bluuebunny/crossref_metadata_2025 huggingface dataset:
Foreign Bodies in Tendons
Authors: Jozsa L. , Reffy A. , Demel Susanne , Balint J. B.
Published: June 2005

At the National Institute of Traumatology in Budapest, a search has been made for foreign bodies in tendons over the last 15 years. 53 foreign bodies have been found in 931 tendons removed at operation and 45 foreign bodies in 950 tendon samples at autopsy. The foreign material was found to be organic in 29 cases, metal in 20 cases and plastic in six cases. In the others, glass, sand, mineral grease and textiles could be detected. In 33 cases the material could not be identified. The foreign bodies were found in the tendons of the upper extremities in 51 cases and the lower extremities in 47 cases. Foreign bodies in the tendons were more likely to cause problems in the upper limbs than in the lower limbs: these problems were purulent tendonitis, necrosis, foreign body granuloma, fibrosis and peritendonitis and calcification.
The Dorsal Carpal Ligaments: Their Anatomy and Function
Authors: Mizuseki T. , Ikuta Y.
Published: June 2005

The dorsal carpal ligaments were studied in 50 embalmed wrists. The radial collateral ligament was thin and oblique. The distribution of the dorsal radio-carpal ligament varied and it was classified into four subtypes. Neither ulnar collateral ligament nor dorsal radio-nlnar ligament was isolated as a discrete structure: instead, there were confluent soft tissues on the dorso-ulnar aspect of the wrist. The dorsal radio-carpal ligament and the dorso-ulnar component of the triangular fibro-cartilage complex, as well as the fibrous septa and the extensor tendons, were found to be the most important stabilizers of the wrist dorsally.
Treatment of Solitary Enchondromas in Fingers
Authors: Kuur E. , Hansen S. L. , Lindequist S.
Published: June 2005

The results after operative treatment of 21 solitary enchondromas of finger bones are described. 15 cases were treated by curettage and cancellous bone grafting, five by curettage alone, and one with amputation. One case did not heal after curettage and grafting. When symptoms are present or the cortical strength is decreased, we recommend operation. We find that the eccentric type of enchondroma can be treated adequately by curettage alone, while curettage and filling of the cavity with cancellous bone should be preferred in the central and polycentric forms. It is important that all material is removed from the cyst, which has to be packed completely with bone chips. The possibility of malignant change in enchondromas should be borne in mind, but we did not see this.
Bilateral Torsion of the Radius: A Case Report
Authors: Dias J. J.
Published: June 2005

A case of bilateral non-traumatic torsion of the radius affecting forearm rotation is described.
Nerve Abscess Simulated By A Lipoma in a Leprosy Patient
Authors: Malaviya G. N. , Girdhar A. , Mishra B. , Husain S. , Girdhar B. K.
Published: June 2005

A case of suspected giant nerve abscess near the radial nerve in the upper arm of a patient with borderline leprosy is reported. On exploration, it turned out to be a deep seated lipoma. Consideration should be given to exploring nerve masses in leprosy.
Flexor Tendon Sheath Haematoma: A Case Report
Authors: Thakore H. K. D.
Published: June 2005

An open finger injury reported here was diagnosed as a division of the flexor tendons of the little finger. However, surgical exploration revealed intact tendons encased in a tense flexor tendon sheath haematoma. Decompression of the haematoma led to a satisfactory recovery of finger function.
The Staged Island Flap: A New Method of Repair for Thumb Injuries
Authors: VENKATASWAMI R. , GNANASEKARAN T. C.
Published: June 2005

An island flap from the middle finger is described which can be used to cover a terminal wound on the thumb and the adjacent palmar and dorsal defects of the thumb. The flap is transferred in two stages: the first stage ensures good skin cover using a simple technique and the second stage is nerve repair, giving good sensory return with correct cortical representation. Since 1977, 64 repairs have been carried out using this island flap. The follow-up, results and complications are discussed.
Elastic Band Mobilisation after Flexor Tendon Repair; Splint Design and Risk of Flexion Contracture
Authors: BURGE P. D. , BROWN MONIKA
Published: June 2005

Elastic band mobilisation of repaired flexor tendons in zone 2 may be complicated by flexion contracture of the P.I.P. joint. The mechanics of three types of elastic band mobilisation were analysed from lateral video-recordings of finger movement and the flexion moment at the P.I.P. joint was derived at every 10° of flexion. The conventional forearm attachment of the elastic band produced a steep rise in P.I.P. joint flexion moment during extension; this effect was greatest when the M.P. joint was at 70° and least at 20°. Flexion moments for attachments around the dorsum of the hand or under a palmar pulley were lower, uniform throughout the range of P.I.P. joint motion and independent of the position of the M.P. joint. The effort needed to extend the P.I.P. joint is strongly influenced by the method of elastic band attachment; consideration should be given to both tension and moment arm in application of elastic band mobilisation.
Treatment of Trans-Scaphoid Perilunate Dislocations by Internal Fixation with the Herbert Screw
Authors: INOUE G. , TANAKA Y. , NAKAMURA R.
Published: June 2005

Thirteen patients with 14 dorsal trans-scaphoid perilunate dislocations were treated by open reduction and internal fixation of the scaphoid using a Herbert screw. The follow-up evaluations took place after a mean of 18 months. These perilunate dislocations were only trans-scaphoid in ten wrists, trans-radial styloid and trans-scaphoid in three and trans-scaphoid and trans-capitate in one. Based on Cooney's clinical scoring system, the scores of our series were two excellent, six good, five fair and one poor. This suggests that the Herbert screw can offer satisfactory results in the management of trans-scaphoid perilunate dislocations, despite its technical difficulties.
Subcutaneous Release of Trigger Thumb and Fingers in 210 Fingers
Authors: TANAKA J. , MURAJI M. , NEGORO H. , YAMASHITA H. , NAKANO T. , NAKANO K.
Published: June 2005

Subcutaneous release of the tendon sheath has been performed in 210 trigger digits of 172 patients. The follow-up period ranged from 3 to 58 months, with an average of 24 months. Based on our points system, the overall results were as follows: excellent 64.3%, good 9.5%, fair 8.1%, poor 18.1%. There were no infections, no injuries of nerves or vessels and no functional insufficiency. This subcutaneous procedure can be easily, quickly and safely performed by careful hand surgeons in the out-patient clinic.
Congenital Dislocation of the Radial Head
Authors: MIURA T.
Published: June 2005

A retrospective review of 34 patients with congenital dislocation of the radial head was carried out. In 22 patients, the radial head dislocation was the only abnormality. The range of motion of the elbow and forearm was considerably limited in some patients and did cause functional impairment, especially lack of supination. Increased ulnar length in relation to the radius and a hypoplastic capitellum suggest that a dislocation is congenital. Surgical intervention is seldom necessary.
Aneurysmal Bone Cyst of the Proximal Phalanx
Authors: MORTENSEN N. H. M. , KUUR E.
Published: June 2005

A case of aneurysmal bone cyst of the proximal phalanx in a young boy with unfused epiphysial plates is reported. Curettage failed, so diaphysectomy and cortical bone grafting were performed, sparing the epiphysial plate. This resulted in normal length and function, and the graft remodelled completely to a normal appearance of tubular bone.
Benign Haemangioma of Bone in a Middle Phalanx
Authors: THOMAS A. M. C. , MULLIGAN P. J. , JONES E. L.
Published: June 2005

Haemangioma of bone is a rare benign tumour of blood vessels. We report a case arising in a middle phalanx and the problems encountered in its management.
Haemangioma of the Digital Nerve: A Case Report
Authors: NAGAY L. , McCABE S. J. , WOLFF T. W.
Published: June 2005

An intra-neural haemangioma of the digital nerve of the left index finger is described, the first report of such a lesion in a digit. Treatment consisted of excision of the tumour and the affected portion of the nerve, followed by direct coaptation of the nerve ends.
A Case of Neurofibroma of the Palmar Cutaneous Branch of the Median Nerve
Authors: NAGEY L. , McCABE S. J. , WOLFF T. W.
Published: June 2005

This case report describes a previously unreported entity, a neurofibroma of the palmar cutaneous branch of the median nerve. The lesion presented as a palmar mass with an overlying abnormality of the skin. Treatment consisted of excision of the lesion. Infiltration of the terminal branches of the nerve by the tumour prevented nerve reconstruction but provided a previously unknown diagnostic clue: fibrosis of an area of skin innervated by the involved nerve, which had the appearance of a callosity.
Scapho-Lunate Diastasis: a Component of Fractures of the Distal Radius
Authors: MUDGAL C. S. , JONES W. A.
Published: June 2005

Ten cases of fractures of the distal radius associated with scapho-lunate diastasis are reported. The mechanism of injury has been described and an attempt made to analyse the implications in treating such an injury.
Free Lateral Arm Osteocutaneous Neurosensory Flap for Thumb Reconstruction
Authors: ARNEŽ Z. M. , KERSNIČ M. , SMITH R. W. , GODINA M.
Published: June 2005

Three cases are described to illustrate the use of the lateral arm osteocutaneous neurosensory flap in thumb reconstruction. The merits of such a method and its place in the repertoire of techniques for this problem are discussed.
Arteriographic Findings in Radial and Ulnar Deficiencies
Authors: INOUE G. , MIURA T.
Published: June 2005

The arterial pattern in 13 cases of radial deficiency and six cases of ulnar deficiency was studied by arteriography. The radial artery was absent or hypoplastic in 84.6% of cases of radial deficiency and in 50% of cases of ulnar deficiency. A persistent median artery was seen in 76.9% of cases of radial deficiency and in 16.7% of cases of ulnar deficiency. In 12 hands, the deep palmar arch was small or absent, depending upon the degree of radial arterial dysplasia. The digital artery to the deficient digits was missing in some cases. The persistence of an embryonic vascular pattern in cases of radial deficiency and ulnar deficiency with dysplasia of the ulna suggests that the teratogenic injury may have been simultaneous, whereas ulnar deficiency without dysplasia of the ulna was not associated with arterial abnormalities in the forearm.
The Management of the Complete Ring Avulsion Injury
Authors: McGEORGE D. D. , STILWELL J. H.
Published: June 2005

The complete ring avulsion injury presents a difficult choice between microvascular repair and further amputation. The former is technically difficult and the latter leaves an undesirable result. We describe an alternative method whereby a thinned groin flap is applied to volar surface and sides of the finger and a full-thickness skin graft covers the dorsum. This provides good quality cover to the volar aspect and avoids bulk on the dorsum.
Neurophysiological Assessment of the Early Phases of Carpal Tunnel Syndrome with the Inching Technique before and During Operation
Authors: LUCHETTI R. , SCHOENHUBER R. , ALFARANO M. , MONTAGNA G. , PEDERZINI L. , SORAGNI O.
Published: June 2005

In 14 patients with early carpal tunnel syndrome, the diagnostic sensitivity of the measurement of the segmental sensory nerve conduction velocity at 1 cm. steps (“inching”) was compared with the distal sensory latency and the pre-operative wrist-digit and wrist-palm S.C.V. and with similar measurements made at operation immediately after surgical decompression of the nerve. Before operation, distal sensory latency and wrist-digit S.C.V. were normal in all cases, while wrist-palm S.C.V. was pathological in five patients and inching in all 14 patients. Moreover, inching allowed us to determine the site of the slowing across the carpal tunnel, this being between 1–2 cm. from the distal wrist crease in 57% and between 2–3 cm. in 21% of cases. Focal slowing disappeared immediately after decompression in five patients, as is evident from the intra-operative recordings. Inching is, therefore, the most sensitive diagnostic method in early carpal tunnel syndrome.
Human Fight-Bite Injuries of the Hand
Authors: MENNEN U. , HOWELLS C. J.
Published: June 2005

100 consecutive patients whose finger had been bitten by another person, or who had cut it on a tooth in a fight, have been studied. 82 healed completely but 18 eventually needed amputation. Early and thorough debridement is required, plus a suitable mixture of antibiotics. Once infection is established in bone or tendon sheath, amputation is often needed, but most infected joints can be saved.
Rolando’s Fracture
Authors: LANGHOFF O. , ANDERSEN K. , KJÆR-PETERSEN K.
Published: June 2005

The relationship between methods of treatment, quality of reduction and the occurrence of late disability and osteo-arthritic changes was studied in 17 Rolando’s fractures. Three were undisplaced, 14 were displaced: of these excellent reduction was achieved in five of 11 treated by open reduction and in none of the three treated by percutaneous K wire fixation. After a median interval of 5.8 years, six of 16 reviewed patients had minor symptoms, while nine had no symptoms. Radiographic examination of 11 patients showed signs of osteoarthritis in six. We did not establish a relationship between the quality of reduction and the occurrence of late symptoms and osteoarthritis.
Locked Finger Due to Foreign Body in the Flexor Sheath
Authors: RAJASEKARAN S.
Published: June 2005

A patient is described in whom a wooden splinter penetrated the finger and impaled the flexor tendons. It was pulled out but part remained inside and the finger could not be moved until an operation was performed and the remaining part of the splinter removed.
Intra-Tendinous Chondroma of a Flexor Tendon
Authors: CHERUBINO P. , PILATO G.
Published: June 2005

A case of intratendinous chondroma of a finger flexor tendon is described. To our knowledge, such a location has never been reported before.
Silastic Implant Arthroplasty for Post-Traumatic Stiffness of the Finger Joints
Authors: CONOLLY W. B. , RATH S.
Published: June 2005

In the years 1981 to 1987, 50 patients had 59 replacements of the finger joints. Of these, 41 patients with 49 joint operations were reviewed, with follow-up ranging from two to eight years (average 32 months). About 80% of these patients were satisfied that silastic implant arthroplasty had relieved their pain and stiffness and improved function of the finger and hand. They were satisfied that this procedure was preferable to amputation or fusion. Success or failure was assessed not only on the range of movement of the joint being replaced, but on relief of pain, correction of deformity, stability and overall finger function. The seven patients regarded as failures are analysed in detail.
The Arcade of Struthers: An Anatomical Study
Authors: AL-QATTAN M. M. , MURRAY K. A.
Published: June 2005

In an anatomical study of fresh cadavers, 25 arms were dissected. The arcade of Struthers was found to be present in 17 arms (68%). Atypical features of the arcade of Struthers were observed in seven specimens. The anatomical features and clinical implications of the variants are discussed.
Post-Traumatic Rupture of the Extensor Digitorum Communis Tendon
Authors: TAKAMI H. , TAKAHASHI S. , INANAMI H.
Published: June 2005

A case of post-traumatic rupture of the common extensor tendon without associated fracture is reported. The extensor digitorum communis tendon to the middle finger was frayed by the distal edge of the extensor retinaculum at the fourth dorsal compartment.
Extensor Indicis Proprius Opponensplasty
Authors: ANDERSON G. A. , LEE V. , SUNDARARAJ G. D.
Published: June 2005

An analysis of 39 patients (40 hands) who underwent an extensor indicis proprius opponensplasty was carried out. Of these, 29 hands had simultaneous adjuvant surgery to correct other deformities. The mean follow-up period was 33.8 months. Excellent or good results were seen in 87.5%, fair in 10% and poor in 2.4% hands.
Cross-Arm Dermis Flaps for Repair of Dorsal Finger Defects
Authors: FLEMMING A. F. S. , STILWELL J. H.
Published: June 2005

Two cross-arm dermis flaps were successfully used to cover distal dorsal defects on the finger where tendon reconstruction was needed. Division after five days allowed early mobilisation.
Vascularised Nerve Grafts
Authors: MERLE M. , DAUTEL G.
Published: June 2005

Since Taylor (1976) successfully performed the first vascularised free nerve graft, experimental and clinical data have not provided conclusive support for the superiority of this method of repairing loss of nerve substance.

Experimental work yields conflicting results. Histologic results are in favour of vascularised grafts but non-vascularised fascicular grafts placed in a healthy bed recover sufficient neovascularisation within a short period of time (four to six days).

In the field of brachial plexus repair, vascularised grafts give consistent results. However, if thrombosis of the anastomoses occurs, the grafts fail completely.

In our experience, vascularised nerve grafts used for repairing digital nerves and arteries, have a high rate of thrombosis.

There are few potential donor sites. A nerve graft cannot be considered to be physiologically vacularised if it relies only on an artery or on an arterialised vein. Given the present state of immunosuppressant treatments, vascularised allografts are not yet appropriate.

Therefore, vascularised nerve grafts have limited applications. In general it is preferable to repair the tissue bed so as to promote revascularisation of conventional nerve grafts.
Accessory Nerve Injury: Conservative or Surgical Treatment?
Authors: OGINO T. , SUGAWARA M. , MINAMI A. , KATO H. , OHNISHI N.
Published: June 2005

In order to clarify the functional prognosis of accessory nerve injury after nerve repair and non-surgical treatment, 27 of our cases with accessory nerve injury were studied. 20 cases were followed up for more than 8 months. In ten cases treated conservatively, the dull feeling and hypaesthesia did not improve. However, pain and dysfunction of the shoulder improved in half of these cases. In ten cases treated surgically, nerve suture was performed in two cases, nerve graft in five cases and neurolysis in three cases. In the surgically treated group, subjective complaints disappeared in all cases, but hypaesthesia or contracture of the shoulder persisted in three cases. Surgical treatment of the accessory nerve is recommended in fresh cases with complete paralysis and in cases in which there is no sign of nerve recovery within one year after the original injury.
A Double Pulp Flap Technique for Creating Nail-folds in Syndactyly Release
Authors: LUNDKVIST L. , BARFRED T.
Published: June 2005

A method is described of creating nail-folds in the release of cases of complete syndactyly. A double pulp flap was used as a one-stage technique in 13 patients in whom webs were separated. All patients were reviewed after a minimum of one year. Fullness of pulp was achieved in all fingers. The nail-fold was considered normal in 14 of 18 fingers covered with a broad flap and in 8 of 18 fingers covered with a narrow flap. In the remaining cases the nail-fold was small but never absent. No gap loss was encountered and there was no late nail deformity from scarring.
The Effect of Locking Loops on the Strength of Tendon Repair
Authors: MASHADI Z. B. , AMIS A. A.
Published: June 2005

A multiple X-raying method has been developed which allows examination of how the particular features of suturing techniques collapse or pull out of the tendon during tensile testing. This technique was used to examine the locking loop tendon sutures, such as the modified Kessler, Verdan and Ketchum techniques. Locking loops did not contribute towards the strength when small diameter sutures (5/0) of various materials were applied to the tendon, collapsing at 12 Newtons. Larger diameter sutures (4/0) slightly reduced the risk of failure of locking loops, but they still collapsed at 15 Newtons or less, so suture techniques which depend on locking loops will often lead to gap formation at low loads and hence poor results.
Radiographic Changes in Algodystrophy of the Hand
Authors: BICKERSTAFF D. R. , O’DOHERTY D. P. , KANIS J. A.
Published: June 2005

It is not certain to what extent the radiographic features of post-traumatic algodystrophy can be differentiated from disuse atrophy following trauma. A semi-quantitative scoring system has been devised, grading the dominant features seen on radiography in both conditions following Colles’ fracture. The technique had intra- and inter-observer errors of 14% and 17% respectively. When applied prospectively 7 weeks after Colles’ fractures, there was a significantly greater score in patients with algodystrophy (p < 0.001) than those without. Analysis of the scores was performed to identify a score for the optimal identification of algodystrophy. At a score of four or greater, 87.5% of patients with algodystrophy were positively identified with a positive predictive value of 83%. It is suggested that use of this scoring system will aid in the early diagnosis of algodystrophy.
The Use of Streptokinase in Replant Salvage
Authors: PARKHOUSE N. , SMITH P. J.
Published: June 2005

This is the first report of the clinical use of direct intra-arterial streptokinase infusion to promote the salvage of a failing thumb replant. Anastomotic revision was performed on two occasions following thrombosis in the vein grafts used to replant an avulsed thumb. Recurrent thrombosis was treated successfully with conservative thrombolytic therapy consisting of a direct infusion of streptokinase, 20,000 I.U. per hour into the radial artery for 32 hours, followed by intravenous heparin, 40,000 I.U. for 24 hours. The thumb survived, with no tissue loss. Thrombolytic therapy is the only non-surgical means of dissolving intraluminal thrombus, and should be considered when thrombosis occurs in a replanted extremity.
The Anatomy of the Flexor Digitorum Superficialis Relevant to Tendon Transfers
Authors: AGEE J. , McCARROLL H. RELTON , HOLLISTER ANNE
Published: June 2005

The flexor digitorum superficialis is a digastric muscle with a proximal muscle belly from which the tendons to the index, ring and little fingers arise. These tendons are not independent and are not good motors for non-synergistic transfers. Such as for finger extension. The muscle and tendon to the middle finger arise separately and are therefore more suitable for non-synergistic transfers.
Spontaneous Rupture of the Flexor Carpi Radialis Tendon
Authors: TONKIN M. A. , STERN H. S.
Published: June 2005

Three cases of closed rupture of the flexor carpi radialis tendon associated with scapho-trapezio-trapezoidal arthritis are reported. Carpal tunnel surgery preceded all three ruptures. Local steroid injection preceded two ruptures. Long-term disability was minimal.
Two Flaps to Resurface the Basal Flexion-Crease of the Finger Area
Authors: HARRISON D. H. , NEWTON J.
Published: June 2005

Two flaps are described which have been designed to resurface the skin around the basal flexion crease of the fingers. Their most common use is on the ulnar side of the hand but any finger can be resurfaced. Both flaps are 1 cm in width so the donor sites can be repaired directly without the use of skin grafts. Mobilisation of the fingers is therefore permissible within 24 hours and thus postoperative stiffness avoided. The one-stage cross-finger flap is of particular value in resurfacing and preventing the recurrence of Dupuytrens in the M.P. joint area. The palmar transposition flap based on the inter-digital cleft is useful for the release of volar contractures and resurfacing localised full thickness burns. They are quick to raise and very reliable, providing their nutrient vessel is retained. The donor site distortion is minimal. We have had no flap loss and no limitation of flexion
Anatomical Demonstration of the Nerve-Supply to the Flexor Tendon
Authors: PESSON C. M. , FINNEY T. P. , DEPAOLO C. J. , DABEZIES E. J. , ZIMNY M. L.
Published: June 2005

A dissection of four unembalmed human fingers demonstrated a branch from the digital nerve which enters the flexor tendon sheath at the same place as the transverse branch of the digital artery. We conclude that this branch supplies the nerve fibres found within the vinculum.
Nerve Sheath Ganglion of the Superficial Radial Nerve
Authors: GILLIES R. M. , BURROWS C.
Published: June 2005

Nerve sheath ganglia are infrequent and most commonly involve the peroneal nerve. We describe the previously unreported involvement of the superficial branch of the radial nerve.
Magnetic Resonance Imaging in Kienböck’s Disease
Authors: IMAEDA T. , NAKAMURA R. , MIURA T. , MAKINO N.
Published: June 2005

With a 1.5 tesla superconducting M.R. imager and surface coil, M.R. imaging achieved high resolution analysis of the wrist on five normal wrists and 26 wrists with Kienböck’s disease. The purpose of this study was to establish new criteria for diagnosis, staging and prognosis of Kienböck’s disease, based on signal characteristics on T1-and T2-weighted images. Focal loss of signal intensity of the lunate on T1-weighted image was an indication of Kienböck’s disease. A decreased signal containing a high spot and increased signal intensity of the lunate on T2-weighted images indicated a better prognosis. After osteotomy of the radius, the signal intensity of the lunate returned to normal and Lichtman’s stage II cases had better results than those in stage III. M.R. imaging is ideal for evaluating the lunate in Kienböck’s disease.
Detecting Fractures of the Scaphoid: the Value of Comparative X-rays of the Uninjured Wrist
Authors: ABDEL-SALAM A. , EYRES K. S. , CLEARY J.
Published: June 2005

Pain or tenderness in the anatomical snuff-box following trauma suggests an injury to the scaphoid or surrounding soft tissues. It is often difficult to make a definite diagnosis since normal bone markings across the scaphoid can be misinterpreted as a fracture. To clarify whether a fracture is present or not, an X-ray of the uninjured scaphoid is taken in a comparable position to the most suspicious view. If bone markings are similar on both views, then a fracture can be excluded. Conversely, if the bone markings differ, then suspicion of a fracture may be confirmed. In combination with the clinical features, a more accurate diagnosis can be made and unnecessary out-patient and X-ray reviews can be avoided.
Pilon Fractures of the Wrist
Authors: PORTER M. L. , TILLMAN R. M.
Published: June 2005

22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radio-ulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2½ years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radio-ulnar joint were also important.
The Association between Alcohol, Hepatic Pathology and Dupuytren’s Disease
Authors: NOBLE J. , ARAFA M. , ROYLE S. G. , McGEORGE G. , CRANK S.
Published: June 2005

We have looked at the incidence of Dupuytren’s disease in alcoholics, those with non-alcoholic liver disease and a control population. Both alcoholic patients and those with non-alcohol related liver disease had a higher rate (28% and 22% respectively) than the controls (8%), but this did not quite reach statistical significance (p > 0.05). In addition we found no Dupuytren’s disease in 50 Egyptian patients with bilharzia and no consistent biochemical abnormalities in 134 patients with significant Dupuytren’s disease.

We conclude that alcoholics probably do have a higher rate of Dupuytren’s disease and that this effect is largely due to the liver disease caused by alcohol abuse, but that the genetic factors are of greater aetiological importance.
The Mechanical Strength of Various Suture Techniques
Authors: TRAIL I. A. , POWELL E. S. , NOBLE J.
Published: June 2005

The mechanical strengths of five techniques of tendon repair have been evaluated using human cadaver tendons. A modified Kessler repair with a peripheral circumferential suture and the method of Becker were found to require the greatest load to produce gapping, but the Becker and Savage repairs withstood the highest load before failure.
Repair of the Ruptured Distal Tendon of the Biceps Brachii
Authors: WARE H. E. , NAIRN D. S.
Published: June 2005

The biceps brachii is the main supinator of the forearm. Unless the ruptured distal tendon is reattached to its correct anatomical site on the radial tuberosity, its action cannot be restored. We report four cases treated surgically, who all regained full forearm function, and on the basis of our experience suggest a simple method of reattaching the tendon
An Unusual Association of the Windblown Hand with upper Limb Hypertrophy
Authors: SO Y. C.
Published: June 2005

An eight-year-old boy presented with a congenital windblown hand deformity associated with partial hypertrophy of that arm. Many of the classical features of the windblown hand syndrome described in previous papers were absent. In this case, the primary cause of the ulnar-drift deformity was an anomalous epiphysis at the base of the second metacarpal. Surgical correction was readily obtained by osteotomy at the base of the metacarpal combined with soft tissue re-alignment.
Excision of the Pisiform in Piso-Triquetral Osteoarthritis
Authors: BELLIAPPA P. P. , BURKE F. D.
Published: June 2005

12 patients with pain in the piso-triquetral region are described. 11 had radiological evidence of osteoarthritis of the piso-triquetral joint, which was confirmed in the nine cases treated by excision of the pisiform. Seven of these had complete relief of symptoms. The clinical findings are constant and relief of pain by conservative treatment is usually only temporary. Ulnar nerve symptoms were present in four patients and these were also relieved by surgery. Excision of the pisiform is a useful operation for this condition, which often remains undiagnosed due to incomplete clinical and radiological evaluation. Full return to normal function is the rule if the problem is not associated with other wrist pathology.
The Late Reduction of Carpal Dislocations
Authors: WEIR I. G. C.
Published: June 2005

Five cases are reported in which open reduction of a lunate or peri-lunar dislocation was carried out after a delay of two weeks to six months. Results were poor in terms of range of movement and X-ray appearance, but function was surprisingly good, all patients returning to normal activities including heavy manual work. One patient later underwent excision of the radial styloid with an avascular scaphoid fragment; this apart, there were no requests for further surgical treatment. Open reduction remains a reasonable choice in the treatment of late presentation of lunate and perilunar dislocation.
Combined Radio-Carpal and Mid-Carpal Dislocation
Authors: BRUNNER W. G. , SPENCER R. F.
Published: June 2005

We describe a case of combined volar dislocation of the lunate and dorsal dislocation of the remainder of the carpus. Such a combination is probably very rare and the possible mechanism of injury is discussed.
External Fixation of Unstable Metacarpal and Phalangeal Fractures
Authors: PARSONS S. W. , FITZGERALD J. A. W. , SHEARER J. R.
Published: June 2005

A prospective study of the management of 30 patients with 37 unstable or complex metacarpal or phalangeal fractures treated with the “Shearer” micro-external fixator was carried out over an 18-month period. The stability achieved, with minimal soft-tissue tethering, allowed early joint mobilisation with good or excellent function in 94% of metacarpal and 85% of phalangeal fractures by nine weeks. There were no cases of non-union and few complications.
The Contents of Macromolecule Solutes in Flexor Tendon Sheath Fluid and Their Relation to Synovial Fluid
Authors: HAGBERG L. , HEINEGÅRD D. , OHLSSON K.
Published: June 2005

The importance of synovial environment for minimal adhesion formation in flexor tendon healing has recently gained attention. Various techniques have been used to restore an injured synovial tendon sheath. Therefore a quantitative analysis of flexor tendon sheath fluid is of interest to increase our knowledge about the specific synovial milieu and to evaluate the success of different types of sheath reconstructions from a biochemical point of view. Samples of tendon sheath fluid from trigger digits and tendon sheaths containing ganglions have been assayed for contents of hyaluronic acid and proteins of different molecular weights. The results show concentrations of hyaluronate and several proteins similar to those in normal joint fluid. These results indicate that flexor tendon sheath fluid has a character similar to synovial fluid of joints and apparently has specific functions such as soft tissue lubrication and nutrition of avascular tendon tissue.
Free Flaps in the Reconstruction of Hand and Distal Forearm Injuries
Authors: REIGSTAD A. , HETLAND K. R. , BYE K. , RØKKUM M.
Published: June 2005

We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.
Complications and Morbidity of the Donor and Recipient Sites in 123 Lateral Arm Flaps
Authors: GRAHAM B. , ADKINS P. , SCHEKER L. R.
Published: June 2005

The lateral arm flap is a reliable and versatile free tissue transfer. However, the donor and recipient sites may produce an assortment of relatively minor complaints in a large proportion of patients.

109 (89%) out of 123 lateral arm flaps performed over a seven-year period were reviewed an average of three years after surgery. Unsatisfactory appearance of the donor site was noted by 27% of patients and was twice as likely to be reported by female patients and in cases in which the donor site was repaired by a split-thickness skin graft rather than by primary closure. Elbow pain was reported by 19%. Numbness in the forearm was reported by 59% and was unchanged during the follow-up period in the majority of patients. 17% of patients noted hypersensitivity of the donor site to a variety of stimuli such as cold or vibration. Hair formation was reported at the recipient site by 78% of patients. 83% of the patients found the flap to be bulky and 15% had undergone at least one procedure for debulking. We recommend that the use of the lateral arm flap should be limited to males and cases in which the resulting donor site can be closed primarily.
Low Cost Cosmetic Hand Prostheses
Authors: CAMPBELL G. S. , GOW D. , HOOPER G.
Published: June 2005

66 patients with congenital or acquired amputations of the hand have been studied after fitting partial or complete silicone hand prostheses which can be manufactured at relatively low cost. Most patients used their prostheses on social occasions only and all but four expressed satisfaction with them.
Provocative Sensory Testing in Carpal Tunnel Syndrome
Authors: NOVAK C. B. , MACKINNON S. E. , BROWNLEE R. , KELLY L.
Published: June 2005

This study reports the relationship between three clinical tests in the diagnosis of carpal tunnel syndrome and the stages of nerve compression. Assessments of 158 patients with carpal tunnel syndrome were reviewed retrospectively. 77% of patients had at least one of the clinical signs present. The incidence of positive pressure-provocative and Phalen’s tests were similar and more likely to occur in combination than separately. Tinel’s sign was more likely to be positive in the later stages of nerve compression. Our results suggest that the presence or absence of a provocative test is dependent upon the severity of the nerve compression.
Thickening of the Synovium of the Digital Flexor Tendons: Cause or Consequence of the Carpal Tunnel Syndrome?
Authors: LLUCH A. L.
Published: June 2005

Using a monofilament wire suture, the radial and ulnar edges of the flexor retinaculum were approximated in 14 white New Zealand rabbits. As a result, the volume of the carpal tunnel was diminished, and “carpal tunnel syndrome” was produced. At various intervals after this procedure the animals were sacrificed. The median nerve and all the digital flexor tendons passing through the carpal tunnel were excised “en bloc”, and sent for histological examination. Vascular proliferation with perivascular round cell infiltration and oedema, and large areas of fibroblastic activity were observed around the digital flexor tendons. This was probably due to increased vascular permeability secondary to ischaemic endothelial damage. These findings are similar to those observed in the synovium of patients operated on for carpal tunnel syndrome.
Acute Carpal Tunnel Syndrome Due To Pseudogout
Authors: RATE A. J. , PARKINSON R. W. , MEADOWS T. H. , FREEMONT A. J.
Published: June 2005

We report a case of severe fulminating carpal tunnel syndrome secondary to pseudogout.
Soft Tissue Sarcoidosis of the Hand: A Case Report
Authors: GOTTLIEB D. C. , WENNER S. M.
Published: June 2005

A tumour of the hand may be the first manifestation of systemic sarcoidosis. In our patient, this mass involved only the soft tissues; more commonly, there is bone Involvement as well.
Isolated Tuberculosis of a Skeletal Muscle
Authors: ASHWORTH M. J. , MEADOWS T. H.
Published: June 2005

A case is described of tuberculosis in the muscle belly of abductor pollicis longus in a 25-year-old Asian woman. The complaint was of swelling and, as there was no evidence of tuberculosis elsewhere, the diagnosis was not made until the lump was explored surgically.
Trigger Digit: The Needle or the Knife?
Authors: PANAYOTOPOULOS E. , FORTIS A. P. , ARMONI A. , DIMAKOPOULOS P. , LAMBIRIS E.
Published: June 2005

We report our experience in conservative treatment of 30 patients with trigger digits followed up for an average of 22.3 months. In 26 patients (86.6%) the pain disappeared and the others experienced a remarkable improvement. Locking resolved in 23 patients (76.6%): in 19 patients immediately after the injection and in the other four gradually thereafter. Only three patients needed a second injection. All were satisfied and none required any other form of treatment.
Medial Epicondylectomy in Cubital Tunnel Syndrome: An Electrodiagnostic Study
Authors: ROBINSON D. , AGHASI M. K. , HALPERIN N.
Published: June 2005

Prospective analysis of 27 medial epicondylectomies in 22 patients with McGowan grade I ulnar neuropathy demonstrated an improvement in clinical symptoms. In all patients a N.C.V. study, in which compression of the ulnar nerve at the cubital tunnel was evident, has been a prerequisite for operation. Conduction velocity across the cubital tunnel averaged 48% of normal (26.4 +/– 8.7 metres per second) preoperatively and increased to 85% of normal (46.7 +/– 9.7 metres per second) postoperatively.

A preoperative N.C.V. study allows the achievement of a high success rate, especially in the less well clinically defined group of patients with grade I neuropathy (subjective complaints without any objective signs of muscle atrophy). Medial epicondylectomy is safe and predictable in the treatment of cubital tunnel syndrome.
Anatomy of the Extensor Pollicis Brevis Muscle
Authors: BRUNELLI G. A. , BRUNELLI G. R.
Published: June 2005

52 hands have been dissected to check the anatomy and function of the extensor pollicis brevis. Various abnormalities were found: absence of the E.P.B. (two), insertion on the distal phalanx (four), absence of bony insertion on the base of the first phalanx and insertion on the extensor hood (36). In ten cases (in addition to the two with absence of E.P.B.), no function was elicited by pulling the tendon which inserted upon the extensor hood.
Vibration-Induced Muscle Injury
Authors: NECKING L. E. , DAHLIN L. B. , FRIDÉN J. , LUNDBORG G. , LUNDSTRÖM R. , THORNELL L. E.
Published: June 2005

The hind paws of rats were subjected to vibration at a frequency of 80 Hz., an acceleration of 32 m./s.2rms (i.e. ahw~6.3m./s.2rms) for five hours daily during five consecutive days. Morphological, histochemical and immunohistochemical analyses of the soleus, extensor digitorum longus and the plantar muscles in the vibrated limb and the contralateral control limb were performed. No changes were seen in the soleus or extensor digitorum longus muscles but different degrees of degeneration of the muscle fibres were seen in the plantar muscle sections as well as signs of regeneration. No changes were observed in the contralateral unexposed limb. It is concluded that it is not only nervous tissue but also muscle tissue that can be affected by vibration. The changes seem to be confined to muscles close to the vibration exciter.
Intrinsic Mitogenic Potential of Canine Flexor Tendons
Authors: DUFFY F. J. , SEILER J. G. , HERGRUETER C. A. , KANDEL J. , GELBERMAN R. H.
Published: June 2005

Recent studies have demonstrated an intrinsic neovascular response in intrasynovial healing tendons, introducing the possibility of mitogenic and/or angiogenic capability of intrasynovial tendon. To explore this hypothesis, healing canine flexor tendons were treated with early passive mobilization and the repair sites analysed at three, ten and 17 days. Specimens were mechanically digested and subjected to a standard BALB/c 3T3 mitogenic assay, which measures the capacity of tissue extracts to induce DNA synthesis and cell division in fibroblasts. Results revealed that both control and repaired flexor tendons possessed mitogenic activity, with the greatest activity observed in control specimens. Decreasing activity was noted as the time between repair and analysis increased. These data provide increasing evidence for the flexor tendon’s active role in the healing process, and support the concept that mitogenic or growth-promoting factors are associated with flexor tendons and may be released following injury, during the early stages of healing.
Biomechanical Analysis of a Step-Cut Technique for Flexor Tendon Repair
Authors: GORDON L. , GARRISON J. L. , CHENG J. C. , LIU Y. K. , NATHAN R. P. , LEVINSOHN D. G.
Published: June 2005

We compared the strength of a new step-cut technique for flexor tendon repair with that of the widely used Kessler-Tajima technique, giving special attention to the relative contributions of the core and epitendinous sutures. 36 flexor digitorum profundus tendons from human cadavers were used. Corresponding digits from the same donor were paired, and the two tendons of each pair were placed in the Kessler-Tajima and step-cut groups, respectively. Each group had three subcategories of repair: (1) core repair alone; (2) epitendinous repair alone; and (3) full repair. In the Kessler-Tajima repair, the core stitch contributed more to ultimate tensile strength, while the epitendinous stitch contributed more to gap formation resistance. In the step-cut repair, however, the epitendinous stitch contributed more to both measures of strength. The full step-cut repair was 65% stronger in resisting gap formation and had 84% more ultimate tensile strength than the full Kessler-Tajima repair. We attribute the greater strength of the step-cut repair to the additional number of epitendinous loops, which lie perpendicular to the long axis of the tendon.
Features of Algodystrophy Ten Years after Colles’ Fracture
Authors: FIELD J. , WARWICK D. , BANNISTER G. C.
Published: June 2005

The long-term outcome of algodystrophy is unknown. Ten years after Colles’ fracture, 26% of 55 cases showed features of the syndrome. The finding of poor finger function three months following the fracture correlated significantly with the presence of components of algodystrophy after ten years.
The “S” Quattro in the Management of Fractures in the Hand
Authors: FAHMY N. R. M. , HARVEY R. A.
Published: June 2005

The “S” Quattro has shown its value in the management of displaced comminuted intra-articular phalangeal fracture dislocations. Since then the system has been used as a dynamic flexible external fixator in the treatment of five maluniting phalangeal fractures, five comminuted condylar and four severe compound fractures.

These challenging fractures have been dealt with by easy operations, taking full advantage of the versatility of the “S” Quattro to achieve good results.
The Conservative Management of Proximal Phalangeal Fractures of the Hand in an Accident and Emergency Department
Authors: MAITRA A. , BURDETT-SMITH P.
Published: June 2005

147 proximal phalangeal fractures of the hand were managed by Accident and Emergency doctors and hand surgeons. Most were treated conservatively with good results. Those treated in A. and E. were usually transverse or basal fractures of the shaft. Articular, oblique, comminuted and compound injuries were associated with greater morbidity and required specialist care.
Irreducible Distal Phalangeal Epiphyseal Injuries
Authors: BANERJEE A.
Published: June 2005

Two cases are described in which reduction of distal phalangeal epiphyseal fractures was prevented by a bridge of nail fold.
Rupture of the Flexor Carpi Radialis Tendon Associated with Scapho-Trapezial Osteoarthritis
Authors: IRWIN L. R. , OUTHWAITE J. , BURGE P. D.
Published: June 2005

A case of rupture of the flexor carpi radialis tendon in association with scapho-trapezial osteoarthritis is reported. The symptoms of pain and swelling contrast with the loss of function which characterizes rupture of other tendons in the hand and wrist.
A Comparison of Arterial and Venous Flaps
Authors: CHOW S. P. , CHEN D. Z. , GU Y. D.
Published: June 2005

The survival rate and elastic properties of the anterior abdominal skin flap in Sprague-Dawley rats were studied in three groups of animals. In group 1 where the flaps were supplied by a normal artery, arterial flaps (1A) had better survival rate and elastic properties than venous flaps (1B). In group 2, where the flaps were supplied by an artery with diminished perfusion pressure, the arterial flaps (2A) still had slightly better results than venous flaps (2B). However, in group 3 where the flaps were supplied by a vein, venous flaps (3B) had better results than arterial flaps (3A).