bluuebunny/crossref_metadata_2025 huggingface dataset:
Enchondroma of the Scaphoid
Authors: REDFERN D. R. M. , FORESTER A. J. , EVANS M. J. , SOHAIL M.
Published: September 2005

Enchondroma is a common benign cartilaginous tumour which arises from the medullary cavity, most commonly in the phalanges of the hands and feet. Enchondroma involving the carpal bones, however, is rare; only three cases of scaphoid enchondromata and one patient with multiple carpal enchondromata have been reported in the English literature. We report the diagnosis and treatment of a case of scaphoid enchondroma presenting as chronic wrist pain after relatively trivial injury.
Transient Bradycardia in a Mouse Model for the Oromandibulofacial Limb Hypogenesis Syndrome Following Chorionic Villus Sampling
Authors: CHANG H. H. , KAUFMAN M. H.
Published: September 2005

Amniotic sac puncture carried out on day 13 mouse embryos induces a high incidence of craniofacial and limb abnormalities that resemble the anomalies seen in the oromandibulofacial limb hypogenesis syndrome occasionally encountered following chorionic villus sampling carried out during early human pregnancy. It has been hypothesized that this syndrome probably has a vascular basis, possibly due to hypotension and hypoperfusion of tissues secondary to placental trauma, though no detailed aetiology has so far been described. We have determined embryonic heart rates in control embryos, in embryos at intervals following anaesthesia, and following amniotic sac puncture. An increased duration of bradycardia is seen following this procedure which is not observed in anaesthetic-only controls and in embryos in the contralateral (non-operated) uterine horns. We discuss why the incidence of oromandibulofacial limb hypogenesis syndrome is low following chorionic villus sampling, and propose a possible aetiology for the limb abnormalities seen in this condition.
Classification of Limb Anomalies in Oral-Facial-Digital Syndromes
Authors: AL-QATTAN M. M. , HASSANAIN J. M. A.
Published: September 2005

A classification of limb anomalies in oral-facial-digital (OFD) syndromes is offered to help differentiate between the various types of OFD syndromes. A clinical case is presented with clinical features consistent with both OFD syndrome type I (Papillon Leage-Psaume syndrome) and type VI (Váradi syndrome). The final diagnosis as a new mutation of type I syndrome was established after reviewing the radiological findings in the hands.
Functional Motor Innervation of Brachial Plexus Roots
Authors: GU Y-D
Published: September 2005

The electrophysiological properties of the normal brachial plexus and functional motor innervation were examined during the operation of transfer of contralateral C7 transfer from the healthy side. Different roots of the brachial plexus were stimulated and maximum amplitudes were recorded. The results showed that functional motor innervation of brachial plexus roots were: C5 mainly forms the axillary nerve to innervate the deltoid muscle; C6 mainly forms the musculocutaneous nerve to innervate biceps; C7 mainly forms the radial nerve to innervate triceps; C8 mainly forms the median nerve to innervate flexor digitorum superficial is and profundus; and T1 mainly forms the ulnar nerve to innervate the intrinsic muscles of the hand.
Transposition of the Bicipital Tuberosity for Treatment of Fixed Supination Contracture in Obstetric Brachial Plexus Lesions
Authors: EBERHARD D.
Published: September 2005

In nine patients with obstetric brachial plexus lesions (Klumpke type), an impingement of the bicipital tuberosity on the ulna was the main cause for the forearm and hand to be fixed in supination. A surgical technique using reinsertion of the biceps tendon on the bicipital tuberosity is described in detail. It has substantially improved all patients. After a mean follow-up of 29.4 months the hand was in a more functional position than preoperatively in all patients. In seven cases pronation could be increased by contraction of the biceps muscle. By relaxing the biceps muscle and by contraction of the supinator muscle a limited active supination was possible in six cases.
Reconstruction of a Metacarpophalangeal Pulley in the Thumb with a Free Extensor Retinaculum Graft
Authors: GUELMI K. , BARBATO B. , KOLB F.
Published: September 2005

A new method for reconstruction of the pulley system of the thumb using the extensor retinaculum is described.
The Radiological Demonstration of Dynamic Ulnar Impingement
Authors: LEES V. C. , SCHEKER L. R.
Published: September 2005

The diagnosis of ulnar impingement is often missed because of a low index of clinical suspicion. Furthermore there has been no investigation that will demonstrate it. Most commonly impingement is seen as a complication of surgical procedures involving resection of all or part of the distal ulna, with or without resection or arthrodesis of the distal radioulnar joint. We demonstrate a simple radiological investigation that clearly confirms the diagnosis.
A Ceramic Endoprosthesis for Giant Cell Tumour in the Distal Radius
Authors: SATAKE K. , HORII E. , ETO Y.
Published: September 2005

The treatment of giant cell tumour (GCT) of the distal end of the radius is still a difficult and most challenging problem. We report a patient in whom the radius was reconstructed with a ceramic endoprosthesis for recurrent tumour, followed up for 10 years.
Nora’s Lesion
Authors: MUDGAL C.S. , JUPITER J.B.
Published: September 2005

Isolated primary bony lesions of the digits are infrequent. A phalangeal lesion in the hand is most likely to be benign. Rarely, however, primary benign tumour-like conditions affecting the handmay radiologically mimic an osteochondroma and histologically mimic a malignancy. We describe a case of bizarre parosteal osteochondromatous proliferation (Nora’s lesion, BPOP), which may do both and mislead the unsuspecting surgeon. The aim of this paper is to present our experience with this case, review existing literature and promote awareness among hand surgeons of a condition that can often be misdiagnosed.
Results of Vascularized Joint Transfers from the Foot
Authors: DAUTEL G. , MERLE M.
Published: September 2005

We report our results in ten cases of vascularized joint transfer to reconstruct the proximal interphalangeal joint (five cases) or metacarpophalangeal joints (five cases). Donor sites were the proximal interphalangeal or the metatarsophalangeal joints of the second toe. Indications for surgery were the need to reconstruct both the growth plate and joint space in children or the impossibility of a conventional prosthetic implant. The average range of motion was 44° for the PIP joint and 53° for the MP joint at a mean follow-up of 22.7 months.
The Mechanical Properties of the Palmar Aponeurosis and their Significance for the Pathogenesis of Dupuytren’s Contracture
Authors: MILLESI H. , REIHSNER R. , EBERHARD D. , MALLINGER R. , HAMILTON G. , MENZEL E. J.
Published: September 2005

Normal tendons and palmar aponeuroses from patients with carpal tunnel syndrome and tissues of the palmar aponeuroses from patients with Dupuytren’s contracture were subjected to biomechanical tests. Several parameters characterizing the viscoelastic load response of the tissues were investigated. The tissues from patients with Dupuytren’s contracture were classified according to their macroscopic and histological appearance into apparently normal palmar aponeuroses, thickened fibre bundles and contracture bands. There were biomechanical differences between the normal palmar aponeuroses and the apparently normal palmar aponeuroses indicating that biomechanical changes occur before thickening of fibres or cellular proliferation can be observed. Significant biomechanical changes occurred between apparently normal palmar aponeuroses and thickened fibre bundles.
Percutaneous Fasciotomy for Dupuytren’s Contracture
Authors: DUTHIE R. A. , CHESNEY R. B.
Published: September 2005

Percutaneous fasciotomy has long been established as a treatment for Dupuytren’s contracture. There have been no studies to date of the long-term results of this procedure. We followed up a group of 82 patients 10 years after operation in 1981 and 1982. Thirty-four per cent had had no further surgery. The mean time to further surgery in the rest was 60.4 months. Splitting of the palmar skin which healed with regular dressings occurred in three cases. No other complications were noted. Percutaneous fasciotomy can produce lasting improvement in patients with Dupuytren’s contracture and still has an important role in their overall management.
The Importance of Open Wound Management in High-Pressure Injection Injuries of the Upper Limb
Authors: O’SULLIVAN S. T. , BEAUSANG E. , O’DONOGHUE J. M. , O’SHAUGHNESSY M. , O’CONNOR T. P. F.
Published: September 2005

We have employed a policy of early aggressive débridement with open-wound management for high pressure injection injuries. We present our results in 13 patients. Full finger and hand function was documented in eight cases. All patients were able to resume their normal occupations within 8 months of injury.
A New Instrument for Stripping and Cutting Tendon Grafts
Authors: JIA S. , CHENXIN S.
Published: September 2005

We describe an instrument designed for obtaining tendons for grafting through one incision.
Passage of an Irrigation Catheter with the Aid of a Guide Wire for Pyogenic Flexor Tenosynovitis
Authors: HOFFMAN E. D. , DESAI S. S. , LEVIN L. S.
Published: September 2005

Typically an irrigation catheter or feeding tube is passed within the tendon sheath for treatment of pyogenic flexor tenosynovitis. We describe the use of a guide wire to facilitate the passage of the flexible irrigation device into the narrow sheath. The materials described are standard and readily available.
Trapeziometacarpal Joint Arthrodesis for Osteoarthritis
Authors: LISANTI M. , ROSATI M. , SPAGNOLLI G. , LUPPICHINI G.
Published: September 2005

Fifty-two cases of trapeziometacarpal joint osteoarthritis were treated with arthrodesis using small staple fixation. Eighty-five per cent of the patients were free of pain, with normal thumb. Opposition to the fourth finger tip was always possible and opposition to the little finger tip was observed in 94% of cases. Four patients (7.6%) developed a non-union but only two complained of pain. Arthrodesis with power staple fixation minimizes bone resection and postoperative immobilization (mean 28 days) because of the good stability following this procedure.
Expandable Rings
Authors: GIDDINS G. E. B.
Published: September 2005

A number of solutions are presented for the problem of over-tight rings particularly in patients with deforming arthropathies of the hand. Rings can be adapted by various methods to allow them to be worn on deformed fingers. An illustrative case is reported.
The Extensor Retinacular System at the Metacarpophalangeal Joint
Authors: RAYAN G. M. , MURRAY D. , CHUNG K. W. , ROHRER M.
Published: September 2005

The anatomy of the sagittal bands was studied in 56 cadaver digits. The sagittal band is part of an extensor retinacular system which is integrated with the extrinsic and intrinsic musculotendinous structures. The extensor retinacular system is a single unit with radial and ulnar components and has transverse, sagittal and oblique fibres. The transverse-sagittal fibres, along with the palmar plate, form a closed cylindrical tube which surrounds the metacarpal head. The oblique fibres form the triangular lamina distal to the sagittal band. The radial component of the sagittal band is often thinner and longer than the ulnar component. The sagittal band envelops the extensor digitorum tendon and the superficial fibres are thinner than deep fibres, especially in the central digits. The central digits have palmar soft tissue confluence on each side consisting of the sagittal band, palmar plate, annular pulley and deep transverse metacarpal ligament. The sagittal band also appears to envelop the superficial interosseous tendons on both sides. Our findings explain the propensity for radial sagittal band injuries and suggest that the sagittal band is the primary stabilizer of the extensor digitorum at the metacarpophalangeal joint.
Neonatal Compression Ischaemia of the Forearm
Authors: TSUJINO A. , HOOPER G.
Published: September 2005

A case of neonatal compartment syndrome of the forearm is reported. The cause was thought to be compression during delivery. It not only caused muscle contractures but also affected bone growth. Conservative treatment was given. At the age of 6 years, the muscle contracture had recovered and there was full hand function, but there was growth arrest of the distal radial epiphysis and the affected forearm was shorter than the other.
“Spare Part” Forearm Free Flaps Harvested from the Amputated Limb for Coverage of Amputation Stumps
Authors: WEINBERG M. J. , AL-QATTAN M. M. , MAHONEY J.
Published: September 2005

The use of “spare part” flaps from a non-replantable limb to cover amputation stumps in the upper extremity preserves limb length, provides durable coverage and sensation and will avoid additional donor site morbidity. We have studied the blood supply of the forearm based on the radial artery. The potential for harvesting different tissues is confirmed. In five clinical cases reliable primary soft tissue reconstruction was achieved, even in the presence of trauma.
Reconstruction of Large Palmar Defects of the Hand Using Free Flaps
Authors: NINKOVÍC M. M. , SCHWABEGGER A. H. , WECHSELBERGER G. , ANDERL H.
Published: September 2005

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.
Intraarticular Lesions in Distal Fractures of the Radius in Young Adults
Authors: LINDAU T. , ARNER M. , HAGBERG L.
Published: September 2005

We examined the frequency of associated chondral and ligament lesions in distal fractures of the radius in young adults (men 20–60 years, women 20–50 years). Fifty initially displaced fractures were examined arthroscopically. Chondral lesions were found in 16 patients (32%). All patients but one were found to have a ligamentous injury in the wrist. No major instability was found. The most frequent ligament tear was the triangular fibrocartilage complex in 39 cases (78%), with a statistical correlation to ulnar styloid fractures. The scapholunate ligament was partially or totally torn in 27 cases (54%). No correlation was found between specific fracture type and pattern of ligament injury. Chondral and ligamentous lesions were frequent and may explain poor outcomes after seemingly well-healed distal fractures of the radius. The ligament lesions should also be kept in mind when early mobilization of the distal fracture of the radius is considered.
X-Ray Characteristics of Wrists in Calcium Pyrophosphate Crystal Deposition Disease
Authors: TANIGUCHI Y. , YOSHIDA M. , TAMAKI T.
Published: September 2005

Deposition of calcium pyrophosphate dihydrate (CPPD) crystals has been considered to be a cause of scapholunate advanced collapse (SLAC) wrist. The aim of this study was to look at X-ray changes in wrist joints affected by CPPD crystal deposition disease and to determine whether crystal deposition is a cause of SLAC wrist. A total of 150 wrists of 78 patients with CPPD crystal deposition disease were examined. In our population of Japanese patients with CPPD crystal deposition disease, the incidence of SLAC wrist was very low, and no case of Stage III SLAC wrist was found. We therefore conclude that SLAC wrist is not a radiographic characteristic of CPPD crystal deposition disease and that pyrophosphate crystal deposition cannot be a major cause of SLAC wrist.
Thoracic Outlet Compression Syndrome Caused by a Schwannoma of the C7 Nerve Root
Authors: ATASOY E.
Published: September 2005

This is the first report of a schwannoma originating from the C7 nerve root causing thoracic outlet compression syndrome. The patient was a 30-year-old woman with a 3-year history of numbness on the radial side of the left hand, left arm tiredness, nocturnal pain in the left forearm and pain in the left elbow, shoulder and neck. Conservative treatment and previous operations, including carpal tunnel release and first rib resection, provided no relief. A left scalenectomy was performed. During the removal of the anterior scalene muscle, a mass approximately 3 cm long and 1.5 cm in diameter was noted under the anterior scalene muscle involving the C7 nerve root. The tumour was encapsulated and covered with attenuated and stretched nerve fascicles. It was completely excised without disturbing the nerve fascicles. The clinical impression was schwannoma, which was confirmed on pathological examination.
Avulsion Fracture of the Metacarpophalangeal Joint of the Finger
Authors: SAKUMA M. , NAKAMURA R. , INOUE G. , HORII E.
Published: September 2005

Six patients with avulsion fractures of the metacarpophalangeal joints of the fingers are reported. Operation was performed in all cases. Judging from the operative findings, the radiological assessment of fragment shape is helpful in treatment. Surgery is recommended when the fragment is triangular or rectangular in shape because the fracture involves the articular surface. Conservative treatment is effective if the fragment is round because the articular surface of the joint is not involved in this type of fracture. The avulsed fragment often overlaps the metacarpal head and a collateral ligament injury is likely to be misdiagnosed. It is important to suspect this injury and assess the shape of the whole fragment for a good functional result.
Congenital Palmar Nail Syndrome
Authors: AL-QATTAN M. M. , HASSANAIN J. , HAWARY M. B.
Published: September 2005

A rare case of congenital palmar nail syndrome is described. Nomenclature of this rare form of ectopic nail is discussed and a classification of the palmar nail deformity is offered.
The Hand and the Eye
Authors: FILAN S. L. , RUMBALL K. M. , TONKIN M. A.
Published: September 2005

A variety of systemic diseases may affect both the hand and eye, leading to profound sensory and functional deficits. The aetiology of some of the most common conditions is reviewed, with an explanation of their manifestations in the hand and eye. Recognition of the association between a hand condition and ocular pathology may aid in diagnosis of a systemic disorder or allow early detection and prevention of ocular disease and loss of vision.
A New Type of “Bioartificial” Nerve Graft for Bridging Extended Defects in Nerves
Authors: LUNDBORG G. , DAHLIN L. , DOHI D. , KANJE M. , TERADA N.
Published: September 2005

In the rat sciatic nerve, a gap of around 10 mm in nerve continuity seems to be the maximal distance which can be successfully repaired by silicone tubes. In this study we tested if a new artificial nerve graft, composed of eight polyamide filaments (diameter 250 μm) placed inside silicone tubes (1.8 mm inner diameter), could be used to bridge an extended gap (15 mm) in rat sciatic nerve. Silicone tubes containing eight polyamide sutures were found to support regeneration across such a gap. After 4 weeks sensory fibres had bridged the gap and grown into the distal nerve segment as revealed by a positive pinch reflex test as well as positive staining for neurofilaments in the distal nerve segment. Myelinated axons could be observed in the tissue matrix formed in between and peripheral to the synthetic filaments along the whole length of the tube. In contrast, when silicone tubes without filaments were used to bridge the 15 mm gap, the tubes contained only fluid or in two cases a thin tissue strand. No positive pinch reflex response was elicited in the nerve segment distal to such a tube. We conclude that the new artificial nerve graft can be used to support regeneration across extended gaps in nerves.
Nerve Xenograft Transplantation
Authors: HEBEBRAND D. , ZOHMAN G. , JONES N. F.
Published: September 2005

An experimental model has been developed to study the potential transplantation of nerve xenografts using the newer immunosuppressive agents RS-61443 and FK-506. Sciatic nerve grafts of 2 cm were transplanted from donor Golden Syrian hamsters into a 0.5 cm gap in the sciatic nerve of recipient Lewis rats. Walking track analysis, somatosensory evoked potentials and histology demonstrated improved regeneration across the nerve xenografts that had been immunosuppressed with RS-61443 and FK-506 compared with non-immunosuppressed controls, but the function never approached that seen in control isografts. Regeneration across nerve xenografts immunosuppressed with FK-506 was better than xenografts immunosuppressed with RS-61443.
Martin-Gruber Connections in South Africa
Authors: TAAMS K. O.
Published: September 2005

One hundred and twelve forearms in 56 preserved cadavers were dissected to assess the incidence of Martin-Gruber connections in a population in South Africa. The connections were found in 13 cadavers (23%) and one was bilateral. There were no significant racial or sexual differences in the incidence. The course of Martin-Gruber connections and their anatomical relationship with the ulnar artery are illustrated.
The Dorsal Middle Phalangeal Finger Flap
Authors: LEUPIN P. , WEIL J. , BÜCHLER U.
Published: September 2005

The dorsal middle phalangeal finger (DMF) flap is a (neuro)vaseular island flap based on one palmar proper digital artery, its venae comitantes (and/or a separate dorsal vein) and the dorsal branch(es) of the palmar digital nerve. The main nerve supply of the donor finger is left undisturbed. The flap may be raised on a short antegrade, long antegrade or a retrograde pedicle, and used as a free, arterial and/or venous flow-through or neurovascular flap. In a prospective study (mean follow-up of 50 months), the results of 43 DMF flaps were analysed. All flaps survived, retained patency of their vascular pedicles and fulfilled their goals. Neurovascular flaps provided sensate coverage at the S3+ level with static 2-point discrimination values of about 10 mm. Dissection between the proper digital nerve and the rest of the neurovascular bundle induced a 5% incidence of cold intolerance and a 12% occurrence of S3+ hypaesthesia. Advantages, drawbacks and indications of DMF flaps are outlined.
Spontaneous Rupture of the Flex or Pollicis Longus Tendon on a Sesamoid Bone
Authors: WEBB J. B. , ELLIOT D.
Published: September 2005

We report a case of rupture of the flexor pollicis longus tendon due to attrition by the ulnar sesamoid bone of the metacarpophalangeal joint of the thumb secondary to osteoarthritic changes of this bone.
Use of a Bone Block Graft from the Iliac Crest with Rigid Fixation to Correct Diaphyseal Defects of the Radius and Ulna
Authors: BARBIERI C. H , MAZZER N. , ARANDA C. A. , PINTO M. M. de O.
Published: September 2005

We report our experience with the use of a bone block graft from the lilac crest to correct diaphyseal defects of the forearm bones. The technique was used in 12 patients (ten men and two women, average age 29 years) for defects resulting mainly from either closed or compound fractures, which later developed infection and bone tissue loss. The average dimensions of the graft required to correct the defect was 3.5 × 1.8 cm. The graft application was combined with rigid fixation with an AO 3.5 mm DCP plate, permitting early active motion. The graft incorporated without any additional grafting procedure in ten cases within 17.2 weeks on average. The most frequent complication was infection (four cases), controlled by means of débridement, cleansing and antibiotics. A comparative analysis of the immediate and final radiographs of the graft showed an average 30% loss of bone mass despite integration. We conclude that the technique of bone block grafting to correct diaphyseal defects of the radius or ulna is relatively easy to carry out and has a high success rate.
Cardiac Arrhythmia Caused by a Kirschner Wire inside the Heart
Authors: HAAPANIEMI T. A. T. , HERMANSSON U. S.
Published: September 2005

A 45-year-old woman with no previous history of cardiac disease woke up one morning with an irregular heartbeat and fatigue. An electrocardiogram showed atrial fibrillation and plain chest radiographs revealed the presence of a metallic pin at the position of the heart. A 24 mm-long metallic pin was removed by open thoracic surgery from within the right ventricle of the heart. Postoperative examination of the pin showed it to be one of the 0.8 mm Kirschner wires that had been used for finger osteosynthesis in her left hand 31 months previously.
Peripheral Gangrene Associated with Fulminating Meningococcal Septicaemia
Authors: FITTON A. R. , DICKSON W. A. , SHORTLAND G. , SMITHIES M.
Published: September 2005

We present a case of a 3-month-old boy presenting with fulminating meningococcal septicaemia associated with extensive peripheral gangrene requiring amputation of three limbs. The surgical management options and the role of early fasciotomy are discussed.
Treatment of Scaphoid Nonunions with a Vascularized Bone Graft Based on the First Dorsal Metacarpal Artery
Authors: YUCETURK A. , ISIKLAR Z. U. , TUNCAY C. , TANDOGAN R.
Published: September 2005

Four patients with chronic nonunion of the scaphoid were treated by a vascularized bone graft based on first dorsal metacarpal artery. The mean duration of the nonunion was 28.5 months (range 12–48 months). There was avascular necrosis in all patients confirmed by magnetic resonance imaging (MRI). None of the patients had previous attempts at surgical reconstruction. Two fractures were localized at the waist one in the distal part and one at the proximal pole. Osseous union of the scaphoid was confirmed by X-ray in all patients in an average of 2.1 months.

We recommend this technique for the treatment of established scaphoid pseudoarthrosis with avascular necrosis since it is associated with minimal morbidity and predictable good results.
Arthroscopic Synovectomy of the Rheumatoid Wrist
Authors: ADOLFSSON L. , FRISÉN M.
Published: September 2005

Twenty-four wrists in 19 patients with rheumatoid arthritis affecting the wrist were treated by arthroscopic synovectomy. Range of motion, subjective pain, wrist function and X-ray changes were recorded preoperatively and at an average of 3.8 years after operation. Arthroscopic synovectomy of the rheumatoid wrist reduced pain and improved wrist function in the majority of patients. Progress of arthritic degeneration was significantly less common in patients with no, or very early changes at the time of surgery.
A Comparison of Magnetic Resonance Imaging and Arthroscopy in the Investigation of Chronic Wrist Pain
Authors: JOHNSTONE D. J. , THOROGOOD S. , SMITH W. H. , SCOTT T. D.
Published: September 2005

Forty-three patients with chronic wrist pain have been investigated prospectively with magnetic resonance imaging and arthroscopy. Pathology within the wrist joint was detected in 30 cases with magnetic resonance imaging and 32 cases with arthroscopy. The sensitivity and specificity of magnetic resonance imaging compared with arthroscopy were 0.8 and 0.7 for triangular fibrocartilage complex pathology, 0.37 and 1.0 for scapholunate ligament and 0 and 0.97 for lunotriquetral ligament. It is concluded that magnetic resonance imaging is unhelpful in the investigation of suspected carpal instability. In analysis of the triangular fibrocartilage complex, the results of magnetic resonance imaging should be interpreted with caution.
Pins and Rubbers Traction System
Authors: de SORAS X. , de MOURGUES P. , GUINARD D. , MOUTET F.
Published: September 2005

The Pins and Rubbers Traction System (PRTS) is a mobile frame created with wires to support elastic traction, which produces a ligamentotaxis effect in the same direction and of the same intensity whatever the position of the joint. This technique has been used in 11 cases of complex PIP joint fractures with eight excellent results. The advantages are simplicity, adaptability, the possibility of immediate mobilization, reasonable cost and relatively small bulk.
Alternative Method of Repairing Collateral Ligament Injuries at the Metacarpophalangeal Joints of the Thumb and Fingers
Authors: BEAUPERTHUY G. D. , BURKE E. F.
Published: September 2005

Injuries to the joints of the thumb and fingers frequently cause complete or partial tears of the collateral ligaments, resulting in marked instability of the involved joint. Twelve patients with 12 unstable metacarpophalangeal joints were treated surgically with a Mitek® metal suture anchor. At the last postoperative follow-up (range 6 weeks-6 months) 11 of 12 patients had good to excellent results subjectively and had regained 75% of the strength of the uninjured side.
Stimulated Jitter Measurements In The Assessment of Recovery After Peripheral Nerve Repair
Authors: LENIHAN D. V. , SOJITRA N. , IKEDA M. , CARTER A. J. , GLASBY M. A.
Published: September 2005

The recording of stimulated jitter may offer a highly sensitive, quantitative method for following the recovery of neuromuscular function after peripheral nerve repair. In groups of rats, electrophysiological recording of jitter was carried out on control animals and animals which had had the sciatic nerves divided and repaired 14, 30, 60 and 90 days previously. It was found that values for jitter were highest in the early stages of regeneration and declined with time so that they were within normal limits by 90 days after repair. It is concluded that jitter measurement may be helpful as a test for the postoperative recovery of function in repaired nerves.
Adhesion Receptors and Cytokine Profiles in Controlled Tourniquet Ischaemia in the Upper Extremity
Authors: GERMANN G. , DRÜCKE D. , STEINAU H. U.
Published: September 2005

Adhesion mechanisms mediated by cytokines have been recognized to play a crucial role in ischaemia–reperfusion mechanisms. Although this phenomenon has been well investigated in organ transplantation, little data is available from upper extremity surgery. Profiles of adhesion molecules (CD11/CD18), key cytokines (TNF-α and IL-1), CD4+ and CD8+ lymphocytes, and polymorphonuclear neutrophils were investigated following controlled tourniquet ischaemia of the upper extremity for elective hand surgery. Data suggest that relatively short periods of ischaemia activate a mediator cascade and cell–cell interactions that may be associated with adverse pathopyhsiological effects on peripheral tissues after prolonged ischaemia.
Special Characteristics of Osteoid Osteoma in the Proximal Phalanx
Authors: SOLER J. M. , PIZÀ G. , ALIAGA F.
Published: September 2005

We report two cases of osteoid osteoma in the proximal phalanx. This is an uncommon location for the lesion and it has special clinical and radiological features. Both cases were successfully treated when an ‘en bloc’ excision of the lesion, including the nidus, was performed. Four operations were required in the first case.
Occult Fractures of the Scaphoid
Authors: KUKLA C. , GAEBLER C. , BREITENSEHER M. J. , TRATTNIG S. , VÉCSEI V.
Published: September 2005

Scaphoid fractures that are not visible on initial radiographs are notoriously difficult to diagnose. This prospective study compared four-view plain radiography at an average of 14 days after injury, with high-definition macroradiography and magnetic resonance imaging at presentation. Initial magnetic resonance imaging was superior to repeat scaphoid radiography for the confirmation or exclusion of fractures as well as for the detection of associated wrist injuries. Macroradiography was unsuitable for screening for occult scaphoid fractures.
Carpal Enchondroma
Authors: EMECHETA I. E. , BERNHARDS J. , BERGER A.
Published: September 2005

Chondromas in the carpal bones are uncommon. A review of carpal bone cysts treated in this institution between 1983 and 1993 revealed three cases. We present these cases and a review of the literature.
Combining the Clinical Signs Improves Diagnosis of Scaphoid Fractures
Authors: PARVIZI J. , WAYMAN J. , KELLY P. , MORAN C. G.
Published: September 2005

This is a prospective study evaluating the efficacy of four clinical signs believed to be useful in the diagnosis of scaphoid fracture. Two hundred and fifteen consecutive patients with suspected scaphoid fracture were examined on two separate occasions to evaluate tenderness in the anatomical snuff box (ASB), tenderness over the scaphoid tuberele (ST), pain on longitudinal compression of the thumb (LC) and the range of thumb movement (TM). At the initial examination ASB, ST and LC were all 100% sensitive for detecting scaphoid fracture with specificities of 9%, 30% and 48% respectively. These clinical signs used in combination, within the first 24 hours following injury, produced 100% sensitivity and an improvement in the specificity to 74%. TM had 69% sensitivity and 66% specificity. Our results suggest that these clinical signs are inadequate indicators of scaphoid fracture when used alone and should be combined to achieve a more accurate clinical diagnosis.
A Useful Technique for Removal of Herbert Screws from the Scaphoid
Authors: SIE T. H. , ABDEL-KADER K. F. M. , ALLCOCK S.
Published: September 2005

We describe a useful technique to remove a Herbert screw after union of a scaphoid nonunion, using a 3.5 mm AO drill guide to cut through the bony ingrowth that surrounded the narrow portion of the screw, which prevented removal using the screw driver.
Controlled Active Motion Following Primary Flexor Tendon Repair: A Prospective Study Over 9 Years
Authors: KITSIS C. K. , WADE P. J. F. , KRIKLER S. J. , PARSONS N. K. , NICHOLLS L. K.
Published: September 2005

One hundred and thirty patients with 339 divided flexor tendons affecting 208 fingers were studied prospectively between 1988 and 1996, to assess a regime of primary flexor tendon suture and active postoperative motion, combined with a modified Kleinert dynamic traction splint. The tendon suture technique used was a high-strength multistrand technique using a modified Kessler core and a Halsted peripheral stitch. The results were influenced by the zone in which the tendon was divided, by the physiotherapy and to a lesser extent by the grade of surgeon operating. Overall results by Strickland criteria were 92% excellent or good, 7% fair and 1% poor. There were 43 complications in 31 patients including five zone 2 ruptures (5.7%) and one further rupture in zone 5.

This method of flexor tendon repair requires good physiotherapy and splint-making capability but gives good results with minimal need for further surgery.
Immediate and Delayed Nerve Repair Using Freeze-Thawed Muscle Allografts
Authors: FULLARTON A. C. , GLASBY M. A. , LAWSON G. M.
Published: September 2005

Six sheep underwent repair of the median nerve in the forearm using freeze-thawed muscle autografts, along with the establishment and repair of a “fracture” adjacent to the site of nerve injury. The “fracture” was created by making a transverse osteotomy of the radius. It was repaired using an 8-hole dynamic compression plate. A further six sheep underwent similar treatment with the repair of the nerve delayed for 30 days after the establishment of the long-bone 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. It was found that delay of the nerve repair and the presence of a complicating long bone injury, both separately and additively, contributed to a poorer outcome in recovery of nerve function and maturation.
Changes in Muscle Cytoarchitecture after Peripheral Nerve Injury and Repair
Authors: CARTER A-J. , KRISTMUNDSDOTTIR F. , GILMOUR J. , GLASBY M. A.
Published: September 2005

The aim of this study was to assess the changes which occurred in the rat in target muscles after the injury and repair of a specific peripheral nerve, using several clinically-appropriate surgical techniques.

There were alterations in the size, shape, morphology and cytochemical architecture of the fibres of the target muscles. These changes were marked when transection and repair of the nerve was compared with the less-severe crush injury. The method of repair did not correlate significantly with the occurrence of changes in muscle cytoarchitecture.

The results suggest that the extent of cell loss and the changes in muscle fibre architecture were influenced by the type of injury, rather than by the method of repair.
Anatomy of the Adductor Pollicis Muscle
Authors: WITTHAUT J. , LECLERCQ C.
Published: September 2005

Release of the origins of the adductor pollicis muscle is used to treat adduction contractures of the thumb. A knowledge of the anatomy of the adductor pollicis muscle is therefore the basis for this technique. A study of 20 specimens showed that the origins of the adductor pollicis are more extensive than generally described. This must be taken into account in release procedures in the first web space.
Arthroscopically-Assisted Reduction of Intra-Articular Fractures of the Distal Radius
Authors: ADOLFSSON L. , JÖRGSHOLM P.
Published: September 2005

Twenty-seven patients with intraarticular fractures of the distal radius with a step of more than 1 mm in the joint surface after attempted closed reduction, were treated by reduction under arthroscopic control and percutaneous fixation. All fractures healed without measurable incongruity of the joint surface and at follow-up 3 to 38 months after surgery 19 patients had excellent and eight patients good results according to the Mayo modified wrist score.
Proximal Row Carpectomy through a Palmar Approach
Authors: LUCHETTI R. , SORAGNI O. , FAIRPLAY T.
Published: September 2005

From 1990 to 1994, nine proximal row carpectomies were done through a palmar approach. With an average follow-up of 20 months, seven of the nine patients were completely painfree. Average range of wrist flexion/extension remained unchanged, and average radial/ulnar deviation increased from 25° to 46°. All the patients demonstrated an increase in grip strength in the operated hand. Four cases showed a slight reduction in articular space and subchondral sclerosis in the radiocapitate articulation, in spite of good function. Dynamic studies demonstrated no sign of radiocarpal instability. All the patients were very satisfied with the results and returned to their previous work within 2 months, on average.
Clinical Features and Management of Traumatic Posterior Interosseous Nerve Palsy
Authors: HIRACHI K. , KATO H. , MINAMI A. , KASASHIMA T. , KANEDA K.
Published: September 2005

The clinical features and results of treatment were reviewed in 17 traumatic palsies of the posterior interosseous nerve. Variations in clinical features depended on whether the recurrent branch or descending branch of the posterior interosseous nerve was injured. Seven patients had nerve repair, and two were treated by tendon transfers. Eight patients were treated conservatively. Sixteen of 17 patients recovered to more than M4 motor power at final follow-up. Associated muscle damage worsened the functional result.
Delayed Posterior Interosseous Nerve Palsy
Authors: SHARMA R. , DIMRI R. K. , DIAS J.
Published: September 2005

A case in which a glass foreign body caused a delayed posterior interosseous nerve palsy is described.
Compression of the Radial Nerve Caused by an Occult Ganglion
Authors: STEIGER R. , VÖGELIN E.
Published: September 2005

We report on three patients with radial nerve compression in the region of the supinator muscle caused by an occult ganglion. After excision of the ganglion and decompression of the posterior interosseous nerve, the nerve palsy resolved completely in all cases.
The Histopathology of De Quervain’s Disease
Authors: CLARKE M. T. , LYALL H. A. , GRANT J. W. , MATTHEWSON M. H.
Published: September 2005

The histopathological appearances of the tendon sheath and synovium from 23 patients treated surgically for de Quervain's disease are described and compared with 24 controls. The condition was not characterized by inflammation, but by thickening of the tendon sheath and most notably by the accumulation of mucopolysaccharide, an indicator of myxoid degeneration. These changes are pathognomonic of the condition and are not seen in control tendon sheaths. The term ‘stenosing tenovaginitis’ is a misnomer and we believe that de Quervain's disease is a result of intrinsic, degenerative mechanisms rather than extrinsic, inflammatory ones.
Kienböck’s Disease in Cerebral Palsy
Authors: LECLERCQ C. , XARCHAS C.
Published: September 2005

The incidence of Kienböck's disease is known to be higher in cerebral palsy patients, but little has been written on treatment. We report a case of Kienböck's disease in a young man affected by cerebral palsy. A proximal row carpectomy was done, which relieved spasticity at the same time as treating the disease.
Movement of the Scaphoid in the Normal Wrist
Authors: NUTTALL D. , TRAIL I. A. , STANLEY J. K.
Published: September 2005

The radiological images of 30 normal wrists in varying degrees of radial and ulnar deviation were analysed by measuring parameters of flexion and translation of the scaphoid bone. Results demonstrated a linear relationship, indicating that movement is consistently either by flexion of the scaphoid, translation or more commonly a combination of the two. The significance of this is discussed. There did not appear to be any age or sex related differences.
Scapholunate Ligament Repair and Capsulodesis for the Treatment of Static Scapholunate Dissociation
Authors: WYRICK J. D. , YOUSE B. D. , KIEFHABER T. R.
Published: September 2005

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78° and was corrected to a normal 47° at surgery. The average final scapholunate angle was 72°, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.
The Initiation and Sequence of Digital Joint Motion
Authors: SOMIA N. , RASH G. S. , WACHOWIAK M. , GUPTA A.
Published: September 2005

We studied the initiation and sequence of digital joint motion during unrestricted flexion and extension using a 3-D motion analysis of all fingers moving simultaneously. Our results showed that motion started in a single joint in 83% of flexion and 80% of extension cycles. The DIP joint initiated flexion and extension in the index, middle, and ring fingers, but in the little finger, flexion started in the PIP joint, and extension in the MP joint. The two most frequent sequences of joint movement during flexion of the three radial fingers were DIP-PIP-MP and PIP-DIP-MP. The two most frequent sequences during extension of the three radial fingers were DIP-MP-PIP followed by DIP-MP/PIP. In the little finger, however, the most frequent sequences during flexion were PIP-DIP-MP followed by DIP-PIP-MP and during extension, DIP-MP/PIP followed by PIP/DIP-MP
Thumb Joint Flexion
Authors: JENKINS M. , BAMBERGER H. B. , BLACK L. , NOWINSKI R.
Published: September 2005

The purpose of this study was to measure the amount of active flexion from a neutral position in normal thumb metacarpophalangeal and interphalangeal joints and compare the results with previously published reports. One hundred and nineteen subjects (238 thumbs) volunteered to have active flexion of the metacarpophalangeal (MP) and interphalangeal (IP) joints of the thumb measured with a computerized Greenleaf goniometer by a certified hand therapist. The mean MP flexion was 59° and IP flexion was 67°. The results of this study suggest that the accepted normal values of thumb flexion should be reconsidered, particularly as a guide for determining impairment.
Treatment of Mallet Finger Fractures by the Extension-Block K-Wire Technique
Authors: DARDER-PRATS A. , FERNANDEZ-GARCIA E. , FERNANDEZ-GABARDA R. , DARDER-GARCIA A.
Published: September 2005

We treated 22 patients with mallet finger fractures involving more than one-third of the articular surface by the extension-block K-wire technique. There were 18 men and four women with a mean age of 23 years (range, 14–34). The Wehbé and Schneider method was used to classify the fractures and the results were graded according to Crawford’s criteria. All the fractures united, with an average healing time of 5.6 weeks (range, 4–7). At a mean follow-up of 25 months (range, 18–48) 21 mallet finger fractures had an excellent or good result. One patient had a fair result with a lag to extension of 20°. We conclude that the extension-block K-wire technique is an effective method of treatment for displaced mallet finger fractures.
Hand Infections Due to Non-Cholera Vibrio after Injuries from St Peter’s Fish (Tilapia zillii)
Authors: SAID R. , VOLPIN G. , GRIMBERG B. , FRIEDENSTROM S. R. , LEFLER E. , STAHL S.
Published: September 2005

We report 49 patients with a wide variety of hand infections, which developed after injuries from St Peter’s fish (Tilapia zillii). Twenty-eight of 36 patients who had been operated on had non-cholera vibrio infections, all identified as Vibrio vulnificus. The course in these patients was characterized by rapid spread of the infection with progressive necrosis of the tendon sheath, subcutaneous tissues and the skin. Two of them required amputations but the others had satisfactory functional results. Thirteen other patients were managed nonoperatively with intravenous antibiotics and all of them recovered completely.
Bilateral Scapholunate Dissociations with Distal Radial Fractures and Post-Traumatic Intercarpal Fusion
Authors: GUPTA A.
Published: September 2005

A patient with bilateral intraarticular distal radial fractures associated with scapholunate dissociation and post-traumatic lunotriquetral fusion on one side is described.
Reconstruction of Fingertip Amputations by Partial Composite Toe Transfer with Short Vascular Pedicle
Authors: DAUTEL G. , CORCELLA D. , MERLE M.
Published: September 2005

Five patients under 15 years-of-age, with a fingertip amputation through the nail plate, were treated with a custom-made partial toe transfer. Two of the patients hid had previous attempts at surgical reconstruction using either a local flap or replantation. Delay between initial injury and reconstruction ranged from 2 to 60 days. In all cases the flap was harvested from the second toe. This “custom-made” compound transfer included the exact amount of pulp, nail bed and bone required for reconstruction. All flaps were harvested on a short vascular pedicle, with anastomoses performed at a digital level on the recipient site. Good to excellent cosmetic results were obtained in all cases, with a nearly normal-looking fingertip. Duration of hospital stay ranged from 4 to 7 days. We recommend this technique for treatment of distal amputation close to the proximal nail fold, in young individuals.