Ian McNab

Palmar Cutaneous Branches of the Proper Digital Nerves Encountered in Dupuytren’s Surgery: A Cadaveric Study

Hypothesis: We hypothesized that palmar cutaneous branches of the digital nerves are a constant anatomical feature not previously described. Methods: Ten fresh frozen cadaveric hands were examined, carefully noting any branches deviating towards the midline over the palmar aspect of the proximal phalanx. The distance from the midpoint of the proximal extent of the A1 pulley to the origin of the first palmar cutaneous branch of the digital nerve was then measured, as well as the ratio of the point of branching relative to finger length. Results: Palmar cutaneous branches of the digital nerves over the proximal phalanx were found as a constant anatomical feature in all 40 fingers investigated. The mean distance from the base of the A1 pulley to the origin of the first palmar cutaneous nerve branch was 15.5 mm (range: 15–16 mm). The mean ratio of the first palmar cutaneous nerve branch origin to finger length was 1:5 or as a mean percentage of finger length 19% (range 18–21%). Conclusions: In our experience these branches can be mistaken for the proper digital nerve, especially when they are of a similar calibre. This could lead to an inadvertent injury of the proper digital nerve. Anatomical landmarks and our data can predict the position of the potentially misleading first palmar cutaneous nerve branches of the digital nerves - facilitating safer surgical dissection.

Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

Background  Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description  A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review  No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance  The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.