Hand Surgery

We report an unusual case of a solitary periosteal chondroma presenting as a snapping finger and pain in the ring finger in a 37-year-old man. The snapping symptom was caused by impingement of this solitary chondroma. In this case, the periosteal chondroma was detached due to a finger sprain. Thus, the solitary chondroma was impinged between basal phalanx and extensor tendon, causing the pain and snapping finger. When patients with snapping finger present, CT scans can be helpful to make a correct diagnosis. To the best of our knowledge, this condition has not been described in the PIP joint.

Finger tourniquets are widely used in hand surgery. However, they do not provide an estimate of the amount of pressure exerted and can potentially be left in situ with grave consequences. We assessed the pneumatic finger tourniquet in 57 adult patients in operations under local anaesthesia distal to the proximal interphalangeal joint. The average tourniquet time was 12 minutes. The tourniquet maintained its pressure for the length of the operation in 96.5% of cases. This airtight flat tubing is made of synthetic polymer, designed and manufactured by Barloworld Scientific Ltd (Staffordshire, UK). The tourniquet was easy to use and easily located after the operation. No complications were reported. This study supports the use of a pneumatic tourniquet in finger injuries requiring use of a finger tourniquet.

We analysed LCP efficiency in type B and type C wrist fractures (according to the AO Classification). We treated 58 wrist fractures (19 B-type fractures and 39 C-type fractures) in 35 male and 23 female patients, aged 19 to 87 years. Forty-one cases were followed up for an average period of 13 months. We performed a volar approach on 32 patients, a dorsal approach on five, and a double approach on four (both volar and dorsal). Twenty-six cases were pre-operatively examined with CT. All patients were evaluated using the "Mayo modified wrist score", with an excellent/good result in 76% of patients and a satisfactory/poor result in 24%. The LCP system proved to be adequately reliable and stable to keep the reduction in complex fractures (e.g. the C-type fractures in patients with low bone quality).

Aim: To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU).

Method: A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified.

Results: Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome.

Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes.

These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up.

Conclusion: The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.

In order to ascertain the utility of a 250 Hz NSD Powerball^® gyroscope in increasing the maximum grip force and muscular endurance of the forearm, ten adults without pathology in their upper limbs exercised one forearm with the device during a period of one month. We evaluated grip strength and forearm muscle endurance with a Jamar dynamometer both at the end of the month as well as after a resting period of one month. There was a tendency (not statistically significant p = 0.054), for the volunteers to increase their maximum grip strength. There was also highly significant increase in muscle endurance (p = 0.00001), a gain that remained slightly unchanged after the rest. Because the gyroscope generates random multidirectional forces to the forearm, the reactive muscle contraction is likely to stimulate more efficient neuromuscular contro of the wrist, a conclusion which our work appears to validate. The use of Powerball^® in forearm proprioception deficient patients is, therefore, justified.

We conducted an anatomical study of arthroscopic surgery for lateral epicondylitis. Currently, the pathogenesis suggests that lateral epicondylitis is caused by extra-articular lesions or intra-articular lesions. We anatomically and histologically examined the relationship between extensor carpi radialis brevis (ECRB), articular capsules, and the lateral collateral ligament complex (LCLC). In addition, we examined the number and location of synovial fringes. This study will be useful for less-invasive treatment of lateral epicondylitis.

Joint incongruity at radiocarpal joint is a common complication of the distal radius fracture, and has received much attention and study. However, the problem and outcome of treatment of intra-articular incongruity at the sigmoid notch after distal radius fracture is rarely reported. We describe a patient with deformity of the distal radioulnar joint, and impairment of supination after distal radius fracture. The evaluation of the distal radioulnar joint revealed the absence of degenerative arthritis and malunion of the sigmoid notch of the distal radius with a prominent volar lip limiting supination. We present a method of corrective osteotomy for the malunited sigmoid notch of the distal radius, to correct the incongruity of the distal radioulnar joint and restore supination.

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.

Lipoblastoma of the hand is a rare benign tumour of infancy. Although benign, the tumour can present as a large mass. We present a case of a two-year-old female with a large, slowly growing soft tissue mass between the second and third metacarpal of the right hand. After excision of the mass, the deep transverse metacarpal ligament (DTML) was reconstructed using a free tendon graft from the extensor indicis propius (EIP).

This case report describes a patient with elbow contracture due to phlebosclerosis induced by anti-cancer drug infusion. Limitation of elbow extension was completely relieved by surgical excision of the sclerotic vein.

We present a rare case of entrapment of the median nerve between sublimis tendons after fractures of the distal radius and ulna in an 80-year-old woman. The entrapped median nerve was elongated redundantly with two regions of constriction. To our knowledge, no case of median nerve palsy caused by such a factor has been previously reported.

Resurfacing a totally degloved hand is one of the most difficult management problems in hand surgery. It is difficult to cover the entire hand by using flaps. Although early coverage can be achieved, secondary amputation is often required due to an inadequate blood supply. We devised a delayed wraparound abdominal flap (DWAF) that was well-vascularised and could cover the whole hand. Here we report on a patient with a totally degloved hand, in whom reconstruction was performed using a DWAF and good functional results were achieved despite late surgery. Reconstruction with a DWAF may be a useful option for the totally degloved hand.

We report on a three-year-old girl with a severely enlarged right ring finger, which was diagnosed as macrodactyly simplex congenita. This was treated by epiphysial resection and osteosynthesis of the distal interphalangeal joint, longitudinal and transverse osteotomy of the phalanges, and soft tissue coverage using palmar proximal and dorsal distal flaps taken from the original oversised finger.

Dislocations involving the four ulnar carpometacarpal joints are rare. These complex dislocations are considered to be due to the application of a hyperflexion force on the metacarpal heads. In the present case, an indirect hyperextension force on the metacarpal bones created a lever-arm effect resulting in rupture of the firm ligament complex of the carpometacarpal joints, inducing complete dislocations of the second to fifth carpometacarpal joints.