Hand Surgery

Introduction: Climbers sometimes support their body with one finger hooked on a rocky ledge. This peculiar manoeuvre may cause a characteristic injury of the flexor tendon sheath, named "climber's finger".

Symptoms: (1) A sharp pain when grasping, and a sudden "snap" sound and snapping phenomenon in the concerned fingers and (2) a tender palpable mass proximal to the PIP joint.

Mechanism of occurrence: When a finger forms a hook, the highest stress point of the flexor tendon sheath is between the first cruciform pulley and the second annular pulley. When the full body weight is held mainly with the weak first cruciform pulley, it sometimes ruptures.

Therapy: Conservative therapy to prevent bowstringing was applied for eight cases. Six patients recovered after three months; the other two cases underwent operations.

Conclusion: If conservative therapy is found to be ineffective after three months, suturing of the tendon sheath should be indicated for climber's finger.

The aim was to study the relationship between impairment (function) and disability (participation) in wrist surgery, according to the WHO definitions.

The outcome of 205 wrist operations were studied. The impairment was expressed as range of motion (ROM) and gripping force, the disability as the DASH score.

There was a significant correlation between DASH and gripping force (R = 0.47). The correlation between ROM and DASH was weaker (R = 0.24).

In manual workers, shorter temporary disability periods were significantly associated with lower DASH score.

In (reconstructive) wrist surgery, impairment, disability and working status are significantly correlated. Gripping force measurement is a reliable tool for evaluation and gives a good impression of the disability. Preservation of some mobility is important, however the amount of ROM is not essential for the disability.

The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.

The most common technique used for non-surgical treatment of trigger fingers is the direct injection of steroids into the flexor tendon sheath over the metacarpal head. However, this method causes more pian to the patient and can result in tendon rupture due to insertion of needle into the tendon. Carlson and Curtis described the mid-axial injection technique which is simple and relatively painless. We aim to compare the pain result from the injection between these two methods. The prospective randomised control trial study was designed. There were 103 trigger fingers included in the study which were divided into two groups: the conventional technique of injection (CI technique) and the mid-axial injection technique (MAI technique). The visual analogue scale for pain score had been recorded at the time of injection: one, three and six weeks. The complication after injection and the recurrent symptoms within one year were also recorded. The Student's t-test, Chi-squared and Fisher-exact analysis were used for statistical testing. The results showed that the mean VAS pain scores immediately after needle insertion were 40.19 ± 23.3 and 48.39 ± 26.5 in the MAI and CI technique groups, respectively. The MAI technique was less painful than the CI technique (p < 0.05). There were no complications from the injections in both methods. However, the recurrent rate seems to be higher in the conventional technique (p = 0.23). We concluded that the MAI injection technique provided less pain result than the CI technique and there were no complications from this injection technique.

Lipomas are space-occupying lesions that may rarely be responsible for compression neuropathies. Here we report a case of a lipoma arising from flexor tenosynovium that was responsible for a sensory disturbance resulting from the compression of the median nerve in the carpal tunnel. The patient had complete relief from the neurologic symptoms six months after lipoma excision.

A 59-year-old man suffered from subcutaneous rupture of the flexor tendon of the little finger associated with fracture of the hook of hamate. He could not flex his little finger completely at the distal interphalangeal joint, but incomplete flexion of the proximal interphalangeal joint was possible. Surgical exploration revealed anomaly of the flexor digitorum superficialis of the little finger, as it originated from the palmar aspect of the carpal ligament, and a small portion of the muscle belly was traversed toward the A1 pulley over the profundus tendon and then it ran into the A1 pulley as a normal superficialis tendon.

The flexor digitorum superficialis of the little finger is well known to show variations, but our case is extremely rare, and furthermore there are no reports in the available literatures about the function of this anomalous muscle.

A 14-year-old male presented with a spindle shape deformity of the right middle finger. X-ray examination showed a lobulated lesion with a "ground glass" appearance, and expanding and thinning of the dorsal cortex of the middle phalanx. Curettage of the lesion and autologous bone graft was performed. Histological examination proved the lesion fibrous dysplasia. Two years after the surgery, X-ray examination showed consolidation of the grafted bone and no recurrence.

We report a rare case of neglected fracture dislocation of the second and third carpometacarpal joints, which was treated by arthrodesis of the involved joints.

A 23-year-old woman who had an episode of elbow injury which was treated cast immobilisation in childhood with residual cubitus varus sustained a posterior fracture dislocation of the same elbow. She was treated with closed reduction. Six months later, however, her elbow became stiff, and a persistent posterolateral rotatory subluxation was noted. Operations were performed in two steps; first, the radial head, which was subluxed posteriorly, was reduced and the lateral collateral ligament complex was reconstructed, and second, the stiff elbow was mobilised. Two years after the first surgery, the function of the elbow was satisfactorily recovered.

We will report on a case with a large intra-articular loose body in the metacarpophalangeal (MP) joint of the middle finger in a 30-year-old-male, which was mimicking a calcified tumourous lesion adjacent to the palmar side of the metacarpal head. It was easily removed through the palmar approach.

The Japanese Society for Surgery of the Hand (JSSH) selects one young hand surgeon under 40 years of age, as a representative to participate in the annual meeting of the JSSH. In previous years, one Indian and one Vietnamese surgeon were selected as traveling fellows and had the opportunity to give talks and participate in operations and meetings.

Background: Ulnar styloid triquetral impaction (USTI), one of many causes of ulnar sided wrist pain, is a pathological entity with clear clinical and radiographic features, distinct and different from the impaction of the ulnar head against the lunate or ulno-carpal impaction (UCI). Pain is ulnar and point-tenderness is present precisely over the ulnar styloid as opposed to the proximal lunate in UCI. The provocative maneouvre of dorsiflexion in pronation followed by supination is markedly different from the ulnar deviation grind test maneouvres used to diagnose UCI. Multiple anatomical and pathological features interplay to produce a situation in which the distance between the tip of the ulnar styloid and the triquetrum is reduced resulting in USTI. The concept of ulnar styloid variance is introduced and anatomical variations of ulnar styloid length are demonstrated.

Methods: The clinical and radiographic features of 56 patients diagnosed with USTI were analysed. One thousand standardised film-file wrist radiographs were measured to determine the average length of the ulnar styloid in the population as well as the average projection of the styloid above the radius (ulnar styloid variance).

Results: An aetiological classification system for USTI was developed based on the clinical and radiographic features of the aforementioned patients and radiographs.

Conclusions: The causes of this syndrome are often complex and classification of the aetiological features is clinically useful. It is important for physicians and surgeons to recognise the clinical and radiographic features of this syndrome in order to properly manage the symptoms and prevent an iatrogenic production of USTI.

We report the results of 28 patients with scaphoid nonunion treated with curettage and biconcave cancellous bone grafting from the distal radius using a volar approach and pin fixation. This study consisted of 28 patients (24 males and 4 females). The mean age at surgery was 28 years. The mean interval from injury to surgery was 22 months. The mean follow-up period was 20 months. By Russe classification, there were 6 distal third nonunions, 19 middle third nonunions and 3 proximal third nonunions. We reviewed final function and radiographic appearance. Bony union was achieved in all cases. Pins were removed at a mean of 7 weeks after surgery. Post-activity pain resolved in all cases. Mean wrist extension was 79° and mean flexion 77°. Mean grip strength was 35.8 kgf. The mean postoperative radio-lunate angle was 4.9° (-21–28.8) compared to -5.9° (-37.5–17.5) preoperatively. No complications were encountered. Our procedure is straightforward and not technically demanding. An STT arthrotomy is not necessary and the technique allows for concurrent correction of carpal instability. Bony union was achieved in all cases with no complications.