bluuebunny/crossref_metadata_2025 huggingface dataset:
The esoteric and exoteric view of homoeopathy: Two sides of the same coin?
Authors: Schmidt Josef M
Published: September 2002

The terms ‘esoteric’ and ‘exoteric’ are used in German idealistic philosophy for the view from the inside (of the thinking process) and from the outside (on the thoughts that result). They can also be used to present new perspectives of homoeopathy.

Homoeopathic literature generally explains homoeopathy esoterically, i.e. as seen through the eyes of devoted practitioners, in terms of faithful obedience to universal laws, eternal truth, divine revelation, etc. In contrast to this, critical medical colleagues usually look at homoeopathy exoterically as a system based on speculation and dogmatism with no clear evidence of efficacy. The reaction to the critics’ exoteric view has divided homoeopaths into those who adopt the critics’ way of reasoning and try to prove their own claims scientifically, and those who ignore external criticism and just go on with their medical work. Both positions are one-sided and have severe shortcomings. Nevertheless, they have decisive practical impacts.

Faithful adherence to the doctrine of homoeopathy is likely to help physicians get a maximum effect out of it that would probably not be possible to achieve with a sceptical attitude towards its principles.

Limiting one’s horizon to a strictly esoteric view, however, may also be detrimental to the patient, if not balanced by a realistic exoteric view of one’s own limitations. A self-critical attitude may curtail otherwise possible clinical results, but in the long run a mixed position will be safer for patients, and is the only way of communicating and collaborating with mainstream medicine and legislators. Keeping the balance between an esoteric and an exoteric view of homoeopathy is an art, dependent on virtues and bound to ethics. Homoeopathy is therefore not merely a medical method. Its wise application also involves spiritual, artistic and ethical dimensions on the part of the practitioner.
The constitution: views from homoeopathy and psychiatry
Authors: Gaylord SA , Davidson J
Published: September 2002

The notion that individuals differ in their physical and psychical makeup, and that these differences predispose them to various illnesses, is found throughout medical history in various healing traditions. In this paper, the authors address the use of the concept of constitution and constitutional type in homoeopathy, as well as in psychiatry, and describe an approach toward validating the existence of such types in the population.
Community Hospital Homeopathy Clinic: Audit of the first 12 months activity
Authors: Neville-Smith R
Published: September 2002

The aim of the study was to examine the activity of a new service providing a homeopathy clinic at a community hospital. This was initiated in a limited way and was served by a relatively inexperienced practitioner. A range of presenting complaints, treatments and outcomes are described. Funding has been maintained by the Health Authority and referrals have continued to be made by the local eligible General Practitioners. The outcomes have been quite good but the default rate has been disappointingly high.
How to prescribe Medorrhinum: the frequency of symptoms and signs in homeopathic patients
Authors: Mercaldo M
Published: September 2002

Medorrhinum is an important, but under-prescribed, homeopathic medicine. This paper discusses how to prescribe
Medorrhinum
on the basis of symptoms, signs and family history.
LM potencies: one of the hidden treasures of the sixth edition of the Organon
Authors: De Schepper L
Published: September 2002

50 millesimal (LM) potencies have great advantages for all patients, not just those who are hypersensitive because of their great power to heal without major aggravations. Before discussing their advantages this paper describes what LM potencies are, and how they are administered, then addresses two questions: why do we want to avoid aggravations if most homeopaths look for aggravation to know if the remedy is working? And if LM potencies are indeed superior, why are they still relatively unknown and unused?
Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial
Authors: Balzarini A , Felisi E , Martini A , De Conno F
Published: September 2002

The aim of this study was to assess the effects of Belladonna 7cH and X-ray 15cH associated in the treatment of acute radiodermatitis. A randomized double-blind placebo-controlled clinical trial involving 66 patients who had been operated on for breast cancer and were undergoing radiotherapy was conducted. The following parameters were assessed over ten weeks: breast skin colour, warmth, swelling and pigmentation.

The efficacy of the treatment was assessed by the comparison of these parameters taken individually and by calculating an Index of Total Severity (sum of the scores of the four parameters) during radiotherapy, and during recovery, 15 and 30 d after the end of the radiotherapy.

The differences of the scores of the Index of Total Severity during Radiotherapy were not statistically significant, but showed a trend towards a better activity of the homoeopathic medicine compared to placebo. Analysis of the data on Total Severity during recovery, showed a statistically significant benefit of the active medicines over placebo. The homeopathic medicines had particular effectiveness on the heat of the skin.

The limited number of patients observed and the posology employed could have interfered with the significance of the results. Chemotherapy and hormonotherapy do not seem to affect the results.
The Doctrine of Signatures: a historical, philosophical, scientific view (II)
Authors: Richardson-Boedler C
Published: September 2002

The first part of this article discussed the history of the Doctrine of Signatures. Bach developed a series of Flower Remedies for emotional states. On the basis of the Doctrine of Signatures, these can liberate the vital force from an alien disease process or ‘archeus’. An understanding of the role of the active principle of a homeopathic medicine, in the physiology of its source, may aid understanding of a curative action.
The toxicology of Myrmecia nigrocincta, an Australian ant
Authors: Stein RC , Medhurst R
Published: September 2002

The biology, behaviour and venom of the ant Myrmecia nigrocincta are descibed. Symptoms of 15 cases of envenomation are described.
Magic of signs: a non-local interpretation of homeopathy
Authors: Walach H
Published: September 2002

Among homeopaths the common idea about a working hypothesis for homeopathic effects seems to be that, during the potentization process, ‘information’ or ‘energy’ is being preserved or even enhanced in homeopathic remedies. The organism is said to be able to pick up this information, which in turn will stimulate the organism into a self-healing response. According to this view the decisive element of homeopathic therapy is the remedy which locally contains and conveys this information. I question this view for empirical and theoretical reasons. Empirical research has shown a repetitive pattern, in fundamental and clinical research alike: there are many anomalies in high-dilution research and clinical homeopathic trials which will set any observing researcher thinking. But no single paradigm has proved stable enough in order to produce repeatable results independent of the researcher. I conclude that the database is too weak and contradictory to substantiate a local interpretation of homeopathy, in which the remedy is endowed with causal-informational content irrespective of the circumstances. I propose a non-local interpretation to understand the anomalies along the lines of Jung's notion of synchronicity and make some predictions following this analysis.
More trials, fewer placebos, please
Authors: Dean ME
Published: September 2002

The argument that randomized placebo-controlled trials of homeopathy might usefully be replaced by observational studies, audit and quality-of life assessment is considered. Randomized equivalence and patient-preference trials are proposed as more informative alternatives. They have the merit of providing hard information for health services on the comparative value of treatments, and can facilitate internal comparisons of competing homeopathic methods. The pragmatic approach also allows clinical change during the homeopathic treatment of chronic disease to be assessed without the time constraints usually imposed by placebo controls.
Audit of outcome in 829 consecutive patients treated with homeopathic medicines
Authors: Sevar R
Published: September 2002

An audit was conducted of 829 consecutive patients presenting for homeopathic treatment of a chronic illness, conventional treatment had either failed, plateaued in effect, or was contraindicated by adverse effects, age or condition of the patient.

Of the 829 patients, 503 (61%) had a sustained improvement from homeopathic treatment, of these:
Prophylactic and acute treatment with the homeopathic medicine Betula 30c for birch pollen allergy: a double-blind, randomized, placebo-controlled study of consistency of VAS responses
Authors: Aabel S
Published: September 2002

A study of the consistency of responses by allergic patients in repeated studies of the homeopathic remedy Betula 30c or placebo against birch pollen allergy, was made. A randomized, double-blind, placebo-controlled trial was performed including participants with a known allergy to birch pollen. Allergy symptoms were assessed on a visual analogue scale (VAS) by patients or parents each day during a 20-day period during two different pollen seasons. The work was carried out in Oslo, Norway during May 1995, 1996 and 1997. There were 51 patients ranging in age from 7 to 50 y. The homeopathic remedy Betula 30c or placebo was given as tablets, both as a prophylactic agent, once a week for 4 weeks before the pollen season started, and as an acute remedy during the pollen season. The mean value of the symptom scores on the visual analogue scale, for all registration days from each patient was the main outcome. The patient groups that received either placebo or Betula 30c for two successive years showed a consistent response (r=0.75, P=0.01 and r=0.70, P=0.003, respectively). No such correlation was found in the two groups that changed remedy from one year to another (either from placebo to Betula or vice versa). Subjective assessment of allergic symptoms to birch pollen differed more from one year to another when different regimens (placebo or homeopathic) had been administered these two seasons, than when the same treatment had been given.
Homeopathic pathogenetic trials of Acidum malicum and Acidum ascorbicum
Authors: Fisher P , Dantas F
Published: September 2002

Two homeopathic pathogenetic trials (HPTs, provings), of identical design were conducted: of Acidum malicum 12 cH and Acidum ascorbicum 12 cH. Each trial included 20 healthy volunteers. Both were of double-blind, placebo-controlled, randomised, four period crossover design, with two sequences. ‘Healthy’ was defined in terms of SF-36 scores, medical judgement and blood tests. All volunteers had regular interviews with the same supervisor. No serious adverse reactions occurred. The causal relationship of each symptom with treatment was judged, blind, by the volunteer, the supervisor and a 9-item pathogenetic index. For Acidum malicum 79 symptoms were identified by the supervisor, 57 were included in the final analysis, 22 occurred in verum treatment periods. For Acidum ascorbicum, of 55 symptoms, 39 were included in the analysis. 16 occurred in verum treatment periods.
Very high dilutions of dexamethasone inhibit its pharmacological effects in vivo
Authors: Bonamin LV , Martinho KS , Nina AL , Caviglia F , Do Rio RGW
Published: September 2002

We evaluated the interaction of dexamethasone 10−17 and 10−33 M (equivalent to 7cH and 15cH) with dexamethasone in pharmacological concentrations, using as experimental models: acute inflammation induced by carrageenan, Ehrlich ascitic tumour, and migration of tumour infiltrating leukocytes (TIL). Male adult BALB/c mice (n=7 per group) were used in all experiments. Carrageenan (1%) was injected into the footpad for oedema evaluation and into the peritoneal cavity (i.p.), for differential counting of inflammatory cells. Ehrlich ascitic tumour cells (107 viable cells/ml) were injected i.p. and tumour cells were counted after 6 days, by the Trypan blue exclusion method. The differential TIL was counted using smears stained by hematoxylin–eosin. Treatments were made immediately after carrageenan inoculation or once a day, during Ehrlich tumour development, until the animals were killed. Animals were treated with the following preparations: (1) phosphate buffer saline (PBS) solution; (2) dexamethasone (0.5 mg/kg for inflammation model or 4 mg/kg for tumour model) mixed with dexamethasone 7cH or 15cH; (3) dexamethasone (same doses) mixed in PBS. Homeopathic dexamethasone partially blocked the anti-inflammatory effect of pharmacological dexamethasone with regard to paw oedema (two-way ANOVA, P≤0.0008) and polymorphonuclear cell migration (χ2, P=0.0001). No important differences were observed between experimental and control groups, in relation to Ehrlich tumour cells viability or count, or bodyweight, but potentised dexamethasone restored control levels of TIL viability, compared to mice treated with pharmacological doses of dexamethasone (χ2, P≤0.001). The results demonstrate that a potentised substance may change its own pharmacological effects and suggest that ultradilutions effects act mostly on host response.
A New Resorbable Wrap-Around Implant as an Alternative Nerve Repair Technique
Authors: HAZARI A. , JOHANSSON-RUDÉN G. , JUNEMO-BOSTROM K. , LJUNGBERG C. , TERENGHI G. , GREEN C. , WIBERG M.
Published: September 2002

Poly-3-hydroxybutyrate (PHB), a bacterial storage product, is available as bioabsorbable sheets and has been used in this study for primary nerve repair. The aim was to assess axonal regeneration following such repair and determine the inflammatory response to PHB.

In 20 adult cats, the transected superficial radial nerve was wrapped in PHB sheets, while primary epineural repair was carried out in the contralateral limb. At 6 and 12 months, the repair sites were assessed immunohistochemically for macrophage infiltration and myelinated axons were counted in the distal nerve.

Mean macrophage counts across the whole width of the nerve in both groups at 6 and 12 months showed no statistically significant difference. Nor was there any significant difference between the two groups at both time-points in axon counts, axon diameter, myelin thickness and g-ratio. There was a statistically significant increase in fibre diameters at 12 months, indicating that fibres were undergoing continuous maturation.
Neuromuscular Electrical Stimulation and Dynamic Bracing as a Treatment for Upper-Extremity Spasticity in Children with Cerebral Palsy
Authors: SCHEKER L. R. , CHESHER S. P. , RAMIREZ S.
Published: September 2002

We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES of the antagonist extensors combined with dynamic orthotic traction during the day. A static brace was used at night. Spasticity of the wrist and fingers was assessed periodically using the Zancolli classification. Treatment ranged from 3 to 43 months. After treatment with electrical stimulation and dynamic bracing, all the patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. These results show that combining NMES and dynamic orthotic traction dramatically decreases spasticity of the upper extremity in young patients with cerebral palsy.
Late Treatment of Unreduced Perilunate Dislocations
Authors: INOUE G. , SHIONOYA K.
Published: September 2002

Twenty-eight patients with perilunate dislocations that had been untreated for a minimum of 6 weeks after injury were assessed at a mean of 6.8 years after subsequent treatment. Treatment consisted of open reduction with or without internal fixation of the scaphoid in six patients, proximal row carpectomy in 16, total excision of the lunate in four, and carpal tunnel release and partial excision of the lunate in two. Open reduction yielded satisfactory results in cases of less than 2 months standing. We believe that proximal row carpectomy should be considered in the treatment of chronic perilunate dislocations in patients who are seen later than 2 months after injury, if the cartilage of the proximal pole of the capitate is well preserved. The results of lunate excision were less favourable.
Histological Study of Resection Arthroplasty with and without Tendon Ball Interposition in Dogs
Authors: SARDENBERG T. , MÜLLER S. S. , PEREIRA H. R. , COELHO K. I. R.
Published: September 2002

We studied an experimental model of resection arthroplasty with or without tendon ball interposition in the wrist of dogs. Animals were divided into two groups. Animals in group A were treated by resection of the os carpi radiale with interposition of a ball made from the tendon of the extensor carpi radialis and the group B underwent bone resection alone. Animals were assessed 1, 6, 12 and 24 weeks after operation. In all of them the wrist joint was stable and had good mobility, allowing walking supported by the operated limb. In both groups biological material filled the cavity created by bone resection. A progressive repair process resulted in fibroplasia with areas of fibrocartilaginous metaplasia. The tendon ball showed complete ischaemic necrosis at the end of the first week, which delayed the healing process.
Solitary Fibrous Tumour of the Forearm
Authors: HARRINGTON P. , MERCHANT W. J. , WALSH M. E.
Published: September 2002

Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm that usually arises from serosal surfaces. Although it is now increasingly recognized in extra-serosal locations, only two previous cases of SFT arising in an extremity have been reported. We describe another such case and review the literature regarding extra-serosal SFT.
An Improved Method of Ring Removal
Authors: THILAGARAJAH M.
Published: September 2002

A number of techniques exist for the removal of rings from swollen fingers. An improved method is described using ribbon gauze and a paper clip. It is cheap, quick and effective and can be used in the presence of minor lacerations and abrasions.
Granular Cell Tumour of the Ulnar Nerve
Authors: YASUTOMI T. , KOIKE H. , NAKATSUCHI Y.
Published: September 2002

Although granular cell tumours have been demonstrated to have a neural origin, they rarely arise in peripheral nerve trunks. We report a case of granular cell tumour of the ulnar nerve in a 51-year-old man. Though dissectable from the nerve, this intraneural tumour showed microscopic involvement of focal nerve fibres. This tumour tended to infiltrate the nerve in the same manner as a neurofibroma.
A Glomus Tumour with Four Recurrences
Authors: DAILIANA Z. H. , DRAPÉ J. L. , LE VIET D.
Published: September 2002

A case of a glomus tumour of the distal segment of the ring finger, with four apparent recurrences in an 8-year period, is described. The patient was treated by two different surgeons (two and three times respectively) and obtained pain free intervals of between 4 and 11 months before recurrence. Histological examination confirmed the diagnosis of a glomus tumour in all five procedures. The location of the glomus tumour was defined preoperatively by high resolution MR imaging.
Painless Osteoid Osteoma in a Metacarpal
Authors: BASU S. , BASU P. , DOWELL J. K.
Published: September 2002

Osteoid osteoma is a benign primary tumour of bone occurring in the first two decades of life. It presents with pain and is uncommon in the hand, particularly so in the metacarpals. We report a painless osteoid osteoma affecting a metacarpal.
Lymphoedema and Hand Surgery
Authors: SMITH W. K. , GIDDINS G. E. B.
Published: September 2002

We report the case of a woman with a previous history of breast carcinoma, treated with a left radical mastectomy and axillary clearance, who developed lymphoedema in the left arm following a carpal tunnel decompression complicated by a superficial wound infection.
The Mailbase Hand Surgery Electronic Mailing List
Authors: NDUKWE A. U. , EATON C. , OLIVER C. W.
Published: September 2002

Hand – an Internet based electronic mailing list – enables surgeons with a common interest in hand surgery to share experiences and engage in worldwide electronic scholarly discussion. This paper examines the thinking behind the setting up of this list and gives examples of how the list is being used.
Long Term Outcome of Early Active Mobilization Following Flexor Tendon Repair in Zone 2
Authors: RIAZ M. , HILL C. , KHAN K. , SMALL J. O.
Published: September 2002

We reviewed 34 patients with 65 zone 2 flexor tendon injuries in 39 digits whose outcome had been prospectively studied in an earlier investigation at a mean of 10.6 years after repair. Grip strength was assessed using a Jamar dynamometer. Outcome of grip strength in relation to normal data indicated an excellent or good outcome in 94% of patients, fair in 3% and poor in 3%. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion was graded as excellent or good in 75% of digits, fair in 15% and poor in 10%. These results compare favourably with those of the original study with 5/39 of digits showing an improvement from good to excellent. Sixteen of the 34 of patients continued to suffer from cold sensitivity.
Neurophysiological Findings in Vibration-Exposed Male Workers
Authors: STRÖMBERG T. , DAHLIN L. B. , ROSÉN I. , LUNDBORG G.
Published: September 2002

Fractionated nerve conduction, vibrotactile sense, and temperature thresholds were studied in 73 symptomatic vibration-exposed male workers. Three symptomatic groups were distinguished: patients with isolated sensorineural symptoms; with isolated vasospastic problems; and with both. Clinical carpal tunnel syndrome occurred in 14 patients and abnormal cold intolerance (without blanching of the fingers) in 23. In the group as a whole, nerve conduction studies were abnormal in the median nerve but not in the ulnar nerve and vibration perception and temperature thresholds were impaired. Of the three symptomatic groups, patients with isolated sensorineural symptoms differed from controls. No differences were seen between patients with and without clinical carpal tunnel syndrome. With severe sensorineural symptoms the vibration perception thresholds, but not the values of the nerve conduction studies, were further impaired. The results indicated two injuries that are easily confused: one at receptor level in the fingertips and one in the carpal tunnel. Careful clinical assessment, neurophysiological testing, and examination of vibrotactile sense are required before carpal tunnel release should be considered in these patients.
Dynamic Traction for Unstable Fractures of the Distal Radius
Authors: HOVE L. M. , HELLAND P. , MØLSTER A. O.
Published: September 2002

We have designed a flexible distracter through which dynamic traction is applied to fractures of the distal radius. The distraction is maintained during flexion and extension as well as radial and ulnar deviation. The results in 30 patients showed that the majority of the fractures maintained reduction during the period of dynamic traction. In several patients the radiological variables even improved during dynamic traction. The median radial shortening was 0 mm, the palmar angulation 7°, and the radial inclination 23°. Continuous dynamic traction applied to fractures of the distal radius did not lead to redisplacement of the fracture, and the overall functional results were good.
Hand Surgery and Quality of Life
Authors: COLVILLE R. J. I. , NICHOLSON K. S. , BELCHER H. J. C. R.
Published: September 2002

The outcome in patients having surgery to the hand was assessed subjectively using a questionnaire that covered activities of daily living (ADL), hand pain and psychological well-being. The questionnaires were completed on average 6.9 months preoperatively and 20.6 months postoperatively by 15 patients with osteoarthritis undergoing trapeziectomy and 25 patients with rheumatoid arthritis undergoing Swanson arthroplasties of the metacarpophalangeal joints.

Surgery resulted in significant improvements in reported ADL and hand pain, in both groups. Improvement in perception of hand function and health was only seen in the osteoarthritic group. There was no improvement in arthritis activity, mood or quality of life in either group.

These results confirm that surgery for arthritis of the hand relieves pain and improves ADL. However, it has a greater effect in patients with localized osteoarthritis than in those with rheumatoid arthritis.
Osteophyte Formation in Association with Dupuytren’s Disease
Authors: ANDERSON P. , SHRIMANKER J. , MILNER R. H.
Published: September 2002

Three cases in which there was osteophyte formation on the middle phalanx at the site of insertion of retrovascular cords of Dupuytren’s disease are presented.
Carpal Tunnel Syndrome After Distal Release of the Flexor Digitorum Profundus and Subsequent Retraction of the Lumbrical Muscle into the Carpal Tunnel
Authors: IMRAN D. , BAINBRIDGE L. C.
Published: September 2002

We present three patients who had traumatic amputation of a finger or fingers with subsequent retraction of the flexor digitorum profundus and lumbrical muscle leading to the development of carpal tunnel syndrome.
Emergency Reconstruction of a Collateral Ligament of a Metacarpophalangeal Joint Using Dacron Material
Authors: LANZETTA M. , CHOLLET A.
Published: September 2002

We present a case in which an open wound involving the ulnar collateral ligament of the metacarpophalangeal joint of the little finger was treated by ligament reconstruction using a strip of Dacron material, nerve grafting and coverage by a posterior interosseous artery pedicled flap. At a long term follow-up of 4 years, the joint was stable and had a full range of movement.
Intraneural Synovial Sarcoma of the Median Nerve
Authors: CHESSER T. J. S. , GERAGHTY J. M. , CLARKE A. M.
Published: September 2002

Intraneural synovial sarcomas are extremely rare in the main nerve trunks of the upper limb. We report on a 16-year-old youth who presented with a painless mass on the flexor aspect of the wrist with the clinical appearance of a ganglion. At operation there was a tumour of the median nerve that was shown on histology to be an intraneural synovial sarcoma.
Use of the “S” Quattro Dynamic External Fixator in the Treatment of Difficult Hand Fractures
Authors: MULLETT J. HANNEN , SYNNOTT K. , NÖEL J. , KELLY E. P.
Published: September 2002

Thirty-seven patients were treated over a 7-year period using the “S” Quattro dynamic external fixator. There were 30 intra-articular and nine extra-articular fractures. Patients were reviewed at an average of 22.5 months. The average total range of motion for the affected digit at follow-up was 232° for intra-articular and 241° for extra-articular fractures. We believe that this device is a simple, reliable technique in the treatment of these difficult fractures.
The Sex Ratio and Rate of Reoperation for Dupuytren’s Contracture in Men and Women
Authors: WILBRAND S. , EKBOM A. , GERDIN B.
Published: September 2002

We identified all patients treated by local fasciectomy at the Department of Hand Surgery, Uppsala University Hospital between 1965 and 1996. A total of 2375 operations were performed on 1600 patients. We found a male: female ratio of 5.9:1. Women had a higher mean age at first operation (62.4 years) than men (59.8 years). One-third of the men required repeated surgery and one-quarter of the women. Early age at first operation was associated with recurrent disease.
Double Second Toe Transfer in Congenital Hand Anomalies
Authors: VAN HOLDER C. , GIELE H. , GILBERT A.
Published: September 2002

A series of 14 patients with congenital hand anomalies who received staged double second toe transfers to the same hand for restoration of function or form were reviewed retrospectively. There were three children with constriction ring syndrome, two with symbrachydactyly and nine with transverse absence (failure of formation). There were different indications, technical difficulties and results with the various anomalies. All transferred toes were mobile and sensate, and were reported to be of benefit in both function and appearance. However, secondary surgical procedures were required in all patients.
Resection of the Distal Scaphoid for Scaphotrapeziotrapezoid Osteoarthritis
Authors: GARCIA-ELIAS M. , LLUCH A. L. , FARRERES A. , CASTILLO F. , SAFFAR Ph.
Published: September 2002

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12–61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119°. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.
Synovectomy Combined With the Sauvé-Kapandji Procedure for the Rheumatoid Wrist
Authors: CHANTELOT C. , FONTAINE C. , FLIPO R. M. , MIGAUD H. , LE COUSTUMER F. , DUQUENNOY A.
Published: September 2002

The aim of synovectomy-stabilization (synovectomy combined with the Sauvé–Kapandji procedure) of the rheumatoid wrist is to obtain a stable painless wrist, retaining enough mobility for function. Thirty-nine wrists were retrospectively examined, at a mean follow up of 64.8 months. The improvement in pain was very significant. We noticed a decrease in wrist motion affecting both flexion and radial deviation. The arthritic change in the wrist continued to increase. We noticed a mean ulnar shift of 2.2 mm and a mean increase in the radial deviation of the wrist of 7°. Only transfer of the extensor carpi radialis longus tendon to the extensor carpi radialis brevis tendon was effective in correcting radial deviation of the carpus. Ninety-seven per cent of patients were very satisfied or satisfied. These encouraging results, even at advanced stages of wrist arthritis, have prompted us to lessen the indications for wrist arthrodesis.
The Prognostic Value and Reproducibility of the Radiological Features of the Fractured Scaphoid
Authors: DESAI V. V. , DAVIS T. R. C. , BARTON N. J.
Published: September 2002

We investigated whether the radiological features of the fractured scaphoid could be reproducibly measured and used to predict the likelihood of union with conservative plaster cast immobilization. We found that the inter- and intra-observer reproducibility of the Compson, Herbert and Russe classification systems were only fair and that none predicted fracture union. Assessments of fracture level, comminution and displacement showed moderate inter- and intra-observer reproducibility but did not predict the likelihood of fracture union. We conclude that the radiological features of acute scaphoid fractures cannot be used to predict the likelihood of fracture union.
Digital Prostheses for Single Finger Amputations
Authors: PILLEY M. J. , QUINTON D. N.
Published: September 2002

After amputation digital prostheses are infrequently used. With modern methods of fabrication both cosmetic and functional use are now possible. We have assessed the use of single digit prostheses in a district general hospital setting.
Advanced Carpal Collapse Associated With Congenital Hypoplastic Thumb
Authors: MORRIS A. D. , JONES W. A.
Published: September 2002

We present the long term sequelae of two patients with congenital hypoplastic thumbs. Neither had surgical correction in childhood, but maintained adequate function in their hands. However, both have developed progressive carpal collapse in adulthood, leading to painful wrists.
Finger Dominance
Authors: RAJ R. , MARQUIS C.
Published: September 2002

Two hundred and ninety-eight normal participants were reviewed to assess finger dominance. Participants were recruited from several large hospitals across the north-west of England and the study was done under blind conditions. From the 298 people originally in the trial, six had to be excluded as the dominant finger could not be confirmed with certainty. The index finger was the most dominant in 82.5% of the test group. However, in 10.6% of the test group, the middle finger was found to be the most dominant.
Proximal Row Transcarpal Fracture from a Punching Injury
Authors: CHRISTODOULOU L. , PALOU C. H. , CHAMBERLAIN S. T.
Published: September 2002

We describe an unusual case of a 31-year-old woman who injured the right dominant wrist when she punched an assailant’s shoulder. She described a mechanism of direct compression, with the wrist in hyperextension, radial deviation and the forearm in pronation. She sustained an oblique transverse fracture of the proximal pole of the scaphoid and a coronal plane fracture of the lunate and the triquetrum. This unusual proximal row transcarpal fracture is in conflict with the Mayfleld sequence and was caused by a low velocity injury.
The Surface Anatomy of the Germinal Matrix of the Nail Bed in the Finger
Authors: REARDON C. M. , McARTHUR P. A. , SURVANA S. K. , BROTHERSTON T. M.
Published: September 2002

Nail spicules result from incomplete excision of the nail matrix of the finger. We report a histological study to delineate the surface anatomy of the nail matrix. Sections were cut longitudinally and transversely in 19 fingertips. The proximal midline extent of the nail matrix was measured and expressed as a ratio of the distance from the nail fold to the distal interphalangeal joint. In the lateral sections, the angle subtended between the midline vertical and the lateral extent of the nail matrix was measured. The mean ratio of the proximal extent was 0.55 in the midline and the lateral angular extent was 66°. The authors recommend that excision of the nail matrix should be rectangular, extending to the midlateral lines and proximally to a point three-quarters of the distance from the nail fold to the distal interphalangeal joint crease.
Delayed Sequential Ruptures Of the Index and Thumb Flexor Tendons Due To an Occult Scaphoid Nonunion
Authors: WACKER J. , McKIE S. , MacLEAN J. G. B.
Published: September 2002

A case of sequential spontaneous loss of flexion in the thumb and index finger over a 10 year period is reported. Previously unrecognized carpal collapse as a consequence of a longstanding scaphoid nonunion was identified as the cause. Fusion of the interphalangeal joint of the thumb and suture of the index profundus tendon to the middle profundus tendon resulted in a good outcome.
The Role of Magnetic Resonance Imaging in the Management of Traction Injuries to the Adult Brachial Plexus
Authors: HEMS T. E. J. , BIRCH R. , CARLSTEDT T.
Published: September 2002

Magnetic resonance imaging (MRI) of the cervical spine and brachial plexus was performed on 26 consecutive patients presenting with traction injuries of the brachial plexus during 1996 and 1997. These included T1 and T2 weighted coronal, sagittal and axial images of the cervical spine and coronal images of the brachial plexus. The results were compared with surgical findings, intraoperative neurophysiology, and subsequent clinical progress. Operations for exploration and repair have been performed in 23 and 26 patients scanned. Evidence of root avulsion was seen in 11 patients in the form of displacement or oedema of the spinal cord, haemorrhage or scarring within the spinal canal, absence of roots in the intervertebral foramena, and meningoceles. Characteristic abnormalities were evident in the MR scans of all cases where exploration confirmed some root avulsions. There were no false positives. MRI underestimated the number of individual roots avulsed; sensitivity was 81%. Post-ganglionic lesions were seen as swelling on T1 images associated with increasing signal on T2 images. It was usually possible to define the level of the injury within the plexus. This study suggests that MR imaging, performed early after traction injury to the brachial plexus, provides useful additional information towards establishing the level of the lesion. It also provides information about injury to the plexus outside the spinal canal.
Dupuytren’s Disease in Marfan’s Syndrome
Authors: RENNIE W. J. , RANGAN A.
Published: September 2002

We report a case of histologically confirmed Dupuytren’s disease of the hand in a young man with Marfan’s syndrome.
Aterialized Venous Toenail Flaps for Treating Nail Loss in the Fingers
Authors: PATRADUL A. , NGARMUKOS C. , PARKPIAN V. , KITIDUMRONGSOOK P.
Published: September 2002

Ten arterialized venous toenail flaps with two venous pedicles, one of which was anastomosed to a digital artery and the other to a dorsal vein of the finger, were used in nine patients to reconstruct nail loss due to trauma. Four flaps were taken from the lateral part of the big toe and six flaps from the second toe. Four toenail flaps with pulp and three flaps with the distal half of distal phalanx were used. Nine flaps survived completely and one had partial necrosis. All showed excellent aesthetic and functional results except for one case with minimal deformity in growth of the nail. The mean operating time was 2 hours.
Optimal Position for the One-Bone Forearm
Authors: CHAN P. S. H. , BLAZER P. E. , BOZENTKA D. J. , GONZALEZ J. B. , NARANJA R. J. , ROROS B.
Published: September 2002

The purpose of the present study was to determine whether there is an optimal position for fixation of the one-bone forearm. Eight normal individuals were fitted with a hinged brace which fixed the position of pronation and supination and underwent functional hand testing using the tests of Jebsen et al. Our results indicate that a one-bone forearm in a position of 30° of pronation will provide the best function for writing and working with small objects using the dominant arm.
The Lateral Pectoral Flap
Authors: AGARWAL R. , AGARWAL S. , CHANDRA R.
Published: September 2002

The lateral pectoral flap is a new pedicled flap based on the superficial thoracic artery which arises from the subscapular artery and courses along the lateral border of pectoralis major. The flap consists of skin, subcutaneous tissue and the underlying pectoral epimysium. It has been used successfully to resurface contralateral soft tissue defects over the fingers, thumb and dorsum of the hand in eight cases. The advantages of this flap are that it provides reliable soft tissue cover to the hand, which can be kept in an elevated position resting comfortably on the contralateral pectoral region with the forearm and arm aligned conveniently in the cross-chest position. It does not interfere with clothing and dressing the lower part of the body in contrast to the groin, hypogastric or lower abdominal flaps, and it allows early ambulation. Primary closure of the donor site in the majority of cases is an added benefit.
Nonunion Following Subcapital (Neck) Fractures of the Proximal Phalanx of the Thumb in Children
Authors: AL-QATTAN M. M. , CARDOSO E. , HASSANAIN J. , HAWARY M. B. , NANDAGOPAL N. , PITKANEN J.
Published: September 2002

Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.
Unusual Complication of Ligation of Rudimentary Ulnar Digit
Authors: HERAS L. , BARCO J. , COHEN A.
Published: September 2002

We report a case of rudimentary ulnar polydactyly of the hand of a 7-year-old female child. Histological examination revealed a central traumatic neuroma which branched into five digit-like projections covered with hyperkeratotic epidermis. We think this was a result of suture ligation during the postnatal period.
4.5 Year Follow-Up after Surgical Correction of Upper Extremity Deformities in Spastic Cerebral Palsy
Authors: NYLANDER G. , CARLSTRÖM C. , ADOLFSSON L.
Published: September 2002

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.
Nonunion of the Distal Radius
Authors: SMITH V. A. , WRIGHT T. W.
Published: September 2002

We report five cases of nonunion of the distal radius. There were three women and two men. The mean age was 44 years (range, 34–56). All five patients were heavy tobacco smokers and three had a history of alcohol abuse. In three patients, union of the distal radius was obtained. Two had a persistent nonunion which was salvaged with a total wrist fusion.
Clinical Diagnosis of Triquetrolunate Ligament Injuries
Authors: CHRISTODOULOU L. , BAINBRIDGE L. C.
Published: September 2002

The clinical diagnosis of peritriquetral injuries is difficult. We describe our diagnostic technique based on specific questions and three clinical tests. The accuracy of our diagnostic technique was compared prospectively with the definitive diagnosis made at arthroscopy. Preoperatively, 19 patients were diagnosed as having triquetrolunate dissociation. This was confirmed at arthroscopy in 17. Another five patients not diagnosed preoperatively were also diagnosed at arthroscopy as having mainly triquetrolunate dissociation. The sensitivity of our diagnostic protocol was 0.77 and the positive predictive value was 0.89.
Free Toe Pulp Transfer for Digital Reconstruction after High-Pressure Injection Injury
Authors: CHAN B. K. , THAM S. K. Y. , LEUNG M.
Published: September 2002

We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.
Osseodistraction after Traumatic Amputation of the Little Finger in a Young Musician
Authors: COBLEY T. D. D. , SACKS L. J.
Published: September 2002

We lengthened the stump of a traumatically amputated little finger by osseodistraction in a young musician, who required a widened span to enable him to reach the octave on the piano. A mini external distraction device was used. No major complications occurred. The bone lengthening gave a good functional and cosmetic result.
Repair of Central Slip Avulsions Using Mitek Micro Arc Bone Anchors
Authors: CLUETT J. , MILNE A. D. , YANG D. , MORRIS S. F.
Published: September 2002

In this study we evaluated the pullout strength of the Mitek Micro Arc anchor for the reconstruction of central slip avulsions at the proximal interphalangeal joint of the finger. Forty paired fresh frozen cadaver fingers were randomized into treatment (anchor) and control groups (horizontal mattress repair) and subjected to tensile loading to failure. The mean (SD) failure loads of the repairs were: Mitek repair group 22.3 (4.7) N, and control group 24.7 (5.5) N. There were no statistically significant differences between the failure loads or the failure mechanisms of the two repairs. The pullout strength of the isolated anchor-bone complex was evaluated by refitting five anchors with stainless steel wire. The mean failure load of the isolated anchor was 400% higher than the tendon-suture-anchor complex, indicating that the weakest link of the system is not the bone-anchor interface.
Cytotoxicity of Cyanoacrylate Adhesives to Cultured Tendon Cells
Authors: EVANS C. E. , LEES G. C. , TRAIL I. A.
Published: September 2002

The in vitro cytotoxicity of four cyanoacrylate adhesives was tested using cultures of cells derived from human tendons. All four were found to be cytotoxic, even at concentrations as low as 1.7%, over the experimental period of up to 18 weeks. This study shows that such adhesives in their present state may not be suitable for re-joining cut tendons as their initial and long-term toxicity may hinder the slow healing process of tendons.
Bone Donor Site
Authors: BIDDULPH S. L.
Published: September 2002

In a series of 18 patients requiring bone-grafting procedures to the wrist, bone structure and bone turnover characteristics were compared between samples of bone harvested from the iliac crest and the distal radius. Histologically and biologically the iliac crest bone was found to be superior to distal radial bone. Axial bone was also shown to be more resistant to the ravages of increasing age and chronic disease. However, in spite of these laboratory findings, clinically, radial bone is equally successful as graft material. This, in all probability, is due to the greater porosity of radial bone which allows better compaction, more accurate filling of defects and easier nourishment of the graft by surrounding body fluids.
Internal Suture for Mallet Finger Fracture
Authors: BAUZE A. , BAIN G. I.
Published: September 2002

An internal suture technique has been used for mallet finger fractures involving at least 30% of the articular surface. It provides fixation without a button or transfixion of the fragment. An independent retrospective review was conducted of ten patients at a mean follow-up of 17 months. Mean visual analogue score (0 to 10) for pain was 2.4 and satisfaction 7.9. Mean active range of motion was 13 to 49°, passive motion was 2 to 56°, pinch strength of effected finger to thumb was 3.8 kgf (81% of the opposite finger), grip strength 37.9 kgf (95% of the opposite hand). All fractures united and there were no neuromas. Complications included two nail deformities, a superficial infection and a pin track infection. One patient with a crush injury continued to have pain despite an arthrodesis.