Hand Surgery

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The objective of this report is to present a case of hand burn linear contracture release performed under local anesthesia. It also introduces the one-per-mil tumescent solution consisted of 0.2% lidocaine and 1:1.000.000 epinephrine as a local anesthesia formula, which has the potential of providing adequate anesthesia as well as hemostatic effect during surgery of the hand without tourniquet. The surgery was performed on a 19 year-old male patient with multiple thumb and fingers flexion linear contracture for 105 minutes without any obstacle...

A wide variety of anatomic variations of the median nerve at wrist have been reported and the awareness of these variations are essential for the surgeon treating carpal tunnel pathologies to avoid inadvertent injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by a persistent median artery found incidentally in a patient who underwent flexor tendon reconstruction for subcutaneous tendon rupture. The current literature regarding the anomaly is reviewed and surgically relevant aspects are discussed...

We report a novel, minimal invasive technique for the treatment of symptomatic arthritis of the carpometacarpal (CMC) joint of the thumb, here termed Cell-Enriched Liposaspirate Arthroplasty (CELA). For CELA, autologous fat tissue was harvested using standard liposuction technique followed by an extra-corporal cellular enrichment step. Finally, 1 ml of cell-enriched lipoaspirate was injected into the CMC-joint. Following CELA, the treated patient became pain free within five weeks with a follow-up of 12 months...

Isolated distal ulnar head and neck fractures are rare. Undisplaced fractures are normally treated non-operatively. We report a case of a reverse oblique ulnar head and neck fracture, which despite the initial undisplaced configuration, was unstable and displaced over the subsequent weeks. We believe that, though this particular fracture pattern could have been treated in a cast, it requires careful follow up, especially early on, or to undergo early internal fixation.

We report a case of flexor pollicis longus tendon rupture after arthrodesis of the trapeziometacarpal joint with headless screws using the criss-cross technique. Although flexor pollicis longus tendon rupture is a conceivable complication after the trapeziometacarpal joint arthrodesis, very few cases have rarely been reported in the literature. We should remind that screws inserted into the trapezium could lead to a rupture of the flexor pollicis longus tendon.

A 13-year-old girl sustained epiphyseal fractures of the proximal phalanges of the left index, middle, and ring fingers. Though manual reduction of the 3 fingers was possible, it was difficult to maintain the reduction due to severe instability of the middle and ring fingers, and closed reduction with external fixation was performed. At 4 years post-injury, the patient had no impairment of daily activities. The use of external fixation (1) causes no injury to the epiphyseal cartilage, (2) enables accurate reduction and maintenance of reduction, (3) is technically easier than pinning, (4) enables earlier range of motion (ROM) exercises of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the externally fixated and other fingers, and (5) allows repeated fine adjustments after reduction...

We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21-year-old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist...

We report the case of an 18-years-old patient with thumb carpometacarpal ligament laxity due to Ehlers-Danlos syndrome who was treated with trapezial opening wedge osteotomy combined with volar ligaments reconstruction. Two years postoperatively she is pain free and the thumb carpometacarpal joint is stable.

Fibro-osseous pseudotumour is a rare, benign ossifying tumour of soft tissue that should be considered in the differential diagnosis of any tumour affecting the digits. Clinical diagnosis is difficult and fibro-osseous pseudotumour is often mistaken for malignancy, leading to inappropriate treatment. Knowledge of its clinical and histopathological features thus allows for appropriate primary treatment, sparing the patient from unnecessary radical surgery associated with presumed malignancy. We present the case of a 48-year-old male with fibro-osseous pseudotumour affecting the right ring finger, successfully treated with local excision...

Soft tissue sarcomas in the thumb are rare, but often require amputation to ensure tumour clearance. This can severely impair the use of the entire upper limb and negatively impact quality of life. We describe a 63-year-old male patient with a large malignant fibrous histiocytoma affecting the base of his dominant right thumb. A wide resection of this tumour was performed, followed immediately by index finger pollicization and first web space reconstruction with a reverse pedicled posterior interosseous artery flap...

BACKGROUND: To present the efficacy of 1:1,000,000 tumescent solution for resection of vascular malformation in hand and upper extremity without tourniquet application. METHODS: Four patients with five slow flow vascular malformations were retrospectively reviewed. Prior to incision, 1:1,000,000 tumescent solution was infiltrated subcutaneously surrounding the lesion until the skin turned pale. Amount of tumescent solution injected, the length of surgery, the clarity of the operative field, and the complications were recorded...

BACKGROUND: This retrospective study assessed the prevalence and outcome of intercarpal ligament injuries in non-osteoporotic patients with AO/ASIF classification type B distal radius shearing fractures treated with or without scapholunate temporary fixation. METHODS: Fifteen patients (mean age, 33 years) were analyzed according to their scapholunate ligament status at the time of injury and graded with a modified Geissler classification system. Each patient's postoperative pain and occupational status were assessed in the context of the Modified Mayo wrist score...

BACKGROUND: Many different surgical strategies for arthrosis of the carpometacarpal joint of the thumb are described in the literature. In 2010 we changed our routine procedure from an interposition arthroplasty using the abductor pollicis longus (APL) tendon to simple trapeziectomy without suspension or interposition. The purpose of this study was to review the clinical outcome after trapeziectomy and to compare it to those we had achieved with the APL procedure. METHODS: We examined 49 hands operated with simple trapeziectomy during 2011-2012...

Forearm rotation is a key function in the upper extremity. Following distal radius fracture, residual disability may occur in tasks requiring forearm rotation. The objectives of this study are to define pronation and supination strength profiles tested through the range of forearm rotation in normal individuals, and to evaluate the rotational strength profiles and rotational strength deficits across the testing range in a cohort of patients treated for distal radius fracture associated with an ulnar styloid base fracture...

BACKGROUND: This study investigated the effect of mesenchymal stem cell implantation on flexor tendon healing using a rabbit model of flexor tendon repair. Specifically, we compared the difference between autologous and allogeneic stem cells. The influence of cell number on the outcome of flexor tendon healing was also investigated. METHODS: Repaired tendons on the rear paws of rabbits were randomly assigned into four groups: control group, 1 million autologous cells, 1 million allogeneic cells, and 4 million allogeneic cells...

BACKGROUND: The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre. METHODS: A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively. RESULTS: A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis...

Fingertip injuries are common in children, with varying degrees of severity. However, there is limited epidemiological information in the literature. An understanding of the characteristics of these injuries can be used as a basis to prevent such injuries. Epidemiological data was gathered through a retrospective review of all fingertip injuries affecting children, that presented to our department. There were 202 children with 234 injured fingertips in a period of 36 months. Most children were boys and most children injured their left hand...

The literature on Dupuytren's contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren's contracture and perform a citation analysis. Utilizing the Web of Science, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren's contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence...

BACKGROUND: Concomitant distal radius and distal ulna metaphysis or head fractures (DRUF) are uncommon and acceptable results have been reported from cast immobilisation and internal fixation. METHODS: We reviewed the charts of 1094 patients treated for distal radius fracture at our institution in a two year period from 2009 to 2010. 24 patients with concomitant DRUF with were treated by cast immobilisation (group 1, n = 11), internal fixation of both bones (group 2, n = 7), internal fixation of radius alone (group 3, n = 2), and internal fixation of radius with distal ulna resection (group 4, n = 4)...