bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vascularised Nerve Grafts
Authors: MERLE M. , DAUTEL G. 
Published: June 2005

Since Taylor (1976) successfully performed the first vascularised free nerve graft, experimental and clinical data have not provided conclusive support for the superiority of this method of repairing loss of nerve substance. Experimental work yields conflicting results. Histologic results are in favour of vascularised grafts but non-vascularised fascicular grafts placed in a healthy bed recover sufficient neovascularisation within a short period of time (four to six days). In the field of brachial plexus repair, vascularised grafts give consistent results. However, if thrombosis of the anastomoses occurs, the grafts fail completely. In our experience, vascularised nerve grafts used for repairing digital nerves and arteries, have a high rate of thrombosis. There are few potential donor sites. A nerve graft cannot be considered to be physiologically vacularised if it relies only on an artery or on an arterialised vein. Given the present state of immunosuppressant treatments, vascularised allografts are not yet appropriate. Therefore, vascularised nerve grafts have limited applications. In general it is preferable to repair the tissue bed so as to promote revascularisation of conventional nerve grafts.
The Association between Alcohol, Hepatic Pathology and Dupuytren’s Disease
Authors: NOBLE J. , ARAFA M. , ROYLE S. G. , McGEORGE G. , CRANK S. 
Published: June 2005

We have looked at the incidence of Dupuytren’s disease in alcoholics, those with non-alcoholic liver disease and a control population. Both alcoholic patients and those with non-alcohol related liver disease had a higher rate (28% and 22% respectively) than the controls (8%), but this did not quite reach statistical significance (p > 0.05). In addition we found no Dupuytren’s disease in 50 Egyptian patients with bilharzia and no consistent biochemical abnormalities in 134 patients with significant Dupuytren’s disease. We conclude that alcoholics probably do have a higher rate of Dupuytren’s disease and that this effect is largely due to the liver disease caused by alcohol abuse, but that the genetic factors are of greater aetiological importance.
Complications and Morbidity of the Donor and Recipient Sites in 123 Lateral Arm Flaps
Authors: GRAHAM B. , ADKINS P. , SCHEKER L. R. 
Published: June 2005

The lateral arm flap is a reliable and versatile free tissue transfer. However, the donor and recipient sites may produce an assortment of relatively minor complaints in a large proportion of patients. 109 (89%) out of 123 lateral arm flaps performed over a seven-year period were reviewed an average of three years after surgery. Unsatisfactory appearance of the donor site was noted by 27% of patients and was twice as likely to be reported by female patients and in cases in which the donor site was repaired by a split-thickness skin graft rather than by primary closure. Elbow pain was reported by 19%. Numbness in the forearm was reported by 59% and was unchanged during the follow-up period in the majority of patients. 17% of patients noted hypersensitivity of the donor site to a variety of stimuli such as cold or vibration. Hair formation was reported at the recipient site by 78% of patients. 83% of the patients found the flap to be bulky and 15% had undergone at least one procedure for debulking. We recommend that the use of the lateral arm flap should be limited to males and cases in which the resulting donor site can be closed primarily.
Medial Epicondylectomy in Cubital Tunnel Syndrome: An Electrodiagnostic Study
Authors: ROBINSON D. , AGHASI M. K. , HALPERIN N. 
Published: June 2005

Prospective analysis of 27 medial epicondylectomies in 22 patients with McGowan grade I ulnar neuropathy demonstrated an improvement in clinical symptoms. In all patients a N.C.V. study, in which compression of the ulnar nerve at the cubital tunnel was evident, has been a prerequisite for operation. Conduction velocity across the cubital tunnel averaged 48% of normal (26.4 +/– 8.7 metres per second) preoperatively and increased to 85% of normal (46.7 +/– 9.7 metres per second) postoperatively. A preoperative N.C.V. study allows the achievement of a high success rate, especially in the less well clinically defined group of patients with grade I neuropathy (subjective complaints without any objective signs of muscle atrophy). Medial epicondylectomy is safe and predictable in the treatment of cubital tunnel syndrome.
The “S” Quattro in the Management of Fractures in the Hand
Authors: FAHMY N. R. M. , HARVEY R. A. 
Published: June 2005

The “S” Quattro has shown its value in the management of displaced comminuted intra-articular phalangeal fracture dislocations. Since then the system has been used as a dynamic flexible external fixator in the treatment of five maluniting phalangeal fractures, five comminuted condylar and four severe compound fractures. These challenging fractures have been dealt with by easy operations, taking full advantage of the versatility of the “S” Quattro to achieve good results.
The Terminal Branch of Posterior Interosseous Nerve: A Useful Donor for Digital Nerve Grafting
Authors: REISSIS N. , STIRRAT A. , MANEK S. , DUNKERTON M. 
Published: June 2005

The anatomical relationships of the terminal branch of posterior interosseous nerve have been studied in 57 cadaver and amputation specimens. Removal of the nerve leaves the patient with no apparent sensory deficit. In all dissections the nerve was present and its location was constant. The mean obtainable length was 3.7 cm (range 2.7–5.1 cm) and its cross-sectional area made the nerve suitable for grafting of digital nerves.
Replantation of the Radial Side of the Hand in the Rhesus Monkey: Anatomical and Functional Aspects
Authors: HOVIUS S. E. R. , STEVENS H. P. J. D. , VAN NIEROP P. W. M. , GODSCHALK M. , KUSUMA A. , DEELEN G. , VAN DE BERGH M. , VAN DER MEULEN J. C. 
Published: June 2005

Before human hand transplantation can even be considered, an appropriate research model must be studied in-a non-human primate. The first ray of the hand, augmented with a radial forearm flap, was chosen as a functional composite tissue graft. Four technically successful replantations of the radial unit have been carried out. One monkey died on the first post-operative day due to cardiac arrythmia. Normal wound healing occurred in the other three animals. In three monkeys, functional sensory and motor recovery was almost complete. The monkeys were able to pick up small particles of food with the index finger and thumb. It is suggested that this model could be used for allogeneic composite tissue transplantation in a non-human primate.
Arteriovenous Fistulae after Free Flap Surgery in a Replanted Hand
Authors: NINKOVIÆ M. , S̆UÆUR Đ. , STAROVIÆ B. , MARKOVIÆ S. 
Published: June 2005

AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand. This paper discusses the mechanisms responsible for the formation of AV fistulae.
The Gymnast’s Wrist: Acquired Positive Ulnar Variance Following Chronic Epiphyseal Injury
Authors: TOLAT A. R. , SANDERSON P. L. , DE SMET L. , STANLEY J. K. 
Published: June 2005

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulno-carpal impingement, for which we describe a clinical test. Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate surgery. Two patients needed distal ulna recession and one needed shaving for a TFCC perforation, with a good result.
The Swanson Ulnar Head Prosthesis for Post-Traumatic Disorders of the Distal Radio-Ulnar Joint
Authors: STANLEY D. , HERBERT T. J. 
Published: June 2005

20 Swanson ulnar head prostheses inserted for post-traumatic disorders of the distal radio-ulnar joint were reviewed at a mean of 44.2 months post-operatively (range 12–104 months). The indication for surgery was painful loss of forearm rotation with or without ulno-carpal impingement and ulno-carpal instability. Symptoms in 16 patients were the result of malunion following severe distal radial fractures (two Frykman 7 fractures and 14 Frykman 8 fractures), and in the remainder were due to unreduced dislocations in the distal radio-ulnar joint (two patients) or unsatisfactory Darrach procedures (two patients). 70% of patients achieved excellent or good clinical results despite the fact that radiographs showed bone resorption in all cases, tilting of the prosthesis in 40% and implant fractures in 15%.
A Review of Repaired Flexor Tendons
Authors: GAULT D. T. 
Published: June 2005

67 patients with 76 repaired flexor tendons have been reviewed after a mean interval of 26.4 months. 160 tendons to 100 fingers, and 16 flexor pollicis longus tendons were repaired. When evaluated by Buck-Gramcko criteria, the functional results in 92% of the fingers and 69% of the thumbs were graded as excellent or good. Patients with partially divided tendons fared no better than those whose tendons were completely divided. The results of repair in the little finger were less satisfactory than in other fingers.
Conservative Surgery for Dupuytren’s Contracture
Authors: Thurston A. J. 
Published: June 2005

The trend towards conservativism in the management of Dupuytren’s contracture has resulted in less radical surgery than was previously advocated to release disabling contractures of the fingers. 38 cases of Dupuytren’s contracture in the palm have been treated by Z-plasty of skin and underlying contracted band without fasciectomy. Proximal interphalangeal joint contractures were treated by fasciectomy and skin closure with Z-plasties as required. Only one of 16 patients reviewed after two years had evidence of recurrence. Skin compliance has been measured and a return to near-normal levels was found in all but the one patient with a recurrence.
Changes in Carpal Tunnel Shape During Wrist Joint Motion
Authors: YOSHIOKA S. , OKUDA Y. , TAMAI K. , HIRASAWA Y. , KODA Y. 
Published: June 2005

This study evaluated dynamically the morphology of the carpal tunnel during the wrist motion. The object was to determine the transverse dimension (TD), anteroposterior(AP) dimension and cross-sectional area (CA) of the carpal tunnel in the neutral, flexed and extended positions. The wrists of eight male and eight female volunteers aged 20 to 38 years were studied. With wrist extension, AP and CA decreased while the TD increased at the pisiform level, and CA increased at the hamate level. With flexion, TD and CA decreased at the pisiform level and CA decreased at the hamate level. The results showed that the median nerve may be subjected to significant pressure at the pisiform level when the wrist is extended. During wrist flexion, the cross-sectional area decreased at both the level of the pisiform and the hook of the hamate.
Finger Dynamography
Authors: MALAVIYA G. N. , HUSAIN S. 
Published: June 2005

The movements of the MP and PIP joints occur together and enable the fingers to acquire different postures. A graphic record of these movements gives an idea of the working space of the fingers. Normally, the tracing forms the shape of a quadrangle with almost parallel sides. If muscle paralysis occurs or joints are diseased, the shape of the quadrangle—the “working space”—becomes distorted. Different patterns of distortion are seen with different finger problems. “Finger dynamography” is a simple bedside procedure requiring only a goniometer. If supplemented with additional data on pinch and grip strengths and sensibility, it gives a pictorial record which is easy to interpret and can be used for documentation.
Treatment of Volar Instability of the Metacarpophalangeal Joint of the Thumb by Volar Capsulodesis
Authors: SCHUURMAN A. H. , BOS K. E. 
Published: June 2005

The metacarpophalangeal joint bears most of the stresses to which the thumb ray is subjected. Instability of this joint results in considerable functional impairment of the hand. Volar instability may be secondary to trauma, rheumatoid arthritis, or adduction spasms in cerebral palsy. The resulting hyperextension causes pain and weakness of pinch (Fig 1). Various techniques have been described to correct this deformity. We prefer a volar capsulodesis as first described by Filler (1976), in which the whole volar plate is reinserted. Detailed knowledge of the complicated volar anatomy is essential. We have treated eight patients (two bilaterally) with this technique, all with satisfactory results.
The Value of Radiographs and Bone Scintigraphy in Suspected Scaphoid Fracture
Authors: TIEL-VAN BUUL M. M. C. , VAN BEEK E. J. R. , BORM J. J. J. , GUBLER F. M. , BROEKHUIZEN A. H. , VAN ROYEN E. A. 
Published: June 2005

The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy. Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%. The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.
The Role of Cross-Finger Flaps in the Primary Management of Untidy Flexor Tendon Injuries
Authors: Gault D. T. , Quaba A. A. 
Published: June 2005

This is a report of five patients who sustained untidy division of flexor tendons in zones 1 and 2, associated with overlying soft tissue loss. Contrary to traditional teaching, the tendon injuries were repaired primarily, and the tissue loss was made good with a cross-finger flap. At final evaluation, three cases were assigned excellent grades and two cases fair grades by Kleinert criteria. This unexpectedly favourable outcome may be due to a quality of the inner surface of the cross-finger flap and/or to staggering of the skin and tendon suture lines.
Treatment of Post-Replantation Retardation of Bone Growth by Callus Distraction
Authors: GRAF P. , BIEMER E. 
Published: June 2005

Hand and forearm replantation in children may lead to premature closure of the distal radial or ulnar growth-plates. Following successful replantation, bone growth may be retarded, resulting in a length discrepancy between the radius and ulna with secondary deviation of the replanted hand. We present two cases in which callus distraction was employed to correct a length discrepancy. The relative merits of the various treatment options are discussed.
Replantation of Fingertips
Authors: YAMANO Y. 
Published: June 2005

During the period between 1976 and 1990, 207 fingertips have been replanted in 133 male and 55 female patients whose ages ranged from 14 months to 80 years, with an average of 32.7 years. Of the 207 fingers with complete amputation, 131 were injured in zone 1 and 76 in zone 2. The minimum follow-up period was 6 months. The results of zone 1 amputation have been analyzed according to the type of injury. The survival rate was 100% in clean-cut amputation, 95% in blunt-cut, 64.3% in crush and 65.5% in avulsion. From the point of view of survival and function, satisfactory results were obtained in amputations in zone 2, and in all cases in zone 1 that were clean-cut or blunt-cut.
Prevalence of Dupuytren’s Contracture and its Correlation with Degenerative Changes of the Hands and Feet and with Criteria of General Health
Authors: BERGENUDD H. , LINDGÄRDE F. , NILSSON B. E. 
Published: June 2005

The prevalence of Dupuytren’s contracture and its coincidence with degenerative changes in the hands and feet as well as loss of distal pulses, were studied in 574 55-year-old residents of Malmö, Sweden. Dupuytren’s contracture occurred in 6% of the subjects studied, predominantly in men. Dupuytren’s contracture was more common in men with degenerative changes in the feet and in men with signs of impaired arterial blood flow in the lower limbs. Men with Dupuytren’s contracture had significantly less subcutaneous fat tissue, as measured by a triceps skinfold index, than men without Dupuytren’s contracture. Other signs of general health, occupational work load or psychosocial factors did not interact with Dupuytren’s contracture in the current study.
Basil Kilvington
Authors: GLASBY M. A. , HEMS T. E. J. 
Published: June 2005

In the early years of the present century, a group of experiments assessing the results of the surgical repair of peripheral nerves and spinal roots was performed by Basil Kilvington. The outcome of the experiments was assessed using both electrophysiological and morphological techniques. Much of Kilvington’s work remained unrecognized and was thus repeated at a later date. Kilvington’s role in the early history of the surgical repair of nerves appears to have been forgotten and his substantial and prophetic discoveries deserve better recognition.
Fractures of the Distal End of the Radius in Young Adults: A 30-Year Follow-Up
Authors: KOPYLOV P. , JOHNELL O. , REDLUND-JOHNELL I. , BENGNER U. 
Published: June 2005

76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up. In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints. Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only. 47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men. In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistant incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.
Long-Term Follow-Up of Swanson’s Silastic Arthroplasty of the Metacarpophalangeal Joints in Rheumatoid Arthritis
Authors: WILSON Y. G. , SYKES P. J. , NIRANJAN N. S. 
Published: June 2005

77 patients with rheumatoid arthritis, 62 female and 15 male, underwent metacarpophalangeal joint arthroplasty on 375 joints using the Swanson design silicone rubber spacer between 1976 and 1985. Retrospectively, 48 of these patients were evaluated by postal questionnaire and 35 of them also underwent objective assessment at intervals ranging from five to 14 years post-operatively. Objective variables recorded included range of active motion, recurrence of ulnar drift and radiographic appearances. Both in the early and late stages, the vast majority of patients were satisfied with the outcome, with abolition of pain, correction of deformity and improved range of motion. There was some loss of mobility with time. However, functional improvement was maintained in the majority. Complication rates compare favourably with other reported series and no case of silicone synovitis was diagnosed. We agree with previous studies that the procedure is useful for lasting relief of pain and enhancement of a patient’s sense of well-being and is associated with few complications.
The Isolated Scapho-Trapezio-Trapezoid Ligament Injury
Authors: MASQUELET A. C. , STRUBE F. , NORDIN J. Y. 
Published: June 2005

Isolated injuries of the scapho-trapezial ligament complex are not well recognized. The ligament complex comprises the stout scapho-trapezial ligament, the floor of the flexor carpi radialis (FCR) tendon sheath and the scapho-capitate ligament. Between August 1991 and May 1992, we diagnosed and treated four cases of partial chronic post-traumatic lesions of this ligament complex. There was chronic pain at the base of the thenar eminence and instability of the thumb-index-middle finger pinch. Standard X-rays were normal. The diagnosis of ligament rupture was confirmed by mid-carpal arthrography showing filling of the sheath of FCR tendon. Surgical exploration showed complete rupture of the tendon sheath of FCR in two cases, associated in the other two cases with complete rupture of the scapho-trapezial ligament. Direct repair of the ligamentous elements was performed in all cases. The tendon of FCR was sutured to the tubercle of scaphoid to protect and to reinforce the ligament repair. The patients have been followed-up for between 6 and 12 months. All four patients recovered normal pinch strength to the middle finger. One patient suffered from chronic pain at work.
The “Mini-Bier’s Block”: A New Technique for Prevention of Tourniquet Pain During Axillary Brachial Plexus Anaesthesia
Authors: JAMES N. K. , KHOO C. T. K. , FELL R. H. 
Published: June 2005

Tourniquet cuff pain is a significant cause of morbidity following regional anaesthesia of the upper limb. We describe a simple new technique for effectively anaesthetizing the area under a pneumatic tourniquet (the “mini-Bier’s block”), which permits comfortable surgery under axillary block anaesthesia even if the local block is incomplete. We report a controlled study of 40 patients in whom statistically significant tourniquet cuff pain relief was obtained in patients receiving an additional low-dose intravenous injection of local anaesthetic localized beneath the cuff. This technique ensures that the safe axillary approach to the brachial plexus can always be used with avoidance of pain from the pressure of the tourniquet cuff.
The Position of Symbrachydactyly in the Classification of Congenital Hand Anomalies
Authors: MIURA T. , NAKAMURA R. , HORII E. 
Published: June 2005

The clinical features of 53 cases of intercalated hypoplasia and 113 cases of distal aplasia are reviewed and compared with each other and with 129 cases of syndactyly. Tri-, di-and mono-phalangeal symbrachydactyly, and adactyly with nubbin digits are consecutive anomalies. Transverse deficiency may result if the mesenchyme is damaged severely, and if damage is mild and formation has continued, intercalated transverse deficiency may occur. Webbing in symbrachydactyly may result from failure of the apical ectodermal ridge under the influence of damaged mesenchyme.
Duplication of the Thumb
Authors: NAASAN A. , PAGE R. E. 
Published: June 2005

Thumb duplication is a common congenital abnormality accounting for 6.6% of all hand deformities. The object of the primary surgery is to achieve a thumb with aligned joint surfaces and epiphyses perpendicular to the long axis, central flexor and extensor tendons, and adequate collateral ligaments. Experienced surgeons with an understanding of the abnormal anatomy and knowledge of the numerous refinements in technique cannot guarantee a flawless result. Of 43 cases treated in this Unit during the period 1970–1989 49% were noted to have secondary deformities. Angulation at the IP and/or MP joints were the most commonly observed problems. Unsatisfactory results were seen with a greater frequency following correction of the more complex deformities.