcko score.
Dupuytren’s Disease Treated by Palmar Fasciectomy and an Open Palm Technique
Authors: SHAW D. L. , WISE D. I. , HOLMS W.
Published: September 2005

The results of long-term follow-up (range 9–19 years) are presented in a continuous series of patients treated for Dupuytren's contracture by one surgeon using the open palm technique. Mean preoperative total range of movement was 48% rising to 96% postoperatively. Mean total range of movement was 92% at follow-up. Survivorship analysis revealed 86% survival at 10 years and 77% survival at 19 years. There was one digital nerve injury and one case of algodystrophy. This technique gives good long-term results without the use of night splintage or physiotherapy.
Simultaneous Tendon Transfer and Autogenous Augmentation of the First Web Space of the Hand with Intrinsic Paralysis
Authors: AL-QATTAN M. M.
Published: September 2005

Simultaneous tendon transfer and dermofat graft augmentation of the first web space of the hand with intrinsic paralysis is described. Fifty per cent over-correction of the web space volume is recommended in anticipation of postoperative graft resorption. Other techniques of fat auto-transplantation are discussed.
Apparent and Partial Non-Union of the Scaphoid
Authors: BARTON N. J.
Published: September 2005

Ten patients with radiological non-union of the scaphoid and four patients with suspected nonunion were explored surgically. At operation, ten scaphoids looked united; five of these went on to definite union but the other five to non-union (in one case, despite a Herbert screw). In another four patients, there appeared at operation to be partial union; all proceeded to complete union. Even with the scaphoid in front of you, it can be difficult to decide whether it has united or not.
Biodegradable Pins Versus Kirschner Wires in Hand Surgery
Authors: JENSEN C. H. , JENSEN C. M.
Published: September 2005

We compared biodegradable pins with standard Kirschner wires in the fixation of fractures, arthrodeses and osteotomies in the hand in a prospective, randomized study.

Eleven patients were allocated to the biodegradable pin group and 12 to the Kirschner wire group. Age, gender, operative procedure and postoperative treatment did not differ in the two groups.

All patients were evaluated after 6 months. No differences in time to union or complication rates were found, but the number of additional operative procedures in the Kirschner wire group significantly exceeded the number needed in the biodegradable pin group.
Closure of Wounds in the Upper Extremity Using a Skin Stretching Device
Authors: STAHL S. , HAR-SHAI Y. , HIRSHOWITZ B.
Published: September 2005

A skin stretching device (SSD) harnessing the viscoelastic properties of skin using incremental traction has been used in 20 patients with skin deficits in the upper extremity. Complications were few considering the extensive damage to the skin and included slight partial dehiscence, necrosis of skin edges, local infection and hypertrophic scars. All wounds healed without the need for further surgical procedures. Application of the SSD is simple and it can even be used at the bedside under local anaesthesia. It reduces the need for more complicated surgical procedures like grafts or flaps.
Eccrine Spiradenoma of the Hand Clinically Mimicking a Lipoma
Authors: AL-QATTAN M. M.
Published: September 2005

A rare case of eccrine spiradenoma of the hand is described. The tumour mimicked a lipoma on clinical examination and in macroscopic appearance. The classification and treatment of eccrine tumours are discussed.
Carpal Tunnel Syndrome in Amyotrophic Lateral Sclerosis and Late Onset Cerebellar Ataxia
Authors: MONDELLI M. , PORTA P. DELLA , ZALAFFI A. , ROSSI A.
Published: September 2005

We report on clinical and electrophysiological findings and management in nine patients who developed carpal tunnel syndrome during the course of amyotrophic lateral sclerosis and late onset cerebellar ataxia, two neurodegenerative diseases. The patients were treated with surgical decompression (five cases) and local steroid injections (four cases). Only one showed lasting relief of symptoms and significantly improved distal conduction in the median nerve at follow-up after 2 to 3 months. The symptoms and conduction data remained unchanged in three patients who could be followed for more than 1 year. We think that axonal neuropathy plays an important role in the development of carpal tunnel syndrome in these patients and accounts for the failure of the standard treatments.
Basal Joint Arthrosis
Authors: KADIYALA R. K. , GELBERMAN R. H. , KWON B.
Published: September 2005

A radiographic method was developed, the trapezial space ratio, for assessing the space occupied by the trapezium (a space defined by the distal scaphoid and thumb metacarpal base divided by the thumb proximal phalanx). This method was applied to 100 normal thumb radiographs and to the radiographs of 15 patients with symptomatic degenerative arthrosis of the thumb basal joint before and after operative treatment with ligamentous reconstruction and tendon interposition arthroplasty. The trapezial space ratio averaged 0.476 ± 0.033 for radiographs of normal thumbs, 0.372 ± 0.084 for the pre-operative radiographs of thumbs with symptomatic basal joint arthrosis, and 0.270 ± 0.078 for the radiographs of thumbs following basal joint arthroplasty.

A significant reduction in the trapezial space ratio was noted when values from arthritic thumbs were compared to those of normal thumbs (22%; P<0.0001). A further reduction in the trapezial space ratio was noted when post-operative values were compared to pre-operative ones (27%; P< 0.0002). Comparing post-operative trapezial space ratio values to values obtained in normal thumbs, a reduction of 43% was found in those thumbs treated operatively. These finding indicate that the trapezial space is reduced significantly in thumbs with severe degenerative arthrosis compared to normal thumbs and that ligament reconstruction tendon interposition arthroplasty is not entirely successful in either restoring or maintaining the length of the thumb ray.
The Posterior Interosseous Forearm Island Flap for Skin Defects in the Hand and Elbow
Authors: MAZZER N. , BARBIERI C. H. , CORTEZ M.
Published: September 2005

The authors’ experience of 51 posterior interosseous forearm island flaps is presented. Its main indications were inadequate scar or scar contraction and complex trauma with gross skin loss, either acute or postprimary. The flap healed uneventfully in 45 cases (88%), but in six it was partially or subtotally lost due to necrosis. Late complications included hair growth in the first web and palm, flap redundancy and hypertrophic scar at the donor site. The posterior interosseous island flap produces excellent skin coverage but is difficult to raise and tends to develop oedema and occasionally necrosis.
Functional Anatomy of The Triangular Fibrocartilage Complex
Authors: NAKAMURA T. , YABE Y. , HORIUCHI Y.
Published: September 2005

The functional anatomy of the triangular fibrocartilage complex (TFCC) was investigated in 20 fresh cadavers. Dynamic changes in the TFCC during rotation were also examined from both the proximal and distal aspects. In our analysis, the TFCC was separated into three components. The distal component was stable, functioning like a hammock to suspend the ulnar carpus. The proximal component was the fan-shaped triangular ligament, the true radioulnar ligament. This was found to originate from the fovea of the ulna in a vertical fashion and was easily twisted during rotation. The third component, the ulnar collateral ligament, also twisted during rotation. When analysed by coronal section, the internal portion of the TFCC was found to be loose, and probably serves as a cushion to absorb local deformities in the TFCC during rotation.
Giant Cell Tumours of the Hand
Authors: SANJAY B. K. S. , RAJ G. A. , YOUNGE D. A.
Published: September 2005

A study of seven cases of giant cell tumours of the hand is reported. All tumours were treated by an en bloc excision of the tumour or by whole ray resection. En bloc resection of the tumour and reconstruction with a fibular graft where necessary should be considered as the treatment of choice in giant cell tumour of the hand.
Toe To Hand Transfer in Children
Authors: KAY S. P. , WIBERG M.
Published: September 2005

Between 1988 and 1994 40 children (age range 9 months–14 years) with either congenital (85%) or acquired hand deformities underwent reconstruction by microvascular autotransplantation of one or more toes.

Fourteen underwent a single toe transfer whilst 26 had two second toes transferred to one hand. In 14 of these cases both second toes were transferred at one operation. Whether one or two toes were transferred, the children spent on average 9 days in hospital. None of the transfers failed but 75% of the children underwent staged additional surgery to improve appearance and function.

Thirty-seven of the 40 children attended with their parents for follow-up examination by an independent surgeon, a physiotherapist and a clinical psychologist in order to evaluate the results and consequences of surgery. This paper presents the technical considerations for this surgery and examines the influence of the transfer on growth.
Toe To Hand Transfer in Children
Authors: KAY S. P. , WIBERG M. , BELLEW M. , WEBB F.
Published: September 2005

Forty children with congenital (85%) or acquired hand disorders underwent transfer of one or two toes to one hand. The children were reviewed with their parents and assessed for functional and psychosocial performance. There was some evidence that the older the child at the time of transfer, the better the range of motion. The passive range of motion was on average 60° more than the active range of motion despite subsequent procedures such as tenolysis. All transfers recovered protective sensibility and the majority recovered good levels of two point discrimination and light touch perception. Almost all transfers were naturally incorporated into the use pattern of the limb for some or most of the time. Most parents and patients reported a very positive effect of this surgery on the child’s psychosocial functioning.
Impaired Regeneration in Rat Sciatic Nerves Exposed To Short-Term Vibration
Authors: STRÖMBERG T. , LUNDBORG G. , HOLMQUIST B. , DAHLIN L. B.
Published: September 2005

We have studied the effects of vibration on the regeneration capacity of the peripheral nerve. A rat model was used where one hind limb was subjected to vibration of defined magnitude and duration while the contralateral hind limb was not exposed to vibration. Seven days later, the sciatic nerves were transected bilaterally and cross-joined giving the following groups: group A, a proximal vibrated nerve end sutured to a non-vibrated distal nerve end; group B, a non-vibrated proximal nerve end sutured to a distal vibrated nerve end, and group C, non-vibrated proximal nerve end sutured to a non-vibrated distal nerve end. The regeneration distances were measured 3, 6 and 8 days after surgery. The control group showed a normal linear outgrowth. The outgrowth in the two experimental groups was initially not different to controls but later became significantly different, indicating a retardation of outgrowth in these groups. It is concluded that short-term exposure to vibration can impair nerve regeneration after transection and nerve repair.
Rubber Band Constriction of the Wrist
Authors: RASOOL M. N. , STATHOULIS B.
Published: September 2005

We report the effects of rubber bands placed as decorative bands around the wrists of two infants by older children. These bands went unnoticed by their parents for several hours until swelling of the hand occurred. Early decompression of the carpal tunnel and fasciotomy of the dorsum of the hand are recommended. Education of the community is important in avoiding complications from placement of these rubber bands around an extremity.
The Effect of Pulsed Electromagnetic Fields on Flexor Tendon Healing In the Rabbit
Authors: GREENOUGH C. G.
Published: September 2005

A double-blind controlled trial of the effects of pulsed electromagnetic fields on flexor tendon healing in adult New Zealand White rabbits was performed. A pulse burst waveform, previously demonstrated to influence new vessel growth in the rabbit, was employed. No significant effect was observed on either the healed strength of the tendon repair or the adhesion formation between the repair and the surrounding tissues. The model used for examination of adhesion formation was reproducible and is recommended for further work on the adhesion formation of healing tendons.
Assessment of Axons from the Different Types of Neurons Regenerating Through Sites of Repair after Nerve Repair
Authors: Xu J-J. , Huang Y.
Published: September 2005

The percentage of axons from different types of neurons regenerating through the site of repair was assessed by retrograde horseradish peroxidase labelling in 30 male SD rats. These rats were randomly divided into groups and underwent epineurial, perineurial suturing and 4 mm nerve graft for transected peroneal nerves in lower limbs on one side. The contralateral nerves were not injured and served as controls. The number of labelled neurons in the experimental side divided by those in the control gave a percentage of regeneration. Four to 9 weeks after nerve repair, axonal regeneration through the repair site was assessed by number, location and diameter. Results revealed that the percentage of motor axons crossing the nerve repair site was the same as the sensory axons. The percentage of neurons with axons innervating muscle spindles was statistically lower that those innervating the other end organs. Perineurial repair produced a higher percentage of motor axons across the repair than epineurial repair or nerve graft.
The Radiological Anatomy of the Scaphoid
Authors: COMPSON J.P. , WATERMAN J.K. , HEATLEY F.W.
Published: September 2005

The complex shape of the scaphoid and its orientation within the carpus makes the radiological interpretation of scaphoid anatomy difficult. To improve our understanding of how the anatomy appears on plain X-ray, a study was performed using dry cadaver bones. Salient anatomical features were outlined using radiopaque markers, the bones set in wax blocks and the blocks X-rayed in the same axis as six “standard” scaphoid views. The pictures obtained were then compared with clinical X-rays.
Primary Epineural Repair of the Median Nerve in Children
Authors: HUDSON D. A. , BOLITHO D. G. , HODGETTS K.
Published: September 2005

We report 18 children (12 boys and six girls) with a mean age of 6.1 years who sustained lacerations of the median nerve. Associated injuries to other structures occurred in 15 children. Treatment was by primary epineural repair. All the children were assessed at least 1 year after injury. The mean return of motor power to the opponens pollicis was 4.5 with a range of 3 to 5 (MRC scale) and the mean static 2-point discrimination was 5 mm (range 2–10 mm). All children showed a full functional recovery as assessed by the Bruininks–Oseretsky test. Primary epineurial repair in children leads to very satisfactory motor and sensory results. A fully functional hand can be expected.
Upper Limb Triplication with Radial Dimelia
Authors: MENNEN U. , DELEARE O. , MATIME A.
Published: September 2005

We report a very unusual case of upper limb triplication. The fused upper two limbs present as a duplicated mirror hand, joined along the ulnar side from the small finger up to the humerus. This exceptional abnormality further corroborates the theory that the development of the more distal segments of the limb is determined by the more proximal segments.
Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy
Authors: IDE J. , YAMAGA M. , KITAMURA T. , TAKAGI K.
Published: September 2005

The sympathetic nervous system function in 20 patients with reflex sympathetic dystrophy (RSD) of one upper extremity was examined by a non-invasive laser Doppler method to assess fingertip blood flow and vasoconstrictor response to deep inspiration. We observed an increased blood flow but an unchanged vasoconstrictor response in the affected hand in stage 1 of the disorder, but in stage 2 there was a decreased blood flow and a stronger vasoconstriction following an inspiratory gasp. Skin blood flow and vasoconstrictor response returned to normal following successful treatment of the condition. These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages. The objective method used in our study may be of value in the diagnosis and management of RSD.
A Relatively Atraumatic Method of Retrieving Retracted Digital Flexor Tendons
Authors: ADENIRAN A. , BABAR A. Z.
Published: September 2005

A relatively atraumatic, simple and very reliable method of retrieving the proximal end of a severed flexor tendon of a finger or thumb is described. The technique involves passing a Silastic feeding tube into the flexor tendon sheath, placing the retracted tendon within its lumen, and securing it in place with a single stitch. The feeding tube is then withdrawn until the tendon presents within the distal wound. Hypodermic needle fixation and tendon repair is then carried out in the usual manner.
Dynamic Swan Neck Deformity in a Patient with Ehlers-Danlos Syndrome
Authors: ERÇÖÇEN A. R. , YENIDÜNYA M. O. , YILMAZ S. , ÖZBEK M. R.
Published: September 2005

A patient with type I Ehlers–Danlos syndrome with a congenital hand deformity described as a “dynamic swan neck deformity” is presented and causes of the deformity are discussed.
Congenital Fusion of the Scaphoid, Trapezium, Trapezoid and Capitate
Authors: INGRAM C. , HALL R. F. , GONZALEZ M.
Published: September 2005

We describe an unusual case of carpal coalition in an otherwise asymptomatic 28-year-old man. The combination of scaphoid, trapezium, trapezoid and capitate fusion detailed in this article has not, to the best of our knowledge, been previously recorded.
Bilateral Transscapholunate Dislocations
Authors: BARROS J. W. , OLIVEIRA D. J. , FERNANDES C. D.
Published: September 2005

Bilateral transscapholunate dislocations were treated with immediate open reduction and internal fixation. Eighteen months after injury the patient was asymptomatic.
Nonunion of a Distal Radial Fracture in a Healthy Child
Authors: KWA S. , TONKIN M. A.
Published: September 2005

Nonunion of distal radial fractures in children are rare. We report a case of a closed distal radial fracture in a healthy child, which developed a nonunion following closed reduction and plaster immobilization.
The Distally Based Ulnar Artery Island Flap in Hand Reconstruction
Authors: GROBBELAAR A. O. , HARRISON D. H.
Published: September 2005

The distally based ulnar artery island flap is a highly versatile flap for hand reconstruction. It fulfils all the necessary criteria required for a flap to the hand providing thin pliable hairless skin. It can be used as a composite flap including tendon and bone and provides an ideal tunnel for tendons to glide in. It can be used as a fasciocutaneous flap or as a fascial flap and can easily be rotated to the dorsum of the hand by opening Guyon’s canal. The palm or dorsum of the hand and even the fingertips can be reached easily. A superficial venous anastomosis should be made if marked venous congestion is noted intraoperatively. Six cases utilizing a distally based ulnar island flap in hand reconstruction are presented.
Subungual Glomus Tumours: A Different Approach to Diagnosis and Treatment
Authors: EKIN A. , ÖZKAN M. , KABAKLIOGLU T.
Published: September 2005

Nine cases of subungual glomus tumour in which a transillumination test was used for diagnosis and a different operative technique was used to prevent postoperative nail deformity are described. The transillumination test is a new method for identifying a glomus tumour. With our surgical technique it is simple to approach a glomus tumour under the proximal nail bed and it produces a minimal defect.
The Treatment of Enchondromas in the Hand by Endoscopic Curettage without Bone Grafting
Authors: SEKIYA I. , MATSUI N. , OTSUKA T. , KOBAYASHI M. , TSUCHIYA D.
Published: September 2005

Nine patients with enchondromas in the hand were treated by endoscopic curettage of the tumour without bone grafting. The procedure was performed on an out-patient basis using axillary block anaesthesia. New bone formation and remodelling of the lesions were observed in all patients. There were no postoperative fractures, infections, recurrences or other complications. Functional recovery was rapid. We conclude that endoscopic curettage without bone grafting is an effective treatment of enchondroma in the hand.
Chondrosarcoma of the Hand Arising in a Young Patient with Multiple Hereditary Exostoses
Authors: SAUNDERS C. , SZABO R. M. , MORA S.
Published: September 2005

An unusually large chondrosarcoma arising in the hand of a young patient with multiple hereditary exostoses is presented.
Unilateral Hypertrophy of the Upper Extremity Due to Aberrant Muscles
Authors: TANABE K. , TADA K. , DOI T.
Published: September 2005

We present a case of congenital unilateral hypertrophy of an upper extremity due to aberrant muscles. Reviewing the previous Japanese reports, we discuss the clinical features and the pathogenetic factors of this rare anomaly.
Passive Axial Rotation of the Metacarpophalangeal Joint
Authors: KRISHNAN J. , CHIPCHASE L.
Published: September 2005

We measured passive axial rotation at the metacarpophalangeal (MCP) joints of the index, long, ring and small fingers of both hands in 100 healthy subjects using a magnetic position and orientation system called an Isotrak. Large degrees of passive rotation were found, with the ring and small finger MCP joints displaying significantly greater ranges of supination than the other two joints. Supination ranges were also found to be significantly greater than the pronation values in each joint. These results support present anatomical understanding that, during prehensile activities, axial rotation of the MCP joints occurs to allow the hand to adapt to an object being held.
Variations of the Flexor Digitorum Superficialis Tendon of the Little Finger
Authors: GONZALEZ M. H. , WHITTUM J. , KOGAN M. , WEINZWEIG N.
Published: September 2005

Seventy cadaveric hands were dissected to study variations of the flexor digitorum superficialis tendon (FDS) to the little finger. Anatomical variations were present in 13% of hands and 10% of the hands showed an anatomical variation that would preclude independent FDS function in the little finger.

The distance of the decussation from the metacarpophalangeal joint was measured. A ratio of this distance to proximal phalangeal length was calculated. The ratio indicated that decussation position was independent of phalangeal size.
Results of Dynamic Splintage Following Extensor Tendon Repair
Authors: IP W. Y. , CHOW S. P.
Published: September 2005

We report a prospective study of dynamic splintage following extensor tendon repair. Eighty-four patients with 101 extensor tendon injuries were studied. Using Dargan’s evaluation system, there were 97% excellent results for the thumb and 93% excellent and good results for the fingers. The average total active motions were 107° for thumbs and 245° for fingers. Over 80% of patients regained good power grip. Patients with associated digital fractures or with ragged lacerations had poorer results. Overall, we found that dynamic splintage was a satisfactory method after extensor repair.
Limited Wrist Arthrodesis for the Salvage of SLAC Wrist
Authors: GILL D. R. J. , IRELAND D. C. R.
Published: September 2005

We report the results of limited wrist arthrodesis, a salvage procedure for SLAC wrist. It involves excision of the scaphoid, radial styloidectomy and fusion of the lunate to the capitate and the triquetrum to the hamate, using cancellous lag screws. Twenty-four wrists in 22 patients were reviewed retrospectively at an average follow-up of 23 months. Seventeen of the 22 patients had no pain or mild pain and had retained a mean arc of motion of 48°. Grip strength was 70% of the other side. Four of the 24 patients developed non-unions, two of which had successful revision to limited wrist arthrodesis. The other two required pan arthrodesis of the wrist. Two other patients with persisting pain in spite of solid fusion were also treated by pan arthrodesis of the wrist. Radial styloidectomy did not result in early failure of this procedure and secondary ulnar translocation of the carpus was not seen.
Bizarre Parosteal Osteochondromatous Proliferation in a Child’s Hand
Authors: MIYAJIMA T. , SAKADA T. , AZUMA H.
Published: September 2005

We report a case of bizarre parosteal osteochondromatous proliferation in the hand of a boy aged 13 months.
Soft-Tissue Chondroma of the Nail Bed
Authors: DUMONTIER C. , ABIMELEC P. , DRAPE J-L.
Published: September 2005

We report a nail bed tumour which was found to be a soft-tissue chondroma. According to a literature review, this is the fifth reported case of soft-tissue chondroma arising in the nail bed, but none of the others were studied by magnetic resonance imaging.
An Evaluation of Different Methods of Peripheral Nerve Repair In Normal and Diabetic Rats
Authors: FULLARTON A. C. , GLASBY M. A.
Published: September 2005

Successful nerve regeneration depends on the type of injury, the method of repair and the metabolic status of the animal. A state similar to poorly controlled Type I diabetes mellitus in man was induced and maintained in rats using streptozotocin. This provided a model for the study of nerve regeneration in diabetes over a period of 150 days. Two methods of nerve injury (crush and transection) and three methods of repair (epineurial suture, nerve autograft and freeze-thawed skeletal muscle autograft) were compared using electrophysiological and histological methods. The diabetic state did not affect the degree of recovery of nerve conduction velocity after nerve injury. By 150 days, recovery to control values of axon and nerve fibre diameters was not attained. Recovery of axon and fibre diameter was significantly poorer in the diabetic nerve crush group compared with the non-diabetic nerve crush group. It is concluded that this was because of poorer regeneration in diabetic nerve.
The Virtual Hand
Authors: WILLIAMS N. W.
Published: September 2005

Virtual reality technologies are now at a stage in which the various disciplines can be brought together to construct a virtual human hand. Devices can be constructed to record multiple joint positions accurately in clinical environments. Joint prostheses may be tested virtually before undergoing clinical trials, albeit in a simple way at present, but may eventually be incorporated into a virtual model of the hand and driven by goniometric gloves. This will allow more detailed analyses of implant in situ behaviour. These exciting developments will provide a huge advance in our understanding of the functions of the real hand and also a potential way of assessing outcomes in a simple and repeatable fashion. We are on the edge of a new era in hand surgery when the computer scientist, biomechanic, control engineer, hand therapist and surgeon will be able to alternate between the virtual and the real world in producing better outcomes for patients.
Comparison between Single Injection Transthecal and Subcutaneous Digital Blocks
Authors: LOW C. K. , WONG H. P. , LOW Y. P.
Published: September 2005

A randomized double blinded study was performed on 142 patients to evaluate two different techniques of single injection digital anaesthesia. In group A, 86 digits in 71 patients were anaesthetized by a single injection transthecal technique using 3 cc of lignocaine and bupivacaine mixture. Anaesthesia of the whole digit was achieved in 83 (97%) digits. In group B, 80 digits in 71 patients were anaesthetized with a single injection subcutaneous technique using the same amount of anaesthetic mixture. Total anaesthesia of the digit was achieved in 75 (94%) digits. These two techniques were found to have no differences in effectiveness, distribution, onset and duration of anaesthesia.
The Role of Metacarpophalangeal Pattern (MCPP) Profile Analysis in the Treatment of Triphalangeal Thumbs
Authors: ZGURICAS J. , DIJKSTRA P. F. , HOVIUS S. E. R.
Published: September 2005

The metacarpophalangeal pattern (MCPP) profile analysis is a method of comparing the length of each of the 19 tubular bones of the hand on the X-ray with the standard length in the normal population according to age and sex. An MCPP plot is a graphic illustration of the MCPP analysis. It is not the exact height of the curve on the MCPP plot which is most important, but the profile which occurs because of the individual lengthening or shortening of the bones. This pattern profile appears to be specific for several congenital malformation syndromes. We have recently used MCPP analysis in planning surgery for triphalangeal thumbs. The percentage of excessive or reduced length of each individual bone of the hand can be read from the MCPP plot and is helpful in calculating a more accurate length for the newly created thumb. MCPP analysis can be used as a diagnostic tool in a number of congenital hand malformations, but may also be helpful in planning surgical treatment of congenital hand malformations when abnormal bone length is involved.
The Anatomical Basis of the Vascularized Pronator Quadratus Pedicled Bone Graft
Authors: LEE J. C-H. , LIM J. , CHACHA P. B.
Published: September 2005

The vascular supply of the pronator quadratus was studied in 25 cadaveric dissections following coloured latex injections. This showed that the main blood supply of the pronator quadratus came from the anterior interosseous artery. There was, however, a rich anastomosis between the branches of the anterior interosseous artery and those of the radial and ulnar arteries. It was possible to raise a corticocancellous bone graft from the anterior surface of the radial styloid on a pedicle of the lower fibres of the pronator quadratus muscle. This muscle pedicle had a constant branch of the anterior interosseous artery which vascularized the bone graft. Such a vascularized pedicled bone graft may be useful in the treatment of non-union of the scaphoid and Kienböck’s disease.
Extensive Nodular Sarcoidosis in the Hand
Authors: KWON B. , BINDRA R. R. , LIAKOS P. , GELBERMAN R. H.
Published: September 2005

We report an atypical case of nodular sarcoidosis involving both hands. The pattern of extensive involvement of all digits with lesions extending into the pulp spaces has not been reported previously. The diagnosis of sarcoidosis should be considered even in patients presenting with clinically uncharacteristic manifestations.
Composite Graft Replacement of Digital Tips
Authors: MOIEMEN N. S. , ELLIOT D.
Published: September 2005

This study investigated the outcome of composite graft replacement of 50 amputated digital tips in 50 children over a period of 3 years and 6 months. Eleven of 18 tips (61%) which were replaced within 5 hours survived completely while none of 32 digital tips replaced after 5 hours survived completely. This difference was highly significant. The mean delay time between amputation and replacement in the successful group was 3.9 hours and in the others was 7.2 hours. This difference was also statistically significant. The implications of the findings of this series to the use of this treatment are discussed.
Subcutaneous Extensor Tendon Rupture Associated with Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Wrist
Authors: TANIGUCHI Y. , YOSHIDA M. , TAMAKI T.
Published: September 2005

We report a patient with rupture of the ring extensor tendon associated with calcium pyrophosphate dihydrate crystal deposition disease of the wrist. Crystal deposits were noted in synovium and the triangular fibrocartilage complex. Histological examination revealed chronic synovitis with foreign body giant cell reaction to crystals. The cause of the tendon rupture was synovitis due to crystal deposition.
Customized Staple Fixation in Hand and Wrist Surgery
Authors: LOOI K. P. , CHIA J. , KOUR A. K. , PHO R. W. H.
Published: September 2005

Fixation of small bones in the adult and the child’s hands remains a challenge. The authors present a technique of bone fixation using customized staples made intraoperatively from K-wires (0.9–1.6 mm in diameter). Their specific purpose was to provide axial alignment and rotational stability for carpal bone fixation and for epiphysiodesis in phalanges. This technique was used in 14 cases (11 adult and three paediatric). No bone shattering, implant breakage, implant loosening or infection occurred. As K-wires are quite malleable, custom sized and shaped staples which follow the bone contours could be made to give a more exact fixation. All cases had satisfactory outcomes, achieving the preoperative objectives of bony fixation. This method is safe, precise and technically easy. It is also relatively cheap and only requires simple, standard instruments.
Our Experience with the Use of the Dorsal Ulnar Artery Flap in Hand and Wrist Tissue Cover
Authors: ANTONOPOULOS D. , KANG N. V. , DEBONO R.
Published: September 2005

We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery fasciocutaneous flap as described by Becker and Gilbert (1988a; b). Although the territory supplied by the dorsal ulnar artery is 10 cm to 20 cm long by 5 cm to 9 cm wide, Becker and Gilbert suggested that flaps should be confined to smaller dimensions. We have found that larger flaps (15 to 20 cm long and 5 to 8 cm wide) are feasible, extending the use of the flap to the radial side of the wrist and hand. However, problems were encountered with venous drainage and these larger flaps should be used with caution.
The Reconstruction of a Dorsal Digital Defect Using a Reverse Homodigital Island Flap in Corporating Vascularized Tendon
Authors: TONKIN M. A. , AHMAD T. S.
Published: September 2005

We describe a modification of the reverse homodigital island flap, in which a segment of lateral band of the extensor apparatus is harvested with the flap and used to reconstruct the extensor insertion to the distal phalanx.
Post-Traumatic Double Fingernail Deformity
Authors: MAHDI S. , BEARDSMORE J.
Published: September 2005

We report a 5-year-old boy who developed a complete accessory ectopic nail along the dorsoulnar aspect of the left ring finger after injury. The deformity was corrected by surgical resection of the accessory nail and the underlying nail matrix.
Open Carpal Tunnel Release
Authors: JONES S. M. G. , STUART P. R. , STOTHARD J.
Published: September 2005

Carpal tunnel decompression gives relief of symptoms of tingling and numbness in the fingers in around 90% of carpal tunnel syndrome cases. The most common complaint after operation is pain and tenderness about the operation scar. The normal median nerve slides back and forth during wrist movement. Loss of this movement due to scar adhesion is suggested as a cause of wound pain and residual symptoms. We performed a controlled, blinded study of bilateral primary carpal tunnel releases comparing standard closure with a hypothenar fat pad flap modified closure. No significant differences in pain or other symptoms were found.
Isolated Subluxation of the Extensor Pollicis Longus Tendon
Authors: CHURCHILL M. , CITRON N.
Published: September 2005

Isolated ulnar subluxation of the extensor pollicis longus (EPL) tendon occurs when there is damage to the radial side of the extensor hood on the dorsum of the metacarpophalangeal joint of the thumb. The thumb collapses into a pseudoboutonnière deformity because the EPL tendon subluxes and comes to lie palmar to the centre of rotation of the metacarpophalangeal joint to act as a flexor instead of an extensor. The extensor pollicis brevis tendon which lies in a deeper plane to the EPL is unaffected. We describe four cases and propose conservative treatment as being effective in recent injuries.