bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Study of Qualitative Staining of Peripheral Nerve with the Elisa Technique
Authors: Yu C-Y. , Zhang X-Z. , Hu Y-H. , Dong F-J. , Du M-C. , Fa S-Z. , Liu Y-S
Published: September 2005

A new technique of qualitative staining of peripheral nerve fibres was developed using the technique of enzyme-linked immunosorbent assays (ELISA). In 15 Wistar rats and five Harbin rabbits, the antibody IgGs labelled with rabbit-anti-rat enzyme was prepared. This was used to stain the sural nerves of the rats. In six sheep and human sural, radial and posterior interosseous nerves taken from fresh cadavers, the antibody IgGs labelled with sheep-anti-human enzyme was made. Nerve slices were sectioned from the nerve trunks and reacted with the enzyme-labelled antibody IgGs serum. The rat sural nerve and human sural, radial and posterior interosseous nerves showed good contrast of staining 25 minutes later. The sensory nerve fascicles were stained blue or brown blue, but the motor fascicles were negative. The period of staining was tested at 25 minutes, 55 minutes, and 115 minutes, and no obvious difference was observed in the colour of staining in these three groups. This technique was used in six nerves (two radial, two median, one ulnar and one tibial) in clinical cases. Differentiation of the sensory and motor nerve fascicles was possible. Contrast of colour in nerves at secondary nerve repair was less obvious than that in primary repair.
Children’s Proximal Phalangeal Neck Fractures with 180° Rotational Deformity
Authors: NEWINGTON D. P. , CRAIGEN M. A. , BENNET G. C.
Published: September 2005

Five patients under 4 years of age with 180° rotational deformity of a proximal phalangeal neck fracture are described. All cases resulted from a direct shear force to the bone coupled with a sharp withdrawal reaction of the hand. All of the children were successfully treated with open reduction and internal fixation but only after fruitless attempts at closed manipulation and an initial lack of recognition of the severity of the fracture. Each child achieved a full functional recovery of the finger with clinical and radiological union at 4 weeks.
Repeat Russe Bone Grafting after Failed Bone Graft Surgery for Scaphoid Non-Union
Authors: BYNUM E. B. , CULP R. W. , BONATUS T. J. , ALEXANDER C. E. , McCARROLL H. R.
Published: September 2005

We report the long-term outcome of repeat Russe bone grafting after failure of a previous Russe graft for scaphoid non-union. 15 patients were followed for a mean of 71 months after their last surgical procedure. 11 patients had undergone a single previous Russe graft and four patients had two previous graft attempts. Internal fixation was used in only three patients. Eight out of 15 (53%) patients achieved union after a single repeat graft and one out of four united after a third attempt. When union was achieved, range of motion was unchanged, grip strength was increased 10%, and pain was slight to none, allowing return to full employment in seven out of the nine patients. All patients who did not achieve union have either undergone a salvage procedure or are contemplating one. Based on the literature and our relatively low rate of union without internal fixation (53%), we recommend supplementary internal fixation if repeat Russe bone grafting is undertaken. When union is achieved, satisfactory results can be expected.
Influence of Joint Laxity on Scaphoid Kinematics
Authors: GARCIA-ELIAS M. , RIBE M. , RODRIGUEZ J. , COTS M. , CASAS J.
Published: September 2005

Excessively lax wrists more frequently become symptomatic if overloaded or injured than normal joints. Whether this is the consequence of biological or mechanical factors or both remains unknown. This study evaluates the relationship between the degree of joint laxity and scaphoid kinematic behaviour during radio-ulnar deviation of the wrist in 60 normal volunteers. There is a significant linear relationship between the direction of scaphoid rotation and the amount of wrist joint laxity. During lateral deviation of the wrist, joints that are more lax have a scaphoid rotating mainly along the sagittal plane of flexion and extension, with little lateral deviation. In contrast, the scaphoid of volunteers with decreased laxity rotate mostly along the frontal plane of radio-ulnar deviation with minimal flexion extension. These results support the concept of increased out-of-plane scaphoid rotation as a factor of increased vulnerability during over-work or injury.
The Treatment of Chronic Flexion Contractures of the Proximal Interphalangeal Joint
Authors: ABBIATI G. , DELARIA G. , SAPORITI E. , PETROLATI M. , TREMOLADA C.
Published: September 2005

A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90°, had been present for a period of between 2 months and 24 years.

Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions.

In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15°. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.
The By-Pass Extensor Tendon Transfer
Authors: OBERLIN C. , ATCHABAYAN A. , SALON A. , BHATIA A. , OVIEVE J. M.
Published: September 2005

A salvage technique for the treatment of substance loss of the extensor apparatus with some special features is presented. It uses the extensor indicis muscle prolonged with a tendon graft. The tendon is directly attached to the middle phalanx. After surgery, the wrist is immobilized in extension, allowing immediate active mobilization of the PIP joint. The results in five patients are satisfactory.
Post-Traumatic Triggering of Extensor Pollicis Longus at the Dorsal Radial Tubercle
Authors: LANZETTA M. , HOWARD M. , CONOLLY W. B.
Published: September 2005

A case of post-traumatic triggering of the tendon of extensor pollicis longus around Lister’s tubercle is described. This condition was successfully treated by surgical release.
A New Type of Flexor Tendon Repair
Authors: WILLIAMS R. J. N. , AMIS A. A.
Published: September 2005

Experiments were performed to evaluate biomechanical aspects of the performance of a “deep-biting peripheral suture” for flexor tendon repair, either when used alone or with a square or modified Kessler core stitch, and the technique was compared to the Kleinert repair. Tests included progressively increasing cyclic loads, force to pull the repair into the A2 pulley, and ultimate failure strength. 50% of the Kleinert repairs failed under 30 N cyclic loading, while 100% of the DBPS plus Kessler core stitch repairs survived. There was no discernable difference in gliding function or repair bulk between these sutures, but ultimate strength increased significantly with the DBPS repairs. We concluded that the DBPS plus Kessler-type core stitch will survive active mobilization better than the Kleinert method.
Reconstruction of a Complex Defect of the Dorsum of the Hand
Authors: TROPET Y. , BRIENTINI J. M. , GARBUIO P. , RIDOUX P. E. , VICHARD P.
Published: September 2005

A 37-year-old right-handed male truck driver was admitted with a severe injury of the dorsum of his right hand following a traffic accident. He had a large combined defect involving skin, tendons and bone. A complex reconstruction was performed using a large iliac crest allograft, a tendon graft and a free serratus anterior flap in one stage, 8 hours after the injury. A skin graft was performed later. 2 years later the functional and aesthetic result are good.
Correction of Dorsi-Flexed Intercalated Segment Instability after Restoration of Scaphoid Height in a Cadaver Model of Scaphoid Non-Union
Authors: YASUDA M. , KUSUNOKI M. , KAZUKI K. , YAMANO Y.
Published: September 2005

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.
Pre-Operative Progressive Distraction in Old Transcapho-Peri-Lunate Dislocations
Authors: SOUSA H. P. , FERNANDES H. , BOTELHEIRO J. C.
Published: September 2005

Three cases of 6- to 8-week-old transcapho-peri-lunate dislocation of the carpus were treated with pre-operative progressive distraction, using an external fixation apparatus for 1 week. Surgical reduction and osteosynthesis of the scaphoid was then easily performed.
Isolated Dislocation of all Five Carpometacarpal Joints
Authors: YILDIZ M. , BAKİ C. , ŞENER M.
Published: September 2005

Fracture-dislocation of all five carpometacarpal joints is extremely rare, only ten cases having been reported since 1873. A case of isolated dislocation of all five carpometacarpal joints is presented. A good result was obtained 1 year after open reduction and internal fixation. This case is the only isolated dislocation of all five carpometacarpal joints in the English literature.
Occult Distal Radial Fractures
Authors: DÓCZI J. , SPRINGER G. , RENNER A. , MARTSA B.
Published: September 2005

The radiological diagnosis of distal radial fractures is usually easy, but some fractures without displacement cannot be detected at the first examination. In this retrospective study of 626 wrist injuries diagnosed as “wrist sprain” we found 39 distal radial fractures which were discovered only after repeated examinations. The incidence of distal radial fractures was much higher than other wrist fractures that were diagnosed after repeated examinations. Repeat standard four-view X-ray examination, as well as other imaging methods, are necessary to diagnose these fractures.
Elbow Fractures with Carpal Injuries
Authors: LAHOTI O. P. , CALLANAN I. , REIDY D. P. , KELLY E. P. , McELWAIN J. P.
Published: September 2005

We report four cases with six episodes of concurrent carpal and elbow fractures or dislocations. Few such combinations of injuries have been reported in the literature. We discuss the mechanism and management of such injuries and conclude that elbow injuries should be suspected in severe carpal injuries. Surgical treatment may be required in their management.
A Biomechanical Study of the Ulnar Nerve at the Elbow
Authors: SCHUIND F. A. , GOLDSCHMIDT D. , BASTIN C. , BURNY F.
Published: September 2005

The relative elongation with elbow flexion of the ulnar nerve, proximal and distal to the cubital tunnel, and of the cubital tunnel retinaculum, was measured in cadaver specimens by stereophotogrammetry. The proximal part of the ulnar nerve elongated significantly with full elbow flexion. No significant change of length was measured in the distal part of the nerve. The length of the cubital tunnel retinaculum increased by an average of 45% from full elbow extension to full flexion.
Outcome Study of Ulnar Nerve Compression at the Elbow Treated with Simple Decompression and an Early Programme of Physical Therapy
Authors: NATHAN P. A. , KENISTON R. C. , MEADOWS K. D.
Published: September 2005

Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper limb. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 131 patients (164 ulnar nerves) over the past 12 years. 85% of these patients had mild or moderate ulnar nerve disease. In 146/164 ulnar nerves (89%), simple decompression resulted in good or excellent immediate post-operative relief of symptoms. After an average follow-up of 4.3 years (range, 0.8–12.0 years), 130/164 (79%) still reported good or excellent relief. The independent predictors of a better long-term outcome were absence of post-operative subluxation, greater body weight, normal pre-operative two-point discrimination (2-PD), and a more recent date of operation. A physical therapy rehabilitation program generally began on the day after surgery. Active participation in this predicted a rapid return to work or activities of daily living. The average time to return to work with simple decompression was 20 workdays.
Delayed Posterior Interosseous Nerve Palsy
Authors: HASHIZUME H. , NISHIDA K. , YAMAMOTO K. , HIROOKA T. , INOUE H.
Published: September 2005

A rare case of delayed posterior interosseous nerve palsy that developed 39 years after an unreduced anterior dislocation of the radial head is reported. The posterior interosseous nerve was compressed and narrowed at the arcade of Frohse. Radial head resection and release of the arcade was done. The paralysis continued to recover 6 weeks after operation. The nerve, at the arcade of Frohse, was susceptible to compression by the dislocated radial head, especially in the supinated position. Repeated supination and pronation movement over time may have led to developmental changes that caused the delayed nerve palsy.
Early Results of Conventional Versus Two-Portal Endoscopic Carpal Tunnel Release
Authors: DUMONTIER C. , SOKOLOW C. , LECLERCQ C. , CHAUVIN P.
Published: September 2005

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release ( n=40) or a two-portal endoscopic release ( n=56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.
The Effect of Unilateral Intercostal Nerve Transfer upon Lung Function
Authors: GIDDINS G. E. B. , KAKKAR N. , ALLTREE J. , BIRCH R.
Published: September 2005

Intercostal nerve transfer is a well-established technique in the treatment of some severe brachial plexus lesions in adults. There is, however, concern that in the presence of an ipsilateral phrenic nerve palsy it may lead to a significant compromise of respiratory function. 20 patients having intercostal nerve transfers had their lung function assessed pre-operatively and 6 weeks postoperatively. The patients were subsequently questioned about symptoms of respiratory dysfunction. There was no evidence that intercostal nerve transfer leads to a significant reduction in respiratory function in adults. It therefore appears safe to perform intercostal nerve transfers in adults following brachial plexus injuries even in the presence of an ipsilateral phrenic nerve palsy.
The Practical Use of Axillary Brachial Plexus Block for Hand Surgery
Authors: DUNLOP D. J. , GRAHAM C. M. , WATT J. M.
Published: September 2005

A retrospective study of 178 patients undergoing axillary brachial plexus block (ABPB) for hand surgery used information gathered by a computer-aided anaesthetic record keeping system. The practical use of local techniques to augment the block meant that only two of the 178 patients required a general anaesthetic, giving a success rate of' 98.8%. There were no significant complications.
A Method of two-Dimensional Measurement for Evaluating Finger Motion Impairment
Authors: CHIU H-Y.
Published: September 2005

A new method has been designed for direct measurement of the two-dimensional range of motion (ROM) of the finger. The two-dimensional method encompasses the postures imposed by various combinations of contraction and relaxation of the finger motors, so that an individual muscle injury or adhesion might be more easily detected. The figures and values obtained from the two-dimensional method are easier to interpret than those from conventional measurements, making the progress of the rehabilitated finger more apparent. Since the passive ROM cannot be evaluated by this method, it is a supplement rather than a substitution for the conventional range of motion evaluation for each joint. The drawback of the two-dimensional method is that it is more difficult to use than the conventional method.
Restricted Motion of the Median Nerve in Carpal Tunnel Syndrome
Authors: NAKAMICHI K. , TACHIBANA S.
Published: September 2005

Motion of the median nerve was compared on an axial ultrasonographic image in the mid-carpal tunnel in 30 wrists of 15 women with bilateral idiopathic carpal tunnel syndrome and 30 wrists of 15 healthy women. During passive flexion and extension of the index finger, the control wrists had transverse sliding of the nerve beneath the flexor retinaculum (1.75±0.49 mm), which was regarded as a physiological phenomenon. In contrast, the wrists of patients with carpal tunnel syndrome had significantly less sliding (0.37±0.34 mm; P=0.0001), which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of significance in the pathophysiology of carpal tunnel syndrome.
Isolated Sensory Impairment of the Thumb Due to an Intraneural Ganglion Cyst in the Median Nerve
Authors: JARADEH S. , SANGER J. R. , MAAS E. F.
Published: September 2005

We describe an unusual case of digital neuropathy of the thumb due to compression of the median nerve in the distal forearm by an extruded ganglion cyst originating from the radio-scaphoid joint of the wrist. Electrophysiologically, both conduction slowing and block of median motor and sensory axons were present across the cyst. These changes improved after surgery.
Absorbable Sutures in Tendon Repair
Authors: O’BROIN E. S. , EARLEY M. J. , SMYTH H. , HOOPER A. C. B.
Published: September 2005

The risks of foreign implantation may be avoided in tendon repair by the use of absorbable sutures, for example polydioxanone. In this study, the in vivo tensile strength half-life of 4/0 polydioxanone was found to be approximately 4 weeks. Using a rabbit model, we compared polydioxanone tendon repairs with polypropylene tendon repairs. Unilateral flexor digitorum longus repairs were performed on 46 rabbits using either polydioxanone or polypropylene. Tendons were harvested at 3 days, 2 weeks and 4 weeks and the tensile breaking strengths were obtained. 30 intact rabbit flexor digitorum longus tendons and 20 freshly repaired tendons were also tested. By 4 weeks, the repair strength had increased eight-fold from approximately 20 N to 166 N. The sutures made little contribution to the overall strength of a 4-week-old repair. There was no significant difference between polydioxanone and polypropylene repairs at any stage. These results show that polydioxanone repairs were as strong as polypropylene during the first critical weeks of tendon healing.
Flexor Tenosynovitis in the Hand
Authors: AUBERT J. P. , STEIN A. , RAOULT D. , MAGALON G.
Published: September 2005

We report an unusual case of tenosynovitis in the hand. A female farm worker aged 66 developed swelling of the middle and little fingers. Extensive synovectomy of the flexor tendon sheaths was performed, and the synovitis was found to be due to Listeria monocytogenes, which is unusual in this area. Treatment with amoxycillin and gentamicin for 10 days was replaced by trimethoprimsulfamethoxazole for 3 weeks. There was no recurrence of infection 3 months after surgery, and flexion and extension were complete at that time.
Two New Applications for the First Dorsal Metacarpal Artery Pedicle in the Treatment of Severe Hand Injuries
Authors: GERMANN G. , HORNUNG R. , RAFF T.
Published: September 2005

Two new indications for the use of the first dorsal metacarpal artery (1st DMA) in reconstruction following severe hand injury are reported. In the first case, a primary pollicization of the index finger was based solely on the dorsal arterial network. The second case involves a microvascular arterial revascularisation of a 1st dorsal metacarpal artery island flap. Neither procedure has previously been described.
A Flap for Segmental Loss of a Digital Nerve
Authors: SCERRI G. V. , PARK A. J. , HURREN J. S.
Published: September 2005

The use of a V-Y advancement flap for reconstruction of a volar/lateral soft tissue defect in a digit involving segmental loss of the neurovascular bundle of up to 10 mm at middle phalangeal level is described. This flap allows immediate reconstruction with primary repair of the nerve and gives good functional results. Two cases are presented.
X-Ray Analysis after Repair of Scaphoid Non-Union through a Dorsal Approach
Authors: SENNWALD G. R. , FISCHER M. , BENEDETTI R.
Published: September 2005

The consequences of non-union of the scaphoid with or without deformity were evaluated before and after surgery with non-parametric tests, MANOVA and discriminant analysis, and Spearman correlation and contingency tables. 18 consecutive cases of scaphoid non-union, operated upon through a dorsal approach preserving the carpal ligaments since 1987, were used for measurements. Carpal height, radio-lunate and radio-scaphoid angles, lunate covering ratio, and apparent translation of the capitate and lunate were analyzed on standard views of the wrist before and after scaphoid repair. We found that the lunate covering ratio combined with the radio-lunate angle was the main indicator of deformity before the repair as suggested by the strong correlation between the radio-lunate angle and lunate covering ratio ( P= 0.0001). After repair, the only indicator of mal-union was the apparent translation of the lunate on frontal views (P= 0.0033) as suggested by the strong correlation between real-union and lunate translation ( P= 0.0001). Translation of both the lunate and capitate correlated well before and after repair. Radio-scaphoid angle and carpal height showed no significant changes and are not informative in the presence of subtle carpal alteration. Repair of the scaphoid produced an improvement in the radio-lunate angle in all cases, even in the presence of mal-union. However, full restoration was never achieved even in the absence of mal-union. More precise techniques of measurement might contribute to a better understanding of the carpal mechanics in relation to wefi-defined diagnoses such as scaphoid non-union.
A Modified Approach to the Flexor Surface of the Distal Radius
Authors: Allen P. E. , Vickery C. W. , Atkins R. M.
Published: September 2005

Twenty-three preserved cadaver upper limbs were dissected to show the level of entry of the nerve supply to flexor carpi radialis and the extent of exposure of a new approach to the flexor surface of the distal radius. We describe a new approach to the flexor surface of the distal radius in which both the radial artery and the median nerve are protected by muscles or tendons.
Fractures of the Base of the Middle Phalanx Treated by a Dynamic External Fixation Device
Authors: Allison D. M.
Published: September 2005

Intraarticular fractures of the base of the middle phalanx are difficult to treat, especially if the fragments are comminuted. A spring dynamic traction device is described and the results in the first 14 patients presented. Patient acceptance has been high and the results comparable to other methods of treatment.
Steroid Injection for Carpal Tunnel Syndrome
Authors: Irwin L. R. , Beckett R. , Suman R. K.
Published: September 2005

We studied the medium- to long-term results of steroid injection into the carpal tunnel of women with the carpal tunnel syndrome (CTS).

Of 45 hands, only 11 had lasting relief of symptoms and 22 had no relief whatsoever. There was no correlation of the typical signs and symptoms of CTS with outcome.

Other series have offered various predictive factors for the outcome of injection but we found little or no correlation between these factors and outcome.
A Modification of the Catheter Method for Retrieval of Divided Flexor Tendons
Authors: TITLEY O. G.
Published: September 2005

A simple modification of the catheter technique for retrieving flexor tendons is presented. The technique is based on the Seldinger principle. A flexible metal guide-wire is used to route a polythene catheter through the flexor tendon sheath, enabling tendon retrieval.
Recurring Digital Fibroma of Childhood
Authors: BURGERT S. , JONES D. H. A.
Published: September 2005

A case of recurring digital fibroma of childhood is presented. The natural history of this condition over several years is documented. The literature is reviewed, with particular reference to the management of the condition.

Surgeons should be aware of the clinical features and the principles of management of this condition, as patients may be referred because of associated finger or toe deformities.
Spontaneous Thrombosis of Palmar Digital Veins
Authors: LANZETTA M. , MORRISON W. A.
Published: September 2005

Five cases of spontaneous thrombosis of a palmar digital vein are presented. The patients, all female, complained of a tender and unsightly lump over the digital palmar surface at the proximal interphalangeal joint level. Two fingers were affected in one patient. None could recall any history of trauma. In four cases a surgical excision was carried out. Histology confirmed the intraoperative findings of thrombosis of a superficial digital vein in every case. All patients are free from recurrence at a mean follow-up of 2.5 years.
Splint Therapy for Trigger Thumb and Finger in Children
Authors: NEMOTO K. , NEMOTO T. , TERADA N. , AMAKO M. , KAWAGUCHI M.
Published: September 2005

Forty-three trigger thumbs and fingers in 33 children (15 boys and 18 girls, average age 2 years and 4 months) were treated using a polyethylene splint. Affected digits included 40 thumbs, one index finger, and two middle fingers. The IP joint was stabilized in maximum extension via a strap on the dorsal side. The splint was applied only at night and during day-time naps. Twenty-four digits recovered completely in an average of 10 months, seven digits improved, and two digits required surgery. Eight patients (10 digits) dropped out of treatment. Splint therapy is effective in treating trigger thumbs and fingers in children.
Cellular Activity in E-PTFE Reconstructed Pulleys and Adjacent Regions of Deep Flexor Tendons
Authors: HANFF G. , ABRAHAMSSON S-O.
Published: September 2005

The biological adaption and integration of flexor tendon pulleys reconstructed with expanded polytetrafluorethylene (e-PTFE) were investigated 3 months after operation. E-PTFE pulleys showed no signs of failure, adverse tissue reactions or detrimental effects on the surface of underlying tendons. Cells in pulleys reconstructed with e-PTFE synthesized proteoglycan, collagen and non-collagen protein at a higher rate, and DNA at a lower rate, than cells in sham operated pulleys. Cells in pulleys reconstructed with e-PTFE synthesized proteoglycan at a lower rate, and protein at a higher rate, than cells in e-PTFE strips placed subcutaneously. Flexor tendon segments underlying reconstructed or sham operated pulleys synthesized matrix components and DNA at comparable rates.
Scaphoid Exostosis and Radio-Carpal Osteoarthrosis
Authors: RIMMER S. G. , BHOORA I. G. , HOOPER G.
Published: September 2005

We report seven patients (eight wrists) with osteoarthrosis of the wrist associated with an exostosis arising from the dorsal aspect of the scaphoid. We believe that the exostosis is secondary to impingement of the scaphoid on the radial styloid process and is a consequence rather than a cause of osteoarthrosis. Conservative management is advised.
The Intrinsic and Extrinsic Ligaments of the Wrist. A Correlation of Collagen Typing and Histologic Appearance
Authors: JOHNSTON R. B. , SEILER J. G. , MILLER E. J. , DRVARIC D. M.
Published: September 2005

20 fresh frozen human wrist specimens were dissected. Gross and histological examination and biochemical evaluation were performed on the intrinsic ligaments (scapho-lunate and luno-triquetral) and extrinsic ligaments (radio-scapho-capitate and radio-lunate). All ligaments were observed to have longitudinal collagen bundles. The intrinsic ligaments had large amounts of fibrocartilage near insertions and no elastin, while the extrinsic ligaments had little fibrocartilage and sparse amounts of elastin. The intrinsic ligaments were noted to have significantly more collagen Type 3 (41%) than the extrinsic ligaments (19%). These findings suggest that structural differences between the intrinsic and extrinsic ligaments of the wrist may in part account for the biomechanical observations that the intrinsic ligaments are stronger and elongate further prior to failure than the extrinsic ligaments.
Psychosocial Consequences of Upper Limb Injury
Authors: PATERSON M. C. , BURKE F. D.
Published: September 2005

Upper limb surgeons have little in the way of training in the identification or management of the psychological aspects of limb injury. Surgeons in training tend to see their speciality in technical terms, only slowly appreciating that the psychological state of the patient profoundly affects outcome in many cases.

The case report that follows charts the psychological progress of a patient following severe upper limb injury. Surgeons usually view rehabilitation in physical terms. This report emphasizes the psychological aspects of a major limb injury to a policeman (MP) who subsequently studied psychology at PhD level.
Compression of the Ulnar Nerve in Guyon’s Canal by Pseudotumoral Calcinosis in Systemic Scleroderma
Authors: CHAMMAS M. , RECKENDORF G. MEYER ZU , ALLIEU Y.
Published: September 2005

We report one case of ulnar nerve compression in Guyon’s canal due to calcium deposits in a 50-year-old woman with long standing systemic scleroderma. To our knowledge, this is the second known case. The symptoms consisted of a motor and partial sensory disturbance. Calcification of the piso-triquetral joint was prolonging into Guyon’s canal, lifting its contents, and into the subcutaneous tissue of the ulnar border of the wrist. Excision of calcium deposits and of the pisiform in combination with external neurolysis of the ulnar nerve resulted in complete relief of symptoms.
Versatility of the Homodigital Triangular Neurovascular Island Flap in Fingertip Reconstruction
Authors: LANZETTA M. , MASTROPASQUA B. , CHOLLET A. , BRISEBOIS N.
Published: September 2005

This paper reports 25 cases of a versatile homodigital triangular neurovascular island flap for fingertip reconstruction. This flap was used to reconstruct traumatic oblique palmar amputations, with loss of fingertip pulp requiring advancement of not more than 2 cm. Good results were obtained in terms of fingertip contour and padding, sensibility, and functional recovery. The tendency for flexion contracture at the PIP joint was prevented by using a dynamic extension splint at night. Cold intolerance must be expected, especially in cold countries.
Measurement of the Arc of Digital Flexion and Joint Movement Ranges
Authors: ARBUCKLE J. D. , McGROUTHER D. A.
Published: September 2005

Dynamic digital flexion was examined by video recording healthy subjects making a fist. The are of the fingertip sweep from full extension to full flexion was replayed frame by frame and plotted. A similar technique was employed to measure the MP, PIP and DIP joint angles throughout digital flexion. Graphs were plotted of MP against PIP, and PIP against DIP flexion. These results were related to a theoretical 45° line.

The fingertip appears to sweep through an elliptical pathway when flexing, rather than an equiangular curve. Graphs of joint flexion showed that male and female fingers flex in a similar fashion, as do the index and little finger. Graphs of PIP against DIP flexion suggest some limiting mechanism of either the extensor or flexor system.

These graphs give useful insights into the complex mechanisms of dynamic digital flexion, and may be of diagnostic and prognostic importance.
Experimentally Induced Ulno-Carpal Instability
Authors: WIESNER L. , RUMELHART C. , PHAM E. , COMTET J. J.
Published: September 2005

This experimental work studies the role of ligamentous structures in suspending the carpal bones from the radius and ulna.

Thirteen human cadaver wrists underwent a distal radio-ulnar arthrodesis in a neutral position and an arthrodesis between the three bones of the first carpal row. Progressive postero-anterior forces in a palmar direction were applied to the fused carpal bones. Displacement was measured by two dial gauges before and after sequential section of the different fibrous structures.

The largest absolute average displacement (both, dorso-palmar and induced rotational displacement) was observed after section of the ulnar styloid process. No significant differences were observed after section of the extensor retinaculum, extensor carpi ulnaris sheath, posterior ulno-carpal and posterior radio-carpal ligaments.

This work suggests that the carpus is suspended not only from the radius, but also from the distal ulna and particularly at the ulnar styloid and the structures which insert onto it.
Long-Term Results of Vein Grafts Interposed in Arterial Defects Using the Telescoping Anastomotic Technique and Fibrin Glue
Authors: SAITOH S. , NAKATSUCHI Y.
Published: September 2005

Fibrin glue has been applied in the anastomosis of vein grafts placed in rat femoral arteries using the telescoping technique at both ends of the graft. 34 out of 35 grafts which were patent 1 to 3 weeks post-operatively were kept for 3 months to assess the long-term patency, and the effect of the glue on the diameters of the graft and femoral artery. All 34 grafts were patent 3 months post-operatively. Excessive enlargement of the graft diameter was alleviated by the fibrin glue without affecting the diameter of the femoral artery. The diameter at the proximal anastomosis was 66% and that at the distal anastomosis was 87% of the diameter of the femoral artery.
Congenital Neuroepithelioma in an Infant Hand
Authors: ERDMANN D. , BROWN R. E. , RUMBOLO P. M.
Published: September 2005

We describe a congenital peripheral neuroepithelioma of the hand in an infant aged 6 weeks. This primitive malignant tumour of neuroepithelial origin is extremely rare in neonates. Peripheral neuroepitheliomas of the hand have not been described in the literature previously. Specific diagnosis and the current therapeutic approaches are discussed.
Dorsally Displaced Epiphyseal Fracture of the Phalangeal Base
Authors: HASHIZUME H. , NISHIDA K. , MIZUMOTO D. , TAKAGOSHI H. , INOUE H.
Published: September 2005

A dorsally displaced epiphyseal fracture of the middle phalanx (Salter–Harris Type I) is described. The epiphyseal fragments were attached to the central slip of the extensor tendon and collateral ligaments. The articular surface of the PIP joint was intact and smooth. The epiphysis was reduced and fixed without cutting the central slip or the collateral ligaments 8 months after injury. This kind of fracture can occur in the PIP and DIP joints, and presents special diagnostic difficulties. Open reduction is evidently necessary to correct the displacement.
Excision of the Trapezium for Osteoarthritis of the Trapeziometacarpal Joint of the Thumb
Authors: HOLLEVOET N. , KINNEN L. , MOERMANS J. P. , LEDOUX P.
Published: September 2005

We assessed the results of 86 trapeziectomies in 83 patients. Simple excision of the trapezium was performed in 54 thumbs. This was combined with shortening of the abductor pollicis longus tendon in 14 thumbs and with soft-tissue interposition and/or ligamentous reconstruction in 17 thumbs.

88% of the patients were satisfied with the result, 76% had relief of pain and 74% had no functional disability. The subjective results achieved with the three different techniques were similar.

Clinical assessment of 57 thumbs revealed no statistical difference in web span, thumb adductionflexion, key pinch and grip strength between the three operative procedures, nor in comparison with the non-operated contralateral hand.
Tennis Elbow: Treatment of Resistant Cases by Denervation
Authors: WILHELM A.
Published: September 2005

Anatomical and clinical research has shown that the entire lateral epicondylar region is innervated only by radial nerve branches. Based on these investigations we have developed a surgical procedure for complete denervation which is indicated only in resistant cases of tennis elbow. Only one nerve pathway calls for careful exposure, otherwise denervation is accomplished blindly by disinsertion of certain muscles. The result of this procedure also depends on simultaneous indirect decompression of the posterior interosseous nerve. Excellent or good results were obtained in 90% on average. Results of denervation did not improve by additional direct radial nerve release.
Resurfacing Relatively Large Skin Defects of the Hand Using Arterialized Venous Flaps
Authors: WOO S. H. , JEONG J. H. , SEUL J. H.
Published: September 2005

Skin flaps nourished by arterial blood entering through the venous network were applied in 12 cases of relatively large skin defects of the hand. The flaps showed remarkable oedema and multiple bullae on their surface from the second to the 14th postoperative day, but partial necrosis of the flap only developed in three cases. The free arterialized venous flap is a useful procedure for resurfacing relatively large skin defects of the hand.
Does an Ulnar Nerve Lesion Influence the Motion of the Index Finger?
Authors: HAHN P. , HEINDL E.
Published: September 2005

Clawing of the ring and little fingers and “rolling” during prehension grip are well-known clinical phenomena of ulnar nerve lesions. In contrast to this the index and middle fingers seem to move normally. We compared the movement of right index fingers in healthy people with the right index fingers of people with an ulnar nerve lesion. The movement was measured using a three-dimensional real time motion analysis system based on ultrasound. The angles of the joints were plotted in a rectangular coordinate system. Statistical analysis of the numerical data showed no difference between the two groups. We trained a neural-network (Learning Vector Quantization) with the data of both groups. The network was able to distinguish between people with and without lesions of the ulnar nerve. We conclude that prehension grip of the index finger is also influenced by paralysis of the ulnar nerve.
Recurrent Eccrine Acrospiroma of the Hand
Authors: KALAINOV D. M. , DICARLO E. F. , YANG S. S. , WEILAND A. J.
Published: September 2005

A rare case of a recurrent, benign, eccrine acrospiroma of the hand is described.
A Cadaveric Study of The Anatomy and Stability of The Distal Radioulnar Joint in The Coronal and Transverse Planes
Authors: TOLAT A. R. , STANLEY J. K. , TRAIL I. A.
Published: September 2005

Fifty preserved cadaver wrist specimens were studied. The anatomy of the distal radioulnar joint is complex, with varying configurations in the transverse and midcoronal planes. There is disparity in the radii of curvature of the sigmoid notch and the ulna-articular surface in the transverse plane, with resultant articular incongruity. Motion at the distal radioulnar joint is, hence, likely to be a combination of sliding and rotation with a small area of true appositional contact. The palmar osteocartilaginous lip of the sigmoid notch, along with the interosseous membrane, may be of importance in distal radioulnar stability. Palmar and dorsal radioulnar ligaments may act as “check-rein” ligaments, especially when seen with the “flat face” (type A) sigmoid notch.
“Congenital” Trigger Thumb Caused by Intratendinous Granulation Tissue
Authors: CHIA J. , PHO R. W. H. , SINNIAH R.
Published: September 2005

We report triggering of the thumb in a 2-year-old female child caused by intratendinous granulation tissue after trauma to the thumb.
Flexor Tendon Repair in Zone 2 Followed by Early Active Mobilization
Authors: BAKTIR A. , TÜRK C. Y. , KABAK Ş. , ŞAHIN V. , KARDAŞ Y.
Published: September 2005

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated prospectively in 88 fingers of 71 patients using two different early postoperative mobilization programmes. In 33 patients, the Kleinert rubber band passive flexion method was used. In the remaining 38 patients, the early active mobilization programme was used. All patients were reviewed 1 year after operation and the results assessed by the Strickland criteria. During this evaluation maximum grip strength was also measured.

The results were excellent or good in 78% of digits and mean grip strength was 84% of the uninjured hand in the Kleinert rubber band passive flexion group. In the early active mobilization group, excellent or good results were achieved in 85% of the digits and the mean grip strength was 90% of the uninjured hand. There were two early ruptures in each group.
A New Technique of Attachment of Flexor Tendons to The Distal Phalanx without A Button Tie-Over
Authors: SOOD M. K. , ELLIOT D.
Published: September 2005

A new technique of attachment of the flexor digitorum profundus tendon and flexor tendon grafts to the distal phalanx, without using a button on the nail, is described and its use reported in 14 cases.
Restoration of Metacarpophalangeal Extension of the Thumb in Inflammatory Arthritis
Authors: MANUEDDU C. A. , BOGOCH E. R. , HASTINGS D. E.
Published: September 2005

Nine patients (11 cases) with inflammatory arthritis who had an early boutonnière deformity of the thumb treated by rerouting of the extensor pollicis longus tendon were reviewed.

Preoperatively, all patients complained of pain, disability in activities of daily living and extensor lag of the MP joint ranging from 10 to 60°. At a mean follow-up of 38 months, nine thumbs had equal active and passive MP joint extension. Two thumbs had a moderate extensor lag. Functional strength assessment demonstrated no deleterious effect of the procedure in the operated compared to the non-operated thumb. Subjectively, all patients but one were satisfied.

This procedure appeared to correct or to limit the progression of the deformity. A deficit of interphalangeal extension in five patients may require a modification of the procedure to tighten the extensor pollicis longus distal to the MP joint.
Extremity Gangrene in Utero
Authors: CARR M. M. , AL-QATTAN M. , CLARKE H. M.
Published: September 2005

A neonate with extremity gangrene resulting from intrauterine embolization of infarcted placental substances is discussed. This rare clinical entity is thought to be most commonly a manifestation of embolic phenomenon during maturation of the neonatal circulatory system. Management of neonatal gangrene is conservative, delaying amputation as long as possible since the line of demarcation tends to migrate distally. Evidence of multiple emboli should be carefully sought prior to definitive treatment.
Idiopathic Multicentric Osteolysis Principally Affecting the Phalanges of the Hands and Feet
Authors: DOWNING N. D. , GARNAVOS C. , LUNN P. G.
Published: September 2005

The case of a 64-year-old man with idiopathic symmetrical osteolysis affecting both hands and feet is presented. The phalanges were principally affected, with relative sparing of the carpus and tarsus. The relevant literature has been reviewed and this reveals that the distribution of osteolysis in this case is unique. We suggest that this case represents a different disease entity, which has not been described previously.
Total Middle Ray Amputation
Authors: LYALL H. , ELLIOT D.
Published: September 2005

Eight patients underwent middle ray amputation with excision of the whole of the middle metacarpal and careful soft tissue repair. Excision of the base of the middle metacarpal allowed easier approximation of the index and ring rays without the tendency of these fingers to either scissor on finger flexion or to remain slightly apart. Complete removal of the middle metacarpal appears to allow the bases of the index and ring metacarpals to migrate together. The removal of the metacarpal base caused no functional problems and the technique created a good three-finger hand from both a functional and cosmetic point of view.
Osteoid Osteoma of the Radial Diaphysis
Authors: NAKAMICHI K. , TACHIBANA S.
Published: September 2005

We report a case of osteoid osteoma of the radial diaphysis. Excision of the nidus relieved pain.
A Small Cavernous Vascular Malformation in the Hand Mimicking a Glomus Tumour
Authors: AL-QATTAN M. M.
Published: September 2005

A case of a subcutaneous haemangioma of the hand clinically mimicking a glomus tumour is described. Other discrete small hand tumours that may present with the triad of pain, tenderness and cold intolerance are discussed.
Injectable Calcium Phosphate in the Treatment of Distal Radial Fractures
Authors: KOPYLOV P. , JONSSON K. , THORNGREN K. G. , ASPENBERG P.
Published: September 2005

An injectable material which hardened in situ to form a carbonated hydroxyapatite, Norian SRS (Norian Corp., Cupertino, USA), was used as the only treatment of unstable distal radial fractures in six patients. Except for an external dorsal splint for 2 weeks, no other treatment was used. The material maintained reduction except in one case in which there were technical problems during hardening and the material fragmented postoperatively. By 1 year all patients had a satisfactory clinical outcome. There was an early return of motion. The possibility of mobilization 1 or 2 weeks after the operation may reduce postoperative stiffness and increase short-term functional outcome.
Herbert Screw Insertion in the Scaphotrapezial Joint
Authors: CALLANAN I. , LAHOTI O. , McELWAIN J. P.
Published: September 2005

The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.
Explosion Injuries of the Hand
Authors: HAHN P. , BREDERLAU J. , KRIMMER H. , LANZ U.
Published: September 2005

Twenty-six hands in 25 male patients were treated for peace-time explosion injuries of the palmar aspect. All patients were examined after a mean interval of 7 (1–17) years. In order to establish a regional pattern for each injury the palmar surface of the hand was divided in 21 fields. For each field a score depending on the extent of injury was calculated. Comparing this regional score with the spatial relation between hand and exploding object resulted in six typical patterns depending on the grip during explosion. With knowledge of the three-dimensional relation between the hand and exploding object, the hand surgeon is prepared for potential problems during operation.
Ulnar Variance and Age
Authors: SANDERSON P. L. , CAMERON I. C. , HOLT G. R. , STANLEY D.
Published: September 2005

Ulnar variance was determined on 1,023 radiographs of normal wrists taken in standardized fashion. There were 468 women and 555 men. The age range was 13 to 109 years. In both sexes, ulnar negative variance decreased significantly with increasing age. Possible reasons for this are discussed.
Microsurgical Approach for a Venous Malformation of the Thumb
Authors: ADANI R. , BUSA R. , CAROLI A.
Published: September 2005

We report a case of a low-flow venous malformation of the thumb treated by microsurgical excision of the mass and a free toe pulp flap. Forty-two months after surgery the patient had a good cosmetic and functional result without any recurrence of the tumour.