bluuebunny/crossref_metadata_2025 huggingface dataset:
Cleft Hand, Syndactyly and Hypoplastic Thumb
Authors: MIURA T. , NAKAMURA R. , SUZUKI M. , WATANABE K.
Published: June 2005

The clinical features of 58 patients with typical cleft hand were examined and compared with 86 patients with syndactyly between the long and ring fingers, 27 patients with syndactyly between the ring, little and other fingers, 53 patients with hypoplastic thumb and 100 patients with symbrachydactyly. The clinical findings of the typical cleft hand resembled those of syndactyly. There were two unusual cases of typical cleft hand associated with hypoplastic thumb, congenital heart anomalies and absence of the axial triradius. One of these also had cleft lip and palate. The critical embryonic period of the heart anomaly is early, while that of the cleft lip and palate is late. These findings suggest that an embryo with typical cleft hand and hypoplastic thumb results from impairments at two different times in the early embryonic period.
Isolated Flexor Pollicis Longus Palsy in Twin Sisters Treated by Brachioradialis Transfer
Authors: SUMAN R. K.
Published: June 2005

Isolated paralysis of flexor pollicis longus is an uncommon variation of the anterior inter-osseous nerve compression syndrome. Two cases occurring in twin sisters were treated by brachioradialis tendon transfer when no recovery was evident after six months, with good results. Brachioradialis transfer is technically easy to perform, but complete mobilization of the tendon and muscle is necessary to achieve the desired excursion of the muscle-tendon unit.
Micro-Surgical Fascicular Nerve Repair: A Morphological Study of the Endoneurial Bulge
Authors: Archibald S. J. , Fisher T. R.
Published: June 2005

The phenomenon of ‘endoneurial bulging’ from the cut end of the divided nerve fasciculus in the rat sciatic nerve has been examined with light and scanning electron microscopy and the morphological changes compared when dividing the fasciculus with either micro-scissors or a sharp razor blade.
The Blood Supply of Digital Nerves: A Microanatomical Study of Superficial and Deep Palmar Venous Networks
Authors: DAUTEL G. , MERLE M.
Published: June 2005

In this work on vascularization of digital nerves, we have studied the anatomy of the deep network of venae comitantes of digital arteries, and the system of superficial palmar venules. 22 specimens of nerve and artery were dissected as one unit and were infused with Microfil prior to study under the microscope. The deep venous network, a satellite of the digital artery, can be classified into four types. A true network of deep venae comitantes exists in three of these four types, drained by deep veins arising from the transverse anastomotic arches between the palmar digital pedicles. Vascularization of the digital nerve is supplied by numerous anastomotic vessels connecting epineurial vessels, digital artery and the periarterial network (venae comitantes and vasa vasorum). This anatomical configuration lends itself to vascularized nerve grafting; for example, it is possible to use a nerve/artery graft taken as a unit from an amputated finger unsuitable for replantation. Two types of valves in this superficial venous network have been identified and their function is discussed.
The Terminal Branch of Posterior Interosseous Nerve: A Useful Donor for Digital Nerve Grafting
Authors: REISSIS N. , STIRRAT A. , MANEK S. , DUNKERTON M.
Published: June 2005

The anatomical relationships of the terminal branch of posterior interosseous nerve have been studied in 57 cadaver and amputation specimens. Removal of the nerve leaves the patient with no apparent sensory deficit.

In all dissections the nerve was present and its location was constant. The mean obtainable length was 3.7 cm (range 2.7–5.1 cm) and its cross-sectional area made the nerve suitable for grafting of digital nerves.
Replantation of the Radial Side of the Hand in the Rhesus Monkey: Anatomical and Functional Aspects
Authors: HOVIUS S. E. R. , STEVENS H. P. J. D. , VAN NIEROP P. W. M. , GODSCHALK M. , KUSUMA A. , DEELEN G. , VAN DE BERGH M. , VAN DER MEULEN J. C.
Published: June 2005

Before human hand transplantation can even be considered, an appropriate research model must be studied in-a non-human primate. The first ray of the hand, augmented with a radial forearm flap, was chosen as a functional composite tissue graft.

Four technically successful replantations of the radial unit have been carried out. One monkey died on the first post-operative day due to cardiac arrythmia. Normal wound healing occurred in the other three animals.

In three monkeys, functional sensory and motor recovery was almost complete. The monkeys were able to pick up small particles of food with the index finger and thumb.

It is suggested that this model could be used for allogeneic composite tissue transplantation in a non-human primate.
Arteriovenous Fistulae after Free Flap Surgery in a Replanted Hand
Authors: NINKOVIÆ M. , S̆UÆUR Đ. , STAROVIÆ B. , MARKOVIÆ S.
Published: June 2005

AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand.

This paper discusses the mechanisms responsible for the formation of AV fistulae.
The Gymnast’s Wrist: Acquired Positive Ulnar Variance Following Chronic Epiphyseal Injury
Authors: TOLAT A. R. , SANDERSON P. L. , DE SMET L. , STANLEY J. K.
Published: June 2005

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulno-carpal impingement, for which we describe a clinical test.

Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate surgery. Two patients needed distal ulna recession and one needed shaving for a TFCC perforation, with a good result.
The Swanson Ulnar Head Prosthesis for Post-Traumatic Disorders of the Distal Radio-Ulnar Joint
Authors: STANLEY D. , HERBERT T. J.
Published: June 2005

20 Swanson ulnar head prostheses inserted for post-traumatic disorders of the distal radio-ulnar joint were reviewed at a mean of 44.2 months post-operatively (range 12–104 months). The indication for surgery was painful loss of forearm rotation with or without ulno-carpal impingement and ulno-carpal instability.

Symptoms in 16 patients were the result of malunion following severe distal radial fractures (two Frykman 7 fractures and 14 Frykman 8 fractures), and in the remainder were due to unreduced dislocations in the distal radio-ulnar joint (two patients) or unsatisfactory Darrach procedures (two patients).

70% of patients achieved excellent or good clinical results despite the fact that radiographs showed bone resorption in all cases, tilting of the prosthesis in 40% and implant fractures in 15%.
Silicone Rubber Distal Ulnar Replacement Arthroplasty
Authors: SAGERMAN S. D. , SEILER J. G. , FLEMING L. L. , LOCKERMAN E.
Published: June 2005

We retrospectively reviewed 42 patients who underwent resection of the distal ulna with implantation of a silicone rubber ulnar head prosthesis (45 wrists). Two prostheses were used: the original Swanson prosthesis, and a prosthesis of our own design. Follow-up X-rays showed migration or breakage of 63% of the prostheses. No statistically significant correlation existed between the quality of functional outcome and the integrity of the prostheses. There was no significant difference between pre-operative and post-operative range of motion for the entire group or between patients with broken or intact prostheses. Histological confirmation of silicone synovitis was documented in one patient who required implant removal. We suggest that destabilization and breakage of prostheses result from fatigue failure secondary to the torque generated at the distal radio-ulnar joint during repeated pronation and supination. Use of a silicone rubber ulnar head prosthesis following distal ulna resection is not recommended.
Natural History of Scaphoid Non-Union, with Special Reference to “Asymptomatic” Cases
Authors: LINDSTRÖM G. , NYSTRÖM Å.
Published: June 2005

33 patients with non-union of the carpal scaphoid were diagnosed by X-ray examination two to 37 years following the original trauma. All of the patients could be contacted and summoned for a re-examination ten to 17 years later. X-rays revealed a 100% incidence of progressive radio-carpal osteoarthritis. It is concluded that freedom of pain is not a reliable prognostic indicator, and that all patients with non-union of the carpal scaphoid are likely to benefit from surgical treatment of the pseudarthrosis. The only exception to this rule might be the patient in whom the radio-carpal joint is already deteriorated by an advanced degenerative arthritis.
A Review of Repaired Flexor Tendons
Authors: GAULT D. T.
Published: June 2005

67 patients with 76 repaired flexor tendons have been reviewed after a mean interval of 26.4 months. 160 tendons to 100 fingers, and 16 flexor pollicis longus tendons were repaired. When evaluated by Buck-Gramcko criteria, the functional results in 92% of the fingers and 69% of the thumbs were graded as excellent or good.

Patients with partially divided tendons fared no better than those whose tendons were completely divided. The results of repair in the little finger were less satisfactory than in other fingers.
Conservative Surgery for Dupuytren’s Contracture
Authors: Thurston A. J.
Published: June 2005

The trend towards conservativism in the management of Dupuytren’s contracture has resulted in less radical surgery than was previously advocated to release disabling contractures of the fingers.

38 cases of Dupuytren’s contracture in the palm have been treated by Z-plasty of skin and underlying contracted band without fasciectomy. Proximal interphalangeal joint contractures were treated by fasciectomy and skin closure with Z-plasties as required. Only one of 16 patients reviewed after two years had evidence of recurrence.

Skin compliance has been measured and a return to near-normal levels was found in all but the one patient with a recurrence.
Carpal Tunnel Syndrome in Chronic Renal Dialysis Patients: Clinical Evaluation of 62 Hands and Results of Operative Treatment
Authors: Naito M. , Ogata K. , Goya T.
Published: June 2005

A prospective study was performed on 62 hands in 45 consecutive patients on chrome dialysis carpal tunnel syndrome developed within an average of 116 months after formation of the arterio-venous fistula. We measured the intra-carpal canal pressure by the wick catheter technique and performed neurography. At operation, a markedly thickened transverse carpal ligament was usually found. A pneumatic tourniquet was applied in all except three cases, whose functioning fistulae were made of implants, but no complications such as obturation of the fistulae occurred. Thirty-three (76.7%) of 43 cases had good results. Full recovery of sensibility was obtained in all hands in which symptoms had been present for less than two years. There was no benefit from operation in two patients (4.7%), both of whom had symptoms for more than two years.
One Stage Reconstruction of Intercalated Defect of the Thumb Using the Osteocutaneous Radial Forearm Flap
Authors: Chacha B. , Soin K. , Tan K. C.
Published: June 2005

A radial forearm flap including a segment of the cortex of the radius, based on the distal pedicle of the radial vessels and the cephalic vein, was used to reconstruct an intercalated defect of the thumb in two cases. In one case it was used as an ipsilateral pedicle flap while in the other case it was used as a free microvascular flap. In both cases, the skin flap as well as the segment of bone survived in toto without any evidence of creeping substitution. The functional result was good in both cases. This flap provides thin skin of good texture together with bone for a one-stage reconstruction.
Arterial Spasticity and Cold Intolerance in Relation to Time after Digital Replantation
Authors: BACKMAN C. , NYSTRÖM Å. , BACKMAN C. , BJERLE P.
Published: June 2005

Cold induced arterial vasospasm was studied in ten patients with single digit replantation, by measuring finger systolic pressure at different finger temperatures. Each patient was examined three times; within 2 weeks of surgery, after 1 year and after 3 years. The replantations were performed using long arterial and venous grafts. Cold-related vasospasm is established during the first year after trauma, and thereafter seems to be persistent. It is concluded that the subjective cold intolerance, which affects all patients after digital amputation regardless of whether replantation is performed or not, is partly due to vasospasm. It is less pronounced in patients without pathological vasospasm in the replanted digit. Cold intolerance is likely to decrease during the first 2 years after replantation, but not to disappear completely.
The Functional Results of Hand Replantation
Authors: VANSTRAELEN P. , PAPINI R. P. G. , SYKES P. J. , MILLING M. A. P.
Published: June 2005

Eight hands amputated at wrist or distal forearm level were replanted between 1983 and 1990. Steinman pins were used to obtain skeletal fixation at the wrist level in three patients. Secondary surgery was performed in seven patients. Six of the patients were available for review between 1.5 and 7.5 years (mean 3.6) after the injury. The functional results were assessed using the Tamai scoring system. Recovery of useful hand function has been achieved in most patients, although long-term recovery of sensibility was found to be disappointing. Despite this finding, five out of the six patients were highly satisfied with the result and four have returned to work.
Bone Reconstruction with a Free Vascularized Fibular Graft after Giant Cell Tumour Resection
Authors: BAJEC J. , GANG R. K.
Published: June 2005

Free vascularized fibular transfers were used in six patients with extensive bony defects after excision of a giant cell tumour of the distal end of the radius. The results have been satisfactory.
Pronator Quadratus Free Muscle Flap for Treatment of Palmar Defects
Authors: DAUTEL G. , MERLE M.
Published: June 2005

Cutaneous flaps are not entirely satisfactory when used for soft tissue defects of the palm, because the skin cover is too mobile. Use of muscle flaps can therefore be advocated for this recipient site. A case is reported where the pronator quadratus muscle has been used as a free muscle flap for coverage of a small defect of the palm.
Bilateral Extensor Medii Digiti: A Rare Anatomical Variation
Authors: ABU-HIJLEH M. F.
Published: June 2005

A supernumerary extensor muscle to the middle finger was found to be present bilaterally in a male cadaver. It originated from the distal end of the ulna and its tendon inserted into the proximal phalanx of the middle finger. The bilateral presence and manner of insertion appear to be unique from a review of the literature. Morphological variability and clinical significance are reviewed. Such variations may be clinically significant during hand surgery, especially tendon transfer procedures.
Radio-Ulnar Synostosis Following External Fixation
Authors: AYLLON-GARCIA A. , DAVIES A.W. , DELISS L.
Published: June 2005

Post-traumatic radio-ulnar synostosis is an unusual but serious complication of adult forearm fractures. This is the first report of radio-ulnar synostosis following external fixation to be described in the English literature. A 52-year-old man sustained a fracture of the distal radius and ulna which was managed by external fixation. Following this, he developed a radio-ulnar synostosis at the pin-track site. The synostosis was successfully removed and he regained significant rotatory movement of his forearm.
Wrist Arthrodesis Using an Embedded Iliac Crest Bone Graft
Authors: LENOBLE E. , OVADIA H. , GOUTALLIER D.
Published: June 2005

34 patients treated by the iliac crest bone graft technique for wrist arthrodesis were reviewed. The average age was 45.6 years and the mean follow-up was 45 months. The procedure is performed through a straight ulnar approach and the head of the ulna is removed. A longitudinal trench is created in both distal radius and carpus preserving the anterior, posterior and lateral cortices. A curved trapezoidal monocortical iliac crest bone graft is embedded inside the trench. The position of the arthrodesis automatically follows the curvature of the graft. No fixation device is used. A short-arm cast is applied for 2 to 3 months. All arthrodeses except two fused within 3 months. Pain was completely relieved in 85% of the cases. Pronation and supination returned to normal 5 months post-operatively. Grip strength was increased in 80% of the cases. The carpometacarpal joints remained pain-free even when not fused. Complications were rare: two lesions of the dorsal branch of the ulnar nerve; two cases of delayed union due to errors in technique, and displacement of the graft in one case. Although it is technically demanding, the embedded iliac crest graft wrist arthrodesis improves pronation and supination as a result of resection of the distal radio-ulnar joint, preserves or improves grip strength, and relieves pain.
Madelung’s Deformity
Authors: WATSON H. K. , PITTS E. C. , HERBER S.
Published: June 2005

15 wrists with Madelung’s deformity were operated on between 1972 and 1990, constituting the largest series of radial osteotomies reported for this deformity to date. The technique that evolved is described in detail, as are the preliminary follow-up results. All patients reported symptomatic relief and return to normal activity levels.
Excision of the Hamate for an Unusual Hand Tumour
Authors: DALY K. E. , CHOW J. W. M. , VICKERS R. H.
Published: June 2005

A right-handed man with an enlarging bony swelling of his dominant hand developed symptoms of median and ulnar nerve compression. He underwent simple excision of the hamate and histology showed the lesion to be a benign chondroblastoma. At 2-year follow-up he was found to be doing a heavy manual job with no functional problems and there were no signs of recurrence of the tumour. To our knowledge this is the first reported case of a benign hand tumour treated by simple excision of the hamate.
Changes in Carpal Tunnel Shape During Wrist Joint Motion
Authors: YOSHIOKA S. , OKUDA Y. , TAMAI K. , HIRASAWA Y. , KODA Y.
Published: June 2005

This study evaluated dynamically the morphology of the carpal tunnel during the wrist motion. The object was to determine the transverse dimension (TD), anteroposterior(AP) dimension and cross-sectional area (CA) of the carpal tunnel in the neutral, flexed and extended positions. The wrists of eight male and eight female volunteers aged 20 to 38 years were studied.

With wrist extension, AP and CA decreased while the TD increased at the pisiform level, and CA increased at the hamate level. With flexion, TD and CA decreased at the pisiform level and CA decreased at the hamate level. The results showed that the median nerve may be subjected to significant pressure at the pisiform level when the wrist is extended. During wrist flexion, the cross-sectional area decreased at both the level of the pisiform and the hook of the hamate.
Finger Dynamography
Authors: MALAVIYA G. N. , HUSAIN S.
Published: June 2005

The movements of the MP and PIP joints occur together and enable the fingers to acquire different postures. A graphic record of these movements gives an idea of the working space of the fingers. Normally, the tracing forms the shape of a quadrangle with almost parallel sides. If muscle paralysis occurs or joints are diseased, the shape of the quadrangle—the “working space”—becomes distorted. Different patterns of distortion are seen with different finger problems.

“Finger dynamography” is a simple bedside procedure requiring only a goniometer. If supplemented with additional data on pinch and grip strengths and sensibility, it gives a pictorial record which is easy to interpret and can be used for documentation.
A Comparison of Upper Arm and Forearm Tourniquet Tolerance
Authors: YOUSIF N. J. , GRUNERT B. K. , FORTE R. A. , MATLOUB H. S. , SANGER J. R.
Published: June 2005

This study examined the use of upper arm and forearm tourniquets for hand surgery. 40 subjects (20 males, 20 females) were randomly assigned to one of four groups: left upper arm, left forearm, right upper arm and right forearm. Tourniquets were applied to these areas. Subjects were asked to rate their discomfort at 10-minute intervals and the total time of tourniquet tolerance was recorded. The results of a three-factor ANOVA revealed no statistically significant differences in either pain rating or tourniquet tolerance between any of the groups. In addition, forearm tourniquets were used in 18 clinical cases. None of the individuals with tourniquet times less than 30 minutes required any medication in order to tolerate this procedure. Of the 13 patients with tourniquet times greater than 30 minutes, ten required medication in order to tolerate the procedure. We conclude that patients tolerate upper arm and forearm tourniquets equally.
Diagnosis of the Aetiology of a Locked Metacarpophalangeal Joint Using MRI
Authors: SCHUIND F. , STALLENBERG B.
Published: June 2005

A case is reported of a locked MP joint due to ulceration of the metacarpal head. This was clearly visible on MRI scan.
Accidental Injection of White Spirit into the Hand in Golfers
Authors: RIMMER M. G. , KING J. B. , FRANKLIN A.
Published: June 2005

We report two cases in which white spirit has been injected accidentally into the hand by golfers, while attempting to remove the grip of the golf-club handle in order to replace it. One of our patients has anecdotal evidence of this happening in at least two other cases, one of which resulted in amputation of the index finger, and the other in severe damage to the thumb.
Free Tissue Transfers to the Upper Limb
Authors: FOO I. T. H. , MALATA C. M. , KAY S. P. J.
Published: June 2005

90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 children and 42 adults) by one surgeon over a 3-year period. The average age for children was 5 years, and 25 years in adults. 17 transfers were performed as emergency or urgent procedures. The main indications were congenital and traumatic defects. Included in this series were 44 toe transfers, 28 lateral arm flaps and six functional muscle transfers. The overall success rate was 99%. The re-exploration rate was 5.6% with only one failure. There were no failures in children.
Objective Improvements in Algodystrophy Following Regional Intravenous Guanethidine
Authors: FIELD J. , MONK C. , ATKINS R. M.
Published: June 2005

17 patients with established algodystrophy following trauma were treated with serial intravenous regional guanethidine blockade. Subjective improvement occurred in all cases. This improvement could be confirmed quantitatively using objective assessment criteria. The subjective and objective improvements demonstrated in each of the features of algodystrophy correlate closely ( p < 0.001). There appears to be no difference in the effectiveness of one block compared to another in the same patient.
Provisional Fixation of Distal Radial Osteotomies Using the Ao Small External Fixator
Authors: HAGAN H. J. , HOOPER W. E.
Published: June 2005

A technique is presented whereby a small AO external fixator is used to give provisional fixation for corrective osteotomies of the distal radius.
Treatment of Volar Instability of the Metacarpophalangeal Joint of the Thumb by Volar Capsulodesis
Authors: SCHUURMAN A. H. , BOS K. E.
Published: June 2005

The metacarpophalangeal joint bears most of the stresses to which the thumb ray is subjected. Instability of this joint results in considerable functional impairment of the hand. Volar instability may be secondary to trauma, rheumatoid arthritis, or adduction spasms in cerebral palsy. The resulting hyperextension causes pain and weakness of pinch (Fig 1).

Various techniques have been described to correct this deformity. We prefer a volar capsulodesis as first described by Filler (1976), in which the whole volar plate is reinserted. Detailed knowledge of the complicated volar anatomy is essential. We have treated eight patients (two bilaterally) with this technique, all with satisfactory results.
Intraosseous Ganglia of Carpal Bones
Authors: WAIZENEGGER M.
Published: June 2005

25 patients with 26 intraosseous ganglia in carpal bones are described, 14 in the scaphoid and 12 in the lunate. In most cases, attention was drawn to the lesion when X-rays were performed after a recent injury to the wrist. Typically, they occurred eccentrically and were surrounded by a radio-dense rim of bone. In a few cases the cortex was breached but never expanded by the lesion. Curettage and bone grafting were performed only if symptoms persisted and no other source for the pain could be found. Most contained the typical jelly-like material also found in soft tissue ganglia and the histology showed an identical structure. A suggested format for the management of these lesions is presented.
Cysticercosis of the Flexor Digitorum Profundus Muscle Producing Flexion Deformity of the Fingers
Authors: ANDERSON G. A. , CHANDI S. M.
Published: June 2005

Selective flexion deformity of the middle and ring fingers resembling a mild type of Volkmann’s contracture resulted from Cysticercus cellulosa infection within the deep flexor muscle of the forearm in a middle-aged woman. Excision of the fibrotic segment of the muscle and tenodesis of all the flexor profundus tendons restored normal range of motion to these fingers. Vascular compromise in addition to the inflammatory response to the infection were considered causes for the deformity. There is no previous report of this kind in the literature.
Capsular Tissues of the Proximal Interphalangeal Joint: Normal Composition and Effects of Dupuytren’s Disease and Rheumatoid Arthritis
Authors: BENJAMIN M. , RALPHS J. R. , SHIBU M. , IRWIN M.
Published: June 2005

Three fibrocartilages associated with the proximal interphalangeal joint are described—at the attachment of the central slip to bone, within the slip where it passes over the joint, and the volar plate. Material was obtained at surgery following trauma, Dupuytren’s disease and rheumatoid arthritis. The fibrocartilages were structurally distinct and immunolabelled differently with monoclonal antibodies to extracellular matrix components. All fibrocartilages from normal and Dupuytren’s fingers contained chondroitin and keratan sulphate. Type II collagen was present in all attachment zones, although there was little in rheumatoid fingers. It was also present in the dorsal hood of some normal fingers, but not in pathological specimens or the volar plate. The results show that the fibrocartilages are dynamic tissues whose composition varies according to function and use, and changes in disease.
Wrist Arthrodesis in Rheumatoid Arthritis
Authors: HOWARD A. C. , STANLEY D. , GETTY C. J. M.
Published: June 2005

17 wrists were arthrodesed in 13 patients with severe wrist disease due to rheumatoid arthritis. Eight fusions in seven patients were carried out using a radial sliding bone graft technique whilst nine fusions in nine patients were undertaken using a third tubular AO plate. Subjective, objective and radiological assessments confirmed the efficacy of both methods but indicated a shorter period of post-operative immobilization for patients treated using the AO plate fixation technique. The importance of this is discussed.
The Guildford Elbow
Authors: BRADY O. , QUINLAN W.
Published: June 2005

The Guildford elbow is a new unconstrained elbow arthroplasty. From 1985 to 1991, this arthroplasty was used in 24 patients with rheumatoid arthritis. The patients were reviewed after an average of 28 months (4­59 months). Good to excellent results were obtained in 95% regarding pain relief and functional improvement. Complications were few, with only one case of clinical loosening and three of radiological loosening. Ulnar nerve hypo-aesthesia was common but did not jeopardize the final result in any patient.
The Relationship between Handedness, Mechanism of Injury and which Hand Injured
Authors: HOLLIS L. J. , WATSON D. P.
Published: June 2005

This study investigates the relationship between type of hand injury and handedness.
V-Y Advancement of the Entire Volar Soft Tissue of the Thumb in Distal Reconstruction
Authors: ELLIOT D. , WILSON Y.
Published: June 2005

The commonly used variant of Moberg’s advancement flap for thumb reconstruction requires a skin graft to reconstruct the proximal thumb defect after advancing the flap. A modification has been described previously which allows direct closure of this proximal defect by incorporation of the V to Y principle into the design of the proximal part of the flap. A variant of the V-Y Moberg flap is presented and its advantages discussed.
The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture
Authors: TIEL-VAN BUUL M. M. C. , VAN BEEK E. J. R. , BORM J. J. J. , GUBLER F. M. , BROEKHUIZEN A. H. , VAN ROYEN E. A.
Published: June 2005

The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy.

Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%.

The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.
The Role of Cross-Finger Flaps in the Primary Management of Untidy Flexor Tendon Injuries
Authors: Gault D. T. , Quaba A. A.
Published: June 2005

This is a report of five patients who sustained untidy division of flexor tendons in zones 1 and 2, associated with overlying soft tissue loss. Contrary to traditional teaching, the tendon injuries were repaired primarily, and the tissue loss was made good with a cross-finger flap.

At final evaluation, three cases were assigned excellent grades and two cases fair grades by Kleinert criteria. This unexpectedly favourable outcome may be due to a quality of the inner surface of the cross-finger flap and/or to staggering of the skin and tendon suture lines.
Piso-Triquetral Arthrosis as a Cause of Rupture of the Profundus Tendon of the Little Finger
Authors: Lutz R. A. , Monsivais J. J.
Published: June 2005

This case report describes a previously unreported case of profundus rupture of the little finger due to arthrosis of the piso-triquetral joint. With heightened awareness of this entity, it is hoped that delays in diagnosis will be avoided.
Treatment of Post-Replantation Retardation of Bone Growth by Callus Distraction
Authors: GRAF P. , BIEMER E.
Published: June 2005

Hand and forearm replantation in children may lead to premature closure of the distal radial or ulnar growth-plates. Following successful replantation, bone growth may be retarded, resulting in a length discrepancy between the radius and ulna with secondary deviation of the replanted hand.

We present two cases in which callus distraction was employed to correct a length discrepancy. The relative merits of the various treatment options are discussed.
Replantation of Fingertips
Authors: YAMANO Y.
Published: June 2005

During the period between 1976 and 1990, 207 fingertips have been replanted in 133 male and 55 female patients whose ages ranged from 14 months to 80 years, with an average of 32.7 years. Of the 207 fingers with complete amputation, 131 were injured in zone 1 and 76 in zone 2. The minimum follow-up period was 6 months.

The results of zone 1 amputation have been analyzed according to the type of injury. The survival rate was 100% in clean-cut amputation, 95% in blunt-cut, 64.3% in crush and 65.5% in avulsion. From the point of view of survival and function, satisfactory results were obtained in amputations in zone 2, and in all cases in zone 1 that were clean-cut or blunt-cut.
The Spaghetti Wrist
Authors: HUDSON D. A. , de JAGER L. T.
Published: June 2005

The outcome of 15 patients who sustained simultaneous laceration of the median and ulnar nerves with flexor tendons at the wrist is described. Primary nerve repair yielded satisfactory results, the median nerve achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement. Flexor tendons yielded the poorest results. A functional, albeit impaired outcome can usually be anticipated following this severe injury.
The Use of Ultrasonography in Detection of Synovitis in Carpal Tunnel Syndrome
Authors: NAKAMICHI K. , TACHIBANA S.
Published: June 2005

The findings of pre-operative ultrasonography of the carpal tunnel were compared with synovial histology in 50 surgically treated wrists with carpal tunnel syndrome. Eight wrists with a massive hypoechoic area (group 3) had synovitis. 28 with a minimal hypoechoic area (group 1) had no evidence of inflammation. 14 with a moderately increased hypoechoic area (group 2) consisted of three with synovitis, four with lymphocytic infiltration and seven without inflammation. Group 3 strongly indicates synovitis, in which case one should consider aetiology other than the idiopathic cause. Bilateral synovial thickening suggests carpal tunnel syndrome as the initial clinical picture of rheumatoid arthritis, and group 1 indicates idiopathic carpal tunnel syndrome provided that there are no primary causes.
Malignant Schwannoma Mistakenly Diagnosed as Carpal Tunnel Syndrome
Authors: WOOD M. K. , ERDMANN M. W. H. , DAVIES D. M.
Published: June 2005

A rare nerve sheath tumour masquerading as carpal tunnel syndrome is described. It arose in a digit, with perineural spread proximally along the median nerve.
Recurrent Carpal Tunnel Syndrome
Authors: DE SMET L.
Published: June 2005

Based on five observations of recurrent carpal tunnel syndrome, a distally incomplete section of the flexor retinaculum can be identified on clinical grounds: the wrist flexion test becomes negative and the tourniquet test still remains positive.
An Algorithm for Acute Wrist Trauma
Authors: LARSEN C. F. , BRØNDUM V. , WIENHOLTZ G. , ABRAHAMSEN J. , BEYER J.
Published: June 2005

A systematic approach to the acute traumatized wrist is of importance to achieve early diagnosis, with efficient use of advanced imaging modalities. In a 6-month period 641 patients aged 15 years or over were examined using an algorithm for acute wrist trauma in order to secure early and appropriate treatment. In 293 (46%) cases routine radiographic examination supplied sufficient information to establish a fracture diagnosis. All 33 scaphoid fractures (including five scaphoid non-unions) were demonstrated on the initial X-ray examination. In 56 patients (9%) scintigraphy proved useful for selecting cases in need of further radiographic examination. Among 31 patients with focal activity on bone scintigraphy, CT and/or tomography revealed eight distal radial fractures, one fracture of the ulnar styloid, and eight fractures of carpal bones. Fractures were revealed using tomography and/or “hot spot views” in patients with negative CT examinations suggesting that further examinations should be performed in cases with increased focal activity on bone scintigraphy and a negative CT examination.
Tendon Transfer to Restore Extension of the Thumb Using Abductor Pollicis Longus
Authors: CHITNIS S. L. , EVANS D. M.
Published: June 2005

20 patients with rupture or division of extensor pollicis longus (EPL) underwent tendon transfer using abductor pollicis longus (APL). All patients except one were reviewed and examined between 6 and 80 months after surgery. The subjective and objective results were satisfactory and are presented with details of the technique and its advantages and limitations.
The Natural History of Adult Trigger Thumb
Authors: SCHOFIELD C. B. , CITRON N. D.
Published: June 2005

30 consecutive adult patients presenting with trigger thumb (31 thumbs) were entered prospectively into a study to determine the natural history of the condition. Five patients insisted on treatment and could not be followed to resolution, but the rest resolved spontaneously after an average duration of symptoms of 6.8 months (range 2–15). There was a small but non-functional reduction in movement of the thumb in some of the patients: six lost an average of 7° of abduction and ten had an average loss of opposition of 1.4 (Kapandji grade). The remaining patients made a full recovery.
Prevalence of Dupuytren’s Contracture and its Correlation with Degenerative Changes of the Hands and Feet and with Criteria of General Health
Authors: BERGENUDD H. , LINDGÄRDE F. , NILSSON B. E.
Published: June 2005

The prevalence of Dupuytren’s contracture and its coincidence with degenerative changes in the hands and feet as well as loss of distal pulses, were studied in 574 55-year-old residents of Malmö, Sweden. Dupuytren’s contracture occurred in 6% of the subjects studied, predominantly in men. Dupuytren’s contracture was more common in men with degenerative changes in the feet and in men with signs of impaired arterial blood flow in the lower limbs.

Men with Dupuytren’s contracture had significantly less subcutaneous fat tissue, as measured by a triceps skinfold index, than men without Dupuytren’s contracture. Other signs of general health, occupational work load or psychosocial factors did not interact with Dupuytren’s contracture in the current study.
A Clinical, Ultrastructural and Immunochemical Study of Dupuytren’s Disease
Authors: PASQUALI-RONCHETTI I. , GUERRA D. , BACCARANI-CONTRI M. , FORNIERI C. , MORI G. , MARCUZZI A. , ZANASI S. , CAROLI A.
Published: June 2005

Aponeurotic tissue from seven normal subjects and from apparently unaffected branches, nodules and cords of 16 Dupuytren’s patients were compared. Control tissue was characterized by polymorphous cells, showing cytoplasmic microfilament bundles, numerous pinocytic vesicles, basement membrane-like structures, and a thick coat of interwoven filaments, and by type I- and III-positive heterogeneous collagen fibrils, fibronectin, vitronectin, decorin and proteoglycans. The clinically normal branches consisted of fibroblast-like cells, small type III-highly positive collagen fibrils, fibronectin and proteoglycans. Nodules and fibrotic cords contained fibroblast-like cells, type I and III collagen, fibronectin and proteoglycans. Myofibroblast-like cells in only five out of 16 patients were present. There was no relation between clinical stage and structural alterations; the whole aponeurosis always seemed to be involved; cord retraction would seem to depend on the interactions among fibroblast-like cells and matrix components and among matrix macro-molecules themselves.
The Lateral Pulp Flap
Authors: ELLIOT D. , JIGJINNI V. S.
Published: June 2005

A technique for reconstruction of lateral defects of the fingertip by advancing the pulp tissue is described and illustrated.
The Posterior Interosseous Flap in Primary Repair of Hand Injuries
Authors: DAP F. , DAUTEL G. , VOCHE P. , THOMAS C. , MERLE M.
Published: June 2005

The posterior interosseous flap has been used for resurfacing in 23 cases of hand injury in the past 5 years. There was complete necrosis in two cases, partial necrosis in three and temporary postoperative nerve palsy in one.
Basil Kilvington
Authors: GLASBY M. A. , HEMS T. E. J.
Published: June 2005

In the early years of the present century, a group of experiments assessing the results of the surgical repair of peripheral nerves and spinal roots was performed by Basil Kilvington. The outcome of the experiments was assessed using both electrophysiological and morphological techniques.

Much of Kilvington’s work remained unrecognized and was thus repeated at a later date.

Kilvington’s role in the early history of the surgical repair of nerves appears to have been forgotten and his substantial and prophetic discoveries deserve better recognition.
Surgical Management of Recurrent Carpal Tunnel Syndrome
Authors: CHANG B. , DELLON A. L.
Published: June 2005

An approach to the surgical management of recurrent carpal tunnel syndrome was evaluated in 30 patients with 35 involved wrists. This includes internal neurolysis of the median nerve and early post-operative mobilization of the wrist and fingers. The preferred surgical approach is through a second, more ulnar incision. Clinical assessment of sensorimotor function was converted into a numerical score ranging from zero (normal) to 9 (anaesthesia) and 10 (atrophy, severe). The average pre-operative score was mean 6.5 and median 7. At a mean follow-up of 23.5 months, the average post-operative score was mean 1.8 and median 0, a statistically significant improvement (P< 0.001).
Median Nerve Compression Following Trauma in Children
Authors: HODGKINSON P. D. , EVANS D. M.
Published: June 2005

Two cases of subacute median nerve compression in children following trauma are presented. The first highlights problems of incised wounds around the wrist. The second illustrates an unusual presentation of nerve compression following a blunt injury.
Day Care Surgery for Dupuytren’s Contracture
Authors: ROBINS R. H. C. , SCOTT T. D. , GRIFFITHS D. P. G.
Published: June 2005

Contrary to standard practice in the United Kingdom, primary surgery for Dupuytren’s contracture can be performed safely on a day care basis provided that strict criteria are followed. Although demanding on Consultant surgical time, this policy offers a considerable saving in hospital resources.
Fowler’s Tenotomy for Mallet Deformity
Authors: HOUPT P. , DIJKSTRA R. , STORM VAN LEEUWEN J. B.
Published: June 2005

35 patients with established mallet finger deformities were treated with Fowler’s tenotomy of the central extensor tendon. The mean lack of extension before operation was 45° 26 patients regained full extension, eight patients had a residual deformity of 10–20° and one patient of 30°
Revision Procedures for Complications of Surgery for Osteoarthritis of the Carpometacarpal Joint of the Thumb
Authors: CONOLLY W. B. , RATH S.
Published: June 2005

Between the years 1980 to 1987, 17 patients had revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. 12 followed silastic implant arthroplasty, four trapeziectomy and one arthrodesis. The failed silastic arthroplasties were treated by removal of the implant, and soft tissue arthroplasty in eight, revision with another implant in three and intermetacarpal bone grafting in one. Patients with metacarpo-scaphoid arthritis after trapeziectomy were treated by silastic implant arthroplasty in three and fusion in one. Nine of the 17 revision procedures (53%) had good, three (18%) fair and five (29%) poor results respectively.
A Simple Technique for Removing Stubborn Rings Prior to Hand Surgery
Authors: NANCARROW J. D.
Published: June 2005

A very simple method of removing tight rings is described using an arterial tourniquet.
Olecranon Spur
Authors: PATERSON J. M. H. , ROPER B. A.
Published: June 2005

Full extension of the elbow is normally made possible by accommodation of the olecranon within an appropriately shaped fossa in the distal humerus. We report three cases where disability has resulted from an abnormally shaped olecranon.
Premature Closure of the Distal Radial Physis
Authors: HORII E. , TAMURA Y. , NAKAMURA R. , MIURA T.
Published: June 2005

Two cases of fracture of the radius treated by pinning resulted in severe wrist joint deformity due to premature closure of the epiphysial growth plate. Inappropriate pinning through the physis damaged the growth plate in both cases. They were treated by bone bridge resection with free fat interposition. The bone bar resection was effective in correcting the wrist joint deformity, and bone growth was expected without bone grafting.
Autogenous Free Sheath Grafts in Reconstruction of Injured Digital Flexor Tendon Sheath at the Delayed Primary Stage
Authors: TANG J. B. , ZHANG Q. G. , ISHII S.
Published: June 2005

We report our clinical experience of reconstruction of the digital flexor sheath with free autogenous sheath graft at the delayed primary stage. In 21 digits with flexor tendon lacerations, free autogenous sheath was taken from the sheath covering the first dorsal compartment to reconstruct the digital flexor sheath, where there was an obvious defect due to trauma, contusion of the synovial surface or contracture of the digital sheath. Follow-up revealed excellent and good results in 85.7% of the cases. Ample gliding space should be kept inside the sheath tunnel to maintain tendon gliding function.
The Use of Skin Hooks and Hypodermic Needles in Tendon Surgery
Authors: MORRIS R. J. , MARTIN D. L.
Published: June 2005

The skin hook can be used to reduce the need for direct tendon handling and to make the task of tendon repair easier and less traumatic.
Fractures of the Distal End of the Radius in Young Adults: A 30-Year Follow-Up
Authors: KOPYLOV P. , JOHNELL O. , REDLUND-JOHNELL I. , BENGNER U.
Published: June 2005

76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up.

In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints.

Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only.

47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men.

In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistant incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.
Dorsal Avulsion Fractures of the Scaphoid: Diagnostic Implications and Applied Anatomy
Authors: COMPSON J. P. , WATERMAN J. K. , SPENCER J. D.
Published: June 2005

Three cases of acute dorsal avulsion fracture of the scaphoid are presented. Anatomical and radiological studies indicate that these fractures arise from a ridge on the dorsum of the scaphoid at the distal end of the radial facet. This is not the site suggested by other authors. The clinical significance of these fractures is that they are only visible on the 45° anteroposterior oblique X-ray view of the scaphoid. Without this view they are indistinguishable from X-ray negative scaphoid fractures, since both have similar clinical signs and isotope bone scans.