Hand Surgery

Healed distal radial fractures are frequently complicated by chronic wrist pain which is multifactorial and can be debilitating. An accurate delineation of the pathoanatomy is the key for successful treatment. This study reviewed 22 patients who had surgical treatment between 1997 and 2001 for chronic wrist pain after distal radial fracture. Four patterns of pathoanatomy were identified: (1) ulnar impaction caused by radial malunion and shortening; (2) ulnar styloid non-union; (3) triangular fibrocartilage complex (TFCC) tears with or without distal radioulnar joint (DRUJ) instability; and (4) intercarpal ligament injuries and chondral lesions. Surgical treatment directed towards identified abnormalities gave satisfactory outcome. At six months after surgery the mean functional score improved 36%, mean pain score decreased 50%, mean grip strength improved 25%, and 64% of patients returned to work.

This article is a retrospective study of 13 cases of scaphoid non-union in skeletally immature patients.

For the fracture fixation, three cases of stable fibrous union with minimal sclerosis, without deformity or cystic changes were considered for the percutaneous Herbert screw fixation. Ten cases were managed with the open reduction and internal fixation with or without bone grafting.

The average union time was 10.5 weeks post-operatively. The average union time was lesser in percutaneous Herbert screw fixation group (nine weeks) than open procedure group (11.5 weeks). All cases achieved union without any supplemental procedures. According to Cooney's clinical scoring, 12 cases were rated excellent result and one good result.

The percutaneous Herbert screw fixation for scaphoid non-union in skeletally immature patients can be a good treatment option when it is fibrous union with no deformity.

This case report describes the rare occurrence of a flexor digitorum profundus (FDP) avulsion of the left little finger in association with a pathological fracture of an enchondroma. The enchondroma was treated by simple curettage without bone graft. The FDP tendon was re-attached to the distal phalanx using the pull-out technique with a non-absorbable polyethylene suture.

We recommend simple curettage without bone grafting in cases of enchondroma of the distal phalanx in which the bone defect is small.

Carpal tunnel syndrome (CTS) is still today the most common nerve entrapment syndrome at the level of the upper extremity. When surgery is indicated, the surgical treatment of choice is the opening of the retinaculum. The authors describe their experience on 12,702 carpal tunnel decompressions, by the endoscopic procedure in a period of 14 years, outlining the indications, post-operative treatment, complications and results.

We report a rare occurrence of attritional rupture of flexor tendons caused by protrusion of the screw head of the volar radius plate. The cause of the protrusion was plate placement on the prominent distal volar lip of the radius and secondary loss of the original reduction due to using a non-locking osteosynthesis system for the treatment of displaced intra-articular fracture of the distal radius.

The author presents the case report of the rare for infant injury — the laceration of flexor pollicis longus tendon, which requires decisions on some complex questions relating to optimal tendon suture, suture material, type and duration of immobilisation, and the protocol for post-operative management.

Mycobacterial tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis, while mycobacterial tuberculous tenosynovitis of the extensor tendon sheath is extremely rare. We report a case of tuberculous tenosynovitis of the extensor tendon of the finger, occurring in a man receiving immunosuppression following a liver transplantation. Symptoms improved clinically after conservative treatment with anti-tuberculous drugs.

We present a rare case of radial perilunate trans-styloid fracture dislocation, in which the scaphoid invaginated radially into the fractured radial styloid.

Between 2005 and 2006, ten patients with flexor digitorum profundus zone II injuries were included. The mean age was 41 (19–84) years. One thumb, two index, four middle, one ring and two little fingers were injured. Repair method comprised four-strand core suture and 6-0 circumferential sutures. Post-operative rehabilitation included immediate active extension, progressive passive full flexion and active hold in dorsal block splint. Follow-up was four (three to seven) months. Grip strength, pinch strength, ROM was 90% (70%–90%), 90% (60%–110%) and 90% (80%–100%) of normal digit, respectively. Mayo wrist scores were five excellent, two good and three fair. All patients were satisfied. Compared with another group of ten patients with the same suture method and Kleinert splintage, grip strength, pinch strength and ROM were 50%, 40% and 40% of normal side, respectively. All differences between these two groups were statistically significant (p < 0.01) by paired samples T-test. There was no re-rupture.