Eugene S. Kilgore

Diagnosis and treatment of retained foreign bodies in the hand

A retrospective review was conducted of 200 consecutive patients with foreign bodies in the hand seen between 1976 and 1982. Wood, glass, and metal accounted for 95 percent of the foreign bodies seen. The duration of follow-up ranged from 1 week to 3 years (average 6 weeks). Approximately 70 percent of the foreign bodies could be removed in either the office or the emergency room. The foreign bodies were removed anywhere from the day of injury to 20 years later. In 38 percent of the patients the diagnosis was missed by the initial treating physician, in many cases because a roentgenography of the injured area was not taken. Metal was visible in all of the radiographic studies obtained, glass in 96 percent, and wood in just 15 percent.

Treatment of painful hand neuromas by their transfer into bone.

Painful neuromas in the hand are not only very disabling for the patient, but difficult to treat. We present the results of 20 painful neuromas treated by burying the neuroma in the bone. Eighteen of the 20 neuromas operated on had acceptable results, according to the criteria of Herndon et al. We present our technique and compare our results with other treatments in the literature.

Correction of Ulnar Subluxation of the Extensor Communis

An effective technique for correcting ulnar subluxation of the extensor communis tendon off the head of the metacarpal has been described. A pedicle of the involved tendon with a distal base is developed on its radial side. This is anchored to the radial collateral ligament without compromising extensor tendon function.

Necrotizing fasciitis of the upper extremity

Thirty-three cases of necrotizing fasciitis of the upper extremity were reviewed. This disease occurs in an indigent patient population and is associated with the abuse of street drugs and/or alcohol. Physical findings may resemble a benign, low-grade cellulitis on admission. Radical debridement of all involved skin, fat, fascia, and muscle within 24 hours of admission is associated with a significant reduction in length of hospital stay and number of operations required.

Post-traumatic trapped dislocations of the proximal interphalangeal joint.

This paper deals with the uncommon and frequently unrecognized problem of trapped dislocations of the proximal interphalangeal joint. These may be dorsal or volar. Soft tissue forming a noose, or interposed in the joint, is implicated. There is injury to one or more of the following structures: 1) extensor mechanism, 2) collateral ligament, 3) volar plate, 4) flexor tendon sheath, and 5) skin (compound dislocations). Open reduction and appropriate soft tissue repair are mandatory the essential features of diagnosis and management are discussed and four illustrative cases are presented.

Tumorous lesions of the hand

A retrospective study was conducted of 543 tumorous lesions of the hand seen in a busy office practice for a 5-year period from April 1976 to April 1981. The lesions were grouped as benign lesions, of either the soft tissue or skeletal type, or as malignant lesions. The overall chance that a hand tumor was malignant was 2% (11 of 543). There was significant association of palmar radial ganglion and carpal tunnel syndrome (15%). Ganglions recur more often after aspiration than after surgery. Certain lesions, particularly a mucous cyst, have a high postoperative complication rate. A few of these unique lesions are described.

Treatment of felons

Abstract The pitfalls of traditional concepts in the management of a felon are reviewed. A more rational and uniformly successful method is detailed. This consists of a midvolar, longitudinal incision of the fat pad where the majority of abscesses point. Other incisions are reserved for the few cases in which maximal tenderness is shown elsewhere. An abscess should always be drained where it points. It has not been our intent in this report to discuss the problems of extension of infection beyond the closed space of the distal fat pad or to deal with paronychias and eponychias that simulate a felon by their extension.

Atraumatic flexor tendon retrieval.

Abstract A method is presented for atraumatic tendon-threading along a flexor tendon sheath. This method has repeatedly proved itself, without fail, over the past five years.

Volkmann's ischemic contracture due to soft tissue injury alone.

Fifteen upper extremities, in 14 patients in whom incipient or actual Volkmanns ischemic contracture was present, were seen in a 5 year period. Nine patients were stuporous due to drug overdose and had laid on the extremity; two had received a recent injury of main arterial trunks; two had sudden severe compression; one with chronic myelogenous leukemia had each arm involved at different times in a bizarre autoimmune response causing massive swelling. No patient had a fracture or dislocation. Pain and tenderness, loss of sensibility, resistant muscle contracture, and rock-hard muscle compartments were warning signs. Immediate fasciotomy was done. Useful function was restored when treatment was carried out in the early stages of the ischemia.

Compression of posterior interosseous nerve by a ganglion—Case report

A 41-year-old woman presented with a complete posterior interosseous nerve palsy secondary to a ganglion compressing the nerve against the arcade of Frohse. Decompression and neurolysis resulted in full functional recovery.