Narrow Results

A complex manifold X is said to satisfy the Oka–Grauert property if the inclusion is a weak equivalence for every Stein manifold S, where the spaces of holomorphic and continuous maps from S to X are given the compact-open topology. Gromov's Oka principle states that if X has a spray, then it has the Oka–Grauert property. The purpose of this paper is to investigate the Oka–Grauert property using homotopical algebra. We embed the category of complex manifolds into the model category of simplicial sheaves on the site of Stein manifolds. Our main result is that the Oka–Grauert property is equivalent to X representing a finite homotopy sheaf on the Stein site. This expresses the Oka–Grauert property in purely holomorphic terms, without reference to continuous maps.

We report the outcome of a five-year follow-up after wrist arthroscopy and excision of painful dorsal wrist ganglia. The findings at the time of surgery have previously been published. Patients responded to a validated postal questionnaire regarding ganglion recurrence, wrist pain and function. None of the responding patients had recurrence of the ganglia since surgery but only one patient had remained pain free with normal function following surgery. Three of the remaining patients reported moderate to severe problems with work and four reported minimal work problems. Our findings suggest patients with arthroscopic confirmed ligament injuries leading to joint instability or localised osteoarthritis may develop functional disability but less severe injuries are unlikely to cause persistent problems in the short- to medium-term. Surgical excision of the ganglion can give lasting satisfactory cosmetic outcome despite persisting underlying ligament pathology.

A strong association has been reported between keloid formation after syndactyly reconstruction and primary digital enlargement, and methotrexate (MTX) treatment has been shown to produce promising results in a few reported cases. However, detailed surgical technique for revision of keloid formation after syndactyly division has not been well described, and there is still no standard treatment protocol regarding use of MTX in such cases. In this paper, we describe the technical details of keloid excision and full thickness skin grafting followed by MTX medication for the treatment of massive keloid formation after syndactyly division. We also describe a case of unsuccessful use of MTX, and our experience of its prophylactic use for a patient with syndactyly with primary digital enlargement.

Retiform hemangioendothelioma is a rare, intermediate-grade, locally aggressive vascular tumour that involves the skin and soft tissues of the trunk and extremities (1–10). Macroscopically it appears as a plaque or an exophytic lesion. Involvement of the hand or upper extremity is rare, with only Three cases reported in the literature (2, 3, 9). Treatment usually involves surgical excision or amputation (2). We present the case of a middle-aged woman with a retiform hemangioendothelioma of the small finger, successfully treated with surgical excision with no signs of recurrence at 4 years of follow-up.

Ancient schwannoma is a rare variant of schwannoma associated with a longstanding course. They differ from classical schwannomas in the long duration for this subtype of schwannoma to develop and also by demonstrating haemorrhagic and degenerative changes with nuclear atypia. It is because of these histologic hallmarks that they are frequently misdiagnosed as malignant tumours. They usually involve the major nerves of flexor surfaces in upper extremity such as the ulnar and median nerve but schwannomas of the radial nerve are a rare entity. We report two cases of ancient schwannoma involving the radial nerve at mid arm and dorsum of the hand. The differential diagnoses included atypical soft tissue sarcomas and tumours of neural origin. Imaging and histopathology are crucial in diagnoses of these tumours.

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3–4% of ABCs occur in the hand and they mainly take place in metaphysis’ of long bones like metacarpals or phalanges. Carpal ABCs have been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.

Background: The excision of the hook of the hamate is an accepted modality for the treatment of hook of hamate fractures. Three surgical approaches to the hook of hamate have been described in literature. This includes two palmar approaches namely the Guyon canal approach and the carpal tunnel approach, and the lateral approach. The aim of this article is to compare the outcomes of the carpal tunnel approach and the lateral approach.

Methods: Twenty-four patients with hook of hamate fractures were treated by excision of the hook of hamate. The hook of hamate was approached via the carpal tunnel in 15 patients and via the lateral approach in 9 patients. The outcomes with regard to duration of the surgery, complications such as pain, sensory disturbance and scar problems and time to return to sports were measured and analysed.

Results: There were no significant differences in outcomes between the carpal tunnel and the lateral approach for excision of hook of hamate fractures.

Conclusions: The outcomes of excision of the hook of hamate via the carpal tunnel approach and the lateral approach are similar. The decision to choose an approach should be based on the surgeon's familiarity with the approach. Future studies should include a comparison with the Guyon canal approach preferably in a homogenous group of patients.

Level of Evidence: Level IV (Therapeutic)

Locking of metacarpophalangeal (MCP) joints of the thumb may be a consequence of dorsal subluxation from hyperextension injury. The joint is locked in mild hyperextension and cannot flex actively or passively. We report four patients with locked MCP joint of the thumb due to radial sesamoid entrapment after hyperextension or forced flexion injury. All patients had a prominent radial condyle of the metacarpal bone. Three patients had a deformity of the longitudinal groove on which the sesamoid was overlaid. The radial sesamoid was entrapped proximal to the radial condyle which could result in limited extension and hinged flexion of the joint. Excision of the radial sesamoid could release the locked joint. The radial sesamoid should be assessed if the motion of the thumb MCP joint is limited after flexion or extension injury.

Level of Evidence: Level V (Therapeutic)

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery.

Level of Evidence: Level V (Therapeutic)