bluuebunny/crossref_metadata_2025 huggingface dataset:
Attrition Rupture of Flexor Tendons at the Wrist Following Epiphyseal Fracture of the Distal Radius
Authors: SANTANA D. R. , DELISS L.
Published: June 2005

Post-traumatic rupture of flexor tendons is a very rare event. We report such an event following an epiphyseal fracture of the distal radius. This has not previously been reported in the English literature.
Kinematic Analysis of Relative Motion within the Proximal Carpal Row
Authors: SENNWALD G. R. , ZDRAVKOVIC V. , JACOB H. A. C. , KERN H. P.
Published: June 2005

The motions of the scaphoid and triquetrum relative to the lunate have been studied on cadaver specimens. The helical axis concept was applied. The wrist motions performed were flexion-extension and radial-ulnar deviation. The results showed increased relative motion of the scaphoid towards terminal extension, and to a lesser amount in the case of the triquetrum, towards terminal flexion. The lunate might be considered as a keystone in the proximal carpal row when wrist stability is considered. It is doubly intercalated: longitudinally and transversely. Wrist ligaments co-ordinate the positioning of the bones in the mid-range of carpal motions, and restrict further motion in extreme positions of the wrist joint.
Measuring Outcome in Median Nerve Injuries
Authors: JEROSCH-HEROLD C.
Published: June 2005

Assessing the functional outcome of peripheral nerve suture in the hand requires a battery of tests which are valid, reliable and comprehensively evaluate cutaneous sensibility. This study explores the relationship between a battery of sensory tests and the patient’s capacity to perform everyday functional activities. An analysis of the interrelationship between all outcome variables reveals that the tests of sensibility do not predict the patients’ ability to use their hands in everyday activities, thus indicating that patients are able to compensate for sensory deficit through the use of vision and bilateral use of the hands. An assessment of outcome should therefore include an additional measure of performance on daily living tasks.
Can a Divided Digital Nerve on One Side of the Finger be Left Unrepaired?
Authors: CHOW S. P. , NG C.
Published: June 2005

72 fingers with divided digital nerves on one side alone had their nerves repaired and the sensory recovery assessed at different intervals of up to 2 years. Another 36 fingers with similar digital nerve injuries had their divided nerves left unrepaired and sensory recovery similarly assessed for comparison. In the “repaired” group, the result continued to improve and by 2 years, 90% reached S3+ or above. In the “unrepaired” group, improvement plateaued after 6 months, and at 2 years only 6% reached S3+ or above, although all had regained some protective sensibility.
Evaluation of Methods of Claw Finger Correction Using the Finger Dynamography Technique
Authors: MALAVIYA G. N. , HUSAIN S.
Published: June 2005

Finger dynamography is a bedside technique for evaluation of the moving abilities and working space of the hand. Various operative procedures used for correcting the claw finger deformity restore the functional abilities to a varying extent. The palmaris longus transfer with insertion into A1–A2 pulley appears to be a better procedure than lateral band insertion, extensor diversion or extensor many-tail procedures. The use of palmaris longus as a motor seems to have advantages over flexor digitorum superficialis transfer where removal of FDS as a motor produces local deficits.
Irreducible Rotational Anterior Dislocation of the Proximal Interphalangeal Joint
Authors: GRANT I. R.
Published: June 2005

Two cases are described of anterior dislocation of the proximal interphalangeal joint which could not be reduced because of interposition of the central slip of the extensor mechanism. In common with previously reported cases the injuries were sustained in a spin drier. The literature on anterior dislocation of the proximal interphalangeal joint is reviewed. Three distinct patterns of dislocation are recognised and their management is discussed.
Nail Gun Injuries of the Fingers: A Safer Method of Nail Removal
Authors: AL-QATTAN M. M. , STRANC M. F.
Published: June 2005

In nail gun injuries of the fingers, removal of the nail in the antegrade fashion (in the same direction as its introduction) prevents soft tissue entrapment by the hooked barbs of the nail. This concept is illustrated in a case report.
Dermal Dendrocytes in Dupuytren’s Disease: A Link Between the Skin and Pathogenesis?
Authors: SUGDEN P. , ANDREW J. G. , ANDREW S. M. , FREEMONT A. J.
Published: June 2005

The skin has previously been implicated in the process of Dupuytren’s disease. The dermal dendrocyte is a factor XIIIa positive cell, which has been found in normal skin and some pathological conditions associated with fibrosis. In this study we examined the distribution of factor XIIIa positive cells in and around tissue from Dupuytren’s disease. Immunohistochemistry was performed using a panel of antibodies for factor XIIIa, macrophages (CD68 and MAC387) and MHC II. Many factor XIIIa positive dendritic cells were present in and around Dupuytren’s tissue; fewer CD68 and MHC II positive cells and very few MAC387 cells were seen. We propose that the factor XIIIa positive cells are dermal dendrocytes. This study may indicate an important link between the skin and pathogenesis of Dupuytren’s disease.
Incontinentia Pigmenti (Bloch-Sulzberger Syndrome) Manifesting as Painful Periungual and Subungual Tumours
Authors: ADENIRAN A. , TOWNSEND P. L. G. , PEACHEY R. D. G.
Published: June 2005

A 25-year-old lady presented with painful periungual tumours which were associated with lytic changes of underlying terminal phalanges. She had been previously treated as a case of chronic paronychia but the problem recurred. She was subsequently diagnosed as a case of Incontinentia pigmenti which is a rare genodermatosis with mixed ectodermal and mesodermal polydysplasias, onchychodystrophy being a very rare manifestation.

She was treated by excision of painful finger lesions, but there is no specific treatment for the underlying condition.
The Anatomical Course of the Palmar Cutaneous Branch of the Median Nerve, Including a Description of Its Own Unique Tunnel
Authors: NAFF N. , DELLON A. L. , MACKINNON S. E.
Published: June 2005

In order to obtain a better understanding of the palmar cutaneous branch of the median nerve, dissections of 21 forearms from 12 fresh cadavers were done with loupe magnification. Discrete regions of potential surgical significance were identified, including an origin that can be as high as 11 cm proximal to the wrist crease, a radial position immediately after its origin so that it lies adjacent to flexor carpi radialis in the distal forearm, and the existence of an anatomical tunnel through the palmar aponeurosis.
The Results of Secondary Microsurgical Repair of Ulnar Nerve Injury
Authors: VASTAMÄKI M. , KALLIO P. K. , SOLONEN K. A.
Published: June 2005

110 patients with injuries to the ulnar nerve were assessed, on average, 12.7 (3–20) years after secondary repair. 89 were male and 21 female, with a mean age of 27.9 years. Most of the nerve lesions were sharp (63) or blunt (41) injuries. Division was total in 76 cases and most were at the forearm level. The average delay from the injury to the operation was 10.1 (1–48) months. Secondary repair was performed in 34 cases and fascicular grafting in 76 cases. The mean graft length was 5.4 (1–30) cm. Four factors of motor and sensory function were assessed and the quantitative evaluation was compared with the MRC classification. Useful results were obtained in only 51.8% and poor in 30.9%. The age of the patient, the width of contusion, the pre-operative delay, and the level of the injury influenced the results significantly.
The Results of Secondary Repair of 254 Digital Nerves
Authors: KALLIO P. K.
Published: June 2005

95 patients with 254 completely divided digital nerves were reviewed, on average, 12.4 (5–20) years after repair. There were 47 sharp and 48 blunt injuries. 45 injuries were at the level of the palm of the hand and 50 more distally. Secondary epineurial suture was used in 53, fascicular grafting in 37 and fascicular suture in five. Four sensory factors were assessed and evaluated quantitatively. Useful sensory function was recovered in 79.5% of the nerves operated on with epineurial or fascicular suture and in 56.3% with fascicular grafting.
The Association of Peripheral Nerve Compression and Reflex Sympathetic Dystrophy
Authors: MONSIVAIS J. J. , BAKER J. , MONSIVAIS D.
Published: June 2005

35 patients who presented with reflex sympathetic dystrophy (RSD) are reported. Peripheral nerve compression was present in 86% of the patients (30). 50% of the patients (15) had a single nerve compression, and 50% had multiple nerve compressions. The high incidence of these entrapments should alert the clinician to check for this treatable problem early in the course of RSD.
Dupuytren’s Disease in Identical Twins
Authors: LYALL H. A.
Published: June 2005

The aetiology of Dupuytren’s disease remains unknown, although hereditary and environmental influences have been implicated. Previous reports have suggested that identical twins will develop identical contractures. This paper reports two pairs of identical twins, in each of which only one twin has evidence of Dupuytren’s disease. This demonstrates that an appropriate genetic background is inadequate of itself for the development of Dupuytren’s disease without a suitable, and as yet unknown, environmental trigger.
Transfer of Sensory Branches of Radial Nerve in Hand Surgery
Authors: Matloubi R.
Published: June 2005

Transfer of sensory branches of the radial nerve to sensory branches of the ulnar or median nerves has been carried out to restore sensitivity to the digits in patients suffering from severe, longstanding and irreparable damage to the median or ulnar nerves, due to war injuries. The author describes the two surgical techniques in detail and reports the results obtained.
The Use of the Veins of the Thenar Eminence in Digital Revascularization and Replantation
Authors: ELLIOT D. , MEYER M.
Published: June 2005

Use of the small veins of the thenar eminence as an alternative source of vein grafts in distal digital reconstruction is presented.
Prediction of the Outcome 24 Hours after Carpal Tunnel Decompression
Authors: CLARKE A. M. , STANLEY D.
Published: June 2005

A prospective study has been performed on 47 wrists treated by surgical decompression for carpal tunnel syndrome. In all cases where there was symptomatic relief within the first 24 hours postoperatively, a good or excellent outcome was obtained when the patients were reviewed six weeks after surgery. If subjective improvement was not obtained by 24 hours, a good outcome was still possible but a poor outcome became more likely.
Fracture Dislocation of the Fifth Metacarpal Resulting in Compression of the Deep Branch of the Ulnar Nerve
Authors: O’ROURKE P. J. , QUINLAN W.
Published: June 2005

A volar fracture dislocation of the base of the fifth metacarpal resulted in compression of the deep branch of the ulnar nerve. Operative correction of the deformity resulted in full recovery.
Stabilization of Multiple Metacarpal Fractures: A New Use for the Charnley Toe-Fusion Clamp
Authors: EYRES K. S. , KREIBICH N. , ALLEN T. R.
Published: June 2005

Surgery is often required to ensure adequate reduction and fixation of multiple fractures of the metacarpals. In order to stabilize metacarpal fractures with transverse Kirschner wire fixation, the authors have used a simple modification of the Charnley compression clamp designed for toe fusion.
Reinsertion of the Ruptured Ulnar Collateral Ligament of the Metacarpophalangeal joint with an Absorbable Self-Reinforced Polylactide Tack
Authors: VIHTONEN K. , JUUTILAINEN T. , PÄTIÄLÄ H. , ROKKANEN P. , TÖRMÄLÄ P.
Published: June 2005

70 patients with total avulsion or rupture of the ulnar collateral ligament of the first metacarpophalangeal joint were treated surgically, using an absorbable self-reinforced poly-L-lactide mini-tack placed through the ligament and a channel in the base of the proximal phalanx. The device stabilized the joint immediately, and 69 ligaments remained stable at 6 months. The subjective result was good or satisfactory in 66 of the cases. One case needed further surgery for pain in the scar and another developed local infection 9 months post-operatively. On the basis of these findings, the new absorbable fixation method seems to be a suitable method for clinical use.
Regeneration of the Distal Phalanx
Authors: VIDAL P. , DICKSON M. G.
Published: June 2005

A patient who suffered a traumatic avulsion of the distal phalanx of the right index finger is described. Following simple wound toilet and closure, the distal phalanx regenerated to give an excellent functional result.
The Extended Palmaris Longus Tendon Graft
Authors: TOLAT A. R. , STANLEY J. K.
Published: June 2005

A technique is described of increasing the length of a palmaris longus tendon graft by including palmar aponeurosis. The additional 5 cm is often useful in treating high flexor tendon ruptures, especially at the wrist level, without the need for an additional incision.
Arterial Anatomy of the Thumb
Authors: AMES E. L. , BISSONNETTE M. , ACLAND R. , LISTER G. , FIRRELL J.
Published: June 2005

The anatomical literature has indicated that the arterial supply to the thumb comes from the princeps pollicis artery. However, this simplified description does not often correlate with intraoperative findings. The purpose of this study was to investigate and clarify this important area of anatomy by dissection of fresh cadaver hands. 40 dissections were completed on 35 intravascularly injected and five non-injected hands. Five patterns were identified. The most common pattern showed both a superficial and deep vessel to the first web space in 54% of specimens. Dominant vessels included the superficial palmar branch of the radial artery in 8%, first palmar metacarpal artery in 18% and dorsal metacarpal artery in 8%. Only three specimens correlated with the textbook description. We conclude that the term “princeps pollicis” is actually a misnomer.
Magnetic Resonance Imaging of an Obscure Glomus Tumour in the Fingertip
Authors: HOU S-M. , SHIH T. T-F. , LIN M-C.
Published: June 2005

Magnetic resonance imaging was performed on a patient with chronic obscure pain in her little finger. MRI findings helped to establish the diagnosis and guide the surgeon to the glomus tumour.
Rupture of the Ulnar Collateral Ligament of the Thumb in A 5-Year-Old Girl
Authors: WALLACE D. A. , CARR A. J.
Published: June 2005

Injuries to the metacarpophalangeal joint of the thumb are rare in children and usually involve avulsion of the bone or cartilage. We describe a tear of the ulnar collateral ligament of the thumb with minimal symptoms in a 5-year-old girl.
Distal Radio-Ulnar Ligament Motion During Supination and Pronation
Authors: ACOSTA R. , HNAT W. , SCHEKER L. R.
Published: June 2005

The dorsal and palmar distal radio-ulnar ligaments (DRUL) play an important role in the stability of the distal radio-ulnar joint (DRUJ). Various authorities, however, hold opposite opinions regarding DRUL motion during DRUJ pronation and supination, thus implying opposite techniques for reconstruction of the unstable DRUJ. With the hypothesis that relative displacement would increase in the dorsal DRUL during pronation and would increase in the palmar DRUL during supination, measurements were made of the relative DRUL displacement with a Hall-effect displacement transducer during DRUJ pronation and supination in six fresh cadaver wrists. The hypothesis was confirmed that the dorsal radio-ulnar ligament undergoes relative displacement during pronation, while the palmar radio-ulnar ligament undergoes relative displacement during supination.
The Value of Scapho-Trapezio-Trapezoid Arthrodesis Combined with “De La Caffinière” Arthroplasty for the Treatment of Pan-Trapezial Osteoarthritis
Authors: SENNWALD G. R. , SEGMÜLLER G.
Published: June 2005

13 patients, 12 female and one male (mean age 63) with pan-trapezial osteoarthritis were treated by a “de la Caffinière” arthroplasty of the first carpometacarpal joint, combined with a scapho-trapezio-trapezoid (STT) arthrodesis. 11 could be reviewed at least 3 years after surgery (average 3 years and 8 months). Non-union of the arthrodesis occured twice, once when no internal stabilization was used, once with the use of the staplizer. No impingement syndrome was recorded, and there was no correlation between the angular position of the scaphoid and mobility of the wrist. Two out of 11 “de la Caffinière” implants had to be removed. Loosening of the stem is unusual, but the cup remained only perfectly in place in two cases. There was no correlation between radiological and clinical findings and the overall result was good or excellent in 8 out of 13 (62%) of the cases. The grip and pinch strength were comparable to the results of the literature. This method cannot be further recommended because of the high rate of re-operation and the risk to the trapezium which has to be further evaluated.
The Aetiological Significance of Work-Load in the Development of Osteoarthritis of the Distal Interphalangeal Joint
Authors: NAKAMURA R. , ONO Y. , HORII E. , TSUNODA K. , TAKEUCHI Y.
Published: June 2005

The incidence of Heberden’s nodes was determined in three groups of Japanese women with different occupations to investigate the role of work-load in their pathogenesis. School cooks (n = 260), each of whom prepared 150 to 450 lunches daily, pre-school cooks (n = 222), each of whom prepared 30 to 80 lunches daily, and municipal employees (n = 298) underwent physical examination and X-ray of the hand if pathology was present. The incidence of Heberden’s nodes and X-ray incidence of osteoarthritis was 19.2% and 13.5%, 8.6% and 5.4%, 5.9% and 2.0% among school cooks, pre-school cooks and municipal workers, respectively. The incidence of Heberden’s nodes and osteoarthritis was significantly higher among school cooks. These findings support the concept that work-load is an aetiological factor in the pathogenesis of Heberden’s nodes and also support Radin’s hypothesis that women’s daily work pattern explains the increased incidence of DIP joint osteoarthritis in women.
Strength and Functional Recovery Following Repair of Flexor Digitorum Superficialis in Zone 2
Authors: BOULAS H. J. , STRICKLAND J. W.
Published: June 2005

A two-pronged study was designed to evaluate the strength in vitro and functional recovery in vivo of FDS repairs in zone 2. In part I, horizontal mattress or Tajima grasping repairs were performed on fresh-frozen cadaveric digits, using 3/0 or 4/0 braided nylon suture material. The Tajima repair was significantly stronger than the mattress suture, using either 3/0 ( P = 0.0001) or 4/0 ( P = 0.0027) suture material. The 3/0 Tajima repair appeared strong enough to permit gentle early active motion. Furthermore, the clinical portion of the study (part II) demonstrated restoration of FDS function following repair in relatively isolated injuries in 13 out of 15 digits (86.7%), with PIP flexion averaging 80° and grip strength 89% of that in the uninjured hand.
Rotary Subluxation of the Scaphoid: A Spectrum of Instability
Authors: WATSON H. , OTTONI L. , PITTS E. C , HANDAL A. G.
Published: June 2005

Rotary subluxation of the scaphoid is not an “all or nothing” phenomenon, but a spectrum of instability including constant displacement of the scaphoid apparent on plain non-stress radiographs (the previously defined static type), subluxation seen only on loading X-rays or other special studies (“dynamic”), and instability demonstrable on physical examination but not by radiographic studies (“predynamic”). A clinical study of 1,000 random individuals was carried out to determine the incidence of unilateral hypermobility of the scaphoid. 21% of the subjects were found to have an abnormal difference in mobility between their scaphoids. The incidence of significant symptoms and physical findings associated with this hypermobility was determined.
The Distal Ligamentous Complex of the Scaphoid and the Scapho-Lunate Ligament. An Anatomic, Histological and Biomechanical study
Authors: BOABIGHI A. , KUHLMANN J. N. , KENESI C.
Published: June 2005

22 fresh cadaver specimens have been examined to study the anatomy, histology and biomechanical features of the ligaments of the proximal and distal poles of the scaphoid. The biomechanical study was carried out by two methods: an analytical one on an Instron machine, and a global one in situ. The different experiments show the predominant role of the distal ligamentous complex of the scaphoid over the scapho-lunate ligament.

This contrasts with the generally accepted concept and modifies the management of lateral carpal instability.
Hand Function after Digital Amputation
Authors: CHOW S. P. , NG C.
Published: June 2005

127 patients with amputated thumbs or fingers between the level of the DIP and MP joints were followed up at regular intervals until one year after injury. Sensory disturbances subsided rapidly except for numbness which was still present in 50% at one year. Range of movement was regained early. Although pronation and supination improved to 70% only a few months after injury, it took a year for power grip and key pinch to regain 70%. Further analysis showed that power grip was worst in amputees of multiple fingers, thumb, and the middle finger through the proximal phalanx. For key pinch, almost all were impaired to a level of 50% to 60%. Multiple finger amputees also had decreased pronation, and thumb amputees had decreased supination. Other factors were not significant. One-quarter had to change their jobs and one-fifth showed concern with the appearance.
Irreducible MP Joint Dislocation Due to Entrapment of FPL
Authors: HUGHES L. A. , FREIBERG A.
Published: June 2005

A case of irreducible dorsal dislocation of the first MP joint is presented. The tendon of FPL was trapped dorsal to the metacarpal head, and open reduction was necessary.
Scapho-Lunate Diastasis in Fractures of the Distal Radius
Authors: MUDGAL C. , HASTINGS H.
Published: June 2005

The concurrence of scapho-lunate diastasis and distal radial fractures is now well established. External fixation is considered to be one of the best methods of treating distal radial fractures, but in the presence of ligament injury, distraction fixation may lead to carpal instability and chronic wrist pain. We have reviewed existing English literature and analyzed possible mechanisms of injury, and offer some suggestions towards treatment of this combination of injuries.
Ultrasonography of a Subungual Glomus Tumour
Authors: OGINO T. , OHNISHI N.
Published: June 2005

Glomus tumour is sometimes difficult to diagnose accurately before surgery. We report a case where ultrasonography confirmed the presence and precise location of a lesion before surgery.
Vein Grafting with the Telescoping Anastomotic Technique for Venous Defects
Authors: SAITOH S. , NAKATSUCHI Y.
Published: June 2005

The telescoping anastomotic technique was used at both ends of autogenous vein grafts bridging a defect in slow-running, vulnerable veins. This was done on left epigastric veins of the rat, the central part of which was used as a graft. In the right epigastric veins, both the proximal and distal anastomoses were repaired using the conventional anastomotic technique. The overall patency rate of the grafts repaired with the telescoping anastomotic technique was 27/29 (93.3%) compared to 17/28 (60.7%) in the conventional group. The telescoping technique was also easier to perform than the conventional method.
Two-Point Discrimination Tests versus Functional Sensory Recovery in both Median and Ulnar Nerve Complete Transections
Authors: CHASSARD M. , PHAM E. , COMTET J. J.
Published: June 2005

Transection of both median and ulnar nerves provides an objective model to compare sensory and functional recovery. 22 patients were evaluated after nerve repair. The mean age was 30 years and the mean time since surgery 80 months. Primary direct suture was performed in 15 patients and six grafts were necessary. Median nerve suture and ulnar nerve graft were combined in one case. Both sensory and functional evaluation were completed. Statistical evaluation analyzed the relationship between age, injury location, mechanism, type of rehabilitation and the result, and the relationship between two-point discrimination distance (2-PD) and the functional score. According to the S0 to S4 grading, only 26.5% (ulnar) and 31% (median) of direct suture cases achieved S3+ or more. All nerve grafts in adults were poor. A strong relationship was found between two-point discrimination distance (moving and static) and the functional result, even after multivariate analysis. A modification of the Medical Research Council’s classification is suggested.
Interpreting the Results of Unilateral Digital Nerve Repair
Authors: CALDER J. S. , McALLISTER R. M. R.
Published: June 2005

We report the results of examination of patients before primary and secondary unilateral digital nerve repair. Two-point discrimination was uniformly recorded. The results show that significant overlap of adjacent digital nerves is common and this has important implications for interpretation of results after repair. Recommendations are made regarding the evaluation of outcome following surgery.
Early Experience with Endoscopic Carpal Tunnel Release
Authors: KELLY C. P. , PULISETTI D. , JAMIESON A. M.
Published: June 2005

83 hands in 69 patients had endoscopic carpal tunnel release by the Chow method over a 14-month period. 78% of these had a satisfactory outcome with relief of symptoms and no complications. Poor results were explained by incomplete ligament division (five patients), wrong diagnosis (two hands), and post-operative nerve problems (five hands). Two patients after Colles’ fractures had unsatisfactory results. Serious complications included two median nerve lacerations. One of these was clearly a result of deviation from the standard protocol. The authors believe that the technique has advantages over open release but they are divided on whether the benefits outweigh the risk of nerve injury.
Intermittent Occlusion of the Ulnar Artery
Authors: MONSTREY S. J. , JONES N. F.
Published: June 2005

Intermittent occlusion of the ulnar artery developed in a patient causing cramp in her right hand. Both flexion and extension of the wrist completely obstructed bloodflow in the ulnar artery, a level just proximal to the wrist. At operation, a tight hand of antebrachial fascia was found to the cause of this intermittent arterial occlusion. Surgical release of this fascial ban reduced complete relief of her symptoms.
An Experimental Study of Contralateral C7 Root Transfer with Vascularized Nerve Grafting to Treat Brachial Plexus Root Avulsion
Authors: CHEN L. , GU Y-D.
Published: June 2005

Experimental rat models of simulated brachial plexus injuries were devised to compare the effect of contralateral C7 root transfer with phrenic neurotization. The effect of vascularized nerve grafting (VNG) was also compared with the use of conventional nerve grafts (CNG) in the treatment of root avulsion of the brachial plexus. 160 rats were randomly divided into four groups of 40 each; contralateral C7 root transfer with a vascularized ulnar nerve graft (C7-VNG), contralateral C7 root transfer with conventional ulnar nerve grafting (C7-CNG), ipsilateral phrenic nerve transfer with a vascularized ulnar nerve graft (P-VNG) and ipsilateral phrenic nerve transfer with conventional ulnar nerve grafting (P-CNG). Electrophysiological and histological examinations and functional evaluation were performed at different post-operative intervals. C7 root transfer was found to be superior to phrenic nerve transfer and VNG superior to CNG. Severance of the C7 nerve root was not found to affect limb function on the healthy side.
Experience of the Early Use of Technetium 99 Bone Scintigraphy in Wrist Injury
Authors: SHEWRING D. J. , SAVAGE R. , THOMAS G.
Published: June 2005

In a retrospective study, patients with suspected scaphoid fracture had an average of three sets of scaphoid radiographs prior to scintigraphy. Scans were performed an average of 3 months after injury and many were inconclusive because of disuse changes.

A prospective analysis of early scintigraphy in 35 cases over 18 months was carried out. Scans were performed at an average of 15.5 days after injury in selected cases. Patients had an average of 1.28 sets of negative radiographs prior to scanning. There were no false negative scans and in 13 with focal uptake a wrist fracture was demonstrated. Diffuse uptake was thought to be indicative of ligamentous damage or reflex sympathetic dystrophy. Early scintigraphy was found to be a sensitive, reliable and cost-effective examination in cases of suspected significant wrist injury.
Hyperextension Injuries of the MP Joint of the Thumb
Authors: ISHIZUKI M. , NAKAGAWA T. , ITO S.
Published: June 2005

We report 26 cases of hyperextension injury of the MP joint of the thumb. These were classified into the following three categories; dorsal dislocation of the MP joint or volar plate avulsion; locking of the MP joint and fracture of the sesamoid bone. We report the pathomechanics and clinical features of these injuries.
Scissoring Deformity after Closed Reduction of a Dorsal Subluxation of the MP Joint of the Middle Finger
Authors: AL-QATTAN M. M. , ZUKER R. M.
Published: June 2005

A rare case of scissoring deformity after closed reduction of a dorsal subluxation of the MP joint of the middle finger is reported. The aetiology and treatment of this deformity are presented along with a modified classification of dorsal dislocations and subluxations of the MP joint.
Fracture with Non-Union through an Incomplete Preaxial Distal Symphalangism
Authors: FORTEMS Y. , DE SMET L. , STANLEY J. K.
Published: June 2005

A case is reported of traumatic fracture and non-union in a patient with isolated distal symphalangism of unusual distribution.
Simultaneous Scaphoid and Distal Radial Fractures
Authors: HOVE L. M.
Published: June 2005

Simultaneous fractures of the distal radius and scaphoid are uncommon. In a prospective 3-year study we registered 2,330 distal radial fractures and 390 scaphoid fractures, and 12 were combined. Ten of these had high energy trauma; six were styloid fractures, four Colles’ fractures, one was a greenstick fracture and one Salter–Harris Type 2 epiphyseal fracture. All but one of the 12 scaphoid fractures were stable and healed without problems, and one was a trans-scaphoid, trans-styloid peri-lunate fracture-dislocation.

The study supports the opinion that the distal radial fracture constitutes the principal injury that determines the outcome and hence the treatment. If the scaphoid fracture is unstable or dislocated, we recommend internal fixation of the scaphoid. Only a small proportion of these injuries represent a more serious disruption with carpal instability.
Distal Radial Osteotomy for Malunion of Wrist Fractures in Young Patients
Authors: BROWN J. N. , BELL M. J.
Published: June 2005

Malunion after a fracture of the distal radius in a young patient causes a significant disturbance of wrist function. We have performed distal radial osteotomies in 11 patients to correct radial malunion. Surgery was indicated in young patients with functional disability in the wrist due to limited wrist motion and pain. Many had an unacceptable cosmetic appearance of the wrist. In all patients surgery consisted of opening wedge osteotomies to correct radial tilt and radial angle. In some instances it was not possible completely to restore radial length without a reduction in ulnar length. Post-operatively combined dorsal and volar flexion improved from a mean of 34° to 72°. Combined pronation and supination improved from a mean of 68° to 106°. Pain assessed on a simple four-point functional score was decreased from a mean of 3.3 to 1.3.
Comparison of Proximal and Distal One Portal Entry Techniques for Endoscopic Carpal Tunnel Release
Authors: TSURUTA T. , SYED S. A. , TSAI T.
Published: June 2005

Reported complications of endoscopic carpal tunnel release have increased as more surgeons use this technique to release the flexor retinaculum. We used a cadaver model to compare the results of endoscopic carpal tunnel release through a one-portal distal (Group A, 15 specimens) and a one-portal proximal (Group B, 15 specimens) entry site with a new endoscopic technique. Our custom-made glass tube of three different sizes (5, 7, and 9 mm in diameter) is designed to house an endoscope and accommodate a meniscus knife for releasing the flexor retinaculum. Complete release of the flexor retinaculum was obtained in all limbs in both groups. In Group A the one complication (7%) was loss of the cotton tip from the cotton swab stick within the carpal tunnel. In Group B, there was a single case of injury to the superficial palmar arch in one hand and breakage of a glass tube in another hand, for a total complication rate of 13%. No other damage to anatomical structures was noted.
Cystic Radio-Lucency of Carpal Bones in Haemodialysis Patients
Authors: KONISHIIKE T. , HASHIZUME H. , NISHIDA K. , INOUE H. , NANBA T.
Published: June 2005

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radio-lucency of carpal hones in 35% of the hands. Radiographs were classified into three groups: Group A—cyst growing, Group B—cyst not growing, and Group C—cyst absent. The prevalence of carpal tunnel syndrome was 100% (27/27) in Group A, 5.6% (1/18) in Group B, and 6.5% (6/93) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.
Wild Platypus Attack in the Antipodes
Authors: TONKIN M. A. , NEGRINE J.
Published: June 2005

The platypus ( ornithorhynchus anatinus) is a furry duck-billed mammal that inhabits the waterways of eastern Australia. The male may reach 60 cm in length with a 20 cm beaver-like tail. We report the case of an American naturalist stung whilst trying to study the male in the wild. This resulted in an intense local reaction. Warning signs should therefore be erected at air and sea ports warning tourists of the dangers of these venomous Australians.
Interphalangeal Joint Arthrodesis with Oblique Placement of an AO Lag Screw
Authors: TEOH L. C. , YEO S. J. , SINGH I.
Published: June 2005

A damaged interphalangeal (IP) joint may be treated by fusion. Arthrodesis should leave the joint at the most functional angle and give sound bony union in the shortest possible time, maintaining maximum proximal and distal joint motion. The lateral oblique placement of a single AO lag screw, proximal to distal, achieves these aims. This method gives sufficient proximal bone for screw purchase and better control of the desired angle of fusion. This technique has led to fusion in 22 of 23 joints (96%), taking an average of 8.2 weeks.
Long-Term Results of Primary Scalenotomy in the Treatment of Thoracic Outlet Syndrome
Authors: GOCKEL M. , VASTAMÄKI M. , ALARANTA H.
Published: June 2005

A total of 107 patients with thoracic outlet syndrome were reviewed an average of 4.1 years (range 2–11 years) after primary scalenotomy. The sample included 86 women and 21 men, and the mean age at surgery was 41.9 years (range 16–59 years). The three most disturbing pre-operative symptoms were pain at rest (87%), numbness (66%) and lack of power (55%). The post-operative success rate diminished from 71% 1 month after operation to 63% at follow-up. The retirement frequency increased from 6% up to 33% during the follow-up time. It was highest among factory workers at 60%. Of the patients older than 45 years at surgery, 68% were retired at follow-up. The importance of careful selection for operation is emphasized, and also the need to consider vocational rehabilitation before resorting to surgical treatment of thoracic outlet syndrome. We recommend surgical treatment for this disabling disorder, especially for younger patients with clear evidence of thoracic outlet syndrome who are engaged in occupations demanding little repetitive work. The best results have occurred in this group.
Congenital Pseudarthrosis of the Ulna
Authors: CHENG J. C. Y. , HUNG L. K. , BUNDOC R. C.
Published: June 2005

Congenital ulnar pseudarthrosis is a very rare condition. Two cases are reported in addition to 36 already reported in the English literature. One of the cases reported had a “one-hone forearm” procedure done, with a satisfactory result after 6 years. The second case had a free vascularized fibula graft procedure with restoration of the bony alignment and union after 8 months of follow-up.
Ulnar Ray Deficiency
Authors: HORII E. , MIURA T. , NAKAMURA R.
Published: June 2005

We report three cases of ulnar ray deficiency in one family. The father had a left ring finger deficit, and a hypoplastic little finger was amputated at childhood. His first baby had a deep cleft between the ring and little finger in the right hand, and his second baby had complete absence of the left ulna, only one metacarpal, and two digits were present on the hand. All three cases were unilaterally involved and they had no other skeletal abnormalities.
Nerve Repair: Correlation of Restitution of Functional Sensibility with Specific Cognitive Capacities
Authors: ROSÉN B. , LUNDBORG G. , DAHLIN L. B. , HOLMBERG J. , KARLSON B.
Published: June 2005

To test the hypothesis that cognitive capacity is correlated with the outcome of functional sensibility after nerve repair, 19 patients were evaluated 2 to 5 years after median or ulnar nerve repair at the distal forearm level. The sensory evaluation included tests for functional sensibility as well as assessments addressing perception thresholds for touch/pressure and vibration. Psychometric tests for cognitive capacity were also carried out.

Multiple regression analysis, correcting for the effect of age and the ability to perceive touch/vibration, was used to investigate the relationship between functional sensibility and cognitive capacity, and to determine which of the tested central nervous factors had the greatest influence on the outcome of recovery of functional sensibility. On a ranking list of such factors verbal learning and visuo-spatial logic capacity were the most important ones, indicating significant correlations with functional sensibility. It is concluded that cognitive capacity factors may play an important role for the functional outcome following nerve repair and that variations in such factors may help to explain the variability in the outcome of nerve repair.
The Goalkeeper’s Fear of the Nets
Authors: SCERRI G. V. , RATCLIFFE R. J.
Published: June 2005

The soccer goalkeeper is particularly prone to injuries of the hands. We report three cases in which soccer goal-posts were the cause of a hitherto unrecorded type of accident, which resulted in severe ring avulsion injuries requiring surgical amputation or replantation. In each case the injury occurred when a ring worn by the goalkeeper caught on one of the hooks by which the netting is attached to the goal-posts. Proposals made for the prevention of such injuries include increased awareness through education, discouragement of the wearing of rings during sporting activities and the redesign of the attachment systems of goal nets.
Arthrodesis of the Trapeziometacarpal Joint
Authors: CHAMAY A. , PIAGET-MOREROD F.
Published: June 2005

Over a 10-year period, 32 trapeziometacarpal (TM) joint fusions were performed in 29 patients, and reviewed. Pin fixation with tension band wiring was used in 14 cases, screws in eight cases, a plate in six cases, K-wires in three cases and staple fixation in one case. None was bone grafted. Splinting was applied for 4 to 5 weeks. There were four cases of delayed union (more than 2 months) and four cases of non-union requiring re-operation (12.5%). The average follow-up was 6 years and 7 months. Grip (26.5 kg) and pinch (4.9 kg) strength were respectively 7% and 18% less than the normal contralateral side. In bilateral osteoarthritis, grip and pinch were stronger than the contralateral side.

Joint angulations measured on X-ray films showed for the peritrapezial joint an 18° arc in flexion-extension (a reduction of 64% compared to the contralateral side) and 11° of arc in abduction-adduction (a reduction of 72%). MP joint mobility increased in extension (160%), in flexion (23%), in abduction (120%), in adduction (157%). Despite the marked decrease in motion, subjective functional complaints were minimal. 78.1% of the patients were fully satisfied, 15.6% partly satisfied, and 6.3% dissatisfied. Pain was absent in 50% of the cases and very mild in 40.7%. Three patients complained of discomfort. Eight patients were noted to have osteoarthritic changes in the scaphotrapezial joint.
Real Time Ultrasonography in the Assessment of Movement at the Site of a Scaphoid Fracture Non-Union
Authors: DIAS J. J. , HUI A. C. W. , LAMONT A. C.
Published: June 2005

We investigated the use of real time linear ultrasonography in determining movement at a scaphoid fracture site in 27 patients with non-united scaphoid fractures. 24 of these patients had surgical treatment. Fracture movement was observed at the time of surgery and this was compared with the ultrasonographic findings. The technique proved to be 100% specific for visualization of movement at the fracture site and it was non-invasive. However, it was of no benefit in assessing proximal pole non-union.
A New Approach to Flexor Tendon Repair
Authors: CALLAN P. P. , MORRISON W. A.
Published: June 2005

This paper describes a new and simple approach to the flexor tendon via strategically placed transverse incisions in the flexor tendon sheath.
Flexor Tendon Synovial Sheath Haemangioma Mimicking Subacute Tenosynovitis
Authors: RICO A. A. , HOLGUÍN P. H. , GONZÁLEZ I. G. , COBA J. M. C.
Published: June 2005

A case of haemangioma arising from the synovial sheath of the flexor tendons of the ring finger is described. The initial symptoms were those of subacute tenosynovitis. The tumour did not affect the flexor tendons and could be completely resected with functional recovery.
Malunited Colles’ Fracture
Authors: MIYAKE T. , HASHIZUME H. , INOUE H. , SHI Q. , NAGAYAMA N.
Published: June 2005

To try to explain disability in the wrist after malunited Colles’ fractures, an experiment was designed to evaluate pressure distribution through the wrist joint with varying degrees of angulation of the distal radius. The results of computer simulation analysis of stress concentration using finite element methods were compared with those of pressure distribution studies on the radial articular surface of cadaveric radii in various positions using pressure-sensitive film. Stress existed in volar regions of the radio-lunate joint under normal pressure in the neutral position, but shifted to dorsal regions of the joint, and was concentrated when dorsal angulation reached 30°. We believe that concentrated loads result in pain and may lead to early degenerative joint disease. Early additional reduction of a displaced fragment or a post-fusion osteotomy should be considered when dorsal angulation exceeds 30° in malunited distal radial fractures to decrease abnormal loading across the wrist joint.
What Value the Scaphoid Compression Test?
Authors: ESBERGER D. A.
Published: June 2005

It has been suggested that a positive scaphoid compression test will reliably confirm the presence of a fractured scaphoid in those patients presenting with an injury clinically suggestive of this, but without a fracture visible on initial X-rays. A prospective study was carried out in 99 patients presenting with an injury clinically suggestive of a scaphoid fracture. 74 patients had positive scaphoid compression tests with 24 of these patients having a scaphoid fracture visible on initial X-ray and seven having a fracture diagnosed either by repeat X-ray or bone scan 2 weeks after injury. 25 patients had a negative test, with ten having a scaphoid fracture visible on initial X-ray and three on repeat X-ray at 2 weeks. These results show that this test had a sensitivity of 70.5%, a specificity of 21.8% and predictive value of 41.9%. A positive scaphoid compression test is an unreliable diagnostic aid for a scaphoid fracture.
Os Centrale Carpi Simulating a Scaphoid Waist Fracture
Authors: YANG Z. Y. , GILULA L. A. , JONSSON K.
Published: June 2005

The os centrale carpi is a relatively rare accessory carpal bone, and its presence may be confused with a scaphoid fracture. A case is presented which simulated an un-united scaphoid fracture on the plain X-ray film. However, CT in the sagittal plane showed two rounded fragments on the dorsum of the scaphoid with smooth, regular cortical margins differing from an acute scaphoid fracture. Their volume combined with the volume of the scaphoid is more than that of a completely normal scaphoid. There is no evidence of degeneration in the two rounded fragments and scaphoid. Because of these features, the diagnosis of soft tissue injury with an incidental finding of an os centrale carpi was suggested.
CONSISTENT CONDOM USE DYNAMICS AMONG SEX WORKERS IN CENTRAL AMERICA: 1997–2000
Authors: OLADOSU MUYIWA
Published: June 2005

The paper aims to provide evidence on consistent condom use dynamics among sex workers in Central America between 1997 and 2000, and to examine the most important predictors of use behaviour important for policy and programme interventions in the region. Data on 3500 sex workers, 1500 from 1997 and 2000 from the year 2000, were analysed. The samples represented sex workers in low socioeconomic neighbourhoods who met their clients at known sex establishments or by the roadside. Sex workers were more likely to have used condoms consistently in 2000 than in 1997 (Odds Ratio (OR)=1·4, p≤0·05). Sex workers who discussed condoms with their partners or lovers used them consistently with all clients more than those who did not (OR=1·3, p≤0·10). Knowledge of condom advantages had a positive influence on consistent use. Sex workers who reported using condoms to prevent pregnancy or STDs used them consistently with all clients more than those who did not (OR=1·2, and 1·3 respectively, p≤0·10). The source of condoms is an important predictor of consistent condom use. Sex workers who bought condoms from health establishments or from brothels used them consistently more than those who did not (both OR=1·3, p≤0·10, and p≤0·05, respectively). Self-efficacy had a positive effect on consistent condom use. Sex workers who reported that they would use condoms even if clients offered to pay more for unprotected sex used them consistently with all clients more than those who did not (OR=1·8, p≤0·001). The findings suggest that having condom skill is positively related to condom use. Sex workers who had all four skills used condoms more consistently than those who had none (OR=1·6, p≤0·01). In order to increase consistent condom use and avert more incidences of HIV/AIDS and other STIs, programme interventions need to use the most efficient way to provide quality information, and provide repeated training on condom negotiation and use skills to sex workers.