bluuebunny/crossref_metadata_2025 huggingface dataset:
Triplication of the Thumb
Authors: MENNEN U.
Published: September 2002

A child with triplication of the thumb is presented. Each thumb was fully developed with neurovascular bundles, flexor and extensor tendons. Although all three thumbs were triphalangeal, they shared a common metacarpal and two shared a common proximal phalanx. Since this anomaly does not fit in the existing accepted Wassel (1969) classification, a new category is suggested.
The Aetiology of Acute Rupture of Flexor Tendon Repairs in Zones 1 and 2 of the Fingers During Early Mobilization
Authors: HARRIS S. B. , HARRIS D. , FOSTER A. J. , ELLIOT D.
Published: September 2002

Five hundred and eight patients with 840 acute complete flexor tendon injuries in 605 fingers in zones 1 and 2 underwent surgery and postoperative mobilization in a controlled or early active motion (active flexion-active extension) regimen over a period of 7.5 years. Sixty-eight patients with 79 finger flexor divisions who did not complete the rehabilitation programme were excluded. Of the 440 patients with 728 complete tendon divisions in 526 fingers included in the study, 23 patients ruptured 28 tendon repair(s) in 23 fingers, an overall rupture rate of 4%. One hundred and twenty-nine fingers with zone 1 injuries had a rupture rate of 5%. Three hundred and ninety-seven fingers with zone 2 injuries had a rupture rate of 4%. This study analyses the 23 patients with flexor tendon rupture(s) to identify causative factors. In approximately half of these patients, tendon rupture followed acts of stupidity. The implications of this are discussed. There was no significant relationship between tendon rupture and the age or sex of the patients, smoking or delay between injury and tendon repair and there was no particular prevalence of zone 2C level injuries among the fingers in which tendon rupture occurred.
The Role of Allopurinol in Digital Replantation
Authors: WAIKAKUL S. , UNNANANTANA A. , VANADURONGWAN V.
Published: September 2002

The clinical effects of allopurinol on the attenuation of reperfusion injury in thumb replantations after prolonged ischaemic time were studied in a randomized control trial with a 2-year follow-up. There were 60 patients, in the trial group, and 38 patients in the control group. All were young, healthy labourers who had sharp or locally crushed amputations of the thumb at the proximal phalanx with a total ischaemic time of more than 10 hours. The standard management for thumb replantation was used in these patients, except that 300 mg allopurinol was given orally in the trial group on admission and a further 300 mg for another 5 days. After operation, the trial group had a lower infection rate, and less postoperative pain and chronic swelling than the control group. Recovery of sensation was also better in the trial group.
The Role of Low-Profile Titanium Miniplates in Emergency and Elective Hand Surgery
Authors: O’SULLIVAN S. T. , LIMANTZAKIS G. , KAY S. P. J.
Published: September 2002

We report our experience of a low-profile mini-plating system in the treatment of fractures of the hand in 57 consecutive patients (five children and 52 adults).

Thirteen procedures were performed electively, and 44 procedures were performed on an emergency basis. Indications for plating included fixation of metacarpal (36) and phalangeal (eight) fractures, bony fixation following rotation osteotomy (six) digital replantation (two) or free toe transfer (two).

Seventeen patients had postoperative problems, including restricted range of motion (12), rotation deformity (two), significant cold intolerance (two) or fracture (two). Plate removal was required in seven patients, twice as a result of a second injury, and plate removal was unsuccessfully attempted in one other patient. Two patients required extensor tenolysis.

We have found this system to be useful for bony fixation in the hand. However, as with other methods of internal fixation in the hand, there may be complications.
The Results of Ulnar Shortening for Ulnar Impaction Syndrome
Authors: LOH Y. C. , VAN DEN ABBEELE K. , STANLEY J. K. , TRAIL I. A.
Published: September 2002

Twenty-three wrists in 22 patients (mean age, 37 years) with ulnar impaction syndrome were treated by ulnar shortening. The mean ulnar shortening was 2 mm (range, 1–4 mm). At a mean follow-up time of 33 months, 17 patients had obtained good subjective pain relief and 16 were shown to have a good overall outcome using the Wrightington Hospital Wrist Function Evaluation.
Congenital Absence of Flexor Pollicis Longus without Hypoplasia of the Thenar Muscles
Authors: THOMAS C. , MATHIVANAN T.
Published: September 2002

We report a rare case of absence of the flexor pollicis longus in a hypoplastic right thumb, without hypoplasia of the thenar muscles in an 11-year-old girl, who was treated by transfer of flexor digitorum superficialis of the ring finger to the thumb to achieve active flexion at the interphalangeal joint of the thumb.
Use of the Palmaris Brevis Flap for Preventing Recurrent Median Nerve Compression in Mucolipidosis
Authors: KELLY M. B. H. , BOSMANS L. , GAULT D.
Published: September 2002

In a patient with severe, recurrent bilateral carpal tunnel syndrome secondary to mucolipidosis, the ‘turnover’ palmaris brevis flap was used in conjunction with internal neurolysis. The procedure was effective in alleviating symptoms of recurrent carpal tunnel compression in both hands.
Follow-Up After Carpal Tunnel Decompression – General Practitioner Surgery Or Hand Clinic?
Authors: ATHERTON W. G. , FARAJ A. A. , RIDDICK A. C. P. , DAVIS T. R. C.
Published: September 2002

We prospectively randomized 100 patients following carpal tunnel decompression who were having a 2-week postoperative assessment and removal of stitches to either their local general practitioner (GP) or the hospital outpatient department. All patients were seen at hospital 6 weeks postoperatively for a final assessment.

The waiting time for assessment and suture removal was shorter at the GP surgery than in the outpatient department (mean 13 min and 28 min respectively) but significantly more patients were diagnosed as having wound infections (14% and 0% respectively); most were given antibiotics, perhaps unnecessarily.
Comparative Histology of the Annular and Cruciform Pulleys
Authors: KATZMAN B. M. , KLEIN D. M. , GARVEN T. C. , CALIGIURI D. A. , KUNG J.
Published: September 2002

Twenty annular and 12 cruciform pulleys were dissected from four unembalmed fresh cadaveric fingers and stained with haematoxylin and eosin, Verhoeff-van Gieson stain for elastin, alcian blue stain for hyaluronic acid, and a separate stain for S-100 to identify chondroid cells. Three distinct layers were identified in both annular and cruciform pulleys: an outer layer of fibrofatty tissue with vascular channels outermost, an inner layer of hyaluronic acid-secreting cells, and a collagen-rich layer in between. Chondroid metaplasia was noted in the inner layer of both types of pulleys. Minimal differences were noted in regard to the elastin fibre content of the pulleys, with slightly more elastin in the annular pulleys, but no other differences were noted.
Kienböck’s Disease and Gout
Authors: SHIN A. Y. , WEINSTEIN L. P. , BISHOP A. T.
Published: September 2002

A relationship between gout and Kienböck’s disease has been proposed on the basis of a previously published case report. A review of patients at our institution identified a single case with the combination of both Kienböck’s disease and gout. We believe that the association is coincidental.
Autologous Tendons Used as Grafts for Bridging Peripheral Nerve Defects
Authors: BRANDT J. , DAHLIN L. B. , LUNDBORG G.
Published: September 2002

This study was performed to investigate whether autologous collagen and other extracellular matrix components could be used in nerve repair by bridging a 10 mm defect in the rat sciatic nerve. Three models of repair were examined. In the first model, a rat tail tendon was teased and subsequently rolled to form a loose collagen roll which was sutured over the defect. In the second model, an intact tendon was used. In the third model, a teased tendon was pretreated with attachment of nerve segments to each end for 4 weeks before grafting. Both teased and intact tendons supported regeneration, to some extent. Pretreatment resulted in migration of Schwann cells into the graft, and enhanced regeneration.
The Spinal Accessory Nerve Distal to the Posterior Triangle
Authors: PEREIRA M. T. , WILLIAMS W. W.
Published: September 2002

Thirty cadaver necks were dissected to determine the course of the accessory nerve distal to the posterior triangle. The nerve was found to have a constant course on the deep surface of the trapezius muscle. This has clinical implications for surgery in the region.
Intraosseous Ganglion of the Trapezium in Communication with the Flexor Carpi Radialis Tendon Sheath
Authors: VESELY M. J. J. , BURGE P. D.
Published: September 2002

We report a case of an intraosseous ganglion of the trapezium that communicated with the flexor carpi radialis tendon sheath. The findings support the hypothesis that intraosseous ganglia arise from penetration of bone by synovial tissue or fluid.
A Sporadic Case of Tetramelic Mirror-Image Polydactyly and Unilateral Tibial Hypoplasia without Associated Anomalies
Authors: BORG D. H. , VAN ROERMUND P. M. , KON M.
Published: September 2002

We report a sporadic case of tetramelic mirror-image polydactyly in combination with unilateral tibial aplasia. No chromosomal or other associated abnormalities were found. The appearance and function of the upper and lower limbs were improved by surgery.
Distal Thumb Reconstruction Using a Mini Wrap-Around Flap from the Great Toe
Authors: ADANI R. , CARDON L. J. , CASTAGNETTI C. , PINELLI M.
Published: September 2002

We have used a great toe mini wrap-around flap for reconstruction of the thumb at, or distal to, the interphalangeal joint. Our series included 12 patients with traumatic amputations. A flap including the entire nail and most of the distal phalanx of the great toe was used. Eleven of the grafts survived. Sensibility was good with an average of 10 mm static two-point discrimination (range, 5–15) and there were no complaints of cold intolerance. All patients were pleased with the appearance of the thumb and there was no significant morbidity at the great toe donor site. The great toe mini wrap-around flap is an excellent reconstruction technique for selected patients with distal thumb amputations.
The Heterodigital Reversed Flow Neurovascular Island Flap for Fingertip Injuries
Authors: ADANI R. , BUSA R. , SCAGNI R. , MINGIONE A.
Published: September 2002

We report the results of pulp reconstruction with a new heterodigital reverse flow island flap. A dorsolateral flap from the middle phalanx, based on the digital artery is raised from the adjacent uninjured finger. The common digital artery, between the injured finger and the donor finger, is ligated and transected just before its bifurcation. The two converging branches of the digital arteries can be entirely mobilized as a continuous vascular pedicle for the flap. Thus the vascularization is now supplied by reverse flow through the proximal transverse digital palmar arch of the injured finger. To provide sensation the dorsal branch of the proper digital nerve from the donor finger can be included in the flap. Six reverse heterodigital island flaps were used in patients. In five patients the flap was used for pulp reconstruction and in one case for covering a dorsal digital defect. In one case mild venous congestion occurred. Good skin coverage with supple and well-vascularized skin was obtained in each patient. The static two-point discrimination over the flap was between 6 and 15 mm.

This new procedure is indicated for extensive pulp defects in fingers in which reconstruction cannot be done using other flaps and as an alternative to microsurgical reconstruction.
Assessment of Vascularized Fibular Graft One Year after Reconstruction of the Wrist after Excision of A Giant-Cell Tumour
Authors: FERRACINI R. , GINO G. , BATTISTON B. , LINARI A. , FRANZ R. , BERTOLO S.
Published: September 2002

We report a patient in whom the distal radius was resected for a giant cell tumour and the bone defect was replaced using a vascularized proximal fibular graft. The graft was viable and hypertrophied and normal callus formed on the distal radius. Due to chronic instability of the wrist the patient underwent revision arthrodesis 1 year after resection. Microscopic studies of the epishyseal region of the fibula showed wide necrosis of the graft with active creeping substitution. Despite the good technical result of the vascularized fibular graft, the vascularization was incomplete in the proximal epiphysis. We discuss possible reasons for this.
Palmar Lunate Trans-Scaphoid, Trans-Triquetral Fracture-Dislocation
Authors: HARRINGTON P. , QUINLAN W. B.
Published: September 2002

A palmar lunate dislocation associated with fractures of the scaphoid and triquetrum and an avulsion fracture of the radial styloid is described. The injury resulted from a high energy dorsiflexion/axial compression force. Open reduction of the dislocated lunate and internal fixation of the scaphoid were done as an emergency procedure. A second operation was required to internally fix the displaced triquetral fracture and reduce the lunotriquetral dissociation. A good result was documented at 6 months.
Total Wrist Arthrodesis Using Bowed Crossed K-Wires
Authors: MINAMI A. , KATO H. , IWASAKI N.
Published: September 2002

A method of total wrist arthrodesis using a combination of autogenous iliac crest bone graft and “bowed” crossed Kirschner wires is described. The method of bowing the K-wires results in a compressive force on the iliac bone graft. This technique resulted in bony union of 22 wrists in 20 patients. The mean time to union was 12 weeks (range, 8–14 weeks). There were no major postoperative complications. The advantages of this technique are its simplicity, versatility, and reliability which mean that special internal fixation devices are not needed.
Primary Reconstruction of a Degloved Middle Finger with a Temporoparietal Free Flap
Authors: MUNNOCH D. A. , STEVENSON J. H.
Published: September 2002

The treatment of complete ring avulsion injuries is very demanding, and frequently the results are less than optimal. We present a case of a degloved middle finger reconstructed with a temporoparietal fascial free flap and skin grafting. This produced an aesthetic and functional finger.
A Simple Splinting Method for Correction of Supple Congenital Clasped Thumbs in Infants
Authors: LIN S-C. , HUANG T-H. , HSU H-Y. , LIN C-J. , CHIU H-Y.
Published: September 2002

A splint has been designed to correct the congenital clasped thumb. It is like a short opponens splint that can keep the thumb in a position of abduction and extension without limiting wrist movement. The application of the splint was easy and adjustment for fit could be made at each visit if necessary. The device has been used in 11 infant patients (17 thumbs) with congenital clasped thumb of the supple type. The functional results were excellent in 15 of 17 thumbs, and the other two were good according to the grading system of Weckesser et al. (1968) .
Dupuytren’s Disease
Authors: FITZGERALD A. M. P. , KIRKPATRICK J. J. R. , NAYLOR I. L.
Published: September 2002

Histologically, Dupuytren’s disease has been compared to the process of neoplasia because of fibroblast proliferation, recurrence, chromosomal abnormalities and antigenic profiles.

However, a comparison of Dupuytren’s tissue with the granulation tissue formed in wound healing could be more valid. Histology reveals similarities in cell types, proliferation, vascularity and collagen morphology. Pharmacologically, both tissues have a similar range of agonist and antagonist responses. Biochemical analysis reveals new collagen synthesis, an increased ratio of type III to type I collagen, and similar changes of the ground substance in both processes.

Considering such similarities perhaps it is possible to regard some of the models used for the investigation of wound healing and granulation tissue as the missing experimental “model” for the study of Dupuytren’s disease.

Recently great strides have been made in the basic understanding of wound biology, and such a comparison might well provide novel therapeutic options for Dupuytren’s disease.
Dorsal Adipofascial Turn-Ovesr Flap for Fingertip Amputations
Authors: ÜNLÜ R. E. , MENGI A. S. , KOÇER U. , SENSÖZ Ö.
Published: September 2002

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered with a split thickness skin graft. Ten digital amputations between the distal phalanx proximal to the nail matrix and the mid portion of the middle phalanx were successfully resurfaced with dorsal adipofascial turn-over flaps. All flaps survived completely and the mean follow-up was 11 months. This one-step procedure would seem to be a relatively simple way of achieving early recovery because it does not require the use of distant flaps immobilization of adjacent digits, or homodigital flaps that might jeopardize an already injured finger.
Simultaneous Fracture-Dislocations of the Distal and Proximal Interphalangeal Joints
Authors: NAKAGO K. , HASHIZUME H. , SENDA M. , NISHIDA K. , MASAOKA S. , INOUE H.
Published: September 2002

Sixteen cases of simultaneous fracture-dislocations of both the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints in the same finger that were treated during the past 10 years were classified into three types: the swan-neck injury (dorsal fragment of the base of the distal phalanx at the DIP joint and palmar fragment of the base of the middle phalanx at the PIP joint); the double-hyperextension injury (palmar fragments at the DIP and PIP joints); and the straight-finger injury (with dorsal and palmar bone fragments at the DIP joint). The results of treatment were more satisfactory in PIP joints than in DIP joints.
Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon
Authors: SIROTAKOVA M. , ELLIOT D.
Published: September 2002

This study reports the treatment of divided flexor pollicis longus (FPL) tendons from 1989 to 1998. The first 30 patients, in whom the tendon was repaired with a Kessler suture and simple epitendinous suture and mobilized using early active motion with only the thumb splinted, achieved 70/73% (White/Buck-Gramcko assessments respectively), excellent or good results and a rupture rate of 17%. The next 39 patients underwent the same treatment but in a splint with the thumb position altered and the fingers also splinted, with 67/72% excellent or good results and a rupture rate of 15%. The next 49 patients underwent repair with a Kessler suture and a reinforced epitendinous suture and the same mobilization as group 2, with 76/80% excellent or good results and a rupture rate of 8%. The final combination of repair and early active mobilization for primary repair of FPL tendons compares favourably with previous methods of treatment.
Kienböck’s Disease in Women
Authors: TANIGUCHI Y. , TAMAKI T.
Published: September 2002

We examined 133 patients with Kienböck’s disease, five of whom had bilateral disease. There were 47 women and 86 men. The mean age of patients was 42.7 years (range, 14–80 years). The frequencies of involvement of the right and left sides were approximately equal for women, but male patients tended to have right wrist joint involvement. The side of the affected wrist in the female group differed significantly from that in the male group. The age at onset for women was significantly higher than that for men. The percentage of manual workers was significantly lower among women than among men. The characteristics of Kienböck’s disease in women differed from those in men and those previously reported for this disease. These findings suggest that the pathogenesis of Kienböck’s disease in women differs from that in men.
Recurrent Osteoblastoma of the Hamate Bone
Authors: van DIJK M. , WINTERS H. A. H. , WUISMAN P. I. J. M.
Published: September 2002

An osteoblastoma in a carpal bone is very rare and presents a problem of reconstruction after wide tumour excision. We report a case of recurrent osteoblastoma of the right hamate bone with involvement of the ulnar carpal bones and soft tissues that was successfully treated by en bloc resection, temporary interposition of bone cement and fixation with K-wires, followed by reconstruction with a free vascularized iliac crest flap, tailored to the exact size of the defect, in a second procedure. Rapid fusion was achieved and hand function preserved with no evidence of recurrence 3 years postoperatively.
Anomalies of the Flexor Digitorum Superficialis Muscle
Authors: ELLIOT D. , KHANDWALA A. R. , KULKARNI M.
Published: September 2002

Three anomalies of the human flexor digitorum superficial are presented. The normal development of this muscle from the amphibian to the human is discussed and the described anomalies of the muscle in humans classified.
Variations of the Extensor Indicis Muscle and Tendon
Authors: KOMIYAMA M. , NWE T. M. , TOYOTA N. , SHIMADA Y.
Published: September 2002

Variations of the extensor indicis muscle were examined in 164 hands from 86 Japanese cadavers. Anomalous cases exhibiting supernumerary muscles or tendons were found in 22 hands. These variations were classified into four types: type 1, an additional tendon slip from the extensor indicis tendon; type 2, an extensor indicis radialis or extensor pollicis et indicis accessorius; type 3, an extensor medii proprius with or without extensor medii brevis; and type 4, an extensor indicis radialis and extensor medii proprius. The extensor medii proprius was the most common variation, followed by extensor indicis radialis. There were no clear differences in incidence of variations between men and women or between right and left hands. When variations were bilateral, both sides were identical or similar in type.
The Effect of the Additional Use of Grommets in Silicone Implant Arthroplasty of the Metacarpophalangeal Joints
Authors: SCHMIDT K. , WILLBURGER R. , OSSOWSKI A. , MIEHLKE R. K.
Published: September 2002

After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.
Desmoid Tumours of the Hand
Authors: DUTEILLE F. , DAUTEL G. , SOMMELET D.
Published: September 2002

We report a case of a 3-year-old child with a desmoid tumour of the hand, which is an exceedingly rare location. Desmoid tumours of the hand are difficult to treat because of the many important structures concentrated in the area as well as the infiltrative and recurrent character of these tumours.
Failed Endoscopic Carpal Tunnel Release
Authors: VARITIMIDIS S. E. , HERNDON J. H. , SOTEREANOS D. G.
Published: September 2002

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal tunnel release for persistent carpal tunnel syndrome after a primary endoscopic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one partial and one complete). One patient had release of Guyon’s canal and not the carpal tunnel. After the open revision carpal tunnel release, 20 patients returned to work with five patients returning to jobs of lighter duty. In addition, these 20 patients had significant improvement in symptoms. The remaining two patients had sustained a median nerve injury and did not return to work. One of these patients developed a painful neuroma in continuity of the median nerve which required vein wrapping with a saphenous vein graft. This study indicates that endoscopic release of the flexor retinaculum holds the same risks and complications as open release. Based on our study we believe that patients with persistent carpal tunnel syndrome after failed endoscopic flexor retinaculum release can be successfully treated with open release.
A Simple Technique for Applying Local Splintage to the Fingers
Authors: PEREIRA J. A. , SCHONAUER F. , BELCHER H. J. C. R.
Published: September 2002

We report a simple method of splinting the interphalangeal joints that we have employed as our standard technique without complication.
Sympathetic Block Significantly Improves Reperfusion in Skeletal Muscle Following Prolonged Use of Tourniquet
Authors: POVLSEN B. , SIRSJÖ A.
Published: September 2002

The effects of guanethidine sympathetic nerve blocks on reperfusion of skeletal muscle was studied in rats. After 3 hours of ischaemia reperfusion was significantly better in animals that had received guanethidine.
Arthroplasty of the Proximal Interphalangeal Joint Using the Sutter Implant for Traumatic Joint Destruction
Authors: MATHOULIN C. , GILBERT A.
Published: September 2002

We report the functional results in a series of 21 Sutter arthroplasties for post-traumatic arthritis with an average follow-up of more than 2 years. The dorsal approach was used in every case. Pain was always present preoperatively and mobility was reduced to an average range of motion of 15°. Postoperatively, pain was absent in 18 cases. The average active range of motion was 55°. There were two fractures of implants. Although the follow-up is limited, the Sutter arthroplasty has given results that are similar to, or better than, those reported for other techniques.
Results of the Wafer Procedure for Ulnar Impaction Syndrome in the Ulnar Negative and Neutral Wrist
Authors: TOMAINO M. M.
Published: September 2002

Thirteen wrists with ulnar neutral or negative variance were treated by open distal ulna excision (the wafer procedure). The mean follow-up was 25 months (range, 12–38). At final follow-up grip strength had increased a mean of 14 kgf and 12 of the 13 patients were very satisfied with the functional outcome and pain relief. In treatment of the ulnar impaction syndrome, the wafer procedure provides excellent pain relief and functional restoration particularly in patients with ulnar neutral or negative wrists in whom triangular fibrocartilage tears have not yet developed.
The Use of Silicone Tubing In the Late Repair of the Median and Ulnar Nerves in the Forearm
Authors: BRAGA-SILVA J.
Published: September 2002

A silicone tube segment was used for repairing the median and ulnar nerves in the forearm. This study includes 26 patients (20 male and six female), with a mean age of 23 years (range, 18-26). Injuries were caused by saw, knife and glass accidents, the latter being most frequent. The mean interval between the injury and repair was 101 days. Fourteen patients had median nerve injuries, eight had ulnar nerve injuries and four had both median and ulnar nerve injuries. The technique was effective in the repair of peripheral nerve injuries with gaps of up to 3 cm, with better results in the ulnar nerves than in the median nerves.
Comparative Results of Resection of the Distal Ulna in Rheumatoid Arthritis and Post-Traumatic Conditions
Authors: FRASER K. E. , DIAO E. , PEIMER C. A. , SHERWIN F. S.
Published: September 2002

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in posttraumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.
Outcome of Distal Radial Fractures in Young Adults
Authors: GLIATIS J. D. , PLESSAS S. J. , DAVIS T. R. C.
Published: September 2002

The outcome of 169 fractures of the distal radius in adults under the age of 50 were assessed at least 18 months after injury (mean follow-up, 4.9 years) using a validated, patient-based outcome questionnaire. The questionnaire responses demonstrated that neither the Frykman nor the Mayo classifications of distal radial fractures predicted outcome. Fracture union with more than 10° of dorsal tilt was associated with increased difficulty with everyday activities and work, while union with a step in the radiocarpal articular surface was associated with loss of wrist mobility and difficulty with fine dextrous tasks. No measure of either intra- or extra-articular malunion influenced the severity or frequency of persistent wrist pain.
Value of Electrodiagnostic Tests in Carpal Tunnel Syndrome
Authors: DUDLEY PORRAS A. F. , ALAMINOS P. ROJO , VIÒUALES J. I. , RUIZ VILLAMAÒAN M. A.
Published: September 2002

Eighty-five patients who were treated surgically for carpal tunnel syndrome were reviewed by a prospective study to assess the relationship between electrodiagnostic tests and clinical outcome. Before surgery all patients completed a self-administered questionnaire, and an electrophysiological examination was done to assess distal motor latency, sensory and motor amplitudes, and sensory nerve conduction velocity. After 6 months follow-up all these tests were repeated. There was significant correlation between improvement in sensory nerve conduction velocity and clinical improvement at follow-up.
A New Core Suture Technique for Flexor Tendon Repair: Biomechanical Analysis of Tensile Strength and Gap Formation
Authors: ASLAM A. , AFOKE A.
Published: September 2002

The purpose of this study was to test in vitro a new flexor tendon suture technique that has been developed to withstand the in vivo forces of active tendon motion. This new core suture technique involves locking loops in the form of a cross stitch. The new technique was tested for ultimate tensile strength and gap formation in cadaver human flexor tendons on a tensile testing machine. The new technique proved significantly stronger than the modified Kessler core suture.
Brachial Plexus Injuries in Scapulothoracic Dissociation
Authors: MASMEJEAN E. H. , ASFAZADOURIAN H. , ALNOT J.-Y.
Published: September 2002

The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion
Elbow Extension and Flexion–Supination Deformities in Tetraplegia
Authors: FREEHAFER A. A.
Published: September 2002

This paper demonstrates the flexion–supination and extension deformities of the elbows in complete tetraplegics and describes the outcome of simple treatments.

The principal conclusion is that these two deformities are easily corrected by very simple methods. After treatment the patients could fully extend and flex their elbows and fully supinate and pronate their forearms. One of 11 patients, whose bilateral deformities kept recurring, was a failure.
Reverse Radial Forearm Fascial Flap for Soft Tissue Coverage of Hand and Forearm Wounds
Authors: ROGACHEFSKY R. A. , MENDIETTA C. G. , GALPIN P. , OUELLETTE E. A.
Published: September 2002

Six patients with severe hand and forearm injuries involving open wounds and exposed structures were treated with reverse radial forearm fascial flaps and split-thickness skin grafts for soft tissue cover. There were five men and one woman aged between 16 and 36 years. Injuries included soft tissue avulsion on the dorsum of the hand and fingers, extensive flexor and extensor tendon damage, multiple phalangeal fractures, a grade IIIB open dislocation of the index to little carpometacarpal joints, a grade III open metacarpal fracture and a finger amputation. The average wound size was 9 cm in length and 7 cm in width. The mean duration of follow-up was 12 months (range, 5–20 months). All flaps healed well, and all patients were satisfied.
Strength of the Intrinsic Muscles of the Hand Measured with a Hand-Held Dynamometer: Reliability in Patients with Ulnar and Median Nerve Paralysis
Authors: SCHREUDERS T. A. R. , ROEBROECK M. , VAN DER KAR TH. J. M. , SOETERS J. N. M. , HOVIUS S. E. R. , STAM H. J.
Published: September 2002

The aim of this study was to assess the reliability of a technique to measure the strength of the intrinsic hand muscles. Intraclass Correlation Coefficients showed an excellent level of reliability for the comparison of muscle strength between groups of patients. However, for the results of individual patients, the calculated Standard Error of Measurements (10–16%) and the Smallest Detectable Differences for intraobserver (31–36%) and interobserver (37–52%) values indicate that only relatively large changes in strength can be confidently detected with this technique. The results of the present study were compared with those of four previous grip strength studies.
Trigger Digits in Children
Authors: MOON W. N. , SUH S. W. , KIM I. C.
Published: September 2002

Seven thousand, seven hundred newborn children were examined prospectively to determine the congenital incidence of trigger thumb and finger. No cases were found. The case histories of 43 trigger digit cases (35 trigger thumbs and eight trigger fingers) noted in 40 children diagnosed at our center between 1995 and 1998 were reviewed with special reference to the spontaneous recovery rate, treatment outcome, and age at presentation. Of the 35 thumb cases, 23 underwent surgical release and all responded satisfactorily to surgical treatment. Spontaneous recovery was noted in 12 trigger thumb cases and in all eight trigger finger cases. Trigger finger developed earlier in life than trigger thumb and the spontaneous recovery rate was higher in trigger finger than trigger thumb.
A Comparison of Trapeziectomy with and without Ligament Reconstruction and Tendon Interposition
Authors: BELCHER H. J. C. R. , NICHOLL J. E.
Published: September 2002

Forty-three patients were randomly allocated to undergo either trapeziectomy alone (control) or with a ligament reconstruction and tendon interposition (LRTI) using an abductor pollicis longus tendon slip. The patients were reviewed at a median 13 (range, 7–29) months after surgery. The demographic characteristics, severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes. Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit.
Midcarpal Arthrodesis with Complete Scaphoid Excision and Interposition Bone Graft in the Treatment of Advanced Carpal Collapse (SNAC/SLAC Wrist): Operative Technique and Outcome Assessment
Authors: SAUERBIER M. , TRÄNKLE M. , LINSNER G. , BICKERT B. , GERMANN G.
Published: September 2002

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.
Carpal Tunnel Release Using a Short Palmar Incision and a New Knife
Authors: AVCI S. , SAYLI U.
Published: September 2002

A new knife with its own battery powered light source (Knifelight®, Stryker Instruments, Kalamazoo, Michigan, USA) was used for carpal tunnel release in 31 wrists of 25 patients. Under local anaesthesia, a short palmar incision was used and the carpal tunnel contents were visualized during division of the flexor retinaculum. The mean operation time was 11 minutes and no major complications were seen. The patients could use their hands for self-care after 3 days and returned to work at a mean of 23 days. At a minimum follow-up of 6 months, all but one of the patients were satisfied with the final result. Mild scar tenderness was seen in two patients and pillar pain in one patient.
Flexor Tendon Blood Vessels
Authors: JONES M. E. , LADHANI K. , MUDERA V. , GROBBELAAR A. O. , MCGROUTHER D. A. , SANDERS R.
Published: September 2002

The aim of this study was to assess rabbit long flexor tendon vascularity in a qualitative and quantitative manner using immunohistochemistry. The endothelial cell surface marker CD31 was targeted with a specific monoclonal mouse-anti-human antibody with good species cross-reactivity. Subsequent signal amplification and chromogen labelling allowed vessel visualization. Computer image analysis was performed. Values for vessel number and total vessel area per section, as well as the sections’ cross-sectional tendon areas, were obtained.

There was a consistent deep tendon avascular zone between the A2 and A4 pulley in the rabbit forepaw. This was not the case in the hindpaw, with dorsally orientated longitudinal vessels coursing the length of the intrasynovial tendon. The area of least vascularity in the hindpaw was around the metacarpophalangeal joint. We therefore recommend the use of hindpaw tendons when using the rabbit as a flexor tendon experimental model. This is because its vascular pattern is similar to that of the human flexor digitorum profundus.
Adhesion Formation after Nerve Repair: An Experimental Study of Early Protected Mobilization in the Rabbit
Authors: IP W. Y. , SHIBATA T. , TANG F. H. , MAK A. F. T. , CHOW S. P.
Published: September 2002

The common peroneal nerve and its surrounding muscles were cut and repaired in 14 rabbits. The injured limb was then either immobilized for 3 weeks or passively mobilized within a “safety range” every day. At 3 weeks after operation, the “stretch test” and “peel test” showed no difference in the biomechanical features of the adhesions between the nerve repair and the surrounding soft tissues.
Treatment of Phalangeal Fractures in Severely Injured Hands
Authors: VAN OOSTEROM F. J. T. , BRETE G. J. V. , OZDEMIR C. , HOVIUS S. E. R.
Published: September 2002

This retrospective study was performed to assess the incidence of complications of operative treatment of phalangeal fractures. Risk factors for the development of complications were also investigated. Records and radiographs of 350 patients with 666 operatively treated phalangeal fractures were studied. Minimum follow-up was 1 year. A total of 176 fractured fingers were amputated primarily or secondarily, leaving 490 fractures for follow-up. Ninety-three fractures were treated conservatively. Nonunion necessitating reoperation developed in 6% (31/490) of fractures, malunion in 9% (44/490) and infection in 2% (8/490). Infection, segmental bone loss and (neuro)vascular injury predisposed to nonunion and replantation predisposed to malunion. There was a statistical correlation between the use of external fixation and malunion. Nonunion, malunion, and infection rates were similar to other studies.
A Comparative Clinical and Electromyographic Study of Median and Ulnar Nerve Injuries at the Wrist in Children and Adults
Authors: DUTEILLE F. , PETRY D. , POURE L. , DAUTEL G. , MERLE M.
Published: September 2002

The outcome of 38 median and ulnar nerve injuries at the wrist in 15 adults and 15 children were studied with a follow-up of at least 1 year. Each patient was assessed clinically and with nerve conduction studies. The results confirm a markedly superior sensory recovery in children. However the children had persistent motor deficiencies. This difference in the clinical results of adults and children was not reflected in the nerve conduction results which were similar in both groups.
The Incidence of Simultaneous Fractures of the Scaphoid and Radial Head
Authors: WILDIN C. J. , BHOWAL B. , DIAS J. J.
Published: September 2002

In a 2-year period 181 scaphoid fractures were seen at our institution, of which 11 (6%) had a simultaneous fracture of the radial head. In four of these cases the scaphoid fracture was diagnosed late.
Neurophysiology not Required Before Surgery for Typical Carpal Tunnel Syndrome
Authors: FINSEN V. , RUSSWURM H.
Published: September 2002

Sixty-eight patients with typical carpal tunnel syndrome underwent neurophysiological investigations preoperatively, but these were not assessed until the end of the study. Open carpal tunnel release was performed and the clinical diagnosis of carpal tunnel syndrome was considered as confirmed when there was a prompt resolution of the preoperative symptoms. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. The neurophysiological tests were normal in these two patients, but were also normal in 14 of the 63 patients who improved with carpal tunnel surgery. Preoperative neurophysiology might therefore have led to up to 14 of the 63 cases of carpal tunnel syndrome being turned down for surgery. We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance.
Treatment of Phalangeal Fractures by Tension Band Wiring
Authors: SAFOURY Y.
Published: September 2002

This retrospective study assessed the outcomes of 30 patients with phalangeal fractures which were treated by open reduction and tension band wiring. Oblique, transverse and comminuted extraarticular fractures, as well as intraarticular fractures, were treated with this technique and they all united in about 8 weeks. There were no significant complications. At a mean follow-up period of 2.3 years, the active range of movement of the involved fingers was excellent in 17, and good in 13 instances. There were no fair or poor results.
The Use of a Moulded Metacarpal Brace Versus Neighbour Strapping for Fractures of the Little Finger Metacarpal Neck
Authors: HARDING I. J. , PARRY D. , BARRINGTON R. L.
Published: September 2002

Seventy-three patients with fractures of the neck of the little finger metacarpal were randomized to treatment with a moulded metacarpal brace or neighbour strapping. Sixty-five of these attended for follow-up at 3 weeks. Both treatment modalities permitted a functional range of movement, but patients treated with the metacarpal brace had significantly less pain than those treated with neighbour strapping, and this facilitated an early return to work.
Transthecal Digital Block at the Proximal Phalanx
Authors: TOROK P. J. , FLINN S. D. , SHIN A. Y.
Published: September 2002

This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.
Preoperative Ampiroxicam Reduces Postoperative Pain after Hand Surgery
Authors: SAI S. , FUJII K. , HIRANUMA K. , SATO T. , NEMOTO T.
Published: September 2002

We performed a double blind randomised controlled study to assess whether the preoperative administration of ampiroxicam reduced the level of postoperative pain in 120 patients who underwent surgery to a hand under brachial plexus block. We found that preoperative (pre-emptive) administration of ampiroxicam significantly reduced the postoperative pain levels and the need for postoperative analgesia.
Dynamic External Fixation for Pilon Fractures of the Interphalangeal Joints
Authors: HYNES M. C. , GIDDINS G. E. B.
Published: September 2002

Eight consecutive pilon fractures of the finger proximal interphalangeal joint and one of the interphalangeal joint of the thumb were treated by closed reduction and application of a new dynamic external fixator. The average range of movement achieved was 12°–88° and there were no serious complications. The technique described offers an effective and simple solution for treatment of pilon fractures of the interphalangeal joint.
Closed Reduction and Percutaneous Pinning of Fractures of the Proximal Phalanx
Authors: HORNBACH E. E. , COHEN M. S.
Published: September 2002

This study reports the results of 12 unstable extraarticular fractures of the proximal phalanx treated with transarticular intramedullary Kirschner wires. Early proximal interphalangeal joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°. Objective physical assessment revealed one significant flexion contracture, one flexor tendon adhesion and one significant rotational deformity. Excellent results were observed in ten of the 12 patients.
Ulnar Nerve Decompression in the Cubital Canal using Local Anaesthesia
Authors: LANKESTER B. J. A. , GIDDINS G. E. B.
Published: September 2002

We assessed the outcome of surgical release of the ulnar nerve in the cubital canal under local anaesthetic. Seven of the 20 patients reported complete resolution of their preoperative symptoms. Eleven reported significant improvement immediately following surgery and some continuing improvement thereafter. One patient had no significant benefit, and one had complete resolution, but then his symptoms returned. Sixteen patients stated that they would choose to have the operation performed under local anaesthesia again, but four would have favoured a general anaesthetic. We conclude that decompression of the ulnar nerve under local anaesthetic is a reliable procedure, which is well tolerated by the majority of patients.
Replantation of Very Distal Thumb Amputations with Pre-Osteosynthesis Interpositional Vein Graft
Authors: HATTORI Y. , DOI K. , EJIRI S. , BALIARSING A. S.
Published: September 2002

Replantation of distal thumb amputations is difficult because of the anatomic orientation of the thumb and the location and size of vessels. A simplified technique is presented, in which interposition vein grafts are anastomosed to a terminal branch of the digital artery and a subcutaneous vein in the amputated thumb tip. This technique is convenient, relatively easy and reliable.
Biomechanical Assessment of a New Type of Flexor Tendon Repair
Authors: SMITH A. M. , EVANS D. M.
Published: September 2002

A four-strand adaptation of the Kessler repair is described and the results of biomechanical testing in pig tendons are reported. The strength of our repair was compared against standard Kessler repairs using Ethibond or Ti.cron as the core sutures. The average tensile strength for the Ethibond Kessler repair was 33 Newtons and that of the Ti.cron Kessler repair was 31 Newtons. The average tensile strength for the Evans repair was 52 Newtons. This new method of flexor tendon repair is significantly stronger than the modified Kessler repair and is simpler to use than other multi-strand repair techniques.