bluuebunny/crossref_metadata_2025 huggingface dataset:
The Efful (Evaluation of Function in the Flail Upper Limb) System
Authors: EGGERS I. M. , MENNEN U.
Published: September 2005

The EFFUL (Evaluation of Function of the Flail Upper Limb) system measures in numerical terms the improvement, achieved through reconstructive surgery and hand therapy, in patients with brachial plexus injuries.

The EFFUL system measures practical, everyday activities performed with the shoulder, elbow, forearm, wrist and hand. The ranking system is based upon a classification of function, with a hierarchy of increasing functional demands until normal function has been achieved. These activities focus on two-handed coordination and hand dominance.

The score is plotted on a star histogram known as the patient’s profile, and shows the preoperative score achieved in the first evaluation, and the postoperative score achieved in the second evaluation. The shaded area between the two plotted points clearly demonstrates any improvement in function obtained by surgery and rehabilitation. It also demonstrates the interrelationship between the various regions: improvement in function in one region often results in improvement in other regions.
Surgical Management of Eosinophilic Fasciitis of the Upper Extremity
Authors: SUZUKI G. , ITOH Y. , HORIUCHI Y.
Published: September 2005

Eosinophilic fasciitis is a rare inflammatory disease associated with peripheral eosinophilia, hyper-gammaglobulinaemia and contractures of any joint in the upper extremity. Although conservative treatments are generally advocated, this study reports the results of surgical intervention. Four patients aged from 20 to 48 years underwent fasciectomy followed by oral administration of prednisolone. All presented with contractures of digits, wrist, or elbow due to eosinophilic fasciitis in the upper extremities. Despite one case that required a second operation for recurrence, all patients regained the range of motion of the affected joints a few weeks after surgery. The recovery was much sooner than in previously reported cases treated conservatively, suggesting that surgical management of eosinophilic fasciitis is effective in alleviating symptoms quickly and allows patients to resume activities of daily living sooner.
Biceps Rupture in a Patient on Long-Term Anticoagulation Leading to Compartment Syndrome and Nerve Palsies
Authors: RICHARDS A. M. , MOSS A. L. H.
Published: September 2005

We report the case of a man on long term anticoagulation who presented with a rupture of the long head of the biceps resulting in a compartment syndrome and nerve palsies.
Radial Artery Injury in Association with Fractures of the Trapezium
Authors: CHECROUN A. J. , MEKHAIL A. O. , EBRAHEIM N. A.
Published: September 2005

Three cases of trapezial fractures in which the radial artery was injured are reported. The injuries occurred during the initial trauma in one, when internal fixation was done in the second, and during hardware removal in the third. Six cadaveric wrists were dissected to study the relationship between the course of the artery and the trapezium.
Candida Infection of a Silicone Metacarpophalangeal Arthroplasty
Authors: DUNKLEY A. B. , LESLIE I. J.
Published: September 2005

Fungal infections following joint arthroplasty are extremely rare. Only 16 cases of Candida prosthetic infections have been reported, involving the hip, knee or shoulder joints. We report a case of a silicone metacarpophalangeal joint replacement complicated by a Candida albicans infection.
De La Caffinière Thumb Carpometacarpal Replacements
Authors: CHAKRABARTI A. J. , ROBINSON A. H. N. , GALLAGHER P.
Published: September 2005

The results of 93 de la Caffinière thumb joint replacements in 71 patients were reviewed between 6 and 16 years. The survival rate was 89% at 16 years. Eleven thumb joints had failed requiring revision. The commonest reason for failure was aseptic loosening of the trapezial component. The failure rate was higher in men of working age than any other group, which possibly reflects the increased demands on the prosthesis of these patients. We support the use of this implant for degenerative osteoarthritis, but caution against its use in men under 65 years.
Traumatic Palmar Dislocation of the Head of the Ulna with Associated Carpal Instability
Authors: WALCZAK J. P. , BONNICI A. V.
Published: September 2005

We report a case of a traumatic palmar dislocation of the ulna with an associated, but initially unappreciated, radiocarpal instability which led to ulnar translocation of the carpus and degeneration of the radiocarpal joints within 18 months of injury.
The Modified Cross Finger Flap for Finger Pulp and Nail Bed Reconstruction
Authors: SPOKEVICIUS S. , GUPTA A.
Published: September 2005

We describe a modification of the cross finger flap procedure. The modification enhances the amount of soft tissue under the flap, permitting reconstruction of the nail bed where necessary. We present two clinical cases.
An Anatomical Study of the Palmar Ligamentous Structures of the Carpal Canal
Authors: TANABE T. , OKUTSU I.
Published: September 2005

To determine which structures should be divided for complete release of the carpal canal, we studied the palmar structures in 12 embalmed and eight fresh cadaveric hands. In all hands, fibres run transversely between the thenar and hypothenar fascia, distal to the flexor retinaculum in a layer separate from it. In fresh cadaveric hands, we first released only the flexor retinaculum as in endoscopic management of carpal tunnel syndrome and then these distal fibres. When the flexor retinaculum was released, the mean distance between the sectioned ends of the flexor retinaculum was 1.3 mm. When the distal fibres were also divided, the mean distance was 6.6 mm. We conclude that release of both the flexor retinaculum and the distal transversely running fibres is essential for complete release of the carpal canal in endoscopic surgery.
Biomechanical Characterization of Tissues in Dupuytren’s Disease
Authors: AFOKE A. , MEAGHER P. J. , STARLEY I. , McGROUTHER D. A. , BAILEY A. J. , BROWN R. A.
Published: September 2005

The aim of this study was to characterize mechanical properties of tissues of Dupuytren’s disease and to attempt to identify changes due to cellular activity. Tensile tests confirmed the heterogeneity of Dupuytren’s disease tissue with distinct stress-strain curves for the three tissue types normally present, namely, cord, transition zone and nodule. The tensile strength for cord tissue was nearly twice that of nodule tissue, but the latter was nearly twice as stretchable as cord. In contrast, the transition tissue had the tensile strength of cord with the stretchability of nodule. It was found that tensile loading stimulated a cellular response as demonstrated by an increase in the creep strain rate of the tissue at 37°C compared with that at 4°C using Dupuytren’s tissue in an in vitro culture test. The creep strain rate for nodule at 37°C was more than seven times that for cord at a nominal creep stress of 0.75 MPa.
Vascularized Bone Graft from the Palmar Carpal Artery for Treatment of Scaphoid Nonunion
Authors: MATHOULIN C. , HAERLE M.
Published: September 2005

We report the use of a bone graft harvested from the palmar and ulnar aspect of the distal radius and vascularized by the palmar carpal artery for the treatment of scaphoid nonunion in 17 patients, ten of whom had already had unsuccessful surgery. Union was obtained in all cases at an average of 60 days (range, 45–90 days).

The average follow-up was 16 months (range, 12–36 months). There were no failures.
Scaphoid Fractures and Nonunions: A Comparison between Panoramic Radiography and Plain X-Rays
Authors: BERNÁ J. D. , ABALEDEJO F. , SANCHEZ-CAÑIZARES M. A. , CHAVARRIA G. , PARDO A. , PELLICER A.
Published: September 2005

This study describes the diagnostic potential of the panoramic X-ray technique in the evaluation of scaphoid fractures and nonunions. Fifty-eight symptomatic wrists were examined using both plain X-rays and the panoramic procedure. The panoramic images showed in detail the line of the scaphoid fracture and nonunion in detail; they revealed four scaphoid fractures and five nonunions that were not shown clearly with plain X-rays. The panoramic technique is a useful complement to plain X-rays for the investigation of scaphoid fractures and nonunions.
Tendon Excursion Measurements With Colour Doppler Imaging
Authors: BUYRUK H. M. , HOLLAND W. P. J. , SNIJDERS C. J. , LAMÉRIS J. S. , HOORN E. , STOECKART R. , STAM H. J.
Published: September 2005

We assessed the applicability of tendon excursion measurement by means of Colour Doppler Imaging (CDI) on human specimens, and also assessed the correlation between values measured by Doppler and by displacement meters. Muscles were separately connected to a mass of 1 kg with a steel wire running over a pulley. This weight moved the telescopic end of a digital displacement meter up and down during passive extension and flexion of the fingers. Excursion was measured with a pulsed multi-channel CDI scanner on the same arm. Assessment of finger tendon excursion with CDI correlated well with the mechanical micro displacement meter, the latter being considered the most accurate method in cadaver studies.
Immediate and Delayed Nerve Repair Using Freeze-Thawed Muscle Autografts in Complex Nerve Injuries
Authors: GLASBY M. A. , FULLERTON A. C. , LAWSON G. M.
Published: September 2005

Five sheep underwent repair of the median nerve along with the establishment and repair of a brachial artery defect adjacent to the site of nerve injury. The defect in the brachial artery was of similar length to the nerve defect and lay in parallel with it. It was repaired using a reversed vein autograft harvested from one of the superficial veins of the arm. A further five sheep underwent similar treatment with the repair of the nerve delayed for 30 days after the establishment of the complicating vascular injury. Six months after the nerve repair, each group of sheep was assessed using electrophysiological and morphometric methods in order to establish objective indices of nerve recovery and regeneration. These results were compared with those from other sheep which had undergone nerve repair both immediate and delayed with no complicating injury and groups in which the complicating injury consisted of a cavity, fibrosis and haematoma. It was found that delay in the nerve repair and the presence of a complicating arterial injury, both separately and additively, contributed to a poorer outcome in recovery of nerve function and maturation. The effect of an arterial injury, in both of these respects, was to produce a worse outcome than the presence of a cavity with fibrosis and haematoma.
An Anomalous Muscle in the Hand
Authors: KELLY E. J. , RIAZ M. , O’SHAUGHNESSY M.
Published: September 2005

An anomalous muscle crossing the wrist joint is described. The morphology and clinical relevance of this and other unnamed muscles occurring at the wrist are discussed.
Intraarticular Fractures of the Distal Radius Treated with Metaphyseal External Fixation
Authors: KRISHNAN J. , CHIPCHASE L. S. , SLAVOTINEK J.
Published: September 2005

Twenty-two patients with unstable Frykman grade 7 or 8 intra-articular fractures of the distal radius were treated with an external fixator. The distal pins were inserted into the distal radial fracture fragments, permitting movement of the wrist and hand.

Eleven patients were male and 11 female, with a mean age of 50 years. All patients had regained full function with good range of motion at mean final follow-up of 12 months. However function, pain and range of motion had returned to acceptable levels 4 weeks after removal of the external fixator. This method of external fixation provides a reliable method of maintaining fracture reduction whilst allowing early return of function.
Kinematics of the Capitolunate Joint in the Sagittal Plane
Authors: LOEWEN J. L. , PIRELA-CRUZ M. A. , LUCAS G. L.
Published: September 2005

A new method of assessing capitolunate alignment is presented. Three anatomical carpal reference points were evaluated on lateral radiographs using triangulation. Connecting these three points forms a triangle with dorsal, palmar and somewhat vertical sides. One hundred normal lateral wrist radiographs were measured. The overall dorsal limb (DL) to palmar limb (PL) ratio was found to be 0.74 (SD 0.07) over a range of 40° extension to 42° flexion. As the DL to PL ratio approached 1.0, a dorsal intercalated segment instability (DISI) deformity developed. Conversely, as the DL to PL ratio approached 0.5, a palmar intercalated segment instability (PISI) occurred. This method appears useful for evaluating static lateral radiographs for intercalary carpal alignment and possibly instability.
Osteomyelitis of the Scaphoid with Sequestration of the Primary Ossification Centre
Authors: MONSELL. F P. , McVIE J. L. , SMITH R. B.
Published: September 2005

An 8-year-old boy presented with Staphylococcus aureus osteomyelitis affecting the left (non-dominant) scaphoid. Surgical drainage resulted in the expulsion of the primary ossification centre as a sequestrum. Seven years later the wrist function was minimally impaired and X-rays showed complete ossification of the cartilage remnant with a relatively normal scaphoid.
Dysplasia Epiphysealis Hemimelica with Carpal Instability
Authors: TANIGUCHI Y. , TAMAKI T.
Published: September 2005

We report a case of dysplasia epiphysealis hemimelica in the left wrist of a 9-year-old girl. This resulted in symptomatic carpal instability which was relieved by excision of the abnormal bone.
A Palmar Ganglion Arising from the Metacarpophalangeal Joint
Authors: VAN GEERTRUYDEN J. P. , VANDEWEYER E.
Published: September 2005

We present a case of a ganglion arising from the palmar aspect of the metacarpophalangeal joint.
T- and B-Lymphocyte Subsets in Patients with Dupuytren’s Disease
Authors: GUDMUNDSSON K. G. , ARNGRÍMSSON R. , ARINBJARNARSON S. , OLAFSSON A. , JONSSON T.
Published: September 2005

Previous reports have indicated that inflammatory mechanisms may be involved in the pathogenesis of Dupuytren’s disease and it has even been suggested that this condition is a T-cell mediated autoimmune disorder. We investigated peripheral blood lymphocyte subsets from 21 patients with Dupuytren’s disease and compared them with ten healthy blood donors. The Dupuytren’s patients had an increase in DR+ T-cells compared with healthy controls. Furthermore, patients with both palmar and plantar involvement had a higher percentage of DR+ T-cells than those with only the palm affected. The percentage of circulating CD5+ B-cells was lower in the Dupuytren’s patients compared with the control group; this feature was marginally significant for the whole group of Dupuytren’s patients but was strongest in the group of patients with both palmar and plantar involvement. These findings support previous suggestions that immunological mechanisms, involving activated T-cells and probably also B-cells, are involved in the pathogenesis of Dupuytren’s disease.
Measurement of Invasive Potential Provides an Accurate Prognostic Marker for Giant Cell Tumour of Tendon Sheath
Authors: GROVER R. , GROBBELAAR A. O. , RICHMAN P. I. , SMITH P. J.
Published: September 2005

Giant cell tumours of tendon sheath vary from solitary nodules to a multinodular variety that exhibits local infiltration. Recent advances in molecular oncology have defined a gene, nm23, expressed in normal cells which is responsible for inhibiting infiltration. The aim of this study was to investigate the expression of nm23 in a series of 52 giant cell tumours using immunohistochemistry and to assess its prognostic potential, nm23 expression was absent in 21% of tumours and this was associated with a highly significant risk of local recurrence ( P<0.0001). Multivariate analysis of outcome showed nm23 expression to be more reliable than other clinicopathological parameters for predicting outcome. This immunohistochemieal test for nm23 is easily performed on standard paraffin sections and is recommended as an accurate prognostic marker for giant cell tumours of tendon sheath.
Proximal Row Carpectomy Versus Limited Wrist Arthrodesis for Advanced Kienböck’s Disease
Authors: NAKAMURA R. , HORII E. , WATANABE K. , NAKAO E. , KATO H. , TSUNODA K.
Published: September 2005

The outcomes in 20 patients with advanced Kienböck's disease treated by proximal row carpectomy (seven patients) or limited wrist arthrodesis (13 patients) were reviewed retrospectivey. Postoperatively, the results were more satisfactory in terms of wrist pain, the range of wrist flexion–extension, and grip strength following limited wrist arthrodesis than after proximal row carpectomy, although the differences were not statistically significant. We recommend scaphotrapeziotrapezoid arthrodesis in selected patients with advanced Kienböck's disease who have a fragmented lunate.
The Early Results of the Brunelli Procedure for Trapeziometacarpal Instability
Authors: ROBERTS S. N. J. , BROWN J. N. , HAYES M. G. , SAIES A.
Published: September 2005

We report the results of Brunelli’s abductor pollicis longus transfer for symptomatic instability of the trapeziometacarpal joint in 15 hands (14 patients) at a mean follow-up of 21 months.

Patients were assessed subjectively, and objectively by an independent observer. All but one of the patients were very satisfied with the result of the operation, including the six patients who had significant degeneration of the carpometacarpal joint surface preoperatively. Four patients said they had no pain and the mean pain score overall on a visual analogue scale was 1.2 (out of a maximum of 10). Overall the outcome was rated good or excellent in 11 of the 15 thumbs.
Progressive Patterns of Degenerative Arthritis in Scaphoid Nonunion Demonstrated by Three-Dimensional Computed Tomography
Authors: HIDAKA Y. , NAKAMURA R.
Published: September 2005

Degenerative arthritis following scaphoid nonunion was studied in 28 patients (29 wrists) using X-ray computed tomography and three-dimensional computed tomography (3-DCT). Degenerative changes were observed in 18 wrists with plain radiography and 27 wrists with 3-DCT. 3-DCT imaging more readily revealed osteophyte formation in osteoarthritis than plain radiography. 3-DCT images showed degenerative changes in the distal fragment of the scaphoid earlier than plain radiography. We found three stages of osteophyte formation in the radioscaphoid joint using 3-DCT. In the first stage, a linear osteophyte formed along the most radial portion of the distal fragment of the scaphoid. In the second stage, the radial styloid became pointed. In the third stage, the osteophyte on the distal fragment enlarged and lay over the dorsum of the radioscaphoid joint and other intercarpal joints.
Results of Treatment of Chronic Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joints of the Fingers
Authors: ISHIDA O. , IKUTA Y.
Published: September 2005

We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.
Mycobacterium malmonese Infection
Authors: SYED A. A. , O’FLANAGAN J.
Published: September 2005

We report a case of non-tuberculous tenosynovitis of the wrist caused by Mycobacterium malmoense. The patient presented with a ganglion-like swelling on the flexor aspect of the wrist. The diagnosis was confirmed by fine needle aspiration biopsy. A satisfactory resolution was obtained by antibiotic therapy alone, indicating that radical synovectomy may not be necessary in all cases of M. malmoense infection.
Neurotrophins, Neurones and Peripheral Nerve Regeneration
Authors: YIN Q. , KEMP G. J. , FROSTICK S. P.
Published: September 2005

Successful peripheral nerve regeneration requires optimal conditions both in the macro-environment and micro-environment. Many methods have been used to improve the macro-environment for the regenerating nerve. However, much less is known about the micro-environment, and in particular the complex neurochemical interactions involved. Several neurotrophic factors have been shown to play an essential trophic role in the development, maintenance and regulation of neuronal function. These include nerve growth factor (NGF) and several recently identified members of the NGF family, namely brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), neurotrophin-4/5 (NT-4/5) and neurotrophin-6 (NT-6). In this review we summarize recent studies of the effects of these neurotrophins on neurones, especially their effects on motor neurones and their axonal outgrowth. We discuss prospects for the future and point out what remains to be understood about the role of neurotrophins to enhance peripheral nerve regeneration.
Ulnar Lengthening in Juvenile Chronic Arthritis
Authors: MINK VAN DER MOLEN A. B. , HALL M. A. , EVANS D. M.
Published: September 2005

Ten wrists in eight children with severe destructive changes in the wrist due to juvenile chronic arthritis underwent distraction lengthening of the ulna between 1983 and 1996 in an attempt to restore wrist alignment, which had not been preserved by previous splinting. Eight wrists in six patients (four female and two male) were evaluated. The average age at the time of operation was 13.8 years (range, 12–15.5). The average follow-up period was 70 months (range, 12–152). The average ulna minus deformity was between 8 and 9 mm. It was found that ulnar lengthening can be done safely and the procedure seems to stabilize the carpus, is likely to improve appearance, may improve function and in the majority of cases does eliminate the use of an external splint. Results seem to be stable for at least 3 to 5 years.
A Method to Locate the Radial Digital Nerve of the Index Finger
Authors: LOURIE G. M. , RUDOLPH H. P. , LUNDY D. W.
Published: September 2005

The radial digital nerve of the index finger is susceptible to injury during penetrating trauma or elective release of the Al pulley. The intersection of a line drawn down the midline of the index finger and the proximal palmar crease identifies the location of the radial digital nerve. This method of identifying the topography of the nerve should assist the surgeon in determining the likelihood of injury after penetrating trauma, and preventing injury during elective procedures.
Defining a Normal Finger Web in Children
Authors: PATERSON P. , NANCARROW J. D.
Published: September 2005

We calculated the interdigital web ratios for children between the ages of 5 and 6 and 10 and 11 years. We compared these ratios with those seen in adults and conclude that there is a change in finger web morphology with age. We found that a photocopier provided images of similar quality to conventional photography.
A Large Family with Type IV Radial Polydactyly
Authors: SEYHAN A. , AKARSU N. , KESKIN F.
Published: September 2005

This study examines one of the largest pedigrees with radial polydactyly type IV (uncomplicated polysyndactyly) comprising a total of 69 individuals, of whom 26 have been affected over six generations. Typical manifestations of the pedigree were bilateral radial and ulnar digital duplications, as well as syndactyly between the middle and ring fingers and the second and third toes. There was no craniofacial anomaly in any of the 17 cases examined physically. This observation suggests that radial polydactyly type IV and Greig craniofacial-synostosis syndrome with similar digital manifestations are clinically-distinct entities.
Trigger Finger in a Child as a Complication of Interphalangeal Dislocation
Authors: CASE R. D. , LESLIE I. J.
Published: September 2005

We describe stenosis of the A2 pulley in a 13-month-old infant following a dislocation of a proximal interphalangeal joint, resulting in triggering of the finger.
Palmar Metacarpophalangeal Joint Dislocation
Authors: VANDEWEYER E. , ZYGAS P. , LIBOTTE M.
Published: September 2005

Palmar dislocations of the long finger metacarpophalangeal joint are extremely rare and easily missed at the first clinical examination. We describe a palmar metacarpophalangeal dislocation of the long finger following a hyperflexion injury. The presentation, aetiology and treatment are discussed.
Avascular Necrosis of the Trapezoid Bone
Authors: STURZENEGGER M. , MENCARELLI F.
Published: September 2005

A case of idiopathic avascular necrosis of the right trapezoid is presented. The aetiology was not clear. Treatment consisted of bone curettage, autologous bone graft and revascularization with a dorsal metacarpal artery.
Delayed Rupture of an Extensor Digitorum Tendon Following Repeated Attempts at Intravenous Cannulation
Authors: HAYWOOD R. M. , O’DONOGHUE J. M. , REGAN P. J.
Published: September 2005

A case of delayed extensor tendon rupture is reported. This followed repeated attempts at intravenous cannulation 16 months previously. The differential diagnosis and treatment are discussed.
Tendon Interposition In A Juxta-Epiphyseal Fracture Of The Proximal Phalanx
Authors: FREEDMAN E. L. , VANDER GRIEND R. A. , DELL P. C.
Published: September 2005

Juxta-epiphyseal fractures of the proximal phalanx are relatively common. A case report and literature review calls attention to the possibility of entrapment of either a flexor or extensor tendon in this type of fracture.
Evidence for Immune System Involvement in Reflex Sympathetic Dystrophy
Authors: CALDER J. S. , HOLTEN I. , McALLISTER R. M. R.
Published: September 2005

Skin biopsies from patients with reflex sympathetic dystrophy were immunostained using a variety of antisera. An incidental finding with S100 staining was the presence of numerous Langerhans cells in the epidermis. All patients had significant pain at the time of biopsy, and all had symptoms refractory to treatment. The potential implications of this finding are discussed.
The Sensitivity and Specificity of Tests for Carpal Tunnel Syndrome Vary with the Comparison Subjects
Authors: GERR F. , LETZ R.
Published: September 2005

The performance of a variety of common office-based clinical tests for detection of carpal tunnel syndrome (CTS) was assessed in 119 subjects with and without electrophysiological evidence of CTS. Symptoms compatible with CTS and electrophysiological tests positive for median mononeuropathy at the wrist were observed in 57 hands, symptoms compatible with CTS and normal electrophysiological test results were observed in 58 hands, and no symptoms compatible with CTS and normal electrophysiological test results were observed in 123 hands. For all the diagnostic tests studied, the proportion of subjects who had a false positive clinical test result was much higher in the electrophysiologically normal subjects who had CTS compatible hand symptoms than in the electrophysiologically normal subjects who were asymptomatic. These results suggest that many studies that have evaluated diagnostic tests for CTS have produced falsely optimistic estimates of the test’s performance because of their use of asymptomatic comparison subjects.
The Flexor Pollicis Longus and its Relation to the Anterior and Posterior Interosseous Nerves
Authors: SHIRALI S. , HANSON M. , BRANOVACKI G. , GONZALEZ M.
Published: September 2005

Sixty paired cadaver upper extremities were dissected to study the anatomy of the flexor pollicis longus in the forearm and its relation to the median and anterior interosseous nerves. An accessory head was noted in 33 (55%) of 60 specimens. The accessory head was noted to pass anterior to the anterior interosseous nerve in all specimens. The accessory head was noted to pass posterior to the median nerve in 57 specimens, and anterior to the nerve in three. Tendon or muscle anomalies were noted in eight specimens (13%), seven of which involved an anomalous attachment between the FPL and the flexor digitorum profundus of the index.
The Interosseous Membrane and its Influence on the Distal Radioulnar Joint
Authors: GABL M. , ZIMMERMANN R. , ANGERMANN P. , SEKORA P. , MAURER H. , STEINLECHNER M. , PECHLANER S.
Published: September 2005

From the interosseous membrane of the forearm a tract extends to the dorsal capsule of the distal radioulnar joint. The structure and function of this tract have been investigated. The tract originates from the radius 22 mm proximal to the distal dorsal corner of the sigmoid notch. Central fibres are attached there with fibrous cartilage and superficial bundles mix with the periosteum. The tract is 8 mm wide, 31 mm long and 1 mm thick. Distally it inserts at the capsule of the distal radioulnar joint between the tendon sheaths of extensor digiti minimi and extensor carpi ulnaris. Deep fibres insert directly at the triangular fibrocartilage. The tract of the interosseous membrane is taut in pronation and loose in supination. It strengthens the dorsal capsule of the distal radioulnar joint. During pronation the tract protects the ulnar head in a sling. Its attachment at the triangular fibrocartilage influences the distal radioulnar joint. Its insertion at the triangular fibrocartilage and the support of the weakest part of the dorsal capsule are of interest.
Distraction Lengthening of the Ulna in Radial Club Hand Using the Ilizarov Technique
Authors: PICKFORD M. A. , SCHEKER L. R.
Published: September 2005

Six children with radial club hand had distraction lengthening of the ulna using the Ilizarov technique at the mean age of 10 years. The mean lengthening achieved was 4.7 cm (46% of original ulna length). Complications included nocturnal pain, pin track infection and callus fracture or delayed union. Distraction lengthening of the ulna can enhance the ability to perform normal activities of daily living, such as reaching the perineum or driving a car, but complications are extremely common. The high rate of callus fracture in this series reinforces the need for regular radiographic review during distraction and suggests that after distraction it may take more than 4 weeks for satisfactory callus consolidation before removal of the fixator.
Ilizarov Distraction-Lengthening in Congenital Anomalies of the Upper Limb
Authors: HÜSLSBERGEN-KRÜGER S. , PREISSER P. , PARTECKE B-D.
Published: September 2005

Nine patients underwent Ilizarov distraction-lengthening for congenital anomalies. All were late cases and had undergone other procedures. In five radial club hand patients with very short forearms, we achieved an average 5.8 cm increase in length with each distraction cycle. In two patients with symbrachydactyly of the cleft hand type, we achieved pinch grip between a radial and an ulnar digit by lengthening the short ray. Another case of the monodactyly type in which we tried to lengthen three transplanted proximal toe phalanges ended in failure. A soft tissue distraction was attempted in a case of camptodactyly but failed. We report the problems we encountered and suggest some solutions.
A Regional Audit of Hand and Wrist Injuries
Authors: HILL C. , RIAZ M. , MOZZAM A. , BRENNEN M. D.
Published: September 2005

This study reports the characteristics, causes and disposal of isolated injuries to the hand and wrist presenting to six accident and emergency departments over a period of 4 months. The rate of isolated injury to the hand or wrist was 6.6%. The male: female ratio was 2.2: 1, with the mean age for injury being 26.4 years in men and 29.2 years in women. The modal age group for injury was 21–25 years in men and 11–15 years in women. The right and left hand were injured almost equally. The dominant hand was more commonly injured although this was influenced by the cause of injury: 16.3% were caused by a fall; 15% by sport; and 7% were work/machinery related. 13.3% were referred to specialities for further treatment.
The Prognostic Value of Concurrent Phrenic Nerve Palsy in Newborn Children with Erb’s Palsy
Authors: AL-QATTAN M. M. , CLARKE H. M. , CURTIS C. G.
Published: September 2005

The prognostic value of concurrent phrenic nerve palsy in newborn babies with Erb’s palsy was investigated. The records of 191 babies with Erb’s palsy were reviewed retrospectively at two institutions. Poor spontaneous return of the motor function of the limb was found for infants both with and without concurrent phrenic nerve palsy. Concurrent phrenic nerve palsy in newborn babies with Erb’s palsy has no prognostic value in predicting spontaneous motor recovery of the limb.
The Treatment of Fractures of the Ring and Little Metacarpal Necks
Authors: HANSEN P. B. , HANSEN T. B.
Published: September 2005

A total of 105 patients with fracture of the neck of the ring or little metacarpal bone were randomized to receive three different types of treatment: dorso-ulnar plaster-of-Paris from the proximal interphalangeal joint to elbow; functional brace around the wrist; or elastic bandage. Twenty patients (19%) had to be excluded for different reasons leaving 85 patients in the study. The remaining patients were examined after 4 weeks and 3 months. There was no difference in patient satisfaction between the three different types of treatment. The functional brace was in our opinion superior to the two other types of treatment: the patients had as little pain as the patients treated with plaster-of-Paris and less pain than patients treated with elastic bandage. Patients treated with a functional brace mobilized as fast as patients treated with elastic bandage and faster than patients treated with plaster-of-Paris. Based on these findings, we recommend the functional brace for treatment of fractures of the neck of the ring and little metacarpals.
Dislocation of the Pisiform in a 9-Year-Old Child
Authors: ASHKAN K. , O’CONNOR D. , LAMBERT S.
Published: September 2005

A dislocated pisiform associated with type II Salter-Harris fractures of the distal radius and ulna in a 9-year-old child is described. Closed reduction followed by immobilization achieved good radiological and clinical results. The current literature on dislocation of the pisiform is reviewed.
Giant-Cell Lesion in a Sesamoid Bone of the Thumb
Authors: CLARKE E. P. , PRITCHETT J. W.
Published: September 2005

We treated a 72-year-old woman by excision of the right thumb sesamoid which contained a giant-cell lesion. Nine years later she had normal function and no evidence of other lesions, recurrence or metastasis. We recommend that the diagnosis of giant-cell reparative granuloma and giant-cell tumour be considered when a bony mass in a sesamoid bone is discovered. Surgical excision at least in our one case was definitive treatment.
The beneficial helminth parasite?
Authors: McKAY D. M.
Published: September 2005

There is unequivocal evidence that parasites influence the immune activity of their hosts, and many of the classical examples of this are drawn from assessment of helminth infections of their mammalian hosts. Thus, helminth infections can impact on the induction or course of other diseases that the host might be subjected to. Epidemiological studies demonstrate that world regions with high rates of helminth infections consistently have reduced incidences of autoimmune and other allergic/inflammatory-type conditions. Here I review and assess the possible ways by which helminth infections can block or modulate concomitant disease processes. There is much to be learned from careful analysis of immuno-regulation in helminth-infected rodents and from an understanding of the immune status of acutely and chronically infected humans. The ultimate reward from this type of investigation will likely be a more comprehensive knowledge of immunity, novel ways to intervene in the immune response to alleviate autoimmune and allergic diseases (growing concerns in economically developed areas), and perhaps the development of helminth therapy for patients suffering from specific inflammatory, autoimmune or allergic disorders.
JUDITH WEIR IN CONVERSATION
Authors: Hughes Bernard
Published: September 2005

Judith Weir (b.1954) is one of Britain's leading composers. Her three full-length operas (A Night at the Chinese Opera, The Vanishing Bridegroom and Blond Eckbert) have been widely performed in Britain and abroad. Since the 1990s she has had a fruitful association with the City of Birmingham Symphony Orchestra and its sister group, the Birmingham Contemporary Music Group (BCMG). Weir's theatre work includes collaborations with the Royal National Theatre and the Royal Shakespeare Company. Her interest in community music projects included an innovative spell of six years as the Artistic Director of the Spitalfields Festival in London. Recent works include the orchestral piece The Welcome Arrival of Rain for the Minnesota Orchestra, heard at the Proms in 2002, and the ensemble work The Tiger Under the Table for the London Sinfonietta.
Three BBC premières: Dean, Martinsson, Cresswell
Authors: Anderson Martin
Published: September 2005

Time was when it was almost axiomatic that a new concerto would be premièred by its composer, pretty well from the beginnings of the genre until the onset of the recording age, which captured Rachmaninov at the keyboard for his own concertos. These days, though Rachmaninov is barely 60 years dead, composers and performers inhabit such separate boxes that it's a surprise to see a composer step forward to perform his own piece – the more so when the composer is a violist; the last person to do that may well have been Hindemith. So when Brett Dean came to the front of the Barbican platform on 15 April, to join the BBC Symphony Orchestra under the baton of Ramon Gumba, he became an important link in a fairly short chain.
Anthony Gilbert on NMC
Authors: Harris Richard Leigh
Published: September 2005

ANTHONY GILBERT: On Beholding a Rainbow1,4; Certain Lights Reflecting2,4; … Into the Gyre of a Madder Dance3; Unrise3. 1Anthony Marwood (vln), 2Susan Bickley (mezzo), 3RNCM Wind Ensemble c. Clark Rundell, 4RNCM Symphony Orchestra c. Garry Walker. NMCD105.
Birmingham: Norgård, Skempton, Weir, Anderson
Authors: Conway Paul
Published: September 2005

The City of Birmingham Symphony Orchestra celebrated the birthday of Hans Christian Andersen, 200 years to the day, with a world première by Per Norgård. His 50-minute ‘fairytale cantata’, entitled Will- O'-the-Wisps Go to Town, was inspired by one of the great Danish author's last stories.
David Diamond String Quartets
Authors: Johnson Bret
Published: September 2005

DIAMOND: String Quartets (complete); Concerto for String Quartet; Night Music for Accordion and String Quartet1. Potomac String Quartet with 1Carmelo Pino (acc). 4-CD set (each disc available separately): Albany TROY 504 (Nos. 3 and 8, Concerto), 540 (Nos. 2, 9 and 10), 613 (Nos. 1, 5 and 6) and 727 (Nos. 4 and 7, Night Music).
Thomas Adès's Piano Quintet
Authors: Venn Edward
Published: September 2005

ADÈS: Piano Quintet1. SCHUBERT: Piano Quintet D667, The Trout2. Thomas Adès (pno), 1Arditti Quartet, 2members of the Belcea Quartet, 2Corin Long (db). EMI 7243 5 57664 2 7.
Eli Zion: Music of the ‘New Jewish School’
Authors: Miller Malcolm
Published: September 2005

Eli Zion – from St Petersburg to Jerusalem: Music from the ‘New Jewish School’. David Geringas (vlc), Jascha Nemtsov (pno). SWR and Hännsler-Classic CD 93.122.
Introduction
Authors: Jacobs Jeffrey P.
Published: September 2005

Florida is the fourth largest state in the United States of America, and the Congenital Heart Institute of Florida is the largest programme providing services for congenital cardiac surgery in Florida. Our Institute is very grateful to Bob Anderson, and the team at Cardiology in the Young, for their support of our programme, and for the opportunity to publish this Supplement. Bob Anderson was a valued faculty member, and tremendous supporter, of our third annual symposium, held at the All Children's Hospital and The University of South Florida, and devoted to echocardiographic, anatomic, surgical, and pathologic correlations of congenital cardiac disease. Our Symposium to be held in 2004, coinciding with the appearance of this supplement, will mark the third consecutive year that Bob Anderson has traveled to Saint Petersburg, Florida as a Featured Guest Speaker. In 2002, at our Second Annual Symposium, the focus of our four-day meeting was the abnormalities of the ventricular inlets and atrioventricular valves, with a full day devoted to echocardiography, followed by three single days spent discussing the tricuspid valve, the mitral valve, and the common atrioventricular valve. In 2003, at our third annual symposium, the focus of our four-day meeting was controversies concerning the hypoplastic left heart syndrome, again beginning with a full day devoted to echocardiography, followed by three single days this time discussing staged palliation by means of the Norwood sequence, replacement by cardiac transplantation, and biventricular repair. A feature of the symposium was the numerous debates. In 2003, our featured guest speakers, in addition to Bob Anderson, were Leonard L. Bailey and his wife Nancy, from Loma Linda University Medical Center, Loma Linda, California. Bob Anderson will again return in 2004, when our other featured guest speaker will also be from Great Ormond Street, namely Martin J. Elliott. The focus of our meeting in 2004 will be controversies concerning the arterial switch, the Ross procedure, and reconstructions of the right ventricular outflow tract, again beginning with a full day devoted to echocardiography, followed by three single days discussing the pulmonary valve, the aortic valve and the Ross procedure, and the arterial switch procedure, with daily debates.
A European perspective on the management of hypoplastic left heart syndrome
Authors: Elliott Martin J.
Published: September 2005

Recently, the well-known American political commentator, Robert Kagan, reapplied an existing populist statement in describing Americans as being from Mars, and Europeans from Venus.1He said “they agree on little and understand one another less and less”. In general, it would be churlish to say that this applied to the medical fraternity, but it has great resonance with intercontinental differences in the management of hypoplastic left heart syndrome. In this review, I offer a personal view of those differences, potential explanations for them, and consider how the situation may change in coming years.
Recent innovations in the Norwood sequence of operations
Authors: Jacobs Marshall L.
Published: September 2005

Although Norwood's first stage palliative procedure has been adopted by most proponents of reconstructive surgery for hypoplastic left heart syndrome, several technical modifications have recently been introduced. Some are intended primarily to minimize the adverse effects of cardiopulmonary bypass, hypothermic circulatory arrest, or both. Some are intended to simplify the technical performance of the initial palliative procedure. As the number of patients surviving staged reconstructive surgery for hypoplastic left heart syndrome grows steadily, there is a shift in emphasis toward investigation of methods to minimize morbidity. Specifically, the quality of life after staged reconstructive surgery may be affected by the potential for neurologic injury associated with bypass, deep hypothermia, and circulatory arrest. The pathology of cerebral injury includes ischemic cerebral necrosis, periventricular leukomalacia, necrosis of the brain stem, and intracranial hemorrhage. Neurologic injury associated with cardiac surgery during infancy is undoubtedly multi-factorial, and as yet is poorly and incompletely understood. Several surgical teams, nonetheless, have revised the technical aspects of the palliative operations with a goal of minimizing the duration of hypothermic circulatory arrest.
Surgical palliation of hypoplastic left heart syndrome: is there a role for hypothermic circulatory arrest?
Authors: Jacobs Marshall L.
Published: September 2005

The technique of deep hypothermia with circulatory arrest has been important in the history of the evolution of cardiac surgery. Wilfred G. Bigelow, working in Toronto in the late 1940s, performed pioneering research on hypothermia, and developed a workable technique of hypothermia in human cardiac surgery.1Based upon Bigelow's experimental premises, F. John Lewis, at the University of Minnesota, also conducted a number of experiments utilizing hypothermia. On September 2, 1942, Lewis operated on a 5-year-old girl with an atrial septal defect under general hypothermia with inflow occlusion. He was assisted by Richard Varco, Mansur Taufic, and C. Walton Lillehei. Rubberized refrigerated blankets were used to cool the patient to 28°C. The septal defect was closed during five and a half minutes of inflow occlusion. This was the world's first successful open operation on the human heart performed under direct vision, and marked the beginning of the era of open heart surgery. Now, as amazing and as primitive as that methodology may seem, those of you who read Life magazine, or watch the Discovery Channel on television, are aware that, in parts of the Soviet Union, a large fraction of today's open heart surgery is performed not using the technique of cardiopulmonary bypass, but rather using the methodology of immersion hypothermia from the 1950s, with surprisingly good results.
Echocardiographic evaluation before and after cardiac transplantation
Authors: Asante-Korang Alfred
Published: September 2005

Transplantation of the heart remains a viable option not only as primary treatment for hypoplastic left heart syndrome, but also for end-stage problems after the Norwood sequence of palliations. In this review, I discuss the pre-operative, intra-operative, and post-operative echocardiographic evaluation of these patients, with special emphasis on hemodynamic and functional assessment as well as surveillance for rejection and coronary arterial disease.
Staged reconstructive surgery – the most appropriate therapy for hypoplastic left heart syndrome
Authors: Jacobs Marshall L.
Published: September 2005

I am grateful for the opportunity to participate in this debate forum, and for the honor of exchanging concepts with Len Bailey. This debate, fortunately, represents a “win-win” situation. The innovations and evolution of both replacement of the heart and reconstructive surgery for hypoplastic left heart syndrome are stories with lots of winners. The entire field of transplantation biology, the entire scope of management of the newborn with complex congenital heart disease, including both medical and supportive therapy and surgical strategies, has each been advanced tremendously as a consequence of the introduction and refinement of these two very different therapies for hypoplastic left heart syndrome. So, it is a debate that cannot be lost.
Long-term follow-up after staged reconstruction or transplantation for patients with functionally univentricular heart
Authors: Wernovsky Gil , Chrisant Maryanne R. K.
Published: September 2005

As recently as 35 years ago, children born with a functionally single ventricle were destined to a lifetime of multiple palliative operations, and disrupted growth and development. Physical signs of their cardiac disease were evidenced by chronic hypoxemia, polycythemia, clubbing, small stature, and severely reduced exercise ability. A normal lifestyle, with typical landmarks such as uninterrupted adolescence and potential childbearing, was unlikely. The successful application of right heart bypass by Fontan and Kreutzer in the early 1970s heralded an era of multiple medical and surgical breakthroughs that have systematically improved the quality of life and long-term outlook for these children.