Hand Surgery

Thirty-eight patients with comminuted and impacted fractures at the base of the middle phalanx of the finger involving, on average, 60% of the joint plateau were treated by open reduction, cancellous bone grafting as necessary and minimal internal and/or external fixation. The results were evaluated after a mean follow-up time of 14 months. All patients were satisfied with the outcome and returned to their previous occupations after nine weeks on average. Forty-two percent of patients achieved a good result (no pain, proximal interphalangeal joint flexion/extension better than 90°/–15°, full functional use and good radiographic appearance); 32% had an acceptable result and 13% an unsatisfactory global result. The quality of anatomical reconstruction was the most significant factor determining the final outcome.

A new microvascular flap from the plantar aspect of the second toe is described. The flat is usually cutaneous, but it may also include nerve and tendon. It is ideal for finger reconstruction and its use and versatility is illustrated in five cases.

This experimental study investigated the effectiveness of three methods of neurorrhaphy, nerve grafting and nerve implantation in phrenic nerve transfer for treatment of brachial plexus root avulsion injuries. 180 Sprague-Dawley rats were used. The electrophysiological, histological and muscle functional evaluations were performed at 1, 2, 3, 4, 5 and 6-month postoperatively. Variable recovery in each group was found at different postoperative intervals. At six months after operation, the following results were observed in descending order of superiority: neurorrhaphy, nerve grafting, nerve implantation. Nerve implantation demonstrated a recovery of function of 75.76% and the characteristic electrical activity of the phrenic nerve might contribute to the motor endplate regeneration. Our experimental results will serve as the basis for our clinical practice.

Prompt angiogenesis has been hypothesised as beneficial for successful surgical repair of the flexor digitorum profundus (FDP) tendon, especially in the avascular area known as zone II. After the tendon has been lacerated and sutured, we analysed the angiogenic effects of the basic fibroblast growth factor (bFGF) on the suture site of zone II and the normal vasculature of rabbit FDP tendons, using the silicon vascular casting method in combination with microscopy. Intratendinous angiogenesis was accelerated at two weeks in the bFGF group. Capillaries formed well-developed vascular networks in the layer of the epitenon and invaded the tendon internally in the suture site along the connective tissue sheath. Three weeks after laceration and repair, the suture only group approved the same as the bFGF group at two weeks following treatment. These results suggest that bFGF has a significant angiogenic effect on a lacerated and sutured avascular area of an FDP tendon, along with development of the connective tissue sheath which may promote intratendinous vascular invasion and favourably influence the tendon repair process.

Congenital synostosis of the elbow is a very rare malformation of the upper limb. We present two similar cases with congenital humeroradial synostosis in association with absence of the ulnar carpals, fourth and fifth metacarpals and phalanges, and syndactily between the second and third fingers. Both cases were male and their anomalies were on the right side. In the second case, an Aitken type-2 proximal focal deficiency of femur was also present.

Bony non-union and muscle ischaemic contracture are the most frequent late complications of forearm replantation. We report our experience in a case of forearm replantation, where an early restoration of arterial inflow was achieved by the anastomosis of the anterior interosseus artery (A.I.A.) immediately after bone fixation. There was no complication in this case and the functional results were particularly encouraging. The biological and practical advantages of using the A.I.A. for vascular anastomosis are described and discussed.

We have found the Bilhaut-Cloquet procedure, with certain modifications, to be a useful method of reconstruction of thumb duplication. Seven thumbs were reviewed at an average follow-up of two years. A thumb of normal size and stability was obtained. Interphalangeal joint motion was 50% of normal. Nail ridging was considered to be less than satisfactory in one case only.