Hand Surgery

The diagnosis of chronic wrist pain is challenging and wrist arthroscopy has been recognised as the "gold standard". The present study investigated the efficacy of adding distal radioulnar joint (DRUJ) arthroscopy to routine wrist arthroscopy. The records of 67 patients who underwent DRUJ arthroscopy were reviewed, and the success rates for visualisation of intra-articular structures were determined. Pathological findings were correlated with ulnar-side wrist pain. In seven patients, pre-operative diagnoses were altered after DRUJ arthroscopy. The ulnar head and proximal surface of the triangular fibrocartilage complex (TFCC) were visualised in 100% and 99% of patients, respectively, while the foveal insertion of TFCC and sigmoid notch were visualised in 57% and 69%, respectively. Pathological findings of the proximal surface of TFCC tended to relate to ulnar wrist pain (p = 0.06). DRUJ arthroscopy should be included in routine wrist arthroscopy to enhance the accuracy of diagnosis.

The purpose of this study is to present the results of a new intramedullary fixation technique for metacarpal fractures. A J-shaped nail, which is a curved 2.0 mm diameter Kirschner wire sharply bent at the proximal end, was inserted from the dorsal aspect of the metacarpal base. Twenty-one metacarpal fractures (five transverse shaft fractures and 16 neck fractures) in 19 hands of 18 patients with were operated by this technique. All fractures had successful unions. Clinical and radiographic results were excellent in all ten hands that had excluded concomitant injuries. There was no mechanical irritation of the skin or extensor tendons in any patient. This intramedullary fixation technique is very useful for neck or transverse shaft fractures of the metacarpals without concomitant injuries such as severe soft tissue damage.

The main complaint of the patients after an open trigger finger release is a discomfort at the incision site. In this prospective study, we compared the two consecutive groups of patients with trigger fingers. One was treated by an open approach and the other by the endoscopic release of the A1 pulley. Pre- and post-operative evaluation at seven, 30 and 90 days showed a faster recovery from the discomfort with a faster return to daily and working activities, after the endoscopic procedure.

Many modifications to trapeziectomy have been proposed for the treatment of thumb basal joint arthritis. Their final outcomes have been discussed intensively, whereas functional changes in the early post-operative period have not been fully documented. The purpose of the present study is to evaluate an early functional change following our modified ligament reconstruction with tendon interposition (LRTI) arthroplasty. Nine patients (ten thumbs) were included in this study. Pain levels, strength, and mobility were assessed before and after surgery at intervals of two months. Pain level significantly improved at two months after surgery. Grip and pinch strengths had increased gradually after a temporal decrease at two-month follow-up, and were significantly stronger at six months after surgery. Palmar abduction improved significantly at six months after surgery, whereas opposition did not change significantly. A modified LRTI is an effective procedure in terms of early functional improvement of pain, strength, and mobility.

This retrospective study evaluates the functional and radiological results of a series of acute trans-scaphoid dorsal perilunate fracture-dislocations treated operatively by minimally invasive technique. Twenty-one patients had surgery performed by one of three surgeons between 1994 and 2006, and all cases involved: (1) closed reduction of the carpus; (2) closed reduction and percutaneous screw fixation of the scaphoid fracture; and (3) closed reduction and multiple Kirschner wire stabilisation of the carpal dissociation. Seventeen males and four females with an average age of 29 years were evaluated. Ninety five per cent of internally fixed scaphoid healed at a mean time of 16 weeks. Radiographic alignment of the carpus was satisfactory in 17 cases. The average Mayo wrist score was 80 with three excellent and two poor results. There was one patient with asymptomatic DISI deformity. Two patients had radiographic evidence of mid-carpal arthritis. One patient with a scaphoid nonunion required surgical repair with bone grafting. The results of this study suggest that a minimally invasive technique for treating acute trans-scaphoid perilunate fracture-dislocations can be considered as an alternative to open approaches.

This article documents the outcome of treatment of intraosseous ganglia and simple bone cysts of the carpal bones by curettage and injectable calcium phosphate bone cement (CPC) grafting. The patients consisted of five men and three women. One had a cystic lesion in the scaphoid, one in the hamate, and five in the lunate. Curettage of the lesions was performed, and CPC was injected into the cavity. Five patients were diagnosed with a ganglion and three with a simple bone cyst. Among the five patients with wrist pain, the pain disappeared completely in four. Radiographs showed apparent partial absorption of CPC in four patients and no absorption in other four. There were no recurrence of tumours and no other complications were encountered. We conclude that calcium phosphate bone cement is a useful material for repairing bone defect after curettage of an intraosseous ganglion or bone cyst of a carpal bone.

Two 17- and 11-year-old brothers appeared with mitten pseudosyndactily of both hands. They have been suffering from recessive dystrophic epidermolysis bullosa with recurrent cutaneous blister formation either spontaneously or due to minor trauma. Surgeries were performed to release and widen the first web space. Full thickness skin graft which was used to cover the resulting raw surface appears stable as normal skin to them. The two brothers have improvement in range of motion of their thumbs and index fingers.

Aneurysms of the hand are uncommon lesions. The most common location is the ulnar artery. We present a case of a young female who consulted us for a hand mass with a history of trauma to the hand. Pre-operative arteriogram showed a superficial palmar arch aneurysm. The mass was excised and the arch was reconstructed using a reversed Y-shaped vein graft. Fourteen months after surgery, there was no recurrence of the aneurysm and the patient only reported occasional cold intolerance.

We present a case of delayed rupture of extensor digitorum communis tendon seven years after volar plating of distal radius fracture. Drill bit penetration during surgery and prominent screw tips into the fourth extensor compartment have a potential risk to damage the tendons. Careful and accurate use of internal fixation instruments is necessary to avoid this complication.

Extensor Carpi Radialis Longus (ECRL) avulsion is a rare injury which follows resisted wrist hyperflexion. Treatment of this condition with open reduction and internal fixation is not previously described in the literature, and treatment with plaster immobilisation or k-wire fixation requires a prolonged period of immobilisation. We believe that open reduction and internal fixation of these fractures with early mobilisation will result in the best possible wrist function. We describe a sign to raise the index of suspicion for this injury: a palpable bone lump on the dorsum of the hand in the presence of wrist extensor pain or weakness after wrist hyperflexion injury is a sign of wrist extensor avulsion.

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.

Acute carpal tunnel syndrome (CTS) secondary to calcific deposition is rarely reported. In this article we describe a case of acute CTS in the dominant hand of a 94-year-old female patient secondary to calcific tendinitis within the carpal tunnel. Diagnosis was difficult clinically and radiologically. Urgent complete median nerve decompression led to a good clinical recovery.