bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Properties of Various Circumferential Tendon Suture Techniques
Authors: KUBOTA H. , AOKI M. , PRUITT D. L. , MANSKE P. R.
Published: September 2005

We evaluated the mechanical properties of six different circumferential tendon sutures with a variable number of suture strands. Seventy-two human cadaver flexor profundus tendons were cut and repaired using only a 6/0 polypropylene circumferential suture. The six running suture techniques were: Simple; Simple-locking; Lembert; Halsted; Cross-stitch; Lin-locking; using 10, 14 and 18 suture passes. The increased suture passes increased both tensile and gap strengths. The tensile strength of the Lin-locking technique (29 to 63 N) was significantly stronger than the others, followed by Cross-stitch (27 to 38 N), Halsted (21 to 27 N), Lembert (20 to 27 N), Simple (11 to 22 N) and Simple-locking (10 to 17 N). The gap strength values were between 3 to 14 N, with no significant differences between the techniques. The resistance to gliding, as measured by work of flexion, was not affected by the number of strands. However, the Lin-locking significantly increased the resistance to gliding (33-36%) compared to the other techniques (6-21%); there were no significant differences between these five techniques.
High Resolution Magnetic Resonance Imaging of the Proximal Interphalangeal Joints
Authors: LEWIS A. R. , NOLAN M. J. , HODGSON R. J. , BENJAMIN M. , RALPHS J. R. , ARCHER C. W. , TYLER J. A. , HALL L. D.
Published: September 2005

The magnetic resonance imaging appearance of the proximal interphalangeal joints of cadavers was correlated with histology of the same specimen allowing many small-scale features to be identified that might otherwise have been misinterpreted. It enabled the magnetic resonance signal to be understood at a tissue and cellular level, allowing identification of synovial folds extending from the extensor tendon and volar plate, the entheses of the proper collateral ligament, the epitenon of the flexor tendons and the presence of osteophytes and sites of cartilage erosion. The main difficulties in matching two-dimensional magnetic resonance images with histology were the differing section thicknesses of the two methods and shrinkage of histological specimens. There are many advantages in producing high resolution three-dimensional datasets—the magnetic resonance section thickness is reduced and the individual components of the joint can be viewed simultaneously in two or more planes. A unique magnetic resonance atlas of three dimensional joint structure is presented.
Flexor Tenosynovectomy and Tenolysis in Longstanding Rheumatoid Arthritis
Authors: TOLAT A. R. , STANLEY J. K. , EVANS R. A.
Published: September 2005

A total of 43 patients (49 hands; 424 flexor tendons), who had rheumatoid arthritis of more than 15 years duration at the time of surgery, were clinically assessed at a mean follow-up of 5.7 years (range, 1.2–12 years). Pain and inability to flex actively despite a good passive range of motion were the main surgical indications. The results suggest that the patients had excellent sustained pain relief (mean score=0.9) and were highly satisfied with the outcome of the procedure (mean score = 2.2). 81% had adequate pulp-to-pulp and key pinch. Range of finger motion (total active motion, TAM) was excellent to good in 45% and fair in 22%. Thirty-three per cent were graded as poor and these were found to be multifactorial in origin, with associated significant joint disease, preoperative tendon ruptures, extensive digital surgery, readhesions and combinations of operative procedures which adversely affect the rehabilitation programme. Flexor tenosynovectomy with tenolysis is a useful procedure with a low rate of recurrence.
Cubital Tunnel Syndrome Caused by Tophaceous Gout
Authors: NAKAMICHI K. , TACHIBANA S.
Published: September 2005

We report a case of cubital tunnel syndrome caused by tophaceous gout. The ulnar nerve was compressed by a tophus at the distal cubital tunnel. Surgical decompression relieved the symptoms.
Opportunistic Mycotic Infections of the Upper Limb
Authors: AL-QATTAN M. M.
Published: September 2005

Opportunistic fungal infections of the upper limb are rare and require a host who is immunologically compromised. A review of these rare mycotic infections is presented. The hand surgeon should be aware of these infections and should have a high index of suspicion in order to establish an early diagnosis and institute an appropriate management.
Lengthening of the Forearm by Callus Distraction
Authors: ABE M. , SHIRAI H. , OKAMOTO M. , ONOMURA T.
Published: September 2005

Ten patients aged 3 to 13 years (mean, 9 years and 7 months) underwent forearm lengthening by callotasis. The indications for lengthening were shortening and/or deformity of the forearm due to exostosis of the distal ulna in five cases, enchondroma of the distal ulna in one, growth disturbance after fracture of the distal radius in one, radial club hand in one, congenital amputation of the forearm in one and congenital dislocation of the radial head in one. Four had lengthening of the ulna, one of the radius and five of both the radius and the ulna. The average lengthening achieved was 30 mm. Complications encountered were pin track discharge in three cases, callus fracture in five, delayed consolidation of the callus in one and no callus formation in one. Review after 1 to 7 years follow-up (with a mean of 4 years and 9 months) showed satisfactory improvement in appearance and function especially in patients who had tumorous conditions or traumatic epiphyseal arrest.
Constructive Paralysis of the Posterior Interosseous Nerve without External Compression
Authors: INOUE G. , SHIONOYA K.
Published: September 2005

Four cases of constrictive neuropathy of the posterior interosseous nerve (PIN) in the absence of external compression are reported. All patients presented with a history of severe elbow pain with no apparent cause, followed by paralysis of the PIN. There were one or two well-localized constrictions on the PIN proximal to the arcade of Frohse where no obvious external compressive structure was observed.

After epineurotomy with or without neurorrhaphy, three patients had a complete return of motor function within 1 year. The remaining patient required tendon transfer after resection of the abnormal segment of nerve.
Excision of the Distal Ulna in Rheumatoid Arthritis
Authors: NANCHAHAL J. , SYKES P. J. , WILLIAMS R. L.
Published: September 2005

Patients with rheumatoid arthritis who underwent excision of the distal ulna were reviewed and the operated wrist was compared with the non-operated side in the 40 patients who had the procedure performed unilaterally. Radiological assessment showed that the radiocapitate measurement of carpal translocation was the most consistent and that excision of the distal ulna was not associated with statistically significant collapse, ulnar translocation or radial rotation of the carpus. 61% of wrists spontaneously developed a radial shelf or limited radiocarpal fusion following excision of the distal ulna, compared to 21% of non-operated wrists. However, there was no statistically significant difference in carpal collapse or ulnar translocation between these two groups.
Midcarpal Instability: Is Capitolunate Instability Pattern a Clinical Condition?
Authors: ONO H. , GILULA L. A. , EVANOFF B. A. , GRAND D.
Published: September 2005

Five cases are presented with clinical findings of capito-lunate instability pattern of the wrist. All painful areas and tender points were dorsal, but variable in location and intensity. All plain radiographs and fluoroscopic instability series were normal. None of the cases had an explanation for the dorsal wrist pain other than a positive dorsal capitate-displacement test. Four out of five cases were treated in a cast for 4 weeks and two had subsequent splint immobilization. Although at short-term follow-up two of these five patients became pain-free, none was completely pain-free at long-term follow-up. Three patients treated with a cast had long-term follow-up. Only one could perform his original work. These findings support a clinical condition of midcarpal instability producing dorsal wrist pain reproduced with a simple stress test. Conservative, non-operative treatment will not usually produce long-term pain relief.
A Prospective, Randomized Study with an Independent Observer Comparing Open Carpal Tunnel Release with Endoscopic Carpal Tunnel Release
Authors: JACOBSEN M. B. , RAHME H.
Published: September 2005

In order to define the role of two-portal endoscopic carpal tunnel release, a prospective randomised study with an independent observer was performed to compare endoscopic and open surgery.

Thirty-two hands in 29 patients, with symptoms, clinical signs and EMG changes consistent with idiopathic carpal tunnel syndrome were randomised to either endoscopic carpal tunnel release or open release.

No significant difference in sick leave between the two groups could be found, being a mean of 17 days (range 0–31 days) with endoscopic surgery, and 19 days (range 0–42 days) with open conventional surgery.

No differences in surgical results were found, but three patients in the endoscopic group suffered transient numbness on the radial side of the ring finger.
The Value of Wrist Arthroscopy
Authors: DE SMET L. , DAUWE D. , FORTEMS Y. , ZACHEE B. , FABRY G.
Published: September 2005

In order to evaluate diagnostic and therapeutic wrist arthroscopy we analyzed 129 arthroscopies with a follow-up of at least 6 months. Seventy-seven arthroscopies were performed for therapeutic purposes; 52 arthroscopies were diagnostic. There were diagnostic benefits in 55 arthroscopies (42.5%), therapeutic benefits in 29 arthroscopies (22.5%), combined diagnostic and therapeutic benefits in 39 (30%) and no benefits in six (5%).

In 65 cases of the therapeutic group (with preoperative diagnosis) the authors found that the arthroscopy had been worthwhile. For the diagnostic group without a preoperative diagnosis, an arthroscopic diagnosis was made in 44 cases.

Complications occurred in two patients: one tendon incision over a Kirschner wire in the therapeutic group and one superficial infection in the diagnostic group.
Ulnar Buttress Athroplasty for Reconstruction after Resection of the Distal Ulna for Giant Cell Tumour
Authors: HASHIZUME H. , KAWAI A. , NISHIDA K. , SASAKI K. , INOUE H.
Published: September 2005

A giant cell tumour of the distal end of the ulna was treated by en bloc resection. The resected distal end of the ulna was replaced by an iliac bone graft, preserving the triangular fibrocartilage complex. The wrist was pain-free and had a full range of motion 6 months postoperatively.
A Comparison of Immediate and Staged Reconstruction of the Dorsum of the Hand
Authors: SUNDINE M. , SCHEKER L. R.
Published: September 2005

The treatment of complex dorsal hand lesions involving skin and subcutaneous tissues, extensor tendons, and bone remains a difficult problem for reconstructive surgeons. Traditional treatment of these defects uses staged reconstruction, first obtaining soft tissue cover and then performing bone and tendon grafts. The purpose of this study was to compare a series of seven patients who underwent staged reconstruction with seven patients who had immediate reconstruction involving primary bone and tendon grafting. All procedures were performed to correct similar severe dorsal hand defects. Patients with immediate reconstruction had a significantly faster return to maximum range of movement (ROM) (214 days compared to 630 days, P = 0.002), significantly fewer operations (2.1 compared to 5.9, P = 0.002) and a greater chance of returning to work (86% compared to 48.2%, P = 0.3) than patients with staged reconstruction.
Diabetes and Trigger Finger
Authors: BLYTH M. J. G. , ROSS D. J.
Published: September 2005

Trigger finger is a stenosing tenovaginitis in which there is a constriction of the annular sheath associated with a nodule in the digital flexor tendon. Clinically this can present as triggering or snapping of the nodule as it passes through the tight constricting tendon sheath. Although many triggering fingers settle spontaneously, and others respond to local anaesthestic and steroid injection, others require surgical decompression. The association between diabetes and trigger finger, although not widely known, has been described and forms part of the “diabetic hand syndrome”. We studied 100 adult patients in the group that required surgery. Eighteen of the 100 patients were diabetic with six insulin dependent diabetics (IDDM) and 12 non-insulin dependent diabetics (NIDDM). In the current climate of day case surgery this has significant implications both for the management of known diabetics as well as the preoperative detection of those with the condition.
Mucormycosis of the Upper Limb
Authors: AL-QATTAN M. M. , AL MAZROU A. M.
Published: September 2005

A rare case of mucormycosis of the upper limb in a patient with AIDS is described. The pathophysiology and natural history of the disease are described along with a classification of its clinical stages.
Obstetrical Brachial Plexus Injury in Newborn Babies Delivered by Caesarean Section
Authors: AL-QATTAN M. M. , EL-SAYED A. A. F. , AL-KHARFY T. M. , AL-JURAYYAN N. A. M.
Published: September 2005

The hand surgeon is frequently involved in the medicolegal assessment of birth palsy cases. Although brachial plexus injury has been reported in newborns delivered by Caesarean section, it is difficult to determine if these cases are due to excessive forcé when delivering the infant from the uterus or whether the palsy is related to other factors. We have studied our series of 16 cases of obstetrical brachial plexus palsy with special attention to the newborn baby delivered by Caesarean section. We have reviewed the English literature over the last decade and found that birth palsy in newborns delivered by Caesarean section is extremely rare (1% of all birth palsy cases). The differentiation between brachial plexus injury caused by forcible delivery and congenital upper limb palsy from other causes is discussed.
Classification of Hand Anomalies in Apert’s Syndrome
Authors: AL-QATTAN M. M. , AL-HUSAIN M. A.
Published: September 2005

The literature states that all patients with Apert’s syndrome should have complex (osseous) syndactyly of the index, middle and ring fingers. We describe a case of Apert’s syndrome with simple syndactyly and recommend extending the classification of hand anomalies in Apert’s syndrome.
Dysfunctional Postures of the Hand as Part of a Conversion Reaction
Authors: HONING M. L. H. , KON M.
Published: September 2005

A dysfunctional posture of the hand could be due to an anatomical disorder or a conversion reaction. A conversion reaction implies that an unconscious intrapsychic conflict is expressed in a physical dysfunction.

Treatment of dysfunctional postures due to conversion reactions is often difficult, and case reports are used to outline management. The need for a multidisciplinary approach is stressed.
Post-Traumatic Digital Overgrowth
Authors: SHIBU M. M. , GAULT D.
Published: September 2005

A case is reported of length discrepancy between the two thumbs in a 12-year-old girl following trauma to her left thumb twice before the age of 3 years. The distal phalanx of the left thumb overgrew by 5 mm. There was no functional disability and surgery was requested to improve the appearance.
Replantation–Revascularization and Primary Amputation in Major Hand Injuries
Authors: HOLMBERG J. , LINDGREN B. , JUTEMARK R.
Published: September 2005

Thirty consecutive patients with amputation or devascularizing injuries of the thumb or two or more fingers proximal to the PIP joint were reviewed. Replantation or revascularization had been done in 27 patients, in 24 successfully. Three patients had primary amputation. The distribution of calculable costs was dominated by those for sick leave (49%), operation (26%) and ward costs (20%). Out-patient care, physiotherapy and travel together constituted only 6%. The cost of a successful replantation was equal to 1.6 times the mean annual salary of these patients and that of primary amputation about half as much. Mobility, power and performance of a standardized grip test were better for the successfully replanted or revascularized patients. Subjective evaluation of 23 parameters of function, cosmesis and quality of life did not disclose any differences. All patients except three had returned to their original work within 2 years.
A New Technique for The Assessment of Wrist Movement using a Biaxial Flexible Electrogoniometer
Authors: RAWES M. L. , RICHARDSON J. B. , DIAS J. J.
Published: September 2005

A new electrogoniometer technique is described for the measurement of wrist movements, including circumduction, with the results being displayed as figures.

Clinical validation has been performed and the system found to be highly accurate and reliable. Applications of the technique are illustrated. It is suggested this technique should in the future be used to assess wrist movement in clinical and research applications.
Congenital Triggering of The Index Finger at The A2 Pulley
Authors: HIRATA H. , FUJISAWA K. , SASAKI H. , MORITA A. , MATSUMOTO M.
Published: September 2005

A case of trigger index finger is reported. The diagnosis was made in the neonatal intensive care unit. The proximal interphalangeal joint (PIP) was locked in a flexed position. A nodular thickening of the flexor tendon was felt at the A2 pulley level. Surgery revealed thickening of both the A2 pulley and the radial slip of the flexor superficialis tendon. Division of the A2 pulley released the PIP joint locking.
Extensor Indicis Opposition Transfer in The Ulnar and Median Palsied Thumb in Leprosy
Authors: MEHTA R. , MALAVIYA G. N. , HUSAIN S.
Published: September 2005

Twenty seven opponensplasties for ulnar and median paralysis in 25 leprosy patients were performed using extensor indicis proprius. An additional transfer of the radial half of flexor pollicis longus to extensor pollicis longus was done to stabilize the metacarpophalangeal joint of the thumb. The biomechanical aspects of extensor indicis proprius tendon transfer were studied and results evaluated using various anatomical and functional parameters. Extensor indicis proprius provides adequate strength to position the thumb. However, sometimes it does not reach its new insertion. There is no significant deficit at the donor site but in a few cases the index finger may lose its capability for independent extension and sometimes a proximal interphalangeal joint contracture may develop.
An Unreported Cause of Rupture of the Extensor Pollicis Longus Tendon
Authors: CASSELL O. C. S. , VIDAL P.
Published: September 2005

Avulsion fractures of the index metacarpal at the insertion of extensor carpi radialis longus are rare. We report such a fracture and the resulting complication of division of the extensor pollicus longus tendon, by the avulsed bony fragment.

Careful clinical assessment and appropriate radiological examination is needed to diagnose this rare fracture and internal fixation is recommended.
Matrix Synthesis and Cell Proliferation in Repaired Flexor Tendons within E-PTFE Reconstructed Flexor Tendon Sheaths
Authors: HANFF G. , ABRAHAMSSON S-O.
Published: September 2005

Expanded polytetrafluoroethylene (e-PTFE) may be used as a barrier to reduce formation of restrictive adhesions following tendon surgery within the flexor tendon sheath region. In order to assess its effects on the cellular activity of healing tendons, synthesis and contents of matrix components and synthesis of DNA were compared in divided and sutured flexor tendons that either had been covered with e-PTFE membranes or with sham-operated tendon sheaths in 30 rabbits. At intervals of up to 12 weeks segments of the tendon repair sites were harvested, placed in wells and labelled with 35S-sulphate, 3H-proline and 3H-thymidine during short-term culture in vitro. Adverse tissue reactions and tendon disruptions were not observed at harvest. At each time interval synthesis of matrix components and DNA and contents of protein and collagen in the repaired tendon segments were similar in the two groups. Measured over all intervals, synthesis of non-collagen protein and contents of protein and collagen were lower in the e-PTFE groups. These results show that reconstruction of flexor tendon sheaths with e-PTFE membranes may not significantly impair cell proliferation but to some extent may reduce protein synthesis of healing tendons.
Pressure Changes in Guyon's Canal After Carpal Tunnel Release
Authors: ABLOVE R. H. , MOY O. J. , PEIMER C. A. , WHEELER D. R. , DIAO E.
Published: September 2005

We measured pressure changes in Guyon's canal and the carpal tunnel before and after endoscopic (11 cases) and open (10) carpal tunnel release. We found that release of the flexor retinaculum by endoscopic and open techniques measurably decreased pressure in both the carpal tunnel and Guyon's canal. This study provides an explanation for relief of ulnar tunnel syndrome symptoms following carpal tunnel release and may indicate that carpal tunnel release alone may be sufficient to provide symptomatic relief for most patients with carpal and ulnar tunnel syndromes.
Compression Neuropathy of the Palmar Cutaneous Branch of the Median Nerve by the Antebrachial Fascia
Authors: SEMER N. , CRIMMINS C. , FORD JONES N.
Published: September 2005

An isolated compression neuropathy of the palmar cutaneous branch of the median nerve is described in a woman who presented with a small tender mass over the anterior aspect of her distal forearm and complete numbness over the thenar eminence. Surgical exploration revealed thickening of the palmar cutaneous nerve as it passed upwards through the antebrachial fascia on the ulnar aspect of the flexor carpi radialis tendon. Neurolysis of two separate fascicles of the palmar cutaneous branch of the median nerve and excision of a window of antebrachial fascia resulted in complete return of sensation over the thenar eminence.
Complete Endoscopic Carpal Tunnel Release in Long-Term Haemodialysis Patients
Authors: OKUTSU I. , HAMANAKA I. , TANABE T. , TAKATORI Y. , NINOMIYA S.
Published: September 2005

The roof of the carpal tunnel (or canal) consists of the distal portion of the flexor retinaculum, the flexor retinaculum (or the transverse carpal ligament) and the proximal portion of the flexor retinaculum. We tried to determine which anatomical structures were relevant to complete endoscopic carpal tunnel decompression in long-term haemodialysis patients with carpal tunnel syndrome. Carpal tunnel pressure was measured using the continuous infusion technique before and after endoscopic release of the flexor retinaculum, distal portion of the flexor retinaculum and the proximal portion of the flexor retinaculum respectively in 257 hands.

We concluded that release of the distal portion of the flexor retinaculum, in addition to the flexor retinaculum, is essential for complete carpal tunnel decompression in long-term haemodialysis patients.
A Severe Infection Following Endoscopic Carpal Tunnel Release
Authors: RIEGER H. , GRÜNERT J. , BRUG E.
Published: September 2005

A 59-year-old patient underwent endoscopic carpal tunnel release by Chow's two-portal technique. He developed a pyogenic tenosynovitis and an infection within the ulnar and radial bursae, an abscess in the middle palmar, thenar and Parona's space, and a pyogenic wrist arthritis. Surgical treatment included a wide exposure of the infected region, débridement, irrigation, application of a resorbable collagen sponge containing gentamicin, insertion of two drains and primary wound closure. The infection was brought under control and hand function restored.
Long-Term Follow-up of 50 Duke Silicone Prosthetic Fingers
Authors: O’FARRELL D. A. , MONTELLA B. J. , BAHOR J. L. , LEVIN L. S.
Published: September 2005

Thirty-three patients with single and multiple digital amputations were fitted with a total of 50 prosthetic silicone fingers over a mean period of 4 years. The prosthetic fingers were custom made using a special method which has been modified at our institution. This study provides a detailed analysis of patients’ occupational and cosmetic usage of and satisfaction with their prostheses, as well as describing the fabrication technique.
Pronator Quadratus Revisited
Authors: STUART P. R.
Published: September 2005

The pronator quadratus muscle has been neglected to a great extent in the anatomical and functional literature. This study confirms the consistent presence of two distinct heads to the muscle, and defines the gross and microscopic anatomy. The functional significance of these heads has been studied using in vitro and in vivo techniques to demonstrate that the superficial head is the prime mover in forearm pronation, and that the deep head is a dynamic stabilizer of the distal radioulnar joint.
Is Vibration-Induced White finger A Reversible Syndrome If Vibration Is Stopped?
Authors: ÖSTMAN F. , LUNDBORG G. , BORNMYR S. , LILJA B.
Published: September 2005

The purpose of the study was to investigate if vibration-induced white finger may be a reversible symptom after cessation of vibration exposure. Fifty-nine welders, previously employed by a ship building company and who had shown various levels of vibration-induced vasospastic symptoms in the hand were interviewed 5 to 6 years after closure of the company. Out of the 43 patients exposed to no or insignificant vibration subsequently, 28 claimed improvement, 11 claimed unchanged problems and four complained of worse problems. Twelve of these patients had the cold provocation test repeated at follow up. One patient showed the same result as 5 years earlier, six showed improvement and five showed much improvement. Of 16 patients with continued vibration exposure none showed subjective improvement, nine claimed unchanged problems while seven patients were worse. It is concluded that vibration-induced white finger is not a progressive condition following cessation of exposure to vibration. On the contrary it may be static or even reversible to some extent.
Complete Avulsion of the Palmar Cortex of the Distal Phalanx
Authors: KEVU J. E. , CALDER S. J. , CLEARY J. E.
Published: September 2005

We report a case of avulsion of the insertion of the flexor digitorum profundus in which the whole palmar cortex of the distal phalanx was avulsed, giving an unusual radiological appearance.
External Fixation for Comminuted Phalangeal Fractures
Authors: FITOUSSI F. , IP W. Y. , CHOW S. P.
Published: September 2005

The mechanical rigidity obtained by external fixation in a comminuted phalangeal fracture model was assessed and the results compared with two other types of internal fixation commonly used (lateral plate and crossed Kirschner wires) in a biomechanical cadaver study. Each fixation technique was tested in apex palmar bending, compression and torsion. The results showed that lateral plating provided the best rigidity in apex palmar bending and compression and that external fixation and Kirschner wires showed the same mechanical properties. For the torque test, external fixation provided the best rigidity.
Fractures of the Distal Radius and Scaphoid
Authors: OSKAM J. , DE GRAAF J. S. , KLASEN H. J.
Published: September 2005

Simultaneous fractures of the distal radius and scaphoid is an uncommon wrist injury. During the period 1980 to 1993, 23 patients with a median age of 39 years were treated for this injury. The median follow-up period was 7 years. All scaphoid fractures were undisplaced and located in the waist or distal third. An extraarticular distal radial fracture was observed in 15 wrists. A below elbow cast including the thumb was applied in 18 wrists for a mean duration of 9 weeks, and operative treatment was used in only 5 patients.

All scaphoid fractures healed without complications. During conservative treatment there were three redisplacements of distal radial fractures. The final functional results were good in 18, fair in four, and poor in one patient. Because complications occurred at the distal radius we have changed our conservative treatment policy from a below elbow cast including the thumb to a dorsal splint for 6 weeks.
Superficial Radial Nerve Compression Due to a Scaphoid Exostosis
Authors: SPINNER R. J. , SPINNER M.
Published: September 2005

We present a patient who developed irritation of the superficial radial nerve from an underlying scaphoid exostosis.
Pyoderma Gangrenosum Severely Affecting Both Hands
Authors: ADAM D. J. , NAWROZ I. , PETRIE P. W. R.
Published: September 2005

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient’s dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.
The “S” Quattro in Severe Dupuytren’s Contracture
Authors: BEARD A. J. , TRAIL I. A.
Published: September 2005

Postoperative traction, using the “S” Quattro external fixation device, improved the initial correction in 17 of 18 fingers treated by limited fasciectomy for severe proximal interphalangeal joint contracture in Dupuytren’s disease. Unfortunately significant recurrence occurred in eight within 1 year and only five maintained improved function. Complications included infection, loosening, recurrence, stiffness and amputation.
Treatment of Radial or Ulnar Nonunion by Distal Ulnar Bone Block Graft with Dorsal Interosseous Artery
Authors: Wang F-B. , Hong G-X. , Wan S-X. , Chen Z-B. , Huang Q-S. , Kang H.
Published: September 2005

A new method of using a distal ulnar bone block graft pedicled on the dorsal interosseous artery was developed to treat nonunion of the distal radius or ulna. Seventy cadaver upper extremities were injected by latex through humeral arteries and dissected under magnification to investigate the branches from the posterior interosseous artery of the forearm to the ulna. It was found that the dorsal interosseous artery gives off a perforating branch about 2.5 cm proximal to the ulnar styloid to participate in the dorsal carpal vascular network, and two to three constant branches to supply the distal ulna at a level 3 to 4 cm proximal to the ulnar styloid. These branches course along the interosseous membrane and supply the distal part of the ulna. Seven patients with distal forearm bony non-unions (five radius and two ulna) were treated by this procedure. The dorsal interosseous artery was separated with 1 cm of surrounding tissue beneath the radial edge of the extensor capri ulnaris until the periosteal branches to the ulna were observed. A bone block of the distal ulna 1.0 × 3.5 cm in size was harvested with the vascular pedicle and transferred to defects in the radius or ulna. Satisfactory bony healing was achieved about 3.5 months after operation, and a follow-up over 1 year showed good function of the hand. Removal of the bone block did not affect continuity of the ulna or function of the distal radioulnar joint.
Microsurgical Anatomy of Hypothenar Flap
Authors: Lao J. , Gu Y-D. , Wu Z-P.
Published: September 2005

A microsurgical anatomical study was performed in the hypothenar area in 34 hands of 17 fresh cadavers. The hands were injected by latex through the humeral arteries. The hypothenar area was dissected under a microscope. The length, diameter and location of the branches from the ulnar artery and cutaneous branches from the proper artery of the little fingers were examined. The sources of blood supply to the hypothenar flaps were: (1) one fairly constant hypothenar cutaneous branch of the ulnar artery together with two to six other cutaneous branches from the ulnar artery. The hypothenar cutaneous branch of the ulnar artery had a pedicle of 9.9mm in length, 0.13mm in diameter. This artery originated from the ulnar artery 1.6 cm proximal to the pisiform; (2) four to six cutaneous branches from the proper arteries of the little finger; (3) the cutaneous and muscular branches from the deep branch of the ulnar artery. The venous return was through (1) concomitant veins of the cutaneous branches of the ulnar artery; (2) a palmar subcutaneous venous network. The flap was innervated by one to two branches from the superficial branch of the ulnar nerve. This anatomical study indicates that a flap from the hypothenar area can be harvested with the pedicle of the hypothenar branch of the ulnar artery to repair soft tissue defects in hyopthenar area, palmar wrist region or fingers with the advantage of direct closure of the donor area.
Free Vascularized Mini-Flaps in Replantation of the Digits
Authors: Jiang C-Z. , Teng H-J. , Dou Y-B. , Guan L. , Wang X.
Published: September 2005

Free vascularized mini-flaps have been used in 18 patients with digital replantations since 1989. The mini-flaps were only 1 × 2 cm to 3 × 4 cm in size. These flaps were harvested from abandoned digits in 12 cases and from venous flaps of the forearm in six cases. The flaps taken from a useless finger included the extensor tendons in two, digital nerves in six and interphalangeal joints in one case. The primary surgical indication for the mini-flap was excessive soft tissue loss with vascular defects in the digits with intact phalanges. The mini-flap was also indicated in cases with severe injuries of several digits in which vascularized nerves, phalanges or interphalangeal joints were available from the relatively unimportant digits, and there was need to reconstruct these structures in functionally important digits. The methods of vascular anastomosis of the flaps included: (1) interposition graft of the vessels with the flaps between the proximal and distal parts of the amputation; (2) arterial–venous bypass anastomosis; and (3) arterial–venous network anastomosis. All the mini-flaps survived with fairly good functional return. This study provides new approaches for severe crush injuries in amputated digits, which had been considered previously as not suitable for replantation.
Altered Patterns of Subchondral Bone Mineralization in Kienböck’s Disease
Authors: GIUNTA R. , LÖWER N. , WILHELM K. , KEIRSE R. , ROCK C. , MÜLLER-GERBL M.
Published: September 2005

The pattern of subchondral bone density, which is supposed to reflect the long-term distribution of stress, was investigated in both wrist joints of nine healthy young subjects and seven patients suffering from Kienböck’s disease by means of CT osteoabsorptiometry. Two density maxima were found on the distal articular surface of the radius in the healthy subjects, corresponding to the position of the scaphoid and the lunate. Our relative quantitative results showed three different physiological types of stress indicated by the predominantly monocentric density maxima either on the scaphoid or the lunate surface of the radius and the symmetrical distribution of the mineralization. In Kienböck’s disease no type of mineralization predominated. In the progressive stages the lunate density maximum was absent. The overall mineralization was generally less than in controls. Changes in the pattern of mineralization were also found on the contralateral side.
The Reverse Pedicle Heterodigital Cross-Finger Island Flap
Authors: GERMANN G. , RÜTSCHLE S. , KANIA N. , RAFF T.
Published: September 2005

The use of the reverse pedicle island flap as a heterodigital cross-finger flap is reported in five patients in whom conventional cross-finger flaps or homodigital flaps could not be used. All flaps survived and patient satisfaction was high. However, the indication for the flap must be considered carefully as the dissection is technically demanding and there is some donor site morbidity.
Anterior Transposition of the Posterior Interosseous Artery Flap through the Interosseous Membrane
Authors: GUPTA A. , WANG A. , BAYLIS W. , BREIDENBACH W.
Published: September 2005

A posterior interosseous artery flap was used to cover a large palmar defect after passing it through the interosseous membrane to avoid tension on the vascular pedicle.
The Diagnosis of Carpal Tunnel Syndrome
Authors: GUNNARSSON L.-G. , AMILON A. , HELLSTRAND P. , LEISSNER P. , PHILIPSON L.
Published: September 2005

The study group consisted of 100 persons referred with suspected carpal tunnel syndrome. Clinical and neurophysiological examinations were performed blinded from each other. The gold standard for the carpal tunnel syndrome (CTS) diagnosis was based on the results of these examinations but relief of CTS symptoms after surgery was also required. The sensitivity and specificity for the combined results of the clinical examinations were 94% and 80% respectively, and for the neurophysiological examinations, 85% and 87%. Of the neurophysiological methods used, the quotient of sensory nerve conduction velocity between palm to wrist and wrist to elbow was best and the cut-off for this test was studied by means of an ROC-curve. According to our results clinical examination by an experienced doctor seems to be sufficient if there are typical symptoms of carpal tunnel syndrome, but if there is a history of pain, atypical symptoms or earlier fractures in the arm, wrist or hand, it is important to add a neurophysiological examination.
Guyon’s Canal Syndrome
Authors: HIROOKA T. , HASHIZUME H. , NAGOSHI M. , SHIGEYAMA Y. , INOUE H.
Published: September 2005

An atypical case of Guyon’s canal syndrome is reported. A 40-year-old woman with hypoaesthesia and claw-finger deformity of the little finger, hypothenar muscle atrophy but no first dorsal interosseous muscle atrophy, underwent release of a fibrous band to decompress the ulnar nerve at the deep branch just proximal to the branch to the abductor digiti minimi muscle. The claw-finger deformity recovered 1 week after surgery.
Neurofibromas of Digital Nerves
Authors: BASHEER H. , RABIA F. , BASHEER H. , EL-HELW K.
Published: September 2005

We report four cases of neurofibromas affecting the digital nerves. Diagnosis and management are both difficult and demanding. Excision of the tumour while preserving the nerve was achieved by meticulous dissection in three out of four cases, resulting in normal sensation in two. The risk of recurrence is outweighed by the risk to sensation.
Anterior Interosseous Nerve Palsy
Authors: SOOD M.K. , BURKE F.D.
Published: September 2005

Sixteen patients with paralysis of the anterior interosseous nerve (AIN) in 19 limbs who were treated in a single unit were reviewed at a mean of 6.4 years (range 2–14 years) following onset of the paralysis. There was a high incidence of incomplete lesions (seven limbs) and of associated neurological lesions (six limbs) in the same or opposite upper extremity. Patients treated conservatively and with surgical exploration showed no difference in the time of onset of recovery, the time taken to achieve complete recovery or the extent of recovery. Those with incomplete lesions recovered well irrespective of the type of treatment. A distinct cause of compression of the AIN or visible changes in the AIN were seen in just three of the eight limbs that were explored. Surgery is indicated in complete lesions with no evidence of recovery for at least 6 months; incomplete lesions and other neurological signs are indications for conservative management in the first instance.
Ulnar Nerve Injury at the Elbow after Steroid Injection for Medial Epicondylitis
Authors: STAHL S. , KAUFMAN T.
Published: September 2005

We describe an accidental injury to the ulnar nerve at the elbow following steroid injection for medial epicondylitis in a patient with undetected recurrent dislocation of the nerve. The chalky substance found on exploration to intermingle with the nerve fascicles was removed and the nerve was placed under the flexor-pronator mass. After surgery, complete resolution of the epicondylar pain was noted, along with significant improvement in two-point discrimination of the ulnar digits. We recommend clinical assessment of the ulnar nerve location prior to injection to avoid injury. Should recurrent dislocation of the nerve be diagnosed, injection should be given cautiously, preferably with the elbow in an extended or semiflexed position.
Upper Limb Traumatic Amputees
Authors: GAINE W.J. , SMART C. , BRANSBY-ZACHARY M.
Published: September 2005

The prosthetic status of the traumatic upper limb amputees was reviewed. Fifty-five upper limb amputees were reviewed using a detailed questionnaire, telephone or clinic review and by case note study. Twenty-three patients were traumatic amputees and 32 were congenital amputees. The amputees’ function, prosthetic use and satisfaction were evaluated and this formed the basis of a scoring system. The traumatic group were less satisfied with their prosthesis and their functional ability was poorer, especially in the use of the myoelectric prosthesis. Traumatic amputees wore their prosthesis for an average of 6.5 hours per day compared to 9.3 hours in the atraumatic group. None of the traumatic amputees fitted after 12 weeks returned to gainful employment. Early prosthetic fitting, rehabilitation and post-traumatic counselling are advocated in upper limb traumatic amputees in order to achieve an optimum prosthetic benefit for the patient.
Anchorage of Wrist Joint Prostheses to Bone Using the Osseointegration Principle
Authors: LUNDBORG G. , BRÅNEMARK P. I.
Published: September 2005

Five patients with rheumatoid arthritis (age 28–60 years) underwent wrist joint arthroplasty with individually designed artificial joint mechanisms, anchored to bone using the osseointegration principle. We report on the result from a 4 to 6.5 year follow-up with special emphasis on the fixation of the prosthesis to bone. There was no bone resorption or loosening of screws. Osseointegration of the titanium screws occurred in all cases and persisted throughout the observation period, although scattered lytic zones could sometimes be seen around the screws. The clinical results were satisfactory with pain relief and maintenance of a functional range of movement. The principle has prospects for fixation of a wrist joint mechanism to bone, although the presently used joint mechanism requires further refinement.
Hand Function Following Silastic Arthroplasty of the Metacarpophalangeal Joints in the Rheumatoid Hand
Authors: ROTHWELL A. G. , CRAGG K. J. , O’NEILL L. B.
Published: September 2005

Twenty-one consecutive rheumatoid patients (23 hands, 92 joints) who underwent Silastic metacarpophalangeal joint arthroplasty between 1989 and 1993 had the 33-task Baltimore quantitative upper extremity function test prior to surgery and then repeated at intervals from 6 weeks to 1 year for all 23 hands and 3 to 4 years for 14 of the hands. In addition all hands had goniometer measurement of active range of finger joint motion and ulnar drift at each assessment. The average preoperative score was 71 improving rapidly to 89 at 6 weeks, to 91 at 1 year and 92 at 3 to 4 years. Most improvement occurred in functions requiring pinch span or hook grip and could be attributed largely to correction of ulnar drift and the change of metacarpophalangeal arc of motion. These results confirm that the Silastic metacarpophalangeal joint arthroplasty significantly improves hand function and that the improvement is maintained over a 3- to 4-year period.
Extravascular Papillary Endothelial Hyperplasia Following Surgery for De Quervain’s Disease
Authors: RAMPOLDI M. , BONICA J. , REMOTTI D.
Published: September 2005

We report a case of extravascular papillary endothelial hyperplasia following surgery for De Quervain’s disease, clinically presenting as an angiosarcoma.
Antimicrobial Treatment of Fish Tank Granuloma
Authors: LAING R. B. S. , FLEGG P. J. , WATT B. , LEEN C. L. S.
Published: September 2005

Three patients with fish tank granuloma of the hand and forearm are reported. Each patient was treated with antimicrobial regimes which have rarely or never been previously used in this condition. Two patients responded well to treatment, one who received ciprofloxacin plus clarithromycin and another who was given clarithromycin plus ethambutol. The third patient received six different antimicrobial regimes before responding to a combination of rifabutin and ciprofloxacin.

Our experience suggests that there now exist a number of effective alternatives to antimicrobials which have been traditionally used in the treatment of cutaneous Mycobacterium marinum infection.
Experience with Scaphoid Grafting
Authors: BARTON N. J.
Published: September 2005

Over a period of 24 years, the author has used five different methods of bone-grafting for ununited scaphoid fractures. The clinical and radiological results have been reviewed, with a minimum follow-up of 1 year. Radiologically the best results (78% definite union) were obtained with a “wedge” graft and Herbert screw, while the worst results followed the original Russe operation. The clinical result often did not coincide with the radiological outcome. All methods led to a decrease in pain in most cases, but little or no pain was achieved most often by the modified Russe graft. With proximal pole fractures, bony union was only achieved in 54% but the symptoms were always lessened.
Anatomical and Biomechanical Studies of the Pathogenesis of Trapeziometacarpal Degenerative Arthritis
Authors: NAJIMA H. , OBERLIN C. , ALNOT J. Y. , CADOT B.
Published: September 2005

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.
Scaphotrapeziotrapezoid Osteoarthritis after Scaphotrapezial Ligament Injury
Authors: SICRE G. , LAULAN J. , ROULEAU B.
Published: September 2005

We report a case of osteoarthritis of the scaphotrapeziotrapezoid (STT) joint secondary to a scaphotrapezial ligament injury.
Day Care Surgery for Advanced Dupuytren’s Contracture
Authors: EBSKOV L. B. , BOECKSTYNS M. E. H. , SØRENSEN A. I. , HAUGEGAARD M.
Published: September 2005

Seventy-six consecutive patients suffering from advanced Dupuytren’s contracture were analysed in order to evaluate the safety of day care surgery. The complication rates for haematoma, necrosis, infection and reflex sympathetic dystrophy were acceptable, but we found an unacceptably high percentage of nerve lesions. Day care treatment was achieved in all but seven cases. We concluded that advanced Dupuytren’s contracture can be treated by day care surgery but the operations should be performed by surgeons who are skilled in hand surgery, and individual selection of patients with recurrence seems advisable.
Extending the Use of the Palmar Advancement Flap with V-Y Closure
Authors: KINOSHITA Y. , KOJIMA T. , MATSUURA S. , HAYASHI H. , MIYAWAKI T.
Published: September 2005

Recently we have extended the use of the V-Y advancement flap for the purposes of releasing flexion contractures of finger joints, improving the appearance of congenitally anomalous fingers and repairing segmental skin defects in fingers, with gratifying results.