Hand Surgery

A total of 71 patients with 78 metacarpal or phalangeal fractures were treated using one of two different methods of fixation. Thirty-nine fingers were treated using a low profile plate and screw system (LPP group), whereas 39 fingers were treated using Kirschner wire (K-wire group).

In the LPP group, three cases of screw breakage were recorded. The LPP group required use of a splint for 0.9 weeks, significantly less than the 4.4 weeks of the K-wire group. The mean of 2.6 ± 1.6 months for the time to union in the LPP group was significantly greater than the 1.6 ± 0.6 months in the K-wire group. There were no instances of non-union in both groups, but one delayed union was observed in the LPP group. Total active flexion was 235° and 243° in the LPP and the K-wire groups, respectively. Total extension loss was 12° and 9° in the LPP and the K-wire groups, respectively. Although use of either method resulted in a good range of motion, LPP fixation required a much shorter time with a splint. However, because of the possibility of screw breakage, we have to exercise caution with post-operative treatment.

The reproducibilities of various measurements of thumb abduction were compared. Two independent observers measured the thumb abduction in 30 volunteers by the following four methods: distance between the thumb tip and the flexion crease of the index finger proximal interphalangeal joint; distance between the flexion crease of the thumb interphalangeal joint and the proximal palmar crease; angle between the thumb and index metacarpals; and angle between the thumb and index proximal phalanxes. Measurements were repeated in three weeks and their reproducibility was assessed by the intraclass correlation coefficient (ICC). Intra-observer reproducibilities by distances were high with ICCs between 0.74 and 0.89, compared with those by angles with ICCs between 0.28 and 0.71. Inter-observer reproducibilities by distances were also high (ICCs = 0.79 and 0.81) compared with those by angles (ICCs = 0.28 and 0.42). Assessment of thumb abduction based on distance in the first web is recommended in terms of reproducibility.

Diffusion-weighted images based on magnetic resonance reveal the microstructure of tissues by monitoring the random movement of water molecules. In this study, we investigated whether this new technique could visualize pathologic lesions on ulnar nerve in cubital tunnel. Six elbows in six healthy males without any symptoms and eleven elbows in ten patients with cubital tunnel syndrome underwent on diffusion-weighted MRI. No signal from the ulnar nerve was detected in normal subjects. Diffusion-weighted MRI revealed positive signals from the ulnar nerve in all of the eleven elbows with cubital tunnel syndrome. In contrast, conventional T2W-MRI revealed high signal intensity in eight elbows and low signal intensity in three elbows. Three elbows with low signal MRI showed normal nerve conduction velocity of the ulnar nerve. Diffusion-weighted MRI appears to be an attractive technique for diagnosis of cubital tunnel syndrome in its early stages which show normal electrophysiological and conventional MRI studies.

The purpose of the study was to compare angiogenic response of isolated saphenous and epigastric arteriovenous bundles in avascular environment, in an in-vivo model. Saphenous and epigastric bundles of 20 rats were dissected and ligated distally. The bundles were implanted into silicone tubing to create a biologically neutral environment. Gross and histologic examination was performed at different intervals. No thrombus was detected in any of bundles prior to 24 hours. An adherent thrombus was seen at 24 hours in all ligated saphenous bundles; it persisted at three weeks with no evidence of neovascular sprouting. The ligated epigastric bundles remained patent with evidence of neovascular sprouting. The saphenous vessels are more likely to thrombose and do not show vascular proliferation when placed in an isolated environment, whereas the epigastric vessels are likely to remain patent and show vascular proliferation.

Chronic lunate dislocation is a difficult problem to deal with. We describe a surgical technique whereby gradual wrist distraction is applied using an external fixator followed by open repositioning of the lunate. We have successfully used this technique in a rugby player with an undiagnosed chronic lunate dislocation. Our case was able to return to competitive rugby playing.

Masson's tumour (intravascular papillary endothelial hyperplasia) is a benign vascular tumour, which can present in a similar manner to a soft-tissue sarcoma. Rapid differentiation between these two differing pathologies is the most important part of the initial management of this problem. We report a case of Masson's tumour presenting in a 32-year-old woman as a painful lump around her elbow.

More than 25% of unintentional gunshot injuries and more than 15% of intentional gunshot injuries involve extremities.

In these patients, early acute multidisciplinary treatment is essential and critical to achieve a satisfactory mobility and composite wounds repair.

We hereby report a logistic delayed successful treatment of a complex arm gunshot wound with a free fibula flap. The significance of this case report is related to the necessity of emphasising the organised and multidisciplinary approach required to cure these patients in the proper way from a surgical and medical point of view.

The Essex-Lopresti injury consists of a fracture of the radial head, rupture of the interosseous membrane and disruption of the distal radioulnar joint. The greatest challenge with this injury pattern is the diagnosis, because it is frequently missed and the attention usually focused on the elbow joint. In this paper we report an unusual pattern of Essex-Lopresti injury with a radial neck fracture, a tear of the interosseous membrane and a disruption of the distal radioulnar joint in which initial wrist radiographs did not show significative abnormalities. Open reduction and internal fixation for the radial head fracture was performed. Forearm rotation was locked with two Kirschner wires from ulna to radius to allow interosseous membrane to heal.

This case is even more difficult to diagnose than classic Essex-Lopresti pattern because of the absence of radius shortening, due to this specific radius fracture pattern, and also the absence of distal radioulnar joint dislocation. When treating a radial head fracture but also a radial neck fracture, interosseous membrane injury should be suspected to avoid misleading in diagnosis.

Elderly patients suffering from avascular necrosis of a carpal bone in both wrists are extremely rare. We report a case of an elderly kendo (Japanese fencing) competitor who sustained Preiser's disease in the left hand following the occurrence of Kienböck's disease in the right hand. The current case demonstrates the importance of raising awareness of these diseases as potential sports-related problems in the elderly.

To our knowledge, the combination of a palmar subluxation of the thumb carpometacarpal (CMC) joint with low median nerve deficit followed by the recurrent branch injury is extremely rare. We present a case of the subluxation of the thumb CMC joint with low median nerve deficit.

Reports describing trapeziometacarpal joint fractures of the thumb have discussed Bennett's fracture or Rolando's fracture primarily. We report a patient with an unusual fracture which could not be classified as a Bennett's-type or Rolando's-type injury. The aetiology of the fracture pattern is proposed and treatment considerations are discussed.

We report a rare case of open dorsal dislocation of the proximal interphalangeal joint which needed operative reduction. A 39-year-old man injured his right middle finger while playing baseball. There was a laceration on the proximal interphalangeal crease, and the condyles of the proximal phalanx protruded through the wound. The flexor tendons had slipped behind the radial condyle, and made reduction impossible. After the flexor tendons and volar plate were replaced back into their normal position, the reduction was successful. Finally, the patient had full and painless motion of the digit. We review the reported cases of this injury in the relevant literature.