Gary K. Frykman

Peripheral nerve hamartoma with macrodactyly in the hand: Report of three cases and review of the literature

Two patients with hamartomas of the median nerve and one with hamartoma of the ulnar nerve associated with macrodactyly are described. Nineteen similar cases of this association have been found in the literature. There is evidence that these two conditions are part of a localized regional growth disturbance. This type of macrodactyly should be differentiated from neurofibromatosis.

A new class of ring avulsion injuries

Sixteen patients with ring avulsion injuries treated at Loma Linda University over 10 years were reviewed. According to Urbaniaks classification scheme, there were two class I, seven class II, and seven class III injuries. Follow-up functional measurements showed that the grip strength of our class II patients were, on the average, no better than that of the class III patients, even though all of class III patients had amputation revisions. Five class II patients required only venous microvascular repair. We propose to modify Urbaniaks classification to IIC to include only ring avulsion injuries with venous compromise. These patients had excellent functional results, with an average total active motion of 224 degrees.

Winging of the scapula as a complication of first rib resection: a report of six cases.

Long thoracic nerve injury occurred in 6 patients as a complication of first rib resection by the transaxillary route for relief of thoracic outlet syndrome. In a review of 38 patients following 48 first rib resections, this is the second most frequent complication. This complication has rarely been reported in the literature. In 4 patients the long thoracic nerve palsy was transient, and complete recovery of serratus anterior function occurred within 6 months. In one patient, complete recovery followed repair of the long thoracic nerve.

Irreducible epiphyseal plate fracture of the distal ulna due to interposition of the extensor carpi ulnaris tendon ( a case report)

It is well known that tendon or muscle interposition can cause fractures to be irreducible by closed means. A rare tendon interposition of extensor carpi ulnaris occurred in an 11-year-old boy. The isolated displaced distal ulnar physeal injury was the result of a motor vehicle accident. Attempts to perform a closed reduction failed. At operation, an interposed extensor carpi ulnaris tendon was found. After repositioning the tendon, a near anatomic reduction was easily accomplished. Only two cases seem to have been reported in the literature on the need for open reduction of distal ulnar physeal injury, none with an interposed tendon. Interposed extensor carpi ulnaris tendon should be considered as a cause of irreducible displaced distal ulna epiphyseal fracture.

Role of synovial fluid cells in the healing of flexor tendons.

A 1-cm segment of repaired rabbit flexor tendon was first subjected to 10,000 rads of x-radiation and then placed in the synovial cavity of a rabbits knee joint. Macroscopic examination revealed healing at the repair site and rounding of the tendon ends without adhesions. Light- and electron-microscopic studies revealed cells resembling fibroblasts at the repair site and the periphery laying down collagen. Healing of this irradiated nonviable tendon was brought about by the cells present in the synovial fluid.