bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of The Results of Opponensplasty
Authors: MEHTA R. , MALAVIYA G. N.
Published: September 2005

A comprehensive evaluation system for opponensplasties has been described taking into consideration several variables. Each variable has been assigned a score depending upon its significance in the normal hand. The total score of the hand is used for grading the results as good, fair and poor.
Arthrogryposis Multiplex Congenita in a Monozygotic Twin
Authors: MENNEN U. , WILLIAMS E.
Published: September 2005

Arthrogryposis multiplex congenita is a specific, well-defined congenital deformity which primarily affects muscles of limbs resulting in secondary joint deformities. The aetiology is still uncertain.

One of monozygotic twin brothers with classical arthrogryposis multiplex congenita is presented, proving that this specific condition is not genetically transmitted.
Finger Duplication in Apert's Syndrome
Authors: ANDERSON P. J. , HALL R. , SMITH P. J.
Published: September 2005

Three cases of unilateral duplication of the little finger in children with Apert's syndrome are presented. They provide additional evidence that the hands in Apert's syndrome are not always symmetrically affected.
Selective Reinnervation of Regenerating Mixed Nerve Fibres Across a Silicone Tube Gap
Authors: LUO Z-J. , LU S-B.
Published: September 2005

This study investigated specific regeneration of a mixed motor and sensory nerve by the method of spinal dorsal root ganglions resection. A 10 mm segment of tibial nerve was resected and the nerve ends inserted in a silicone tube. Fourteen weeks later, dorsal root ganglia from L6 to S1 were resected on the experiment side. Twenty weeks later, the regenerating motor nerve fibres of mixed nerves selectively grew into motor branches. The rate of misdirected growth in mixed nerves was less than 6%. These results suggest that regenerating motor and sensory axons of mixed nerves are able to select their distal target organs accurately. Better results may be obtained using the entubulation repair method.
Hand Trauma and Herpes Infection
Authors: STARLEY I. F. , HOLMES J. D.
Published: September 2005

A herpes simplex type 2 infection of the hand after injury is described in a 26-year-old man. The management and implications of such an unusual hand infection are discussed.
Myxoma of the Hand
Authors: AL-QATTAN M. M.
Published: September 2005

A rare case of myxoma of the dorsal aspect of the little finger is described. Classification of myxomas of the upper limb is discussed.
Brachial Plexus Palsy and Carotid Artery Dissection
Authors: EDMUNDS I. , TONKIN M. A.
Published: September 2005

We report a case of stroke due to carotid artery dissection in a young man following a traumatic brachial plexus palsy associated with a pseudoaneurysm of the axillary artery.
Tissue Displacement Is a Causative Factor in Vibration-Induced Muscle Injury
Authors: NECKING L. E. , LUNDSTRÖM R. , DAHLIN L. B. , LUNDBORG G. , THORNELL L-E. , FRIDÉN J.
Published: September 2005

The early skeletal muscle response to vibration stimulus at two different displacement levels was examined. Twelve rats were anaesthetized and the hind limb was exposed to vibration, 80 Hz, 63 μm rms (root mean square) (group 1) and 40 Hz; 130 μm rms (group 2) for 5 hours/day for 2 days. Cross-sectional areas of vibrated muscle fibres were significantly larger in group 2. Sizes of different fibre types were differently affected: the slow-twitch type 1 fibres were significantly enlarged in both groups, while the fast-twitch type 2 fibres demonstrated a mixed response pattern. Centrally positioned muscle fibre nuclei increased significantly after vibration in group 2. It is concluded that the level of tissue displacement is a crucial factor for development of vibration-induced muscle injury.
Fixation for Comminuted Phalangeal Fractures
Authors: LU W. W. , FURUMACHI K. , IP W. Y. , CHOW S. P.
Published: September 2005

The rigidities of five fixation methods have been studied with a comminuted phalangeal fracture model. Mechanical testing of compression, bending and torsion were performed for each fixation. Lateral plating with six screws seems to provide the most rigid fixation. If such lateral plating is not practicable, the four-Kirschner wire method would be a satisfactory alternative.
Absence of Flexor Carpi Radialis
Authors: RUMBALL K. M. , TONKIN M. A.
Published: September 2005

A case is reported of an absent flexor carpi radialis in a patient undergoing tendon transfers for a posterior interosseous nerve palsy.
Scaphoid Osteochondroma Mimicking Carpal Coalition
Authors: RICE J. , STEPHENS M. , COLVILLE J.
Published: September 2005

We present the case of a 10-year-old girl who presented with a block to wrist abduction. Plain radiographs of the wrist suggested a coalition between the carpal bones. ACT scan, however, revealed the presence of an osteocartilaginous lesion on the distal pole of the scaphoid. This was resected and histology showed it to be an osteochondroma.
Pseudoaneurysm of the Radial Artery Complicating Excision of a Wrist Ganglion
Authors: MAW A. , RENAUT A. J.
Published: September 2005

A case of pseudoaneurysm of the radial artery complicating excision of a wrist ganglion is reported. Tourniquet release prior to wound closure would have allowed detection and immediate treatment of the vascular injury.
“Through-Glass” Injuries
Authors: IRWIN L. R. , DALY J. C. , JAMES J. H. , MUWANGA C. L. , WILLIAMS L.
Published: September 2005

This prospective trial collected all cases where injuries had resulted from the hand passing through or striking glass and had been referred to a hand injury service during 1 year. Eighty-seven cases were referred and the factors relating to these injuries were examined. A record was made of the structures damaged, the surgery performed and prevailing socioeconomic factors. These injuries were very costly in terms of morbidity, surgical effort and time, with significant resource implications. The study appears to confirm other reports that current legislation on glazing safety was too long delayed and is inadequate now that it is in place.
Long-Term Results after Segmental Aponeurectomy for Dupuytren’s Disease
Authors: MOERMANS J. P.
Published: September 2005

Segmental aponeurectomy has been proposed as a less extensive procedure for the treatment of Dupuytren’s disease to limit the incidence of wound complications and stiffness associated with wide dissections.

Analysis of the late results showed that the operation brought a lasting correction of the contracture. In hands which did not show any sign of progression of the disease, the follow-up values were even slightly better than the immediate postoperative measurements. It also showed that the proportions of recurrences, extensions and hands free of the disease are similar to those after other procedures and that the type of operation does not appear to be related to the progression of Dupuytren’s disease.
Contraction of Collagen Lattices by Cells from Dupuytren’s Nodules
Authors: TARPILA E. , GHASSEMIFAR M. R. , WINGREN S. , ÅGREN M. , FRANZÉN L.
Published: September 2005

The aim of this study was to see if nodular cells in Dupuytren’s disease differed from dermal cells in their contractile capacity and motility. Ten surgical specimens from patients with Dupuytren’s disease and contracture of the finger of more than 45° were harvested and the nodular cells were explanted and cultured. Dermal fibroblasts from the forearm were used as control cells. Both types of cell had the same growth pattern. The morphology on confocal laser scanning microscopy was also similar in both types of cell. Dermal control cells caused significantly more contraction of collagen lattices compared with fibroblasts from nodules of Dupuytren’s contracture. The F-actin content was equal in both groups. Platelet derived growth factor, PDGF-BB (but not PDGF-AA), increased the chemotactic activity of both cell types, but there were no differences between them. The results indicate that at a late state of the disease cells from Dupuytren’s nodules lose their contractile capacity and regain a phenotype resembling that of dermal fibroblasts.
Patterns of Cellular Activation after Tendon Injury
Authors: KHAN U. , EDWARDS J. C. W. , McGROUTHER D. A.
Published: September 2005

Mechanisms which lead to disabling adhesions following flexor tendon surgery of the hand were investigated in a rabbit model which was used to assess the relative response of the cells of the synovial sheath, epitenon and the endotenon to injury. A transverse laceration, cutting through 50% of the tendon, was made just outside the synovial sheath on the flexor aspect of the flexor digitorum profundus tendon. The synovial sheath was preserved intact. Using monoclonal antibodies for localizing specific inflammatory markers, we were able to follow the response and activity of the synovial sheath, epitenon and endotenon with respect to these markers at various times after surgery. Our findings suggest that the synovial sheath and the epitenon are relatively more reactive in the early period after injury, as judged by a range of inflammatory indices with the notable exception of the expression of the potent neovascularizing agent, basic fibroblast growth factor (bFGF).
Tensile Strength of Cross-Stitch Epitenon Suture
Authors: KIM P-T. , AOKI M. , TOKITA F. , ISHII S.
Published: September 2005

Using a computerized tensiometer, the mechanical properties of two types of repair in the canine flexor digitorum superficialis tendon were examined. The slope and ultimate tensile strength of a cross-stitch epitenon suture were compared to those of a simple over-and-over running epitenon suture. Both epitenon sutures were combined with a modified Kessler core suture. Suture material was 6/0 monofilament nylon for the epitenon suture, and 4/0 braided polyester for core suture. Average relative values of individual ultimate tensile strength for the cross-stitch group was 245% compared to that for the running suture group. There was no discrepancy in slope between the two groups.
A Two-Dimensional Kinematic Analysis of the Distal Radioulnar Joint
Authors: VAN DER HEIJDEN E. P. A. , HILLEN B.
Published: September 2005

The triangular fibrocartilage and its function in the kinematics of pronation and supination in the distal radioulnar joint was studied. Measurements of the constituent parts of this joint in 11 cadavers showed that the palmar radioulnar ligament is at least 2 mm longer than the dorsal radioulnar ligament. Based on these measurements the movements of the joint were modelled in a two-dimensional kinematic chain. Predictions based on this chain could be confirmed by direct observation and videotaping dissections of joints of unfixed specimens and three-dimensional reconstructions of a CT scan of a healthy volunteer. It could be concluded that (a) the dorsal part is tight during pronation and the palmar part during supination and (b) considerable asymmetrical translations, (dorsal translation being the largest) occur because of the length differences of the ligaments.
Long-Term Follow-Up Study of Peripheral Nerve Repair by Non-Nerve Tissues
Authors: Liu J-C.
Published: September 2005

This paper reported a long-term follow-up of seven cases (eight nerves) with peripheral nerve repair by non-nerve tissues. The injured nerves involved three median, two radial, one ulnar and one tibial nerves. These patients were treated 3 to 10 months after injuries. In five cases, pedicled muscles grafts were used to repair nerve gaps from 3 to 6 cm. Follow-up between 4 years and 10 months and 6 years and 8 months showed functional recovery ranged from MOS1 to M2 + S3. Two cases of nerve gaps 3 and 4 cm in length repaired by empty muscle membrane tubes recovered to M3S4 and M4S4. Liu concluded that pedicled muscle graft is not an ideal substitute for nerve graft. They peculated that inner structures in the muscle graft prevented growth of regenerating axons, which made the graft not function as effectively as an empty tube. One should be cautious in using non-nerve tissues to repair peripheral nerve gaps.
Interfascicular Grafts of Non-Nerve Tissues for Gaps in Peripheral Nerve Trunks
Authors: Tang J.B. , Shi D. , Gu Y-Q.
Published: September 2005

Ten cases with gaps in nerve trunks in the forearm were treated by interfascicular grafts of autogenous veins. These included three cases of median nerve injuries, five cases of ulnar nerve injuries and two cases of radial sensory nerve injuries. The nerve gaps ranged from 1.5 to 4.5 cm with an average of 3 cm. Completely divided nerve trunks were repaired by two or three vein conduits. For incomplete nerve injuries or replacement of a single fasciculus, a single vein conduit was used. For nerve defects over 3 cm, normal nerve tissues were sectioned from the proximal nerve fasciculus and inserted into the vein conduits. These cases were followed for 2 years and 2 months to 3 years. The results were M3 in two, M4 in six and S2 + in two, S3 + in seven and S4 in one nerves. This study suggests that interfascucular grafts of vein conduits can be applied in patients with nerve gaps shorter than 4.5 cm and with favourable wound conditions with fairly good clinical results. Interfascicular vein graft provides an alternative treatment option for gaps in distal peripheral nerve trunks.
Application of Snuff-Box Flaps Based on Branches from the Radial Artery
Authors: Gu Y-D. , Zhang G-M. , Lao J. , Zhang L-Y. , Yu C.
Published: September 2005

This paper reported experience with application of the snuff-box cutaneous flap in 10 patients with skin contracture in the hands. The sites with skin contracture were the first web sight in six, dorsal wrist in two, and palmar wrist in two. The flap was harvested centred by the snuff-box region with a width of 3 to 5 cm and length of 10 to 14 cm. This flap was based on the perforating branches from the radial artery in the snuff-box area. The pedicle of the flap was 4.2 mm in length. Venous drainage was through two concomitant veins of the perforating branch and the cephalic vein. Clinical application of this flap produced good results in nine cases and partial necrosis in one due to venous congention. This local cutaneous flap of the hand is recommended as a rotational pedicle flap to cover skin defects in the first web or the wrist regions. However, the flap may have disadvantages, such as failure of adequate venous return due to flap rotation or the necessity for a skin graft in the donor area when the flap is large.
Endoscopic Carpal Tunnel Release: Prospective Assessment of 255 Consecutive Cases
Authors: ATROSHI I. , JOHNSSON R. , ORNSTEIN E.
Published: September 2005

A prospective study was conducted to evaluate the efficacy and safety of two-portal endoscopic carpal tunnel release. Two hundred and fifty-five consecutive hands (204 patients) were operated on by one surgeon using general or regional anaesthesia in the first 48 hands and local anaesthesia in the following 207 hands. The patients were evaluated preoperatively and 3 and 6 months postoperatively by an independent examiner. At the 6-month follow-up, 83% reported complete relief of symptoms and 89% were satisfied with the results of surgery. The median time until return to work was 17 days. Complications included five postoperative digital neurapraxias, all occurring under general or regional anaesthesia, and four open reoperations due to persistent symptoms. Two-portal endoscopic carpal tunnel release can be effective and safe and appears to shorten the time until return to work. The use of local anaesthesia might be important in avoiding neurological complications.
Anatomical Classification of Sites of Compression of the Palmar Cutaneous Branch of the Median Nerve
Authors: AL-QATTAN M. M.
Published: September 2005

The anatomical course of the palmar cutaneous nerve was studied in ten cadavers and classified into six zones or sites. The literature on entrapment neuropathy of the palmar cutaneous nerve was then reviewed and the cases were classified according to the anatomical site of compression.
Acute Carpal Tunnel Syndrome as a Complication of Oral Anticoagulant Therapy
Authors: BLACK P. R. M. , FLOWERS M. J. , SALEH M.
Published: September 2005

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended. There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. We describe such a case in a patient on long-term warfarin anticoagulation, drawing attention to particular features of the history and clinical findings. In contrast to previous reports, we recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.
The Role of Magnetic Resonance Imaging in the Management of Peripheral Nerve Tumours
Authors: HEMS T. E. J. , BURGE P. D. , WILSON D. J.
Published: September 2005

Fourteen cases of peripheral nerve tumour which had been examined by MRI were reviewed. T1-weighted images showed the tumours to be of intermediate signal and T2-weighted images showed a high signal with some heterogeneity. These appearances are not specific to peripheral nerve tumours, although the diagnosis may be suggested if the lesion arises from a major nerve trunk. The association with a nerve trunk may be defined by MRI, thus assisting with surgical planning. Neurilemmomas, neurofibromas and malignant nerve sheath tumours could not be differentiated with certainty using MR alone. The MR features of lipofibromatous hamartoma are reported.
Compression of the Lateral Cutaneous Nerve of the Forearm by a Glomus Tumour
Authors: VAN DER LEI B. , DAMEN A. , VAN VALKENBURG E.
Published: September 2005

We report a case of forearm pain secondary to compression of the lateral cutaneous nerve of the forearm by a glomus tumour.
Bilateral Osteoarthritis of the Trapeziometacarpal Joint Treated by Bilateral Tendon Interposition Arthroplasty
Authors: DAMEN A. , VAN DER LEI B. , ROBINSON P. H.
Published: September 2005

Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for bilateral trapeziometacarpal osteoarthritis yields satisfactory long-term results on both sides.
Psychological Distress Associated with Algodystrophy
Authors: FIELD J. , GARDNER F. V.
Published: September 2005

We have carried out a prospective study of the level of psychological distress in patients with Colles’ fractures. Those who developed algodystrophy did not show increased distress before the onset of the condition.
The Contractility of Knuckle Pads
Authors: IRWIN L. R. , NAYLOR I. L. , HOLMS W.
Published: September 2005

Strips of tissue from knuckle pads contract in response to the myofibroblast stimulant mepyramine in a reversible, repeatable and dose-dependent manner. The significance of this finding is discussed.
Recurrent Intravascular Papillary Endothelial Hyperplasia
Authors: KATZMAN B. , CALIGIURI D. A. , KLEIN D. M. , NICASTRI A. D. , CHEN P.
Published: September 2005

We report a case of recurrent intravascular papillary endothelial hyperplasia.
Haemangioendothelioma in an Infant’s Wrist
Authors: CHIA J. , TEH M. , PHO R. W. H.
Published: September 2005

A rare case of an epitheloid haemangioendothelioma presenting as an aggressive soft tissue mass in the wrist of an infant is presented. The management of the lesion presents particular difficulties because of its diffuse involvement of surrounding muscles, tendons and neurovascular bundle and the importance of preserving hand function. The epitheloid haemangioendothelioma rarely occurs extravascularly with less than 15 such cases reported in the literature.
A Further Tendon Retrieval Trick
Authors: SANDOW M. J.
Published: September 2005

Atraumatic delivery of the retracted flexor tendon ends following laceration is crucial for accurate tenorrhaphy. Sourmelis and McGrouther (1987) developed a useful method of delivering the proximal flexor tendon and a modification is presented here which further aids atraumatic tenorrhaphy.
Predisposing Factors to Industrial Hand Injuries in Saudi Arabia
Authors: ZAHRANI S. AL , IKRAM M. A. , AL-QATTAN M. M.
Published: September 2005

A prospective study was performed on 108 consecutive cases of industrial hand injuries in Saudi Arabia to highlight predisposing factors to injury. Traumatic amputations and fractures of the radial three digits were the commonest injuries. Eighty patients (74%) worked for more than 8 hours per day, which is against Saudi labour law. Only 5% of the injured workers had similar jobs previously or formal training prior to employment. The majority (81%) admitted that safety measures were not being followed at the time of injury. Ten workers (9%) had a previous history of industrial hand injury. It was concluded that strict implementation of safety measures and Saudi labour law, proper training of employees, and the development of agencies for the prevention of occupational accidents would be important in the prevention of industrial hand injuries in Saudi Arabia.
Hand Infections in the Diabetic Patient
Authors: PINZUR M. S. , BEDNAR M. , WEAVER F. , WILLIAMS A.
Published: September 2005

Between 1984 and 1994, 23 diabetic patients were admitted to a university hospital/Department of Veterans Affairs (DVA) Medical Centre with a primary or secondary diagnosis of hand infection. We also identified 726 patients admitted to all DVA Medical Centres during the years 1989 through 1994 with co-diagnoses of diabetes mellitus and hand infection. Contrary to previously published literature, most diabetic hand infections are non-specific, confined to the soft tissues, and respond to broad spectrum parenteral antibiotic therapy. When surgery is necessary, most patients do not require amputation.
The Palmaris Longus Tendon
Authors: KOO C.C. , ROBERTS A. H. N.
Published: September 2005

The palmaris longus is one of the most variable muscles of the human body. An understanding of its variations is useful as it is often used as a tendon graft and for tendon transfer. We report another interesting variation in its anatomy.
Algodystrophy is an Early Complication of Colles’ Fracture
Authors: FIELD J. , ATKINS R. M.
Published: September 2005

One hundred patients who had sustained a Colles’ fracture were observed for features of algodystrophy at 1, 5, 9 and 12 weeks following injury. The diagnosis of algodystrophy was possible as soon as 1 week after fracture. Early diagnosis has important clinical implications: the aetiological factors may become apparent and different treatment modalities be identified; furthermore, early treatment can be started, limiting the morbidity of the condition. It is proposed that patients with features of algodystrophy require physiotherapy after a Colles’ fracture. Those without features may not.
The Consequences of Punching Glass
Authors: BOKHARI A. A. , STIRRAT A. N.
Published: September 2005

We carried out a retrospective and prospective study of 67 patients who had sustained hand injuries from punching glass over a period of 33 months. All had consumed alcohol and had argued with a partner. The mean age was 25 years, 90% were male and 56% were unemployed. Seventy per cent of injuries occurred between 23.00 and 04.00 hours. Total damage included division of 149 tendons, 33 nerves and nine arteries. Fifty-two per cent of patients required admission for more than 1 day. The mean number of follow-up visits was 3.6 and the majority needed hand therapy and occupational therapy services. Cost per injury was estimated as £1,120. Such injuries cause major disability in an already disadvantaged section of society. The challenge is to educate the susceptible patient group.
Complications Following Mucous Cyst Excision
Authors: FRITZ G. R. , STERN P. J. , DICKEY M.
Published: September 2005

Eighty-six mucous cysts in 79 patients were surgically excised. Follow-up was carried out at an average of 2.6 years. Fifteen digits (17%) had a residual loss of extension of 5 to 20° at the IP or DIP joints. One patient developed a superficial infection and two developed a DIP pyarthrosis, which eventually required DIP arthrodesis. Nail deformities were present in 25 of 86 digits preoperatively (29%), 15 of which resolved after surgery (60%). Four of 61 digits developed a nail deformity which was not present preoperatively (7%). Three of 86 digits (3%) developed recurrence. Other complications included persistent swelling, pain, numbness, stiffness, and radial or ulnar deviation at the DIP joint. We recommend that patients be informed preoperatively of the potential risks of decreased range of motion, persistent swelling and pain, infection, recurrence, and persistent or postoperatively acquired nail deformity.
Closure of Fasciotomy Wounds
Authors: CALLANAN I. , MACEY A.
Published: September 2005

The closure of fasciotomy wounds creates problems for patient and surgeon alike. Split thickness skin grafting results in unsightly and insensate wounds and often requires general anaesthesia and prolonged inpatient care. We describe an improvement of a previously reported technique which is as effective as proprietary medical devices currently available. The technique may also be applied to the delayed primary closure of traumatic wounds.
Grip and Pinch Strength Variations in Different Types of Workers
Authors: JOSTY I. C. , TYLER M. P. H. , SHEWELL P. C. , ROBERTS A. H. N.
Published: September 2005

We measured grip and pinch strengths in non-manual, light manual and heavy manual workers using a Jamar dynamometer and a pinch measuring device. Heavy manual workers had the strongest grips with the least difference between sides. Office workers had the weakest grips and the greatest difference between sides. Light manual workers were between these two groups.

Consequently, the occupation of the patient must be taken into account when using grip and pinch strength measurements to assess the need for rehabilitation and in medicolegal reports.
The Musician’s Hand
Authors: WINSPUR I. , WYNN PARRY C. B.
Published: September 2005

Care of the painful or injured hand or arm in a musician requires time, great patience, sophisticated knowledge and analysis of both the musician and their instrument, and in most cases a non-surgical approach. This is a tall order for the busy hand surgeon. Close collaboration between interested specialized physicians and the hand surgeon facilitates care of these patients. Additional help from music teachers, specialized instrumentalists, psychologists, arts therapists and family may be vital. Nevertheless, nothing short of a comprehensive approach will be successful and a limited approach may be functionally damaging if not disastrous. If an operation is necessary, provided surgery is performed with careful planning and skill, the results need not be as unsatisfactory as previously believed and indeed can in certain circumstances salvage a musician’s career.
The Influence of Joint Laxity on Periscaphoid Carpal Kinematics
Authors: FREEDMAN D. M. , GARCIA-ELIAS M.
Published: September 2005

Our earlier studies have revealed a direct association between global wrist laxity and scaphoid motion. The present study was undertaken to determine what association, if any, there is between laxity and lunate and/or distal carpal row (represented by the hamate) kinematics. Length measurements were obtained from standardized ulnar and radial deviation radiographs of 60 normal volunteers. From these measurements, the relative motion of the lunate and hamate was assessed by derivation of specific flexion and deviation indices. Linear regression analysis was applied to these data and no correlations between global wrist laxity and lunate or hamate motion were observed. We conclude that variability in global wrist laxity is explained only by alterations in scaphoid motion, manifested as variability in periscaphoid ligamentous motion.
Immediate and Delayed Nerve Repair Using Freeze-Thawed Muscle Autografts in Complex Nerve Injuries
Authors: GLASBY M. A. , FULLARTON A. C. , LAWSON G. M.
Published: September 2005

Six sheep underwent repair of the median nerve along with the establishment of a cavity, fibrosis and haematoma at the site of injury. A further six sheep underwent similar repair delayed for 30 days after the establishment of the complicating injury.

Six months after the nerve repair each group of sheep was assessed using electrophysiological and morphometric methods to establish objective indices of nerve recovery and regeneration. These results were compared with sheep which had undergone both immediate and delayed nerve repair with no complicating injury.

It was found that delay of the nerve repair and the presence of a complicating injury, both alone and together, contributed to a poorer outcome in recovery of nerve function and maturation.
Dislocations of the Metacarpophalangeal Joint of the Thumb
Authors: PATEL M. , DAVÉ J.
Published: September 2005

We report 13 cases of thumb metacarpophalangeal dislocations, ten dorsal and three palmar. Eleven had complex dislocations requiring open reductions. With dorsal dislocations the palmar plate, the tendon of flexor pollicis longus and the “thenar trap” (adductor pollicis, flexor pollicis brevis and abductor pollicis brevis) were the main impediments to reduction. The dorsal capsule, extensor expansion and extensor pollicis longus and brevis prevented reduction with the uncommon palmar dislocations.

Cadaver studies showed that dorsal dislocations are hyperextension and pronation injuries and palmar dislocations are hyperflexion and supination injuries. The unique “handlebar grip” injury which can cause either dorsal or palmar dislocations is also discussed. The palmar plate is the single most important stabilizer of the metacarpophalangeal joint and it is impossible to sustain a dislocation without tearing it. It is most likely to get entrapped within the joint in dorsal dislocations. Ulnar collateral ligament tears are more common with palmar dislocations.
Endoscopic Carpal Tunnel Release
Authors: ARMSTONG A. P. , FLYNN J. R. , DAVIES D. M.
Published: September 2005

We report our experience over a 30 month period of endoscopic release of the carpal tunnel by the Chow two-portal technique. The objective of this retrospective study was to evaluate the long-term subjective results of surgery and to assess if any iatrogenic nerve injury had been caused by the endoscopic procedure. The follow-up period was from 3 to 34 months. Our permanent, iatrogenic, postoperative nerve complication rate was 0.9% (2/208). No other serious complications occurred.
Occurrence of Myofibroblasts in Recurrent Dupuytren’s Disease
Authors: SALAMON A. , JÓZSA L. , RENNER A.
Published: September 2005

Surgically removed nodules from ten patients with recurrent Dupuytren’s disease were studied by electron microscopy. Myofibroblasts were found in eight cases in the active (involutional) stage. The distinctive ultrastructural features were similar to those of the original Dupuytren’s disease. We believe that, in addition to other factors, myofibroblasts have a non-specific but important role in the pathology of recurrent Dupuytren’s disease.
Comparison of Silver Sulphadiazine and Paraffin Gauze Dressings in the Treatment of Fingertip Amputations
Authors: RIYAT M. S. , O’DWYER F. G. , QUINTON D. N.
Published: September 2005

Fingertip amputations are common injuries presenting to the accident and emergency department and are usually treated conservatively. We compared silver sulphadiazine occlusive dressing to the traditional paraffin gauze compressive dressing in the management of these injuries over a 6 month period. The use of silver sulphadiazine dressing in fingertip amputations led to a more comfortable dressing change when compared with the paraffin gauze dressing. Although the fingertip amputations within the silver sulphadiazine group took longer to heal, on clinical assessment they had a significantly greater finger length preserved at the end of the trial.
The Hands in Pfeiffer Syndrome
Authors: ANDERSON P. J. , HALL C. M. , SMITH P. J. , EVANS R. D. , HAYWARD R. D. , JONES B. M.
Published: September 2005

Pfeiffer syndrome or acrocephalosyndactyly type 5 is a complex craniosynostosis syndrome characterized by craniosynostosis and broad thumbs and toes. Nineteen cases had their case notes and X-rays reviewed. A wide range of anomalies was seen with many bones within the hand affected on occasion by fusions. The most common anomalies were hypoplasia of the middle phalanx of the little or index fingers which occurred in the majority of cases. This finding may be of more use in establishing clinical diagnosis than the traditional thumb assessment.
The Yearly Outbreak of Orf Infection of the Hand in Saudi Arabia
Authors: HAWARY M. B. , HASSANAIN J. M. , AL-RASHEED S. K. , AL-QATTAN M. M.
Published: September 2005

Human orf virus infection of the hand results from contact with infected sheep and goats. Every year during the month of “Hajj” in Saudi Arabia, hundreds of thousands of sheep are slaughtered. A retrospective study showed that over 60% of patients presented to the authors with orf of the hand aquired the infection during slaughtering of the Hajj month, indicating a yearly outbreak of this infection in Saudi Arabia.
Ganglion Cyst Communicating with the Elbow Joint Presenting as a Distal Forearm Tumour
Authors: ADOLFSSON L.
Published: September 2005

A man presented with a large tumour in the distal, ulnar part of the right forearm and intermittent dysfunction of the ulnar nerve. Further examination revealed a benign ganglion cyst communicating with the elbow joint. The cyst was removed together with affected periosteum and the joint capsule was repaired. No recurrence has been observed 30 months later.
Side-Effects of Rinsing Fluids on the Rat Femoral Artery
Authors: DELAERE O. , MENNEN U. , VAN HEERDEN W. , RAUBENHEIMER E. , WIESE A. M. , BOOMKER D.
Published: September 2005

Rinsing rat femoral arteries with various fluids in experimental conditions similar to those in clinical practice was found to have deleterious effects on the intimal and medial layers of the vessels. No statistically significant difference was found between the effects of Ringer’s lactate and normal saline. Heparinized saline produced significantly less damage to the medial layer and less platelet cell deposition. Lignocaine 2% was found to be extremely damaging to the whole vessel wall, and highly thrombogenic. Nevertheless, all the arteries in each group remained patent 4 days after rinsing.
Combined Sever’s Release of the Shoulder and Osteotomy of the Humerus for Erb’s Palsy
Authors: AL-ZAHRANI S.
Published: September 2005

In children with Erb’s palsy who do not recover fully, the most common residual deformity is internal rotation-adduction contracture of the shoulder. Surgical correction of this contracture is described in this paper in 12 consecutive patients by combined Sever’s release of the shoulder and osteotomy of the humerus. After an average follow-up of 3 years, the average gain of active external rotation of the shoulder was 32° and average gain of active abduction was 61°.
Extensor Tendon Rupture due to Kienböck’s Disease
Authors: MURASE T. , ANDO Y. , HIROSHIMA K.
Published: September 2005

Extensor tendon rupture as a complication of Kienböck’s disease is rare. We report a case of attritional rupture of the extensor tendon to the index finger by a comminuted dorsal fragment of the lunate after Kienböck’s disease in an elderly woman. Excision of the fragment and extensor reconstruction with tendon graft led to a favourable result.
Carpal Tunnel Syndrome: Neurophysiological Results of Surgery Based on Preoperative Electrodiagnostic Testing
Authors: PADUA L. , MONACO M. LO , PADUA R. , TAMBURRELLI F. , GREGORI B. , TONALI P.
Published: September 2005

Fifty-three hands with carpal tunnel syndrome had pre- and postoperative evaluations of median nerve distal motor latency (from wrist to thenar muscles) and orthodromic sensory nerve conduction velocity (from thumb and middle finger to wrist). At 6 months we observed a neurophysiological return to normal in all cases with normal preoperative distal motor latency and in about 50% of the hands with preoperative distal motor latency between 4 and 6 ms. Prolongation of the distal motor latency over 6 ms was not followed by return to neurophysiological normality, although some degree of sensory function was restored in the majority of cases.
Intrauterine Vascular Deficiency of the Upper Limb
Authors: ARMSTRONG A. P. , PAGE R. E.
Published: September 2005

We report six cases of intrauterine vascular deficiency of the upper limb, presenting over a 12-year period, with established areas of necrosis at the time of birth. Three of the six mothers were diabetic. An urgent examination of the neonate should be done to exclude occult systemic thomboses, as early anticoagulation or thrombolytic therapy may be indicated. The majority of cases were managed conservatively with dressings and splintage of the limb; exceptionally surgical intervention was required. Long-term sequelae included flexion contractures and shortening of the forearm bones.
The Combined Use of a Pedicled Scarpa’s Fascia Flap and a Groin Flap for Simultaneous Coverage of Dorsal and Palmar Finger Defects
Authors: KONCILIA H. F. , WORSEG A. P. , KUZBARI R. , HOLLE J.
Published: September 2005

A case is reported in which the dorsal and palmar aspects of the fingers in a severely crushed hand were covered by combining a pedicled Scarpa’s fascia flap and a groin flap. Secondary heterotopic finger transposition was additionally performed to restore satisfactory hand function. An acceptable result was obtained.
Conservative Management of Wrist Ganglia
Authors: VARLEY G. W. , NEEDOFF M. , DAVIS T. R. C. , CLAY N. R.
Published: September 2005

Wrist ganglia were randomly allocated for conservative treatment by either aspiration or aspiration and injection of steroid. Both treatment methods had 33% success rates. Almost all ganglia which recurred after one aspiration did not resolve with further aspirations. After aspiration and explanation of the benign nature of ganglia, only a quarter of patients requested surgical treatment.
Computed Tomography in Partial Carpal Arthrodesis
Authors: SOLER-MINOVES J. M. , GONZALEZ-USTES J. , PÉREZ R. , GIFREU M. , GALLART A. M.
Published: September 2005

We carried out X-rays and computed tomography in 59 wrists in patients who had previous surgical intercarpal fusions. 1.2 mm thick axial images were obtained perpendicular to the axis of the joint. CT showed whether or not the carpal fusions were united. Compared with CT, plain radiography yielded a 25% false negative and 6% false positive rate. We conclude that CT is more useful than plain X-rays for evaluating partial carpal arthrodesis.
Late Treatment of a Displaced Intraarticular Metacarpal Head Fracture
Authors: SUDHAKAR J. E. , SMITH A. M. , LESLIE I. J.
Published: September 2005

This article describes a displaced intraarticular metacarpal head fracture that was successfully internally fixed at late presentation with a Herbert screw.
Upper Limb Escherichia Coli Cellulitis in the Immunocompromised
Authors: BRZOZOWSKI D. , ROSS D. C.
Published: September 2005

The neutropenic state characteristic of acute lymphoblastic leukaemia (ALL) predisposes to infections involving Gram-negative bacilli. An Escherichia coli cellulitis originating in the first web space of the hand is described in a patient undergoing reinductiori chemotherapy for ALL. Proximal extension of the infection progressed at a very rapid rate and required a forequarter amputation as a life saving measure. Due to the blunted inflammatory response in neutropenic patients, the need for close monitoring and quick intervention is stressed.
Local Symptoms After open Carpal Tunnel Release
Authors: CITRON N. D. , BENDALL S. P.
Published: September 2005

We report a randomized trial of two skin incisions for carpal tunnel decompression, namely a standard incision and an ulnar L incision. We looked particularly at the resolution of local symptoms namely pillar pain and scar sensitivity. There were 47 patients in the trial. No difference was found in pillar pain between the two incisions, but one had a lower incidence of scar sensitivity. These results give a baseline for comparison of local postoperative symptoms following open release with those following endoscopic release.
Touch Allodynia Following Endoscopic (Single Portal) or Open Decompression for Carpal Tunnel Syndrome
Authors: POVLSEN B. , TEGNELL I. , REVELL M. , ADOLFSSON L.
Published: September 2005

We investigated if single-portal endoscopic carpal tunnel decompression equipment (Agee®, 3M, USA) would cause increased carpal tunnel pressure during the release and if endoscopic release would reduce postoperative touch allodynia. Measurements on cadavers of the pressure produced during endoscopic release showed similar pressures to those produced during maximal range of motion. One hundred patients underwent either open or endoscopic decompressions. Twenty normal individuals served as controls. At 1 month after surgery both groups had significant allodynia compared with the controls, but at 3 months the endoscopic group had returned to normal though the open group was still significantly abnormal. The reported endoscopic release may therefore be of particular advantage to patients who would seriously be disadvantaged if postoperative touch allodynia should develop. The Agee® endoscope is unlikely to cause disturbance of the nerve function due to increased carpal pressure during the release.
Adcon®-T/N Reduces in Vivo Perineural Adhesions in a Rat Sciatic Nerve Reoperation Model
Authors: PALATINSKY E. A. , MAIER K. H. , TOUHALISKY D. K. , MOCK J. L. , HINGSON M. T. , COKER G. T.
Published: September 2005

Excessive perineural scarring may affect the result of peripheral nerve surgery. The ability of a novel implant material (ADCON-T/N) to prevent this complication was tested in 38 rats. Four weeks after a bilateral sciatic nerve external neurolysis, a secondary bilateral lysis of the adhesions was performed; ADCON-T/N was locally implanted at one side, while the contralateral side was left untreated. Four or 8 weeks later, perineural adhesions were dissected in 24 animals and graded blindly. Significantly fewer perineural adhesions were found in ADCON-T/N treated nerves compared with controls at both 4 and 8 weeks. Residual implant material or adverse effects were not observed at either time. Histological examination of the neurolysis sites in another 14 animals confirmed these findings at both time intervals. This study shows that ADCON-T/N is effective in inhibiting perineural adhesions, is resorbed within 4 weeks and is well tolerated.
Contralateral Transplantation of a Finger for Restoration of Thumb Function
Authors: BRÜSER P. , LARKIN G.
Published: September 2005

Transplantation of a finger from the contralateral hand for thumb reconstruction is seldom done because of possible psychological problems for the patient. We present two cases in which a previously damaged index finger of the contralateral hand was transplanted. In both patients the metacarpophalangeal joint of the index finger replaced that of the thumb. A powerful pinch to the fingers was achieved and the appearance of both the donor and the recipient hands was considerably improved.
Very Distal Finger Amputations: Replantation or “Reposition - Flap” Repair?
Authors: DUBERT T. , HOUIMLI S. , VALENTI P. , DINH A.
Published: September 2005

Management of very distal finger amputations is still controversial. Successful replantation results in an almost normal finger but is not without problems, such as technical difficulty, risk of failure and cost. “Reposition-flap” repair is a simpler procedure: it consists of distal bone and nail bed “graft-reposition” and pulp reconstruction by a flap. We compare ten successful replantations and six reposition-flap reconstructions. Replantation has several advantages over reposition-flap repair in terms of less finger shortening, longitudinal nail curvature, absence of PIP flexion contracture and shorter time off work. The results of reposition-flap repair are less satisfactory, but it is nevertheless a useful alternative when replantation is impossible or has failed.
Limited Microsurgical Arteriolysis for Complications of Digital Vasospasm
Authors: THAM S. , GROSSMAN J. A. I.
Published: September 2005

Twenty-two digits in seven patients with chronic digital vasospasm were surgically treated after failed medical management. All patients complained of severe ischaemic pain. Chronic digital tip ulceration was present in seven digits and dry gangrene in one. Following surgical microarteriolysis all digital ulcers healed completely. Severe digital ischaemic pain was significantly improved in all digits and completely resolved in 19 of 22 digits.
Early Active Mobilization after Second Stage Flexor Tendon Grafts
Authors: KHAN K. , RIAZ M. , MURISON M. S. C. , BRENNEN M. D.
Published: September 2005

We assessed the results of nine two-stage tendon reconstructions. The tendon graft was the ipsilateral palmaris longus tendon inserted into a tunnel which had been previously created by a silicone spacer. Early active mobilization was commenced 48 hours after surgery according to a previously described protocol ( Small et al, 1989 ). Using the grading system of Kleinert and Verdan (1983) the results were: one excellent, two good, five fair and one poor. Using the Buck-Gramcko et al (1976) grading system there were three excellent, two good, two satisfactory and two poor results. There were no cases of tendon graft rupture or dehiscence of the junction between tendon and graft.
Loss of Flexor Pollicis Longus Function after Plating of the Radius
Authors: KEOGH P. , KHAN H. , COOKE E. , McCOY G.
Published: September 2005

Six cases of loss of flexor pollicis longus function after plating of a radius fracture are presented. The exact aetiology of the postoperative deficit is uncertain, but is probably a traction neuropraxia of the anterior interosseous nerve branches to the flexor pollicis longus. All six patients had full recovery within 5 months. An initial conservative approach is recommended if this complication is encountered.
Partial Lacerations of Flexor Tendons in Children
Authors: STAHL S. , KAUFMAN T. , BIALIK V.
Published: September 2005

We compared the outcome of 17 partially lacerated (less than 75% of cross-sectional area) flexor tendons in children treated by surgical repair to that of 19 tendons treated conservatively by early mobilization. The outcome of both groups was similarly favourable. No complications, such as triggering or complete tendon tear, were found in either group. We advocate early mobilization in children in whom a partial division of the flexor tendon is diagnosed clinically. Exploration should be carried out only in doubtful cases to exclude complete division of the tendon.
Flexor Tendon Ruptures Caused By an Intraosseous Ganglion of the Hook of the Hamate
Authors: MASADA K. , KANAZAWA M. , FUJI T.
Published: September 2005

A rare case of pathological rupture of the flexor tendons of the small finger caused by an intraosseous ganglion of the hook of the hamate is described.