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Background: Radial head fractures with comminution and displacement present challenges in achieving optimal treatment outcomes in the long term. This study aims to evaluate the long-term effects of radial head excision (RHE) in patients with Mason type 3 fractures.

Methods: We conducted a retrospective study of patients with a Mason type 3 radial head fracture who underwent primary RHE between January 2010 and January 2020. The primary outcome was the Mayo elbow performance score (MEPS). Additionally, joint stability and arthritis, and the carrying angle were recorded for each patient.

Results: In total, 61 patients (21; 34% female) with a follow-up range of 3–13 years were examined. The mean (SD) total MEPS was 91.8 (9.2). The results were excellent for 46, good for 12 and fair for 3 patients. A model of total MEPS adjusted for sex, age and follow-up time showed a significant effect of patient age on treatment success (p < 0.001). Thirteen patients (21%) showed elbow instability. Six individuals had increased valgus laxity. The mean carrying angle was 19° (range: 11°–27°) on the injured side and 9° (4°–15°) on the uninjured side, t(120) = 12.608, p < 0.001. Overall, 37 patients had degenerative changes in the operative elbow.

Conclusions: Benefits of RHE persist for a long time with predominantly excellent elbow function and minimal complications. An increase in the carrying angle, joint instability and degenerative changes are to be expected. Patient age at the time of the surgery can affect treatment outcomes.

Level of Evidence: Level IV (Therapeutic)

The beautifully coordinated functions of the hand depend on the tendon apparatus acting on the articulated skeletal elements. The flexor muscles are situated on the antero-medial aspect of the forearm, with their tendons crossing the wrist and finger joints in a wonderfully arranged system to provide the infinite movements possible. The anatomical details of the extrinsic and intrinsic flexor apparatus are presented, with their functions described as anticipated by their origins, insertions, and the joints they cross and thus can act upon.

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the Amercian Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

A case of primary Nocardial infection of the hand is presented. This case was notable for lymphocutaneous involvement, and the development of multiple ascending subcutaneous abscesses after healing of the primary lesion. This clinical entity is uncommon, and indicates an atypical infection. Prolonged cultures are required to isolate Nocardia. The infection resolved fully with multiple surgical debridements and prolonged antibiotic therapy.

Any restoration of hand function following tendon and nerve injury has to include the repair or replacement of the hand's ability to perform a great many tasks. It is hard at first to appreciate fully the loss that occurs with flexor tendon injury. With loss of flexor tendons operating at the fingers or thumb, they cannot be fully closed and the hand is impaired for grasp and release as it interfaces with objects. But, sensibility can also be compromised from tendon injury even without direct injury to nerve, as object recognition in the absence of vision requires finger movement. When peripheral nerve injury is combined with flexor tendon injury, sensibility is directly impaired. There is a loss in the sense of finger or thumb position, pain, temperature, and touch/pressure recognition, in addition to the tendon injury.

A rare case of an extra-abdominal desmoid tumour in the hand is reported. Its treatment and a short survey of the literature is given.

Acromegalic arthropathy may affect the hand joints with characteristic radiological changes. Sesamoid involvement in the hand may be presented with unusual changes. A case of a female patient with characteristic hand joint and sesamoid bone osteophytic changes related to acromegalic arthropathy is presented.

We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. Magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.

Myxomas of the upper limb are rare and are classified according to their tissue of origin into tumours arising from periosteum, bone or soft tissues such as skin, fascia and muscle. In the literature, one case of intramuscular myxoma of the forearm has been reported. The current report describes the first intramuscular myxoma within the hand muscles.

Vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with Vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the Vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.

In this paper, the authors offer a classification of benign fatty tumours of the upper limb. There are three histologically distinct types of fat cells: immature fat cells which give rise to lipoblastomas, mature brown fat cells which give rise to hibernomas and mature white fat cells which give rise to lipomas. Lipomas are the most common and they are sub-classified according to the anatomic site of fat cells into dermal, subcutaneous and sub-fascial lipomas; or tumours directly related to muscle, bone, synovium or nerve. Finally, the authors review 67 patients with benign fatty tumours of the upper limb and provide clinical examples of these tumours including their characteristic histological and radiological features.

Rolling belt injuries are commonly seen in the summer when the tractors and water pumps work in agricultural fields. These machines' rolling belts may attract children and entrap their hands. The injuries frequently affect soft tissues and bone of volar side of their hands. Amputations may be seen.

In the present study, 45 patients with rolling belt injuries were retrospectively analysed. It was observed that 133 fingers of 42 patients and three hands (Zone III) of three patients were surgically treated. The treatment included primary closure of the lacerations, tendon/nerve repair, fixation of fractures, grafting, and local or cross-arm or groin flaps. Stump closure procedures were performed in 21 fingers with total amputations or non-viable tissues. The injuries in most of the cases were localised at Zones I and II. We performed revascularisation procedures in five fingers. Only one of them stayed alive (20%). Our results revealed that 13 cases were good, 21 were fair and 11 were poor to according to Gorsche and Wood criteria.

These injuries cause the burns and defects on digital arteries-veins as well as flexor tendons. Frequently, phalanx fractures and finger amputations may occur. Also, the skin defects are common. The treatment of rolling belt injuries is difficult, quite expensive, and the outcomes are not always satisfactory.

Giant cell tumour of bone in the phalanx of the hand is extremely rare. A case of giant cell tumour of distal phalanx treated with a ray amputation is presented.

A case of simultaneous dislocations of the carpometacarpal joints is reported. Closed reduction and splinting produced a good result.

Pain and disability caused by ganglia of the hand and wrist were assessed using a patient-rated wrist evaluation questionnaire in 75 patients. Dorsal wrist ganglia were the most painful and disabling. However, the majority of ganglia cause little pain or disability. Consequently, referral by General Practitioners should be confined to those with pain, disability or failure of conservative management.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.

Benign fibrous histiocytoma (BFH) of the bone is a rare benign lesion characterised by the presence of fibroblasts and histiocytes. Fibrohistocytic lesions involving bone with identical histological appearances are common during childhood such as fibrous cortical defect. However, BFH is very rare and can only be differentially diagnosed with its presentation, localisation and radiologic features. Here we describe a 33-year-old man with BFH in a rare location, a phalanx. To our knowledge this is the second reported case of a BFH involving the proximal phalanx of the thumb in an adult. We report clinical, radiologic and histological findings of the case and briefly review the literature on the subject.

We present a rare case of a 72-year-old woman who had a metastatic bone tumour on the fifth metacarpal of the left hand from gastric cancer. It had occurred in the patient, two years after subtotal gastrectomy and partial resection of a liver for advances gastric cancer with metastasis to the liver. A number of investigations and the needle biopsy confirmed the diagnosis of the metastatic malignant tumour of fifth metacarpal bone and an amputation was performed. Although our patient died 12 months after hand surgery, amputation was effective in providing relief from pain in the affected hand for the remainder of her life.

It is necessary to consider rare acrometastasis to the hand if a patient complains of swelling and pain of the hand without a trigger if there is a history of malignancy, including gastric cancer.

We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.