bluuebunny/crossref_metadata_2025 huggingface dataset:
Fascia-Cutaneous Cross-Arm Flaps in Hand Reconstruction
Authors: DICKINSON J. C. , ROBERTS A. H. N.
Published: December 2021

Experience is reported in the use of eight fascio-cutaneous cross-arm and forearm flaps in three patients. This has proved to be a reliable and satisfactory means of providing skin cover in reconstruction of the hand, giving flaps of a length to breadth ratio of at least two to one. The method was particularly useful where multiple defects were encountered, although in one case where a single defect required reconstruction, the ability to tube the pedicle of the flap allowed full mobility of the injured hand. Primary wound healing was achieved in all cases, and the patients have progressed to a satisfactory functional result. The advantages and disadvantages of this flap are discussed and compared with other established methods of reconstruction.
A Long-Term Study Following Bennett’s Fracture
Authors: CANNON S. R. , DOWD G. S. E. , WILLIAMS D. H. , SCOTT J. M.
Published: December 2021

Twenty-five patients with documented Bennett’s Fractures were reviewed five to sixteen years following injury (Mean 9.6 years). The majority of fractures affected the dominant hand and occurred in males. Twenty-two patients were managed conservatively by plaster immobilisation. At review ten patients were asymptomatic and only two had significant symptoms. Examination revealed loss of movement in the trapeziometacarpal joint of the thumb in twenty-one cases. Five of these exhibited malrotation of the thumb. Review of the post reduction radiographs revealed separation of the fragments by 1 mm or more in sixteen patients, but symptoms at follow-up could not be correlated with accuracy of reduction. Twenty-three patients had a varus angulation of the first metacarpal base which could be correlated to the initial post-reduction displacement. There was no correlation with the restriction of movement. Although metacarpal length will only be maintained by reduction of the fracture, there was little evidence that imperfect reduction leads to significant symptomatic arthritis in the long term.
Calcifying Synovial Sarcoma
Authors: LOUIS D. S. , HANKIN F. M. , BRAUNSTEIN E. M. , VERKLIN R. M.
Published: December 2021

The presence of a calcified mass in the soft tissue may be the result of any number of processes. Post-traumatic changes and metabolic alterations may both lead to such calcification. The presence of calcification is much less commonly seen in malignant neoplasms. A case of calcifying synovial sarcoma with unusual features was recently seen.
A Rare Case of Carpal Tunnel Syndrome due to Tenosynovial Osteochondroma
Authors: NATHER A. , CHONG P. Y.
Published: December 2021

A rare case of carpal tunnel syndrome due to an extra-articular synovial osteochondroma arising from the synovial sheath of the flexor pollicis longus tendon, is described. This has not been described in the literature previously. The cyst with the contained osteochondroma was excised with good relief of symptoms. The histological examination of the osteochondroma revealed another interesting and unusual feature. We would like to document a case of tenosynovial chondrometaplasia of the synovial lining of a tendon sheath. Only a few such cases have been reported in the literature.
Musculotendinous Variations about the Medial Humeral Epicondyle
Authors: DELLON A. LEE
Published: December 2021

Anatomical variations in the musculofascial structures about the region of the medial humeral epicondyle were evaluated in 104 extremities in sixty-four cadavers. This study demonstrated presence of an Osborne’s band in 77%, of some degree of ulnar subluxation in 25%, of an epitrochlearis anconeus muscle in 11%, the ulnar nerve beneath the medial head of the triceps in 24%, the medial head of the triceps within the floor of the cubital tunnel in 28%, the presence of a rudimentary supracondylar process in 1.5%, and a high origin of the pronator teres in 17% of the cadavers. There was a significant association between the presence of an epitrochlearis anconeus muscle and the ulnar nerve being completely covered by the medial head of the triceps muscle (p<.00l). There was a significant relationship between the presence of the medial head of the triceps in the cubital tunnel and ulnar nerve subluxation (p.001). The high origin of the pronator teres may provide a proximal site for “double crush” syndromes of the median nerve.
Use of a Wheel Aesthesiometer for Testing Sensibility in the Hand Results in patients with carpal tunnel syndrome
Authors: MARSH D. R.
Published: December 2021

Tests of spatial discrimination were performed on the hands of patients with carpal tunnel syndrome, before and after surgical decompression. Impairment of sensibility and its recovery after treatment were better demonstrated by a new instrument, the wheel aesthesiometer, than by the moving two-point discrimination test. The psychophysics of the new test and the nature of the sensory impairment in carpal tunnel syndrome are discussed.
Tikhoff Procedure in Recurrent Chondrosarcoma Following Free Vascularised Fibular Graft
Authors: KUMAR V. P. , PHO R. W. H.
Published: December 2021

A forty year old housewife presented with a recurrent chondrosarcoma in a vascularised fibular transplant for a tumour in the proximal humerus. The Tikhoff-Linberg procedure was carried out with satisfactory results. The case report serves to emphasize the need to be aggressive in the initial management of malignant bone tumours. Careful planning and execution of a further aggressive procedure in the presence of a recurrence, ensures adequate clearance of tumour while still preserving a functional and useful limb.
Correlation Between Clinical Results and Carpal Instabilities in Patients after Reduction of Lunate and Perilunar Dislocations
Authors: MINAMI A. , OGINO T. , OHSHIO I. , MINAMI M.
Published: December 2021

Thirteen patients with lunate and perilunar dislocations were treated in our department in the last five years. Ten out of the thirteen patients were followed more than eight months with an average of two years and two months. Two out of the ten patients followed failed to obtain normal anatomical carpal architecture. These two patients were treated by arthrodesis of the wrist and proximal row carpectomy, respectively. The remaining eight patients, that obtained reduction, were classified into three groups according to existence of gap between the scaphoid and lunate, and incongruity between the lunate and triquetrum. Patients with a gap between the scaphoid and lunate of more than 3 millimetres after reduction of their dislocations had poor clinical results. This suggests significant correlation between clinical results and carpal instabilities.
Abducted Little Finger in Low Ulnar Nerve Palsy
Authors: BURGE PETER
Published: December 2021

Persistent abduction of the little finger after ulnar nerve palsy has been attributed to the unopposed action of extensor digiti minimi. Evidence is presented that the deformity can also result when re-innervation reaches abductor digiti minimi but not the palmar interossei. Operative correction of the deformity, if required, should be delayed until it is clear that no further muscle recovery is likely to occur.
A Possible New Operative Method for the Treatment of Metacarpophalangeal Joint Stiffness
Authors: PHIPPS A. R. , HENDERSON H. P.
Published: December 2021

A case is reported in which metacarpophalangeal joint capsulotomy is augmented by the use of a flap of fibrous tissue from around previously implanted silicone sheet as a form of capsular reconstruction.
Wrist Arthrodesis as Part of Composite Surgery of the Hand
Authors: STANLEY J. K. , HULLIN M. G.
Published: December 2021

A simple, quick and reliable method of artbrodesis of the wrist joint enables other surgical procedures to be carried out at the same time under the same tourniquet, thus reducing strain upon the patient and the hospital services.
Differential Diagnosis of Acute Dactylitis Psoriatica
Authors: BRENNER P. , TIZIAN C.
Published: December 2021

A bulbous or “sausage-shaped” finger may represent a special type of psoriatic arthritis without any rheumatoid factor activity. Dactylitis psoriatica must be suspected in cases of arthralgias progressing along the phalanges of a finger associated with global soft tissue swelling. Acute dactylitis psoriatica is characterized by an intermittent course combined with psoriatic and partly extremely mild or masked skin and nail changes. X-rays findings are spicular protuberances at diaphyses in a “cloudy collar” image. Symptomatic treatment of dactylitis psoriatica consists of non-steroidal antirheumatic drugs or basic gold salt therapy. In the interval additional surgical treatment using arthro-plasties and arthrodeses is indicated in cases of joint destruction. Amputation of the affected finger is not to be considered as a mandatory causal therapy of dactylitis psoriatica.
Insiduous Erosion of a Digit by a Ring
Authors: PRASAD S. , PATIL U. , THATTE R.
Published: December 2021

Avulsion injuries in fingers can be caused by rings worn on fingers. If the ring is tight, it can also cause an unusual problem, that of deep erosion into the finger. Only two cases with such erosion, both of them in adults have been reported so far. A child with a similar problem is presented here as a case report.
A Tendon Tumour Presenting as a Trigger Finger
Authors: LAING P.W.
Published: December 2021

A case of trigger finger in a fourteen-year-old child, presenting as locking in extension is reported. At operation a tumour arising from the superficials tendon was found and removed.
Sarcoid Tenosynovitis in the Hand A Case Report and Literature Review
Authors: MERLE M. , BOUR C. , FOUCHER G. , LAURENT Y. SAINT
Published: December 2021

We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.
Congenital Radio-Ulnar Synostosis: Compensatory Rotation around the Wrist and Rotation Osteotomy.
Authors: OGINO T. , HIKINO K.
Published: December 2021

In order to make clear the clinical features of congenital radio-ulnar synostosis, compensatory rotation around the wrist and functional results after rotation osteotomy, 40 cases of congenital radio-ulnar synostosis have been analysed. The mean pronation of the ankylosed forearm in those who complained of disabilities in daily life was 60.7° and that in patients without complaints was 21.2°. In almost all cases with total ankylosis, the forearm had compensatory movement around the wrist, the mean arc being from 76.3° of pronation to 42.9° of supination. 13 limbs in 11 patients treated by transverse rotational osteotomies through the fusion mass have followed up for over two years. The functional results after surgery were satisfactory in all patients. Rotational osteotomy of the forearm is a useful and reliable treatment for congenital radio-ulnar synostosis.
A Modification of the Kleinert Splint for Mobilisation of Digital Flexor Tendons
Authors: KNIGHT S. L.
Published: December 2021

A modification of the Kleinert dynamic splint is described, whereby the rubber band is looped around the hand, rather than attached to the volar aspect of the wrist or forearm. This alters the direction of traction so that the interphalangeal joints are more effectively mobilised.
Hypoplastic Scaphoid — an Unusual Cause of Carpal Tunnel Syndrome
Authors: RADFORD P. J. , MA’ITHEWSON M. H.
Published: December 2021

A case of median nerve compression within the carpal tunnel, secondary to hypoplasia of the carpal scaphoid and dysplasia of the distal radius, is descibed in a 15-year-old boy with Spondylo-epiphyseal dysplasia tarda. Hypoplastic carpal bones and a dysplastic distal radius may be a feature of Spondylo-epiphyseal dysplasias, but carpal tunnel syndrome has not been previously reported either in this condition or in association with hypoplasia of the scaphoid.
Dislocation of Carpometacarpal Joint of the Little Finger
Authors: CHEN V. T.
Published: December 2021

A case is reported of late ulna-volar carpometacarpal dislocation of the left little finger, treated by open reduction and internal fixation.
Calcification in Dupuytren’s Disease: A Report of Two Cases
Authors: ANDREW J. G.
Published: December 2021

Two cases are presented of calcification within Dupuytren’s tissue. Histological appearances of the tissue showed both cartilaginous and osseous metaplasia. This indicates that fibroblasts in Dupuytren’s Disease may undergo this type of metaplasia in a similar fashion to fibroblasts elsewhere.
An Abnormality of Nail Growth Associated with Median Nerve Damage
Authors: ROSS J. K. , WARD C. M.
Published: December 2021

It has been recognised for a long time that damage to the median or ulnar nerves is usually followed by slowing of growth of the fingernails. In the past, this has always been ascribed to immobilization of the appropriate digits, rather than to a neurotrophic factor. No other nail changes appear to have been described in association with nerve damage. We present two patients with marked nail changes following median nerve injury, in which immobilization does not appear to be responsible.
Scaphoid Osteosynthesis: Early Experience with the Herbert Bone Screw
Authors: PRING D. J. , HARTLEY E. B. , WILLIAMS D. J.
Published: December 2021

The results of our first fourteen patients with fractured scaphoids treated with the Herbert bone screw have been disappointing. Six have failed to unite. The operation is technically demanding and there is a high incidence of malpositioning of the screw which correlates with failure to achieve union. This is predictable from initial radiographs and peroperative radiology is advised. The osteosynthesis should be protected until union has occurred radiologically, especially in manual workers.
Soft-Tissue Interposition as a Possible Cause of Scaphoid Non-Union
Authors: WILTON T. J.
Published: December 2021

Two cases of dorsal trans-scaphoid perilunar dislocation are reported, in which the fracture was found, at operation, to contain interposed ligament.

It is recommended that such fractures be explored unless perfectly reduced, and that percutaneous pinning of the reduced fracture may be inadequate treatment.
Fractures of the Triquetrum
Authors: De V. De BEER J. , HUDSON D. A.
Published: December 2021

The commonest carpal fractures are those of the carpal scaphoid. Triquetral fractures are relatively uncommon, but when present, often go undiagnosed or are misdiagnosed as lunate fractures. Clinical suspicion and careful evaluation of the appropriate radiographs, especially an oblique view, should ensure the diagnosis.
Anatomical Relations in the Carpal Tunnel: A Computed Tomographic Study
Authors: JESSURUN W. , HILLEN B. , ZONNEVELD F. , HUFFSTADT A. J. C. , BEKS J. W. F. , OVERBEEK W.
Published: December 2021

Computed tomography of the carpal tunnel was performed in the hands of both patients and controls in a neutral position, in flexion and in extension.

The median nerve was not compressed between the long flexors and the flexor retinaculum in either flexion or extension of the wrist. In flexion, the nerve usually moved dorsally, away from the flexor retinaculum. No difference could be found between the cross-sectional area of the carpal tunnel between patients and controls.
Some Observations on Controlled Mobilisation Following Flexor Tendon Injury
Authors: McLEAN N. R.
Published: December 2021

Several modifications of the Kleinert splint are described including a modified pulley bar, taping of the pulps to prevent skin ulceration and the use of constant-tension springs to simulate more closely the normal flexor muscle function.
The Disappearing Needle
Authors: ARBEL R. , KAPLIN O. , GOODWIN D. R. A.
Published: December 2021

This is a report of an unusual surgical curiosity involving the median nerve at the wrist. A sewing needle, which penetrated the region of the wrist joint anteriorly, unknown to the patient, also penetrated the median nerve without causing any initial discomfort or neurological deficit. There was no damage to the nerve hut locating the “disappearing” needle at operation was difficult.
Diabetes Mellitus Presenting as “Acute Osteomyelitis” of the Index Finger
Authors: SHANKAR S.
Published: December 2021

A case of previously undiagnosed maturity onset diabetes in a fifty-eight-year-old man with a “septic index finger” is reported. Intial X-rays showed gross destruction of the distal phalanx, suggestive of acute osteomyelitis. Control of the diabetes combined with minimal debridement of the finger resulted in healing of the lesion. X-rays taken four weeks later showed complete reconstitution of the distal phalanx, confirming the need to be conservative in the management of lesions associated with diabetes. In spite of a careful and extensive search into the literature covering unusual presentations of diabetes mellitus, the author is unable to trace a similar recorded case involving the digit of upper limb.
Tendon Implantation into Bone: An Experimental Study
Authors: JONES J. R. , SMIBERT J. G. , MCCULLOUGH C. J. , PRICE A. B. , HUTTON W.C.
Published: December 2021

We report the results of an experimental study to investigate the mechanical properties and histological structure of the tendon-bone junction following surgical implantation of tendon into bone in the rabbit.

The results following tendon transfer and tendon grafting were compared.

The normal four-zone tendon junction was not reproduced histologically, in either group, After 20 weeks, the mechanical strength of the tendon transfers had reached 60% of the controls and that of the tendon grafts 20% of the controls.

Microangiography demonstrated that these differences were not related to the vascularisation of the tendon bone juction. The mechanical properties of the tendon-bone junction may be dependent more on the functional state of the implanted tendon than on its structure.
A Quantitative Ultrastructural Study of Collagen Fibril Formation in the Healing Extensor Digitorum Longus Tendon of the Rat
Authors: MATTHEW CARA , MOORE M. J. , CAMPBELL LORNA
Published: December 2021

A study was made of collagen fibril populations in healing tendon using a window lesion in rat extensor tendon. Two environments were thus created. One (the lesion area) where stress levels were reduced; the other (the non-lesion area) where stress levels were increased. In both areas a population of small diameter (<50nm) collagen fibrils were synthesized. Lesion area fibrils increased their diameter only slowly. Non-lesion area fibrils added to a population which increased its diameter distribution comparatively rapidly. It is suggested that in the lesion area fibrils were synthesized in response to tissue damage and low levels of stress. These may be of type III collagen. In the non-lesion area fibrils were synthesized in response to raised levels of stress. These may be of type I collagen. Implications of these events, especially as they might relate to gap formation in flexor tendon surgery are discussed.
A Review of Attitudes to Splintage in Dupuytren’s Contracture
Authors: ABBOTT KATE , DENNEY JOANNA , BURKE F. D. , McGROUTHER D. A.
Published: December 2021

A questionnaire on the use of splintage before and after operations for Dupuytren’s contracture has been completed by 45 hand surgeons and ten hand therapists. None considered that preoperative splintage was beneficial, but nearly all used some form of splintage after operation. The types of splint and programmes for using them varied widely, and these are discussed.
Congenital Constriction Band Syndrome and Transverse Deficiency
Authors: OGINO T. , SAITOU Y.
Published: December 2021

To distinguish the clinical features of amputation due to congenital constriction band syndrome from those of transverse deficiency, 42 cases of constriction band syndrome and 27 cases of transverse deficiency were analysed. All the transverse deficiencies were unilateral. Two cases of transverse deficiency were associated with pectoral muscle absence, whereas amputation from constriction band syndrome was often associated with similar anomalies in other parts of the body. The level of amputation of transverse deficiency was more proximal than that of constriction band syndrome. Rudimentary fingers and/or nails were common in transverse deficiency but there were few in constriction band syndrome. Various degrees of bone hypoplasia existed in adjacent fingers or in a proximal part of the affected limb in transverse deficiency, but there were no such findings in constriction band syndrome.
The Role of Three Dimension Computerized Imaging in Hand Surgery
Authors: ENGEL J. , SALAI M. , YAFFE B. , TADMOR R.
Published: December 2021

Three-dimensional computerized imaging is a new modality of radiological imaging. This new technique transforms the two-dimensional slices of bi-plane CT into a three-dimensional picture by a computer’s monitor adjusted to the system. This system enables the physician to rotate the angle of viewing of the desired region to any desired angle. Moreover, this system can delete certain features of different densities from the picture, such as silicone implants, thus improving visualization. Our preliminary results using this technique are presented. The advantages, pitfalls, and suggested future applications of this new technique in hand surgery are discussed.
Disability following Closed Traction Lesions of the Brachial Plexus Sustained in Motor Cycle Accidents
Authors: ROSSON J. W.
Published: December 2021

102 patients with closed traction lesion of the brachial plexus resulting from motor cycle accidents have been studied. The majority were young men, with the dominant arm involved in 64%. 74% of the patients underwent early operative exploration and 54% of these were amenable to at least partial repair. 65% of the patients had sustained irreparable pre-ganglionic injury to at least three roots of the plexus. 74% of the patients had sustained additional injuries in the accident. Subsequent reconstructive procedures were performed in 26% of patients. 60% of the patients regained employment, but 76% complained of persistent pain in the limb.
Tinel’s Sign in the Diagnosis of Carpal Tunnel Syndrome
Authors: SEROR. P.
Published: December 2021

A positive Tinel’s sign was found in 63% of patients with electrophysiologically proved carpal tunnel syndrome. However, Tinel’s sign was also positive in 45% of control patients. It is therefore concluded that the sign is of no diagnostic value in individual patients with suspected carpal tunnel syndrome.
Carpal Tunnel Syndrome in Chronic Renal Dialysis Patients: Clinical Evaluation of 62 Hands and Results of Operative Treatment
Authors: NAITO M. , OGATA K. , GOYA T.
Published: December 2021

A prospective study was performed on 62 hands in 45 consecutive patients on chrome dialysis carpal tunnel syndrome developed within an average of 116 months after formation of the arterio-venous fistula. We measured the intra-carpal canal pressure by the wick catheter technique and performed neurography. At operation, a markedly thickened transverse carpal ligament was usually found. A pneumatic tourniquet was applied in all except three cases, whose functioning fistulae were made of implants, but no complications such as obturation of the fistulae occurred. Thirty-three (76.7%) of 43 cases had good results. Full recovery of sensibility was obtained in all hands in which symptoms had been present for less than two years. There was no benefit from operation in two patients (4.7%), both of whom had symptoms for more than two years.
Comparison of 1% Lignocaine With 0.5% Bupivacaine in Digital Ring Blocks
Authors: REICHL M. , QUINTON D.
Published: December 2021

In a randomised double-blind trial comparing 1% lignocaine with 0.5% bupivacaine in digital ring block, the mean time of onset of complete anaesthesia was 5.8 minutes (range 5 to 10 minutes) for lignocaine and 11.2 minutes (range 8 to 20 minutes) for bupivacaine. The duration of action was 59.6 minutes (S.D. ± 28.7 minutes) for lignocaine and 476 minutes (S.D. ± 277 minutes) for bupivacaine. We describe how these differences can be exploited in clinical practice.
Duplicate Thumbs: A Survey of Results in Twenty Patients
Authors: ANDREW J. G. , SYKES P. J.
Published: December 2021

20 patients were reviewed following surgery for bifid thumbs. Those patients with Wassel 1 or 2 duplications generally did well after their initial operation, but over half of those with Wassel 3 or 4 duplications required multiple procedures to achieve a satisfactory result.
An Improved Nail-Hook for Kleinert Traction
Authors: NANCARROW J. D.
Published: December 2021

A new type of hook for Kleinert traction is described. It is made out of wire for the individual finger and glued to the nail, the actual hook projecting distally.
Flexor Digitorum Profundus Common to Thumb and Index Finger, Associated with a Post-Traumatic Distal Adherence of Both Tendons
Authors: AGUADO A. RICO , PAREDES V. del PINO
Published: December 2021

The existence of connections, in the form of tendon slips, between the tendons of the flexor pollicis longus and the flexor digitorum profundus indicis has been described by different authors as being a relatively frequent anomaly. Complete fusion between the two muscles, however, must be considered a very rare anomaly. A bilateral case is described, in which the right hand also had post-traumatic adhesions between the two tendons.
Ray Centralization without Bone Fixation for Amputation of the Middle Finger
Authors: ISELIN F. , PEZE W.
Published: December 2021

Twelve patients requiring amputation of the middle finger have undergone resection of the entire ray, including a wedge from the capitate, and soft-tissue approximation of the index to the ring finger to close the gap.

All regained full movement and a satisfactory appearance of the hand.
Idiopathic Thenar Muscle Hypertrophy
Authors: CLAY N. R. , AUSTIN S.
Published: December 2021

Two patients are described with idiopathic hypertrophy of the first dorsal interosseous and thenar muscles. CT scans have proved helpful in defining the abnormality.
The Long-Term Results of Closed Palmar Fasciotomy in the Management of Dupuytren’s Contracture
Authors: BRYAN A S. , GHORBAL M. S.
Published: December 2021

Twenty-three patients were reviewed an average of 5.3 years after a closed palmar fasciotomy for the correction of Dupuytren’s contracture. Results suggest that this procedure is best suited to those whose contracture is mainly at the MP joint and that approximately 55% of such patients can expect the correction to be maintained for at least five years. In those patients with severe deformity affecting the PIP joint in addition to the MP joint, this may be a useful preliminary procedure, but is unlikely to be of any long term benefit.
Out-Patient Surgery for Dupuytren’s Disease Under Intravenous Regional Anaesthesia
Authors: KJELDAL I. , NYGAARD H. P.
Published: December 2021

During a six-month period, 55 operations for Dupuytren’s contracture were performed on an out-patient basis. Intravenous regional anaesthesia was used in all cases, and the skin was closed primarily by Z-plasties. This method, which has not been published earlier, does not allow the surgeon to release the tourniquet before securing haemostasis. It is left to the patients to manage the post-operative elevation. No cases of post-operative haematoma occurred, and recovery of hand function was good in all cases. The method saves resources and is well-tolerated by patients.
Post-Operative Management of Flexor Tendon Grafting
Authors: TONKIN M. , HAGBERG L. , LISTER G. , KUTZ J.
Published: December 2021

This paper reviews the post-operative management of 145 tendon grafts in 127 patients. 80 grafts were managed post-operatively by a period (three to four weeks) of immobilisation followed by gentle active mobilisation. 65 grafts were managed by immediate controlled mobilisation (Kleinert technique) for three to four weeks. The final motion obtained was independent of the post-operative management. However, the rates of graft rupture (nine against four) and tenolysis (sixteen against eight) were higher in the immobilised group.
Functional Deficit Following Loss of Continuity of the Long Extensors of the Fingers: A Method of Assessment
Authors: QUABA A. A. , ELLIOT D. , SOMMERLAD B. C.
Published: December 2021

A method for assessing hand function following loss of the long finger extensors in Zones 6 and 7 (Verdan, 1968) is described. It relies on a number of mechanical and functional tests combined with a detailed questionnaire.
Mal-Union and Dysfunction in Colles’ Fracture
Authors: JENKINS N. H. , MINTOWT-CZYZ W. J.
Published: December 2021

Wrist function was assessed between one and three years after injury in patients who had suffered Colles’ fractures. Both the range of wrist flexion and the strength of grip were found to be deficient. The loss of power in gripping was found to correlate with mal-union effecting the coronal and sagittal inclination of the articular surface of the radius.
The Small AO External Fixator in the Treament of Unstable Distal Forearm Fractures
Authors: PRINCE HEATHER , WORLOCK P.
Published: December 2021

Sixteen patients with severely comminuted displaced fractures of the distal radius and ulna, who were treated with a small AO external fixator, have been reviewed at an average of 2.2 years after injury.

Removal of the fixator, at an average of 4.9 weeks, was followed by significant alteration in position in some cases. The external fixator should be retained for eight weeks to reduce the risk of loss of position.

In those cases with a good or excellent anatomical result on radiological assessment after removal of the fixator, the functional results were good or excellent in 80%.
Carpal Instability with Volar Flexion of the Proximal Row Associated with Injury to the Scaphotrapezial Ligament: Report of Two Cases
Authors: HANKIN F. M. , AMADIO P. C. , WOJTYS E. M. , BRAUNSTEIN E. M.
Published: December 2021

Volar flexion intercalated segment instability may develop after many different injuries to the skeletal and ligamentous architecture of the wrist. We describe two cases in which the presumed cause of instability was an injury to the extrinsic volar scapho-trapezial ligament complex.
Pigmented Villonodular Synovitis of the Extensor Tendon Sheaths in a Child
Authors: HANSEN P. , NIELSEN P. T. , WAHLIN A. B.
Published: December 2021

The first case of diffuse pigmented villonodular synovitis originating in the extensor tendon sheaths of the hand in childhood is reported.
Vibrio Vulnificus Necrotizing Fasciitis Presenting with Compartmental Syndrome of the Hand
Authors: HUNG L. K. , KINNINMONTH A. W. G. , WOO M. L.
Published: December 2021

Vibrio vulnificus necrotizing fasciitis is an unusual clinical problem. When it presented as a compartment syndrome, the picture was obscured. We report a rare case of such a presentation. A below-elbow amputation was performed and the patient recovered.
A Web-Saving Skin Incision for Amputation of the Third or Fourth Ray of the Hand
Authors: PLASSCHAERT M. J. J. T. , HAGE J. J.
Published: December 2021

We describe a new incision for use in ray amputation. A semi-oval flap of skin from one side of the proximal phalanx of the finger to be amputated is preserved so that when the adjoining finger is transposed to fill the gap, the complete web can also be transposed. This avoids scarring in the web space.
Aneurysm of a Common Digital Artery: Resection and Vein Graft
Authors: TYLER G. , STEIN A.
Published: December 2021

A 57-year-old woman developed an aneurysm of a common digital artery and its branches, which caused pain from pressure on digital nerves. There was also evidence of median nerve compression at the wrist. Treatment included resection and vein graft connecting three vessels, and carpal tunnel release. Three years later, the graft is patent, and the patient’s hand has excellent function with no recurrence of symptoms.
Foot-Like Congenital Macrodactyly with Syndactyly of the Hand
Authors: LAUSCHKE H.
Published: December 2021

A case of monstrous deformity of the right hand in a six-year-old girl is reported. The index, middle and ring fingers showed extreme macrodactyly including the metacarpals belonging to these fingers. This deformity, which was associated with syndactyly of the middle and ring fingers, was caused by bone overgrowth in gigantic fashion accompanied by enlarged volar digital nerves and studded with irregular nodules of fibro-adipose tissue in these fingers. No genetic abnormalities were found.
Posterior Interosseous Island Forearm Flap
Authors: ZANCOLLI E. A. , ANGRIGIANI C.
Published: December 2021

The skin of the dorsal aspect of the forearm is supplied by several cutaneous branches of the posterior interosseous artery. This vascular anatomy permits the surgeon to obtain an island flap of the dorsal forearm based on the distal anastomosis between the two interosseous arteries at the distal part of the interosseous space. This flap can reliably be transferred to different skin defects of the hand such as those created by correction of an adduction contracture of the first web space, or on the back or front of the wrist level. Its principal advantages are that it is a thin flap with excellent circulation and that it is possible to close the donor area primarily provided the island flap is not wider than 3 to 4cm. The procedure has been employed in 25 patients with satisfactory results.
Vibration White Finger
Authors: BOYLE J. C. , SMITH N. J. , BURKE F. D.
Published: December 2021

Nineteen consecutive patients claiming compensation for vibration white finger were reviewed. The cold provocation test was found to be of no value in confirming a diagnosis of vibration white finger. Small cysts were apparent on the radiographs in 61% of patients’ wrists but none had developed significant degenerative changes of the wrist or digits. In this group of claimants, 63% had carpal tunnel syndrome on nerve conduction studies.
Early Psychological Aspects of Severe Hand Injury
Authors: GRUNERT B. K. , SMITH CINDY J. , DEVINE CECILIA A. , FEHRING BONNIE A. , MATLOUB H. S. , SANGER J. R. , YOUSIF N. J.
Published: December 2021

We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%).

Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.
Results of Surgery for Trigger Finger
Authors: THORPE A. P.
Published: December 2021

Forty-three patients were reviewed between 17 and 113 months (mean of 47 months) following surgery for acquired stenosing tenosynovitis of the fingers or thumbs. 32 (60.4%) of the 53 operations were completely successful. Of the remaining 21 operations, 26% either failed to relieve all symptoms, or symptoms had recurred at review. 15 operations led to complications that bothered the patient to some extent. Three procedures resulted in significant functional deficit of the hand, two because of nerve damage and one because of stiffness following infection. The three major complications all followed operations performed by junior surgeons. The importance of an adequate trial of conservative therapy to avoid unnecessary surgery is emphasised.
Transmetacarpal Amputations and Replantation: The Importance of the Normal Vascular Anatomy
Authors: TONKIN M. A. , AMES E. L. , WOLFF T. W. , LARSEN R. D.
Published: December 2021

Three transmetacarpal injuries are described in which the patency of one common digital vessel alone provided blood flow to all fingers. Transverse commissural vessels connect the digital vessels proximal to the proximal and distal interphalangeal joints. Retrograde flow to the adjacent common digital vessels revascularises the other digits.

The volar metacarpal vessels, if not ligated, may allow continued bleeding into the palm following reattachment of a transmetacarpal amputation. These vessels may have been responsible for failure of the replantation in one case.
Tendon Interposition Arthroplasty of the First Carpo-Metacarpal Joint
Authors: WEILBY A.
Published: December 2021

After removal of the trapezium, imbrication of abductor pollicis longus and fixing it with a strip of flexor carpi radialis tendon, we obtained a stable arthroplasty having three quarters of normal mobility and half to full power. Of the first 100 operated thumbs, 15 patients had slight pain on heavy use; the rest were painfree. Three patients had radial nerve lesions with minor complaints. Seven patients developed de Quervain’s syndrome and two had rupture of abductor pollicis longus; these complications have since been avoided by routinely splitting the first extensor compartment. Four cases with unstable joints required further surgery, and one joint became stiff due to extra-articular conditions.
Clinical Features and Roentgenograms of Symbrachydactyly
Authors: OGINO T. , MINAMI A. , KATO H.
Published: December 2021

Müller and Blauth have suggested that short webbed fingers, atypical cleft hand and acheiria develop as morphological variants of symbrachydactyly. The clinical features and roentgenograms of our 76 patients were analysed. The common features of all types of symbrachydactyly were that all cases were unilateral, various degrees of bone hypoplasia existed in the affected limbs, and in every grade there were some cases with pectoral muscle absence. There seems to be a successive process of formation of atypical cleft hand. Monodactyly and peromelia occur as a result of more severe reduction occurring in the central finger rays of symbrachydactyly of short finger type.
Locking of the Distal Radio-Ulnar Joint Due to Loose Bodies
Authors: WAN A. , LUNN P. G.
Published: December 2021

A patient is described in whom loose bodies in the distal radio-ulnar joint caused intermittent locking of rotation of the forearm.
Delayed Diagnosis in Non-Union of the Body of the Hamate: A Case Report
Authors: TERRONO A. , FERENZ C. C. , NALEBUFF E. A.
Published: December 2021

Fractures of the body of the hamate are uncommon. We report a case with symptomatic non-union in which the diagnosis was not made until oblique pronated radiographs were taken.
A Complication of Congenital Dysplasia of the Ring Finger
Authors: SAKUMA T. , HOOPER G.
Published: December 2021

We report an adult patient with congenital dysplasia of the ring finger who required a corrective osteotomy for an angulatory metacarpal deformity.
The Conservative Management of Volar Avulsion Fractures of the P.I.P. Joint
Authors: PHAIR I. C. , QUINTON D. N. , ALLEN M. J.
Published: December 2021

A retrospective study was made of 74 volar avulsion fractures of the P.I.P. joint in which there was no radiological evidence of subluxation. Overall, 96% of those reviewed achieved good results but morbidity was increased by immobilisation. Providing the joint is stable, simple neighbour strapping is recommended for these injuries.
Stabilisation of the Trapezio-Metacarpal Joint
Authors: BRUNELLI G. , MONINI L. , BRUNELLI F.
Published: December 2021

A new technique of trapezio-metacarpal stabilisation is described which uses the abductor pollicis longus tendon passed through the bases of the first and second metacarpals to fasten the base of the thumb. A biomechanical rationale is presented, as well as the surgical technique and 12 results at follow-up one to six years later.
En Bloc Excision and Reconstruction with a Fibular Autograft of Giant-Cell Tumour of the Metacarpal—A Case Report
Authors: SANJAY B. K. S. , ASHOK RAJ GITA , VISHWAKARMA G. K.
Published: December 2021

A giant-cell tumour involving the diaphysis of the third metacarpal is reported. The unusual site, age, radiographic atypicality and therapeutic options are reviewed.
Rupture of the Radial Collateral Ligament of the Metacarpo-Phalangeal Joint of the Index Finger: A Report of Three Cases
Authors: DOYLE J. R. , ATKINSON R. E.
Published: December 2021

We have diagnosed and treated three patients with complete rupture of the radial collateral ligament of the metacarpo-phalangeal joint of the index finger. Rupture of the radial collateral ligament of the metacarpo-phalangeal joint occurs most commonly in the little finger and has not previously been reported in the index finger. Operative treatment is recommended in all cases, due to the significant stresses placed on the radial side of the M.P. joint of the index finger.
Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation
Authors: CULLEN K. W. , TOLHURST PAMELA , LANG D. , PAGE R. E.
Published: December 2021

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.
Flexor Pollicis Longus Tendon Repair: A Comparison Between Dynamic and Static Splintage
Authors: PERCIVAL N. J. , SYKES P. J.
Published: December 2021

A retrospective review of 51 patients with isolated flexor pollicis longus tendon repairs has been undertaken to determine the value of post-operative splintage. Evaluation by the Buck-Gramcko criteria confirms the benefit of controlled dynamic mobilisation. Overall, 44% of patients treated by immobilisation post-operatively achieved good or excellent results compared with 60% treated by dynamic traction. For repairs in zone 2, the results of mobilisation were significantly better, 62% achieving good or excellent results compared to 33% treated by fixed splintage.
An Evaluation of Suture Materials Used in Tendon Surgery
Authors: TRAIL I. A. , POWELL E. S. , NOBLE J.
Published: December 2021

The following suture materials have been evaluated for their suitability for use in flexor tendon repairs: 4/0 gauge monofilament and multifilament stainless steel, mono-filament nylon, monofilament polypropylene, monofilament polybutestor, braided polyester, braided polyglycolic acid and a monofilament polyglyconate. These were investigated for their tensile strength (both knotted and unknotted), their extension to failure and knot-holding properties. Stainless steel and monofilament polyglyconate appeared to be the most suitable in that they had high tensile strengths, both knotted and unknotted, and had good knot-holding security. The only disadvantages are that stainless steel is difficult to use and monofilament polyglyconate is absorbable. Polypropylene and braided polyester, although having lower tensile strengths, are reasonable alternatives.
Isolated Anterior Interosseous Nerve Palsy Following Herpes Zoster Infection: A Case Report and Review of the Literature
Authors: NEE P. A. , LUNN P. G.
Published: December 2021

A 64-year-old lady noticed weakness of her thumb within two weeks of having developed “shingles” causing vesicular lesions on her arm and hand. Clinical and neurophysiological testing confirmed a lesion of the anterior interosseous nerve. Although motor involvement after herpes zoster infection is recognised, this usually has a myotomal distribution; isolated involvement of a branch of a peripheral motor nerve has not previously been described.
The Wrightington Classification of Rheumatoid Wrist X-Rays: A Guide to Surgical Management
Authors: HODGSON S. P. , STANLEY J. K. , MUIRHEAD A.
Published: December 2021

We have reviewed the pre-operative radiological appearances, the type of operation performed and the results of surgery of 234 wrists in 179 patients with rheumatoid arthritis. Based on this, a classification of X-rays of the rheumatoid wrist is described. It is designed to provide practical guidance to the surgeon who is planning surgery in a patient with rheumatoid disease. The surgical choices at each stage of the disease are briefly discussed.
Metacarpal Fractures and the Clamp-on Plate
Authors: MENNEN U.
Published: December 2021

Since internal fixation of metacarpal fractures has a high complication rate, most fractures should be managed conservatively, with the emphasis on early mobilisation. However, some fractures do need internal stabilisation. We propose the use of the clamp-on plate, which is simple to use, has a very low complication rate and allows immediate mobilisation.
Why all Finger Fractures should be referred to a Hand Surgery Service: A Prospective Study of Primary Management
Authors: DAVIS T. R. C. , STOTHARD J.
Published: December 2021

The quality of the treatment of finger fractures by Accident and Emergency Department staff has been prospectively assessed during a six-month period. 678 finger fractures were seen in the A. & E. Department. The primary treatment of 624 of these was performed by the A. & E. staff, but in 169 of these (27%), the treatment was inappropriate. Most management errors were elementary: they included failure to prescribe antibiotics for compound fractures, failure to reduce displaced fractures accurately and unsatisfactory splintage. It is recommended that all finger fractures should be assessed and treated by surgeons with training in the management of hand injuries.
Neurovascular Island Flap by the Disconnecting-Reconnecting Technique
Authors: ADANI R. , PANCALDI G. , CASTAGNETTI C. , ZANASI S. , SQUARZINA P. B.
Published: December 2021

The authors report nine cases of hetero-digital neurovascular island flaps raised by the “disconnecting-reconnecting” technique for defects of the tactile pad of the thumb. At an average follow-up of 25 months, all cases had good restoration of sensibility without any “double sensibility” phenomenon and patients regained good dexterity. No tender neuromata developed and donor site complications were not troublesome.
Carpal Tunnel Syndrome in Association with Vibration White Finger
Authors: SAVAGE R. , BURKE F. D. , SMITH N. J. , HOPPER I.
Published: December 2021

In a prospective study, eight patients with 15 hands affected by both vibration white finger and carpal tunnel syndrome were treated by surgical decompression of the carpal tunnel. On review six months later, the symptoms of carpal tunnel syndrome were improved in all cases and the symptoms of white finger were improved in half of the cases. Nerve conduction studies and palmar skin histology are discussed.
Rotational Deformity Following Metacarpal Fracture
Authors: ROYLE S. G.
Published: December 2021

Ninety-one consecutive patients with 98 metacarpal fractures were looked at prospectively for rotational deformity. Whilst a quarter had minor rotation of the fracture of less than 10°, only five had more than this. In just two cases, was there rotational instability requiring operative intervention. Assessment of rotational deformity must include an end-on view of the finger-nail, as there is often restricted movement at the metacarpal phalangeal joint following fracture.